What do Medicaid nursing home benefits cover?

What do Medicaid nursing home benefits cover?

There are approximately 42 Medicaid programs in Texas. It is important to understand that each program has its own eligibility criteria and benefits. If the Medicaid applicant in a Medicaid certified nursing home meets the functional and financial eligibility criteria, Medicaid will cover most of the medical and support needs of the person. As the payer of last resort, Medicaid only begins to pay once other healthcare coverage, long-term care coverage, or other coverage is exhausted.

Nursing home Medicaid does not pay for dental care. If a Medicaid nursing home recipient needs a noncovered medical service such as dental care, and the medical service is not paid for through Medicare or private health insurance, the Medicaid recipient can pay for the care and submit a copy of the paid invoice to HHSC. Provided the medical service is medically necessary, HHSC will reduce the Medicaid recipient’s copayment and pay the nursing home the difference. It is a good idea to check with the HHSC caseworker and billing office prior to paying out of pocket for a noncovered medical service.

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