Texas Medicaid Plans

“Dual eligible beneficiaries” generally describes beneficiaries eligible for both Medicare and Medicaid. The term includes beneficiaries enrolled in Medicare Part A, Part B, or both and receiving full Medicaid benefits or assistance with Medicare premiums or cost-sharing through one of these Medicare Savings Program (MSP) eligibility groups:

• Qualified Medicare Beneficiary (QMB) Program: Helps pay premiums, deductibles, coinsurance, and copayments for Part A, Part B, or both programs
• Specified Low-Income Medicare Beneficiary (SLMB) Program: Helps pay Part B premiums Qualifying Individual (QI) Program: Helps pay Part B premiums
• Qualified Disabled Working Individual (QDWI) Program: Pays the Part A premium for certain disabled and working beneficiaries who have disabilities

Medicare pays covered dually eligible beneficiaries’ medical services first because Medicaid is generally the payer of last resort. Medicaid may cover medical costs Medicare may not cover or partially covers (such as nursing home care, personal care, and home- and community-based services).

Coverage for dually eligible beneficiaries varies by State. Some States offer Medicaid through Medicaid-managed care plans, while others provide Fee-For-Service Medicaid coverage. Some States contract with health plans that include all Medicare and Medicaid benefits.

Federal law defines Medicaid and MSP income and resource standards, but States can effectively raise those limits above the Federal floor (except for QDWIs). Annually, the Centers for Medicare & Medicaid Services (CMS) releases eligibility standards for dually eligible beneficiaries.