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More ways to pay for long-term care


In my last column (Dec. 20), I responded to the question: “How do we pay for disability?” I noted that there are four ways to pay for disability costs that include in-home caretakers, assisted living, or nursing home care, along with the increased costs for medical care.

Recall that two of the four ways to pay for disability are: out of your own personal wealth and with long-term care insurance. A third way to pay for the costs of nursing care is to access the Texas veterans nursing homes located throughout Texas.

The citizens of the state of Texas are so appreciative of the sacrifices made by veterans that the taxpayers subsidize seven nursing homes throughout the state. The homes are in Temple, Floresville, Big Spring, Bonham, Amarillo, El Paso, and McAllen. The cost is significantly discounted for veterans who have served for at least 90 consecutive days of active duty, one of which was during a wartime. Additionally, the veteran must have lived at least one year in Texas and not have a dishonorable discharge. A qualified veteran’s spouse can reside in the nursing home with the veteran, but does not receive the same discounted rate. The spouse can continue to live in the nursing home after the death of the veteran spouse.

There are also limited funds available to a veteran and the veteran’s spouse in the form of a veteran’s pension. This pays an income to certain veterans who are over 65 or who are under age 65 and totally disabled. This benefit does not require a service-related disability, but has asset and income limits. The Texas veterans administration has representatives who can help with the application for the pension. Texas veterans representatives are generally housed at the county courthouse. This is a free service provided to Texas veterans. (An article describing the VA pension was previously published in the La Vernia News. Contact the newspaper office for archived articles.)

If you do not have enough money to pay for disability out-of-pocket, if you do not have long-term care insurance, and if you do not have access to Texas veterans nursing homes or the veterans pension, the only other way to pay for the high costs of disability is through the Medicaid program.

There are more than 40 Medicaid programs in Texas, but the primary Medicaid programs for the elderly are Family Care, Community Assistance Services, Star Plus Waiver, and Medicaid long-term care nursing benefit. If you are disabled and meet very strict income and asset criteria, Medicaid could pay up to all of the cost of nursing home care and could even pay for limited in-home caretakers’ hours. The Star Plus Waiver and nursing home benefit also include cost-free health insurance that will supplement Medicare coverage.

Family Care will provide very limited in-home attendant care for disabled adults who have difficulty caring for themselves. The services are limited to housekeeping, cooking, feeding, toileting, shopping, laundry assistance, and escort to medical appointments. There is no medical assistance under the Family Care program. To be eligible, an individual must have no more than $5,000 ($6,000 for a couple) with gross monthly income below $2,130 per month. The number of caretaker hours depends on a person’s needs, but is capped at 50 hours per week.

If an individual needs the supervision of a registered nurse, Community Attendant Services (CAS) may provide the disabled individual minimal caretaker services for up to about 50 hours per week. To be eligible, an individual needs assistance with at least one personal care task and needs the supervision of a registered nurse. Financially, gross monthly income must be below $2,130 with no more than $2,000 in countable assets. A house, one car, and household goods are exempt. Just about all other assets could be countable.

Sometimes, an older individual needs more than just a few hours a day of assistance in order to stay home. Or maybe the need for round-the-clock care is simply too expensive, requiring nursing home care. My next article will address the more comprehensive Star Plus Waiver and Medicaid Long Term Nursing Home benefits.

Patricia Flora Sitchler is a certified elder law attorney and assists families in planning for disabled children. Patty is a resident of La Vernia and maintains offices in San Antonio as a shareholder in the firm of Schoenbaum, Curphy & Scanlan, P.C.

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