Your Financial Rights in an Assisted Living Facility
STAR+PLUS
If Medicaid is helping pay the costs to live in an assisted living facility (ALF), then you have STAR+PLUS. As a STAR+PLUS participant, you have specific financial rights. You have the right to manage your money or decide who manages it.
Personal Needs Allowance (PNA)
If you have STAR+PLUS living in an ALF, you get a PNA of $85 a month. Your PNA is part of your monthly income kept for personal use. The rest of your income is paid to the assisted living facility for your care.
You can spend your PNA on things you choose, such as:
Entertainment and outside food Cosmetics and hair appointments
Telephone and internet Clothing, books, and gifts
Smoking items
PNA is not for items Medicaid covers, such as:
● Upkeep of your room
● Room and board charges
● Copayment charges
● Nursing services
● Meals at the facility
Trust Fund
If you choose to make the ALF your representative payee, your monthly income will go into an account called a trust fund. A trust fund operates like a personal bank account for you.
If the ALF manages your money, you have the right to:
● Get receipts for deposits into your account.
● Approve or deny each withdrawal from your account.
● Get a written report of all deposits to and withdrawals from your account when you ask, at least every three months.
● Not be charged for services the facility is expected to provide, such as basic bedroom furniture, meals and medication administration.
What You Pay
When you move into an ALF and once a year, you will get a letter in the mail explaining
what you have to pay. Your STAR+PLUS service coordinator can also tell you what you
have to pay.
Room and Board
All assisted living residents with STAR+PLUS pay a room and board charge. You are
responsible for making your payment to your ALF. For an individual, this charge is
calculated based on the Supplemental Security Income (SSI) federal benefit rate of
$735 minus your personal needs allowance of $85. Note: The Supplemental Security
Income federal benefit rate may change each year. As of 2017, the amount for an
individual is $735.
Copayment
The copayment is separate from the room and board charge. Depending on your
income, you may be required to pay a copayment in addition to your room and board
charge. If you receive SSI, you are not required to make a copayment. Your copayment
amount is set by the Medicaid for the Elderly and People with Disabilities (MEPD) staff.
You are responsible for paying your copayment to the ALF.
Questions
Your managed care organization or STAR+PLUS health plan can help resolve problems
related to your room and board charge or copayment. Look on the back of your
STAR+PLUS insurance card for the service coordination phone number.
If you have questions or concerns about your financial rights, contact your ombudsman.
State Long-term Care Ombudsman
https://hhs.texas.gov/about-hhs/your-rights
ltc.ombudsman@hhsc.state.tx.us
800-252-2412
To file a complaint of abuse, neglect or exploitation at a facility:
Consumer Rights and Services
800-458-9858