Medicaid is not a single program. The Texas Medicaid system encompasses many health benefit programs based on financial need for children, pregnant women, parents, older adults, and people with disabilities. Elder law focuses on Texas Medicaid programs that fund long-term care, Medicare out-of-pocket costs, and other health benefits for seniors and disabled adults and children, known collectively as Medicaid for the Elderly and People with Disabilities (MEPD).
When Medicaid was created in 1965 for low-income individuals, it included mandatory coverage of nursing home care. Today Medicaid is required by law, under a U.S. Supreme Court decision, to provide long-term care services to disabled recipients in the least restrictive settings. Consequently, all states offer Medicaid home and community-based long-term care services, as an alternative to nursing facility care. These programs, however, can use waiting lists and are not part of the Medicaid entitlement.
In Texas, the Home and Community-Based Services Star+ Plus Waiver (HCBS – SPW) program was designed to provide the equivalent of Medicaid nursing facility care in recipients’ homes. You must first sign up for the Interest List to have an opportunity to apply and the waiting period is at least 3 – 6 months. HCBS-SPW provides high-level home care and comprehensive Medicaid health care benefits. In contrast, the streamlined Community Attendant Services (CAS) program provides only home care services to applicants with a lower level of medical need and has no waiting list.
MEPD includes Medicare Savings Programs (MSPs) that pay the Medicare Part B premium for low-income beneficiaries. In 2025, the Medicare Part B premium is $185 per month. Medicaid MSPs include Qualified Medicare Beneficiary (QMB), which also pays Medicare copayments and co-insurance, making QMB equivalent to a Medicare Supplement policy or Medigap insurance. Medicare pays about 80% of covered health care costs, while Medigap insurance – and Medicaid QMB – covers the other 20% of costs.