Medicaid Eligibility for Alzheimer’s Patients: What You Need to Know
Taking care of a loved one with Alzheimer's can often result in emotional and financial challenges. As the condition progresses, the need for long-term care often becomes unavoidable and expensive. Many families in Texas turn to Medicaid to help cover the costs of nursing home care, in-home assistance, or other long-term care services. However, the rules around Medicaid eligibility can be confusing and overwhelming.
At Baker & Baker in Corpus Christi, Texas, our attorneys can help you understand how Medicaid works for Alzheimer’s patients so you can make smart decisions about care and financial planning. From income limits to asset protection and spousal rights, there are several factors to think through when applying for coverage.
Medicaid and Long-Term Care
Before jumping into eligibility requirements, it's important to understand how Medicaid differs from other types of health insurance. Unlike Medicare, which typically doesn't cover long-term nursing home care, Medicaid can help pay for the services that Alzheimer’s patients often need on a daily basis.
In Texas, Medicaid is a joint federal and state program, which means the state has some flexibility in how it's administered. Texas Medicaid can cover nursing home care, home health services, and even some assisted living options under special waiver programs. But getting approved means meeting both financial and medical eligibility rules.
Financial Eligibility Requirements for Medicaid in Texas
For Alzheimer’s patients to qualify for long-term Medicaid care in Texas, they must meet specific income and asset limits. These limits are updated annually and differ depending on whether the applicant is single or married. Here are some key financial rules to keep in mind:
Monthly income limits: As of 2025, an individual applying for long-term care Medicaid can’t have more than $2,901 in monthly income. If married, the non-applicant spouse may keep more income through special allowances.
Asset limits: A single applicant may not own more than $2,000 in countable assets. However, not everything counts. Some assets, such as a primary home (up to a certain equity limit), a vehicle, and personal items, are exempt.
Married couples: When one spouse needs care but the other remains at home, Texas follows the “Community Spouse Resource Allowance” (CSRA). This rule allows the healthy spouse to keep a portion of the couple’s assets, often up to $154,140 (as of 2024).
Spousal income protections: Texas also protects the non-applicant spouse by allowing them to keep a certain amount of monthly income, which can go as high as $3,853.50.
Meeting these financial criteria is often the biggest hurdle for families. However, there are legal tools that can help you preserve assets without disqualifying your loved one from benefits.
Medicaid Eligibility and Level of Care
Beyond finances, applicants must show that they medically need long-term care. This part of the process involves an assessment by the state. The primary factors that the state looks at during medical reviews include the following.
Diagnosis and impairment: A formal diagnosis of Alzheimer’s isn't enough by itself. The patient must require help with activities of daily living (ADLs), such as eating, bathing, dressing, toileting, or mobility.
Texas Medicaid assessment: The state uses the "Medical Necessity Determination" (MND) process, which looks at both cognitive function and physical limitations.
Care setting: The level of care required also affects eligibility. Patients needing skilled nursing care or 24/7 supervision are more likely to qualify than those needing only occasional help.
If the Alzheimer’s patient doesn’t meet the medical threshold at first, it may be worth reapplying later as the disease progresses.
Asset Protection Strategies for Families
Many families worry that they’ll have to spend down everything they own to qualify for Medicaid. But with proper legal planning, it's possible to protect your family and your finances. Some common strategies you can use include:
Medicaid Asset Protection Trusts (MAPTs): These irrevocable trusts can protect assets from Medicaid’s five-year look-back period if they're created early enough.
Spending down wisely: Some expenses, like home modifications, medical equipment, or prepaid funerals, can be used to reduce countable assets in ways that benefit the patient.
Transfers to exempt parties: Certain asset transfers, such as giving a home to a caregiver child or a disabled family member, may be allowed without triggering penalties.
Annuities and promissory notes: These tools can convert countable assets into income streams that benefit the healthy spouse while helping the applicant qualify.
Each family’s situation is different, so it’s important to get legal advice before taking action. An experienced long-term care and Medicaid attorney can help you find the best solution.
How the Medicaid Look-Back Period Works
In Texas, Medicaid has a five-year look-back period. This means that when someone applies for long-term care benefits, the state will examine any asset transfers or gifts made in the last 60 months. Some key things to know about the look-back period include:
Penalties for improper transfers: If assets were given away during this period without fair market value in return, a penalty period will apply. This is a time during which the applicant is ineligible for benefits.
Penalty calculation: The penalty is based on the value of the transfer divided by the average monthly cost of nursing home care in Texas. For 2025, that rate is approximately $6,900 per month.
No penalties for exempt transfers: Transfers to spouses, disabled children, or into certain types of trusts may not result in penalties.
Importance of documentation: If a transfer was made for reasons unrelated to Medicaid planning, it’s vital to document the purpose and retain any relevant paperwork.
Families often make innocent mistakes here, so it’s wise to talk with an experienced elder law attorney before applying for Medicaid.
Special Protections for Married Couples
Texas Medicaid rules contain special protections so that spouses who remain at home aren't left in financial hardship when their partner enters long-term care. Some benefits provided to spouses include the following.
Income allowances: The spouse still living at home can keep a portion (or all) of the couple’s income, depending on their needs.
Asset division: Through the CSRA, the non-applicant spouse may keep significant assets, rather than being forced to spend down everything.
Post-eligibility income transfers: Once the spouse in care is approved for Medicaid, some of their income may be transferred to the community spouse to cover living expenses.
Right to appeal: If the protected allowances are insufficient to support the community spouse, they may request a higher allowance through a fair hearing.
These rules aim to strike a balance between helping the spouse in care and protecting the spouse staying at home.
How to Apply for Medicaid
The application process for long-term Medicaid care can be time-consuming and detail-oriented. Mistakes or omissions when applying can delay approval or result in a denial. Therefore, it's important to take careful steps to make sure your application is correct and legally sound. The primary steps you will need to take include the following.
Collect documents: This includes financial records, identification, medical assessments, bank statements, property deeds, insurance policies, and more.
Submit the application: Applications can be submitted online through YourTexasBenefits.com, by mail, or with the help of a local office.
Waiting period: After submission, it may take 45 to 90 days to receive a determination.
Respond to requests: The state may ask for additional information. Failing to respond on time could jeopardize the application.
Appeal a denial: If your application is denied, you have the right to appeal and may present additional evidence.
Legal assistance can make this process smoother and help prevent mistakes or delays in your application. Reach out to an experienced attorney in Corpus Christi, Texas, today.
What Happens After Medicaid Is Approved?
Once approved, Medicaid will begin covering long-term care costs. However, there are still a few things to monitor going forward. After Medicaid is approved, you will generally need to take the following steps.
Verify the coverage start date: Medicaid often pays retroactively for services received up to three months before the approval date.
Review all care plans: Make sure the facility or caregiver meets your loved one’s needs and that services match what Medicaid agreed to cover.
Maintain annual renewals: Medicaid benefits must be recertified each year, with updated financial and medical information.
Monitor changes in status: A change in income, living arrangement, or marital status could impact eligibility.
Contact an Experienced Texas Medicaid Attorney Today
Medicaid eligibility can provide life-changing support for Alzheimer’s patients and their families, but getting approved for Medicaid takes more than just filling out a few forms. That's where an experienced elder law attorney can help.
Our attorneys at Baker & Baker are dedicated to helping you move forward with confidence and peace of mind. Located in Corpus Christi, Texas, we serve clients in Dallas, Houston, San Antonio, and throughout the state. Give us a call today to get started.
