Medicaid and SSI Eligibility
Do I qualify for Medicaid in Texas?
Author Attorney Lloyd Bemis:
If you are struggling financially, live in Texas and are in need of healthcare you may
be wondering if you would qualify for Medicaid. There are criteria you must meet first in order to be eligible.
Medicaid is a health insurance assistance program for Americans with limited means. Medicaid is often confused with Medicare, an insurance program for the elderly and disabled. One main difference between the two is that Medicare is a federal program, while Medicaid is run by the states under federal guidelines. This means that the eligibility requirements and benefits offered vary from state to state.
In Texas, to qualify for Medicaid you must meet the following requirements:
A. You must be a resident of the state of Texas
Residency is determined according to the rules set out in the Code of Federal Regulations. Here you can find specific rules for those being transferred between institutions and those too young or disabled to give consent. In general, the residency requirement is simple; you are a resident of Texas if you live in Texas. You cannot be denied Medicare coverage for not having lived in Texas long enough, nor can you be denied benefits for traveling to another state temporarily.
B. US Citizen or legal alien
The requirements for US residency are also outlined by the Code of Federal Regulations. A home address is generally sufficient to establish residency. In some cases, utility bills or other documentation may be required. You do not necessarily have to prove you are a US Citizen in order to receive Medicaid benefits, though there are many additional requirements and restrictions on non-citizen applicants.
C. Low income
This is the hardest criteria to meet. Many people with low incomes who qualify for other government assistance programs do not meet the stringent financial requirements for Medicaid. If you are a single disabled adult seeking Medicaid for yourself, then the best way to apply for Medicaid is through Supplemental Security Income (SSI).
The application process for SSI is also an application for Medicaid.
The way income and assets are counted is unnecessarily complex. The income limit is based on the Federal Benefit Rate of $914/mo (for 2023). If your countable income is over $914/mo, you will not be eligible for SSI, but only some income is counted. In order to be considered disabled for SSDI purposes, you must earn under $1,470 (for a single individual in 2023) which, depending on how your income is counted, would likely make you eligible for SSI.
SSI eligibility is also dependent on assets.
In 2023 the asset limit was $2,000 for individuals and $3000 for couples. Again, the way assets are counted is not intuitive- your first car, first home, and certain types of savings accounts are not counted. Cash, stocks, household goods (above $2,000), and second vehicles or homes do count towards the asset limit. The asset limit is very difficult to meet as many people- even those traditionally considered “poor”- have more than $2,000 combined between their bank accounts, investments, and vehicles.
You must meet all of the above criteria and at least one of the following:
A. Have a dependent under age 19 or be pregnant
Medicaid in Texas is largely a program for children and mothers.Most of the time Medicaid is mentioned alongside CHIP- a program similar to Medicaid which provides benefits to those who earn a little too much to qualify for Medicaid. Nearly half of all Texas children are covered by either Medicaid or CHIP.
B. Be disabled or have a disabled family member in your household
Medicaid is great way for disabled Texans to get some help with medical costs. In most cases, the best way for a disabled adult to acquire Medicaid is to apply for SSI benefits. If it is determined you are disabled for SSI purposes, then you will have met the disability criteria for Medicaid as well.
C. Be 65 or older
In 2021, 65 percent of residents of nursing homes were covered by Medicaid. Elderly applicants are subject to same citizenship, residency and financial requirements as other applicants.
For disabled adults, the application process for SSI is also the process for Medicaid. If you have applied for SSI benefits and Medicaid, but have been denied, consider hiring an attorney. Having professional representation can go a long way towards helping your claim for benefits succeed. Many applications are denied the first time around. An attorney who handles these types of cases on a regular basis knows what the Social Security Administration needs to see on your application. Contact the attorneys at Bemis, Roach and Reed for a free consultation.
Call 512-454-4000 and get help NOW.
Author: Attorney Lloyd Bemis has been practicing law for over 35 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Bemis obtained dual board certifications from the Texas Board of Legal Specialization. Lloyd is admitted to practice in the United States District Court – all Texas Districts and has argued before the U.S. Court of Appeals, Fifth Circuit. Mr. Bemis is a member of the Travis County Bar Association. He has been active in the American Association for Justice and is a past Director of the Capital Area Trial Lawyers Association. Mr. Bemis and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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