It is scary if your spouse is in need of Texas Medicaid nursing home benefits. Nursing homes cost a lot of money that most people do not have available to spend in their retirement years. Fortunately, with good advice many couples are eligible to qualify for Texas Medicaid nursing home benefits without losing everything. Some couples can even keep all of their assets. Let’s look at the story of Tom and Helen:

Tom and Helen have lived in Houston their entire adult lives. Two weeks ago, Tom and Helen celebrated their 50th wedding anniversary. Yesterday, Tom, who has Alzheimer’s, wandered away from home while Helen was grocery shopping. The police found Tom wandering the neighborhood hours later and took him to a hospital. Tom’s doctor has just told Helen that she needs to place Tom in a nursing home where he can receive the level of care that he needs. Concerned about nursing home expenses, Helen together a list of their assets:

$   5,000.00 – Checking Account
$ 50,000.00 – Savings Account
$ 50,000.00 – CDs/IRAs
$150,000.00 – Residence

In addition to their assets, Tom receives a Social Security check for $800 each month and Helen receives Social Security of $400 each month. Helen begins to research nursing homes to find the best one for Tom and soon discovers that the average cost of a nursing home is over $4,500 every month! Helen’s afraid that everything they have worked for their entire lives will be consumed by nursing home expenses and, even worse, she will be left penniless to pay for her own monthly bills in less than three years.

There is good news for Helen. Texas offers the Medicaid program to help pay for nursing home care expenses. It is possible that Tom and Helen will not have to lose everything they have worked for to pay for nursing home expenses. The process may take some time, but the results are usually worth it.

To apply for Medicaid, Helen will have to go through the Health and Human Services Commission (HHSC). If she does things strictly according to the way HHSC tells her, she may only be able to keep approximately one-half of their assets. The rest of their assets would have to be “spent down”  before Tom would qualify for Medicaid benefits.

In most cases there is an alternative to the traditional “spend down.” That is because federal law protects Helen so that she does not have to impoverish herself before Tom can receive Medicaid benefits. The challenge is that Helen cannot take advantage of this protection at the case worker level.

In order to ensure that she keeps as many assets as she is entitled to, Helen must go through the fair hearing process. She must proceed properly and she should have an attorney advising her of her rights throughout the process because the fair hearing carries significant legal ramifications with respect to Tom’s eligibility for Medicaid benefits and the amount of assets Helen can keep. But with proper advice, Helen can avoid such a large spend down.

This is an example where knowledge of the rules and how to apply them can make a substantial difference in the outcome. Consult a Texas Medicaid Attorney regarding your rights if your spouse has applied or is expected to apply for Medicaid benefits. Call The Shea Law Firm at (832) 856-4526 and don’t spend any more money on nursing home bills than you have to.