Texas Medicaid Community Based Alternatives Waiver

Page Reviewed / Updated - Mar. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

Though not designed specifically for the elderly, this Medicaid waiver allows aged, blind and disabled individuals that require a nursing facility level of care to reside at home or in assisted living residences instead of in a nursing home. It should be noted that this is not a Medicaid entitlement program. Therefore even if individuals are qualified, there may not be space available in the program.

The types of service available under this waiver are non-medical in nature.   Personal care is offered as well as coverage for home medical equipment and home modifications which enable the participant to better care for themselves.

 This program allows family members to be paid for providing personal care services.

Individuals receiving personal care under this waiver can choose to allow the state administrators to manage their care or they can choose to self-direct their care. This is referred to as the Consumer Directed Services Option or CDS. Under the CDS option, participants are given the flexibility to choose their own personal assistance and respite care providers. Usually personal assistance and respite care can be provided by non-medical professionals and participating individuals can hire certain family members to provide this services. Spouses and legal guardians are usually excluded, but siblings, ex-spouses, friends and the children of aging parents can all be hired as paid caregivers.

Texas also offers a robust consumer directed program for non-Medicaid eligible individuals called the Texas Community Attendant Services Program. In certain areas of the state, an alternative to the CBA Waiver exists called the STAR+PLUS Waiver.

 

Eligibility Guidelines

The CBA Waiver is intended to aid individuals that need skilled nursing facility level care. In addition, this waiver has the same financial restrictions as Texas Long Term Care Medicaid.

2013 Texas Medicaid Income Limits
For individuals the monthly income limit is $2,163 and for couples it is $4,326 / month.  If a single spouse is seeking assistance, joint income can be allocated to the non-applying spouse. 

2013 Texas Medicaid Resource Limits
For individuals, the limit is $2,000 and for couples it is $3,000. These figures do not include resources such as the primary residence, vehicle or final expense trusts. If one spouse of the couple is not seeking Medicaid, the resource limit is elevated considerably. The "community", or non-Medicaid seeking spouse is permitted to retain up to $117,240.

Options for Individuals Over the Limits
Unlike many states, Texas does not have a Medically Needy Medicaid program which allows persons with unusually high medical expenses to qualify. Therefore persons, over the limits who hope to qualify must re-allocate their finances into special trusts. It is possible to put income in excess of the limit into a pooled income trust, thereby lowering one's countable income to the appropriate amount for the CBA Waiver. Assets can be converted from "countable assets" to exempt assets. One common approach is to make use of an irrevocable funeral trust which helps individuals within $15,000 of Medicaid's asset limit.

While neither of these techniques is especially complicated, it is very easy to make an error and disqualify oneself for Medicaid. Therefore, we advise Medicaid candidates to work with a financial, legal or public benefits counselor prior to their Medicaid application to ensure the best chance of being accepted in the program. Learn more.

 

Benefits and Services

The CBA Waiver will pay for a broad range of services and supports to individuals that choose to live in their homes or in assisted living. These include:

  • Environmental Adaptive Aids (to increase the independence of the individual in their home)
  • Durable Medical Equipment and Supplies
  • Home Modifications
  • Personal Emergency Responses Services
  • Personal Assistance
  • Home Delivered Meals
  • Respite Care
  • Transition Assistance


It should be noted that Waiver programs, in addition to providing individuals with options, are designed to save the state money and therefore the overall services provided may be limited to not exceed the cost for those same services were they provided in a nursing home or a percentage thereof.

 

How to Apply / Learn More

The CBA Waiver was available statewide however there may be "interest lists" (a.k.a. waiting lists)  to receive services.  Additionally certain areas of Texas may now offer managed care services through the STAR+PLUS Waiver instead of the CBA Waiver.

Interested individuals can learn more on the Department of Aging and Disability Services' website or confirm eligibility and apply for services by contacting their local DADS administrator.

 Did You Know? Texans can receive free assistance finding affordable home care and assisted living.  Get help here.