Financial Assistance for Assisted Living in Texas

The following post contains helpful resource information from assistedliving.org/Texas

 

STAR+PLUS
STAR+PLUS is a multifaceted program which provides reimbursement for people seeking assisted living. The STAR+PLUS Home- and Community-Based Waiver is a part of the program that helps seniors who are assessed as nursing home-eligible continue receiving their Medicaid benefits without being institutionalized. Eligible applicants are reimbursed for services that promote independence, such as assistance with personal grooming tasks, basic mobility, and caregiver respite. Services may be provided by direct care aides at an assisted living facility or by home health contractors.

Who is Eligible?
The STAR+PLUS program has absorbed many Texas Medicaid plans and services, so understanding whether you qualify can be difficult. This is due to the many caveats that may apply if you are eligible for multiple state programs under the STAR+PLUS umbrella, or for other programs like Supplemental Security Income. Eligibility requirements are listed on the Texas Health and Human Serviceswebsite, though understanding what you may qualify for is likely to require the assistance of a dedicated case worker.

Eligible applicants are people who need an institutional level of care and qualify for Medicaid. Medicaid applicants over 65 should have a maximum income of $2,250 and countable assets of no more than $2,000, though eligibility criteria varies with marital status, level of assistance needed, and other factors.

How to Apply
This waiver is a non-entitlement program, which means that it can only support a limited number of active participants. Applying for the waiver is likely to result in one’s name being added to a waiting list for enrollment, so it is advised that interested parties sign up as far in advance as possible. Applicants are encouraged to seek qualified counseling to help them navigate the enrollment process and eligibility requirements of STAR+PLUS. To begin the application process, contact The Office of the Ombudsman at (866) 566-8989, or consult the Texas Area Agencies on Aging by calling (800) 252-9240. Find your local Area Agency on Aging by consulting the directory in this guide.

The Community First Choice (CFC) Program
The Community First Choice program is a lot like the STAR+PLUS HCBS waiver in what it offers, except that CFC is a Medicaid entitlement program, meaning there are no maximum recipient caps and no waiting lists for enrollment. Community First Choice offers Medicaid reimbursement to low-income assisted living residents for the provision of assistance with activities of daily living, such as personal grooming tasks, mobility, and basic house chores. People already enrolled to receive other Medicaid waiver services may elect to switch to the Community First Choice Program.
Services provided under the CFC Program may include:
• Personal assistance with activities of daily living
• Skills education for self-care and independent living
• Emergency response services
• Training for support staff management
• Consumer-directed service options

Who is Eligible?
Applicants for the Community First Choice program must qualify for Medicaid and must be assessed by a physician as nursing home-eligible. Coverage of personal care services through this program is provided based on an assessment of which services an individual requires.

How to Apply
Interested parties can apply online at YourTexasBenefits.com, or call 2-1-1 for guidance and consultation. Your local Area Agency on Aging can also help with Medicaid and non-Medicaid applications. To initiate an assessment and determine your eligibility, consult the directory in this guide to find a nearby Area Agency on Aging.

PACE
Serving the cities of El Paso, Amarillo, and Lubbock, PACE is the Texas branch of the national Program for All-Inclusive Care for the Elderly. It is a Medicaid-administered program intended to provide total coverage of all medical and personal care needs for especially frail seniors, helping them to avoid institutionalization. This program reimburses for a broad array of services that may be provided by assisted living facility staff or home health contractors.
PACE provides these services:
• Personal care services and home healthcare
• Adult day healthcare
• Medical care
• Coverage for all necessary prescription drugs
• Hospital and nursing home care when necessary
• Social services
• Caregiver respite

Who is Eligible?
• Individuals aged 55 and older who are nursing home-eligible
• People who live in an area covered by PACE services
• Those who can live safely at home or in an assisted living community
Private payment is accepted for individuals not receiving Medicare or Medicaid and fees for these participants will not exceed average costs for nursing home care in Texas. However, space in the program is limited, and preference is given to applicants who have greater medical and financial needs. Most recipients of PACE are dually eligible for both Medicaid and Medicare. All applicants must have family or caregivers who can provide limited support during short intervals of respite.

How to Apply
To find out if you’re eligible and to learn about what PACE offers, contact your local HHS office by dialing 2-1-1, or 7-1-1 for the hearing impaired. You can also consult your local Area Agency on Aging for more details and application assistance. Find your local Area Agency on Aging by searching the directory included in this guide.

More Ways to Finance Assisted Living
Some additional ways to finance assisted living costs include:

Free Assisted Living Resources in Texas
Texas is home to hundreds of nonprofits and government resource providers that assisted living residents can look to for added support. Some of these organizations, like the Area Agencies on Aging, operate in every state across the country, while others are dedicated only to specific regions in the state of Texas. All of these services are free to use. However, some organizations listed here may have income and health-related requirements intended to preserve resources for those who are most in need.

The Aging & Disability Resource Center
This center was opened by the HHS as part of the national No Wrong Door initiative, and it is intended to streamline public access to resources and information concerning long-term services and supports. The Aging & Disability Resource Center helps to reduce confusion and facilitate access to care for long-term care recipients in all 254 counties of Texas. Contact them by calling (855) YES-ADRC, or (855) 937-2372. Find out more online by visiting hhs.texas.gov.

The Long-Term Care Ombudsman Program
Most states have a Long-Term Care Ombudsman program which organizes volunteers to act as advocates for recipients of LTC benefits. Ombudsmen periodically visit residents of ALFs and nursing homes to verify the quality of their care and environment, field complaints and concerns, help them protect their rights, and keep them in touch with the service providers and authorities they may rely on. The services of ombudsmen are always free and confidential, and their organizations avoid conflicts of interest by remaining unaffiliated with service providers and government agencies. The Texas LTC Ombudsman program can be reached via e-mail at ltc.ombudsman@hhsc.state.tx.us and toll-free at (800) 252-2412.

211 Texas
The Texas Health and Human Services Commission provides 211 Texas as an anonymous social service hotline with 25 information centers across the state. They are available to take calls 24/7, and can help citizens understand and gain information on any programs administered by Health and Human Services, which includes long-term care facilities like assisted living and other supports for seniors.
Reach 211 Texas by simply dialing 2-1-1, or visit them online at 211Texas.org.

Area Agencies on Aging
The AAA is a national, federally funded organization. It acts as a central agency, unifying hundreds of community outreach programs and supports for citizens over 60 years of age. Texas hosts 27 Area Agencies on Aging, making this a convenient resource for people in all regions of the state.

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