Paying for care in Texas: Medicare, STAR+PLUS and VA Aid and Attendance, plainly

Over Thanksgiving or Christmas, the talk about Mom or Dad usually turns to money before the dishes are done. Who pays, how long the savings last, whether "the government covers it." Some families pay privately from savings, income or the sale of a house. Some get help from public programs. This guide covers the three questions Texas families ask most, with links to the sources so you can check every line, so you can bring facts to the table instead of guesses.

Every family's situation is different, and nothing here is a promise that a program will approve your parent. It is a map of where to ask.

Medicare: what it does not pay for

Start here, because it surprises almost everyone. Medicare.gov says Medicare does not pay for long-term care. Long-term care means help with daily tasks like bathing, dressing and eating, whether at home or in a care home.

Medicare still matters. It covers doctor visits, hospital stays and, for someone on hospice, a short respite stay. Our respite care guide explains that piece. But Medicare will not pay a monthly assisted living bill.

Texas Medicaid: STAR+PLUS and assisted living

Your first job: call a Texas Aging and Disability Resource Center at 855-937-2372 and ask, "Could my mother qualify for help paying for assisted living?" They can walk you through the rest. Here is what you will hear about.

In Texas, Medicaid help with long-term care runs through STAR+PLUS, a Medicaid health plan program. According to HHSC's STAR+PLUS page:

• STAR+PLUS covers adults who have disabilities or are age 65 or older and are approved for Medicaid.
• The STAR+PLUS Home and Community Based Services (HCBS) program provides services that help people live outside a nursing home when they would otherwise need one. Its services include assisted living, personal assistance, respite care and home-delivered meals.
• HHSC assesses a person's need for the program when they apply for Medicaid.

Who qualifies for STAR+PLUS HCBS. HHSC's eligibility handbook lists requirements that include:

• being 21 or older,
• qualifying for full Medicaid on income and assets,
• a medical approval that the person needs the level of care a nursing home gives.

The handbook lists more requirements, such as Texas residency and a service plan that fits within the program's cost limit.

Two more details families should know:

1. Room and board is still owed. The STAR+PLUS handbook on assisted living says members in assisted living are responsible for their room and board costs and, if it applies, a copayment based on income. A copayment is not required of people who receive SSI.
2. There can be a wait. HHSC's STAR+PLUS program overview describes an interest list for the HCBS program. People already enrolled in Medicaid with a health plan may be able to bypass it through an upgrade process.

Not every assisted living home accepts STAR+PLUS. Ask each home directly, and get the answer in writing.

How to start: apply for Medicaid at YourTexasBenefits.com or by calling 2-1-1. The Texas Aging and Disability Resource Centers, at 855-937-2372, can help you understand the steps.

VA Aid and Attendance

If your parent is a veteran or the surviving spouse of one, ask about Aid and Attendance. The VA describes it as monthly payments added to a VA pension for qualified veterans and survivors. A person may be eligible if they get a VA pension, or apply for one together with Aid and Attendance, and meet at least one condition. A VA fact sheet explains that someone not yet receiving pension attaches a pension application to the Aid and Attendance request. The conditions include:

• needing another person to help with daily activities like bathing, feeding and dressing,
• having to stay in bed, or spend a large part of the day in bed, because of illness,
• living in a nursing home because of the loss of mental or physical abilities related to a disability, or
• eyesight limited to 5/200 or less in both eyes even with glasses, or a visual field of 5 degrees or less, which is the VA's test.

The VA pension itself has its own rules. The VA pension eligibility page lists service requirements, an age or disability requirement, and yearly income and net worth limits set by Congress. The VA says you can apply online, by mail or in person. For Aid and Attendance, a medical examiner fills out VA Form 21-2680.

Be careful with anyone who promises your family a dollar amount. Your county veterans service office can help you apply.

Questions to ask every home about money

• What is the monthly rate, and exactly what does it include?
• What are the care levels, and what moves a resident from one to the next?
• Is there a move-in fee or deposit, and what part is refundable?
• How much notice do you give before a rate increase?
• Do you accept STAR+PLUS? Do you have residents using VA benefits?
• If my parent's money runs out, what happens?

A calm plan for the holidays

1. Gather the paperwork: income, bank statements, any long-term care insurance policy, military discharge papers.
2. Make one call to an Aging and Disability Resource Center to learn which programs fit.
3. Shortlist licensed homes in the Texas Senior Care Directory, and check each license with our five-minute guide.
4. Look for free benefits workshops and resource fairs on the events calendar.

None of this has to be settled by New Year's.