Adult Medicaid

Medicaid is the State and Federal cooperative venture that provides medical coverage to eligible need individuals. Medicaid was introduced to to improve the health of people who might otherwise go without medical care for themselves and their children. Please see the information below to learn how you can receive help if you qualify.

Additionally, if you are a woman between the ages of 18-44 you could be eligible for Women's Health Care. Click on the link for more details.

Frequently Asked Questions

What is Medicaid?

You can think of Medicaid as a type of health insurance for low-income families, children, and people who are elderly or have a disability. But unlike regular health insurance, you don't have to pay for it, and most services are free.

Who is eligible for Medicaid?

People who receive Temporary Assistance for Needy Families (TANF), Refugee Cash Assistance, and SSI automatically get Medicaid. (TANF is sometimes called welfare, and SSI is available to people who are elderly, blind, or have a disability.)

Other people also may qualify based on their income and resources.

• Low-income children under age 19 and pregnant women
• Families that leave TANF for work or whose time limits have expired
• Youths aging out of foster care
• Families that have high medical bills they cannot pay
• People who are elderly or have a disability who do not receive SSI may qualify for assistance in a nursing facility, intermediate care facility for people with mental retardation (ICF/MR), state school, or state hospital. They also may be eligible under a Medicaid waiver program or continue to qualify after being denied SSI due to a change in income
• Medicaid also covers out-of-pocket medical expenses for certain Medicare recipients, such as Medicare premiums, deductibles, and co-insurance costs

Different eligibility requirements apply to each group. Please contact us for specific information.

How does Medicaid work?

Each month you will receive a Medicaid ID card. It is very important that you keep it in a safe place. You will have to show that card each time you visit a doctor or get a prescription filled. You will not receive a monthly ID card if your only benefit is payment of all or part of your Medicare Part B premium.

Medicaid pays for most services, but not for everything. To make sure that you receive your benefits, follow these rules.

• You cannot pay for a service yourself and ask Medicaid to pay you back. Payments are only made to providers, such as your doctor, hospital, pharmacy, or lab.
• The providers you use must accept Medicaid. It will not pay if you see a non-Medicaid doctor.
  

What is covered?

In most cases, Medicaid pays for doctors' services, laboratory and X-ray charges, medication, nursing facility and hospital services, family planning, eyeglasses, hearing aids, ambulance, podiatry, chiropractic, maternity, nurse midwife, and other health care services.

People who are elderly or have a disability who need help with daily activities may be able to receive services in their homes. The state also offers some non-Medicaid community care services.

Medicaid often pays for regular checkups, especially for children. In some cases, children may even get to see a dentist. your Medicaid ID card will tell you what services you can receive, and when regular check-ups are scheduled.

What are the minimum qualifications?

Medicaid is available to qualifying Texans of all ages and abilities. There are separate programs for families and children and for people who are elderly or have a disability. In general you must:

• Be a Texas resident
• Be a U.S. citizen or a non-citizen in certain recognized categories
• Meet certain source and income limits, which vary by eligibility group

How do my assets, such as my home and bank accounts, and my income affect whether I can Receive Medicaid?

The amount of assets and income you are allowed depends on the category you apply under. Contact the San Antonio Food Bank for more information. You will need to provide proof of income and assets when you apply. in most cases, a homestead is not counted as an asset.

I have several unpaid medical bills. Will Medicaid pay for them if I'm eligible for coverage?

Coverage usually begins on the first day of the month in which you applied for benefits. Sometimes Medicaid pays unpaid bills as far back as three months before you applied for coverage or you began receiving SSI benefits.

Can I get Medicaid coverage if I already have health insurance?

Yes, but your other insurer must pay first. Medicaid may pay for things not covered by your other policy.

Can I work and still be eligible for Medicaid?

Yes, certain earnings may not be counted. If you meet the other requirements, it doesn't matter if your income is from a job or other source. If you are elderly or have a disability, $65 plus one half of the remainder of certain earnings, won't be counted when eligibility is determined.

I was told I make too much money for regular coverage, but that my child might qualify for spend down. What does that mean?

Spend down is another name for the Medically Needy Program. You can be reimbursed for unpaid medical bills if, by paying them, your income would be low enough to qualify you for Medicaid coverage. For example, a family of four with an income of $1,000 a month would be covered if their medical expenses were at least $692 a month. Doctor visits, prescriptions, past medical bills, and medical insurance charges are covered. If you have other insurance it must pay first. Only the amount that it doesn't pay may be counted. this program is for children and pregnant women only.

