Applying for Medicaid in Texas. Any advice?

The TX Medicaid initial application for my mom, I did 3 years ago & it was 3 years & 6 mos of financials & the state did a review on real property that went back 5 years.The medical review aspect for the Medicaid application is done by the NH but you may have to get some of the health records if they aren't coming from a hospital stay (so they have a medical history showing the need for skilled nursing services). And every year, I get a TX renewal application that also requires documentation. When mom applied the income ceiling was $ 2,094.00, it is now up to $ 2,163.00 ($ 2,931 for CSRA) but the asset ceiling is still at 2K and they can have a NCV funeral & burial up to 10K. TX does do detailed check on what insurance policies are so be sure to see what's what on that before you send. If your mom's monthly income is over the $ 2,163 then TX has a pretty easy Miller Trust or QIT system if their income qualifies for the QIT restrictions - it's a full spend out every mo for TX Miller which is nice &neat for reporting.

Now the NH should have given you a list of what they want to see. For my mom's NH it was 1 page but for my MIL it was 2 pages. Both in TX too and this seems to be based on how the NH does their own review to decided whether to accept the resident as "Medicaid Pending". For us, the NH took the documentation and reviewed to determine if it seems mom would pass the state review, then NH submitted it with their invoice to Medicaid and it goes to the caseworker assigned to their NH or their district. If your NH does it this way, it is important that you double check with the NH that all was done & in a timely manner. The NH imho are notorious in just not doing this in a timely manner…….my MIL's NH stalled on the app for months and she died before getting on Medicaid but SIL dogged the application and she was approved retroactively after death.

What I think the state caseworker is looking for is a "pattern of spending" that makes sense for what their income & assets are. They have all their income and tax details in front of them and know what they have. For us, mom was in a very, very nice IL she was paying for & she still had her home and paying for those costs. She had closed out all CC except for 1 so nothing there but small bills for cc purchases at HEB or Target sort of stuff. So it was pretty clear where her money was going. Imho there is likely a formula that they can plug in their income to see how much $$ they should still have based on their pattern of spending.


For the initial application, for mom it was about 120 pages of documents submitted. Really truly 120+ pages but many due to my mom's old school insurance documents which the state wants a copy of each & every page and the old ones are like 20+ pages per policy. The one big sticky was the 3 year banking review, they wanted detailed information on any & all bank accounts, CD's, Tbills, etc that were closed out for 3 years prior and where the proceeds went to. Basicially any financials that show her SS#. Now for mom, it was done such that as her CD's etc expired, all the funds went into her main drawing account for the years before so the history was clear & clean. I'm sure that say a 10K CD was cashed out and not deposited to her account, that I would have had to dealt with a transfer penalty inquiry. The banking letter took a full morning at the bank with a bank VP and they were quite nice (free) about it but I know some banks will charge you research fees for all this.

I had to deal with 2 things from her application: 1. clarification on what type of insurance she had & had 72 hours to submit too. Old policies are hard to discern if there is any cash value or if it is just a term policy. I got a broker with a TX insurance license to do a letter stating it was term & faxed it over to caseworker so got past that hurdle. Then about month 5 got a transfer penalty inquiry on my mom's car which was old and of no value imho and sold to worthless nephew almost at the edge of 5 year look-back. Had to do some scurring about to get documentation to show it was not the Blue Book value that state said it was, so got that cleared up. Mom approved almost 5 1/2 months after initial application. The caseworkers really do want to work with you and get your parent accepted into the program but they have to have the documentation in order to do so and all that falls to you to provide and in super-short order.

I would suggest you submit all as a "document dump" that is all paperwork in one giant pile. Make 2 copies of all this too - 1 goes with application and the other set you carry around with you to answer any ? upon any phone call. You do not want to have to say to the caseworker let me call you back later on this if you can help it. It will make the review easier for all. The caseworker has like 10 minutes to do the initial review so if something is missing, the app gets back into the review pile and stuff just goes amiss every time that happens. You want it all there for the initial review. Also the caseworker is local and has a good idea of where the wealth is in the area. It is my belief that the app's zip code & census zone makes a huge butt difference in whether a detailed review is done. Like a 78209 is going to get more scrutiny than a 78201.

Personally I would suggest that you start now to get yourself organized on all this and start a binder for banking, and one for insurance, income and everything else. If you are going to also do some medical, then another binder for medical. Find a FedEx / Kinko's location that you are going to use & make friends at too.
TX seems to always find something that will need clarification on and you will have a small window to get whatever it is back to the caseworker asap. If not then the app will go into the "information not provided" pile and after 30 days you get a letter from TXDADS/TXDHHS that they are disapproved and you have to do an appeal. You don't want to get on that hamster wheel, that is why the full document dump is so important to do. Also you can fax over whatever is needed from the FedEx / Kinko's and you will get a transmission report that shows that the document was received by TXDADS/TXDHHS too.

