Cost of Care Responsibility

If you are eligible for Medicaid in a nursing facility, ICF/IID facility, IMD (if 65 or older) or for waiver program services, you may have to pay toward the cost of your care. This is referred to as your copayment. From your total income, you are allowed to keep a standard personal needs allowance. The amount of this allowance is different for different programs. Certain medical expenses you may pay, such as general health insurance premiums, Medicare premiums, deductibles and coinsurance, certain dental fees or prescription drug costs, may also be deducted. HHSC staff will calculate your copayment and notify you and your case manager or your service provider of the amount. The arrangement for your portion of the payment is between you, your case manager or the service provider. Medicaid payments for your care will be made directly to the service provider.

To access the Medicaid eligibility rules on the Internet, follow the steps below:

Go to www.sos.state.tx.us/tac .

Under Points of Interest , select View the current Texas Administrative Code .

A menu will appear entitled Texas Administrative Code: Titles . Select Title 1, Administration .

Select Part 15, Texas Health and Human Services Commission .

Select Chapter 358, Medicaid Eligibility for the Elderly and People with Disabilities .

Select the subchapter you desire.

This information is a general overview about Medicaid financial eligibility determinations and may not specifically cover your situation. The information is dated because the eligibility policies may be changed by federal, state, and agency rules. If you have questions about your situation, please contact 211.