My family doesn't qualify for Medicaid, but we can't afford insurance. Is there any help available for us?

Friendly, bilingual Application/Renewal Assistance is only a phone call away. Don’t delay; apply today, friendly staff waiting to assist you.

Phone: (210)431-8326 or 1-800-246-9121

Hours: Monday - Friday 8 a.m. to 8 p.m. and Saturdays 9 a.m. to 3 p.m.

Social Services Manager: Yvonne Vaughan (210) 431-8327 This e-mail address is being protected from spambots. You need JavaScript enabled to view it

I'm covered by Medicaid, but I have a hard time paying my share of the costs. Can Medicaid help with my out-of-pocket expenses?

Texas has several Medicare savings programs that may help people who are eligible for Medicare Part A. Different income and resource limits apply to each.

Do I have to be broke to qualify for long-term care Medicaid?

No. You can have some income and other resources and still be eligible for Medicaid. Income sources include earnings or wages, Social Security, certain veterans benefits, private pension and retirement benefits; interest or dividend income, royalty or rental income (after expenses); gifts or contributions; and civil service and annuities. Resources include financial accounts; stocks and bonds; real property, such as land; a car; life insurance policies; burial funds; and personal property such as jewelry, antiques, and coin collections. Some resources are protected. they generally include your homestead, household goods, personal effects, a car, and certain burial funds and burial space items.

If I have a job, can I still qualify for long-term care Medicaid?

That depends on how much you earn at your job. Having a job may not disqualify you, but the amount of money you can earn and still be eligible for Medicaid is low. A Medicaid eligibility worker can tell you whether your job makes you ineligible for Medicaid.

Do I have to sell my house before I can qualify for long-term care Medicaid assistance?

No. Some resources are protected. Protected resources generally include your homestead, household goods, personal effects, a car, and certain burial funds and burial space items.

If I need long-term care Medicaid assistance, what will happen to my spouse?

Spouses can usually keep some amount of protected resources if they continue to live in their home or community. The resources a spouse may keep include a homestead, household goods, personal effects, and a car.

What other requirements must I meet for long-term care Medicaid eligibility.

• You must require RN/LVN nursing care
• You must meet certain health conditions that put you at risk for long-term care
• You must be a Texas resident and a U.S. citizen or an alien with approved status (e.g., lawful permanent resident)
• If you choose to live in a nursing facility, you must have been living for 30 consecutive days in a medical facility that has a contract to accept Medicaid patients
• You must either be age 65 or older or have a health condition that the Social Security Administration guidelines define as a disability.

If I qualify for Medicaid, do I have to pay anything for long-term care for me or my spouse?

It's possible that you may be required to contribute some of your income toward the cost of care. Only a long-term care Medicaid eligibility worker who knows the details of your situation can tell you for sure whether or not you will have to contribute to the cost of care.

My mother can't really take care of herself anymore, but she will not consider a nursing home. Does Medicaid provide any way for people to get help so they can stay in their homes?

There are a number of Medicaid-funded home and community services for qualifying people of all ages. Some programs are available on a first-come, first-served basis.

• Community-based Alternatives offers home and community-based services to people who are elderly or adults who have a disability as a cost-effective alternative to institutional care in nursing facilities.
• Community Living Assistance and Support Services furnishes home and community-based services to people with developmental disabilities as a cost effective alternative to placement in an ICF/MR facility.
• Day Activity and Health Services facilities offer daytime services to clients residing in the community as an alternative to placement in nursing homes or institutions. Services address the physical, mental, medical, and social needs of clients
• Deaf-Blind with Multiple Disability Waiver program provides community-based services to help people who are deaf and blind with multiple disabilities become more communicative and independent.
• Home and Community-based Services are an alternative to institutionalization for children and young adults who meet medical necessity criteria for care in an ICF/MR facility.
• Home and Community-based Services - OBRA is a community alternative for nursing facility residents who have mental illness, mental retardation, or a developmental disability.
• Medically Dependent Children is an alternative to institutionalization for children and young adults who require licensed nursing services.
• Personal Care Services provides assistance with daily living activities, such as dressing, eating, grooming, bathing, and food preparation. People may receive these services even if they don't have another Medicaid coverage.

If I don't qualify for Medicaid, can I still get help with any long-term care services?

Yes. Even if you are not eligible for Medicaid, you may still qualify to receive a number of the community-based services. Community care services are provided on a first-come, first-served basis at little or no cost to you. Contact you local Eligibility office for information.