Every year you have to renew the app and submit all the current documentation on income, banking (4 months based on whenever the letter is sent), their NH trust account balance, insurance, etc. Yeah they totally already have some of this stuff but it has to be resubmitted annually. That is why the binders are so important as it helps keep your sanity to get this done in the 14 days required. For more fun, I get the letter always either just a day or two before the due date or a day right past the due date.

Don't think about getting cute and leaving anything out either. State has it so that all the real property records dovetail into the state system so stuff will surface eventually. Once you apply for Medicaid you sign off for an all-access pass to their life, so state can access any banking, IRS, credit cards, etc without letting you know in advance. If there are things that you think will pose a problem, I'd suggest you wait to submit the Medicaid application by either keep them at home with caregivers or private pay for care for a couple of months, meet with an elder law attorney to come up with options on how to best deal with a penalty if that is what will likely happen. Good luck.

Also the only assets that I have ever heard of that are under the radar or outside of purview are oil, gas, mineral rights. I'm not talking anything Spindletop but those O&G&M pass through assets that are tiny. The whole 1/32nd of 1/10 of a field asset that only a good land-man can even start to figure out. Many of those pay so irregular that often family or even the owner doesn't know that they are there or are dormant for forever so no income. I had old O&G with 1 aunt's estate and it's a total PIA to get a value. Mom's renewal form now does ask about O&G but she doesn't have any so we're good on that. But I can see that it could be a whole disqualifier for those who have a homestead or ranch with sections.

Really if you have anything that is not straightforward, I would suggest you get an elder law attorney to go over the application and the documents before your apply.
I did my mom's app on my own but I have done grant submissions and went through dealing with Hurricane Katrina with FEMA, SBA and insurance companies so pretty good with paperwork and how to get documentation done & I've been executrix twice too. So going to a courthouse or doing a deposition…. well I can totally roll with it. There are several good elder law attorney's in Dallas. I would go to one that is NAELA certified. This site has a drop down list of elder lawyers by state so you can start there. Good luck and try to keep a sense of humor in all this too…it won't be easy sometimes!

Wow, what great information!! But I am shocked by some of it. I applied for my MIL and didn't have to provide much of anything but that was 20 years ago. This is for my father and he has been in a NH for 5 years now and the one he is currently in he is on private pay but they take Medicaid so it will just be simply changing rooms. They are in a different zip code from me so do they go by the zip code the facility is in or the one I am in? I have a couple of years but wanted to start collecting documents in advance. There's no house or car just one brokerage account that will be closed out next year. There is one term life insurance policy held by a former employer that I just have a 1 page letter for. Does that mean I have to have them send a letter to the caseworker? After they get your application do they call you in to go over it? Or just talk on the phone. Do I need to save all credit card (Mastercard) bills so they can see who all the charges were to. I am talking $100 per month or so for the total bill and most were for perscriptions. This is going to be a lot harder than I realized so I'm glad I asked ahead. Thanks again.

Txdaug - didn't mean to scare you. Mom's volume was really about insurance policies as the list I got from the NH (as to what to submit) stated all pages (front & back) of all insurance policies. Mom's term life was almost 30 pages; funeral & burial were each at least a dz pages each. Also mom still had her home & was living in a rather upscale IL (she went from IL to NH and totally bypassed AL phase) so I think met the profile of "probably has assets". lmao.

The admission person or perhaps billing at the NH, should have a list of what they want submitted for documentation for the Medicaid application. It would be a list that they give to anyone who is going to be having Medicaid pay. i'll do another post on what was on my mom's list that I can remember.

For my mom, I did not submit any CC statements & it wasn't on the list. Her payments were small, really just for trips to HEB, Target, Steinmart. Nothing outrageous. So when looking at her bank statements everything was very routine and repeated month after month for funds in & funds out. So they could see that check written to Visa for $ 123.45 in May and then $ 78.69 in June sort of thing. Mom's "pattern of spending" was pretty set and made sense for where her funds went for the years prior to the NH. really if they live long enough, they will run out of $ & thank goodness there is Medicaid & Medicare out there for them.

