Non-Financial Eligibility

Age and Disability — You must be at least 65 or older or , if under 65, you must get Social Security or Railroad Retirement disability benefits. If you are not getting a disability benefit, HHSC will complete a disability determination using your medical, education, and work history information.

Citizenship — You must be a U.S. citizen or a qualified legal alien. Qualified legal aliens include those who have been lawfully admitted for permanent residence, active-duty military or honorably discharged veterans (or the spouses or dependent children of veterans), certain refugees or asylees, and certain people for whom deportation has been deferred. Unless you already have Medicaid or Medicare, a U.S. public birth certificate showing birth in one of the 50 states, the District of Columbia, Puerto Rico (if born on or after Jan. 13, 1941), Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after Jan. 17, 1917), American Samoa, Swain’s Island or the Northern Mariana Islands (after Nov. 4, 1986) may be necessary to prove your citizenship. You may also need proof of earning 40 quarters of Social Security credit or proof of 10 years of verifiable work credit to prove your alien status.

Residence — You must be a resident of the U.S. and Texas.

Medicare Savings Programs — You must be entitled to Medicare Part A for QMB, SLMB and QI-1. You will need a Medicare card, award letter, or some other document from the Social Security Administration as proof of your Medicare Part A entitlement.

Medical Necessity, Level of Care for Nursing Facility, ICF/IID and Waiver Programs — Your need for medical care available in a Medicaid facility or a Medicaid waiver program will need to be determined.

30 Consecutive Days in an Institution — This applies after admission to a nursing facility, ICF/IID or IMD (if 65 or older). If you want help paying for care in a facility, you must stay in a facility that has a Medicaid contract for 30 consecutive days. If you must go to the hospital before the end of 30 days, but return directly to a Medicaid facility, the hospital stay counts toward the 30 days. If you meet all other eligibility criteria from the day you are first admitted to a facility, Medicaid can pay for care beginning the day of admission, once 30 days has passed.