Medicaid Insurance in Texas

The Texas Health and Human Services Commission -- with a budget of $16 billion and 9.300 employees -- oversees the state's Medicaid program and supervises other agencies, such as the Department of Aging and Disability Services. As of May 2010, over 3.3 million Texans were covered by Medicaid, a health insurance program for individuals with limited income and other resources. The recipients included over 2.1 million infants and children and almost a quarter-million residents over age 65.

Medicaid Eligibility Categories

• All Texans eligible for Medicaid must have income and resources within required limits. Eligible individuals include children younger than age 19, pregnant mothers and newborns during the first year of life. Pregnant women receive prenatal care, coverage of childbirth expenses and two additional months of coverage after giving birth. Texas' "Women's Health Program" provides preventative exams for conditions such as breast or cervical cancer, diabetes, blood pressure and birth control education to women age18 to 44 who meet neediness criteria. Needy Texans who are age 65 or older, blind or disabled also may qualify for Medicaid. Eligibility is automatic if the federal Supplemental Security Income program has awarded SSI benefits based on age, disability or blindness.

Community Attendant Services

• Section 1929(b) of the federal Medicaid statutes established a program called Home And Community Care For Functionally Disabled And Elderly Individuals. Texas is the only state to take advantage of this provision to design its Community Attendant Services program. The program currently services approximately 47,000 elderly and disabled Texas residents living in their own residences who need help with bathing, dressing, cooking, shopping and getting to medical appointments. The recipients would not qualify for such services from other programs due to their incomes. The income limit for qualifying was $2,022 monthly as of 2010 and recipients receive on average 16 hours of assistance weekly. Most recipients -- 73 percent -- are over age 65 but 27 percent are disabled individuals age 18 to 64.

Help With Medicare Costs

• Texas' Medicaid program helps Medicare beneficiaries afford full coverage. Medicaid's Medicare Savings Plan pays the Part B Medicare premiums, even though the recipients' income is too high to permit eligibility for regular Medicaid coverage. Income limits in 2010 were as high as $1,734 monthly for an individual or $2,334 monthly for a couple. The Medicare premium in 2010 was $110.50 monthly. Individuals with income low enough to qualify for Medicaid automatically have their Medicare premiums paid by the state.

Medicaid Estate Recovery Program

• When the Texas State Medicaid program pays at least $3,000 toward a recipient's long-term care, the state can recover its costs from the recipient's estate upon his death. Medicaid-covered services subject to the Medicaid Estate Recovery Program include nursing facility care, special care facilities for the mentally retarded and community attendant services. Recovery applies to services received on or after March 1, 2005, to recipients at least age 55. Texas will not pursue recovery of Medicaid funds spent from an estate if there is a surviving spouse or a child under age 21, a child of any age who is disabled or when an unmarried adult child has been living in the deceased recipient's home for a year prior to her death.