About your dad's term life, when you read the 1 page does it clearly state that the policy is term and that there is NO CASH VALUE? the whole NCV status is mucho importante for Medicaid, and NCV status goes for any policy like life insurance as well as funeral & burial policies (some of the old ones you can cash in, really truly). If it's not clear, then what I would suggest is that you contact the broker who has dad's brokerage account. He probably holds insurance licenses for your state (as he probably also sells annuities which is an insurance product) & if he doesn't then another broker in the firm will for sure. Anyways you want them to do a letter on company letterhead that states they have reviewed the policy and it is fully term with no cash value. That's what I did for my mom and I got my stockbroker in my state (LA) who holds a TX insurance license to do it. It just bolsters that the policy is term, so caseworker can put in the file and it does a cya for the caseworker too. Comprende? What this is all about is making sure that if the Medicaid applicant has anything with a cash value, that it is fully cashed in and spent-down before Medicaid will pay. A whole life policy will have a cash value, term usually doesn't (could happen if the policy is old and was a mutual but it would be an old, old policy). Medicaid just needs to be assured that any cash value out there is spent. For the brokerage account, you may have to get the broker to do a letter as to the disposition of the funds for the past 3 years, so like if dad got $ 725.89 from the account each month that went into his checking account or was direct deposit paid to the NH for his private pay, the letter (1 page) needs to state that. Again it just establishes a pattern of spending that makes sense.

For my mom, the Medicaid application I did at the NH with the regional admissions gal (this NH is a group of maybe 8 in the state). Now I already had gotten the list of what they wanted to see from NH the month before from admissions when I went looking for a NH to move her to. So was prepared (I'm pretty OCD so this was totally me to do) with copies of all the documents on the list. The regional admission gal filled it out based on my answers and the documents. Took maybe 1/2 hour. I did get her to sign off a list of the documents I submitted. She had never had anyone ask for this but did it anyways. Then NH submitted the application along with their bill to state. Did not hear from caseworker till about month 4 on the insurance ?. Phone call and I faxed over the letter within 48 hours to him and then called & left message that it was faxed. Also got a letter on it but TXDADS sends everything snail mail (no email) so I got that maybe a week later. Caseworker was local for the insurance ?. For the car transfer ?, that was a letter & phone call from Midland where there is a huge office for secondary review & processing for Medicaid. I think Midland personnel have more forensic training. The gal is spoke with was pretty precise to speak with. And that too needed to be responded to in short-order. Everything is very time sensitive so you can't get a letter and set it aside for a couple of weeks from now.

The zip code is that of the applicant. SInce dad is in a NH, that's the zip code for him. So if you live in Highland Park and do dad's paperwork, it will NOT be about your zip code! Since he is already in a NH and doing his spend-down by private pay for all these years you probably will just sail through the Medicaid approval process. You can certainly show payments to the NH to establish a "pattern of spending" that shows dad used his savings (assets) and his income to do this. So no worries for the big picture of your dad getting accepted.

For list of what the NH wanted to see, it was 1 page for my mom's NH but for my MIL application up in the Panhandle, it was 2 pages from that NH. Go figure.

- the annual statement from SS. This is the 3 fold form that gets sent out in Dec that states what SS will be paying them as monthly income for the next year. You just need the current year's one.
- any annual statements from retirement or other income. My dad was a fed, so mom gets federal retirement & it too comes in 3 fold form in Dec. But any income will need a statement that clearly shows how much MONTHLY income.

the whole monthly income is mucho importante because both Medicaid & the NH has to know this to be able to base what your dad has for his required co-pay or his "SOC" (share of cost in Medicaid speak). My mom gets between the 2 sources, $ 1,800 a mo in income and TX allows them to keep $ 60 a month as their personal needs allowance. So every month, mom has to pay the NH $ 1,740 as her SOC. SOC or co-pay HAS to be paid to be in compliance for Medicaid too.

Also they wanted a copy of:
- any life insurance policies
- any funeral & burial policies
- citizenship. My mom is naturalized so more paperwork on that for her.
- bank statements for 6 months and then on bank letterhead a signed form from a bank officer on 3 years back on any & all accounts closed or transferred with details as to where all the funds went. My mom had CD's etc and as they expired they all went into her main checking account so her pattern was all good for Medicaid review. Very fortunate to have done it this way too on retrospect!
-health insurance cards & policies
- documentation on any & all real property
- details on any annuities, SPIA's, etc. Mom didn't have this, but I have heard if there any any annuitities to expect a more detailed review
- any trusts. Again mom didn't have this, but expect a detailed review if so.
- details on any investment or other financial products.
(Really anything that gets an IRS form as it is tied to their SS #.)
- advance directives, DPOA, MPOA and any other legal
-military discharge stuff
-death details for my dad (had the certificate but for MIL just submitted an obit)

You want to keep this all organized for anything you get in the future too. TX does an annual recertification. For the renewal you have to submit some of the very same items from the initial application (again!) and then the new years SS & retirement payout. This is so TXHHSC can figure out what the new years SOC is going to be. If you are not getting all dad's mail now, it will be easier to have it such that you get any & all of his mail rather than sending anything to the NH imho. As you know stuff just walks out of their rooms and goes MIA….. Good luck, get organized and buy some cute fun binders as they are out right now for back to school shopping!