Imagine up to $50,000 for your goals or unexpected needs, directly in your account, without the wait.
Apply Now & Get Fast Funding!
On this page:
Texas Medicaid is a crucial state and federal program that gives free or low-cost health coverage to millions of eligible Texans. It acts as a safety net, ensuring that children, pregnant women, adults with disabilities, and seniors can access the medical care they need. The program is designed to help you and your family stay healthy by covering services from routine doctor visits to hospital stays and prescription drugs.
How Managed Care Works
Most people in Texas receive their Medicaid benefits through a managed care system. Once you are approved, you will enroll in a health plan, similar to an HMO or PPO, that will coordinate all of your healthcare services. This approach helps ensure you receive quality, consistent care from a network of doctors and specialists.
Understanding the Different Programs
To meet the diverse needs of Texans, the program is divided into several key components. Understanding which one applies to you is the first step toward getting the right coverage.
Navigating the application process can feel complex. The following sections break down the requirements into simple, clear steps, giving you the information you need on eligibility, covered services, and how to apply.
Qualifying for Texas Medicaid is not based on a single rule but on specific requirements for your age, income, family size, and health status. This complexity is a common source of confusion for applicants.
The income limits for a parent are significantly stricter than those for their child or for a pregnant woman. This is because Texas has not expanded Medicaid coverage under the Affordable Care Act (ACA), which would have created more uniform income rules for most low-income adults.
The Texas "Coverage Gap"
This policy decision has created a "coverage gap" where many low-income adults are ineligible for assistance, no matter how low their income is, unless they are pregnant, disabled, or caring for a dependent child.
The state operates a patchwork system with different standards for different groups. More generous rules apply to children and pregnant women, while much stricter rules apply to parents. This can result in a parent qualifying for coverage only during pregnancy and for a year after, while their child remains covered.
A. Foundational Requirements for All Applicants
Before looking at specific programs, every applicant must meet two basic criteria:
B. Coverage for Children and Teenagers (Children's Medicaid & CHIP)
Texas provides health coverage for children through two main programs. The state automatically determines which program your child qualifies for based on family income.
Children's Medicaid
This program offers free, comprehensive health coverage for children and teens 18 and younger in low-income families. There are no monthly premiums or co-pays.
Children's Health Insurance Program (CHIP)
CHIP is a low-cost health plan for children whose families earn too much for Medicaid but can't afford private insurance. Families may pay a small annual enrollment fee ($50 or less per family) and low co-pays for doctor visits and prescriptions.
C. Coverage for Pregnant Women
Texas offers strong health coverage options to ensure pregnant women receive vital care for their health and their baby's.
Medicaid for Pregnant Women
This program provides free, full Medicaid benefits during pregnancy and for 12 months after the baby is born.
CHIP Perinatal
This program is for pregnant women who don't qualify for Medicaid due to income or immigration status and lack other insurance. It covers prenatal care, labor and delivery, and two postpartum checkups. The newborn is typically enrolled in Medicaid or CHIP after birth.
D. Coverage for Parents and Caretaker Relatives
This is the most restrictive category, with some of the lowest income limits in the nation due to Texas not expanding Medicaid. To qualify, you must be the parent or caretaker relative of a child 17 or younger who lives with you and receives Texas Medicaid.
The monthly income limits are exceptionally low:
E. Coverage for Adults Age 65+ and People with Disabilities (MEPD)
Medicaid for the Elderly and People with Disabilities (MEPD) is for individuals who meet specific age or disability criteria, along with financial limits on both income and assets.
Who is Eligible?
You must meet one of these criteria:
Financial Requirements
MEPD considers both your income and your "countable assets."
If you are applying for a program with long-term care, like STAR+PLUS, you must also have a medical need for that level of care.
Your benefits are delivered through the managed care health plan you choose. While all plans must cover a core set of essential services, they also compete by offering "value-added services"—extra benefits at no cost to you. Comparing these extra benefits is an important step in selecting the right plan for your family.
A. Essential Health and Medical Services
All Texas Medicaid plans provide comprehensive coverage for medically necessary services with little to no cost. Core benefits include:
B. Prescription Drug Coverage
Your Medicaid plan covers a wide range of prescription medications.
How It Works
Your doctor can prescribe any medically necessary drug, which you can fill at a pharmacy in your health plan's network.
Formulary and Preferred Drugs
Texas Medicaid uses a statewide list of covered drugs, known as the formulary. Some drugs are "preferred" and are easily filled. Others are "non-preferred" and may require special approval from your doctor, called a prior authorization. Sometimes, you may need to try a preferred drug first before a non-preferred one is approved ("step therapy").
Emergency Prescriptions
If you urgently need a medication that requires prior authorization, your pharmacist may be able to provide a 72-hour emergency supply.
C. Dental Care Benefits
Dental coverage under Texas Medicaid varies significantly based on age.
For Children (up to age 20)
Children receive comprehensive dental benefits through a separate managed dental plan. These plans cover a full range of services at no cost, including:
For Adults
Standard Medicaid for adults generally only covers emergency dental services, such as treating an injury or severe infection. Routine care like cleanings and fillings is typically not covered. Some STAR+PLUS plans may offer limited routine dental care as a value-added service.
D. Vision Care Benefits
Most Texas Medicaid plans provide vision benefits to help with eye care and corrective eyewear.
Covered Services
Benefits typically include routine eye exams and an allowance for eyeglasses or contact lenses. The specifics, such as how often you can get an exam or the dollar amount for glasses, vary by age and the health plan you choose.
Texas Medicaid is divided into distinct managed care programs, each tailored to a specific group. The main difference between the STAR program and the others is the inclusion of Long-Term Services and Supports (LTSS), which help people with significant health needs live in the community.
A. STAR Program: Core Coverage for Families and Children
B. STAR+PLUS Program: Health and Long-Term Support for Adults
C. STAR Kids Program: Specialized Care for Children with Disabilities
The application process requires a lot of information, but breaking it into steps makes it manageable. Be aware that due to a high volume of applications and the "unwinding" of pandemic-era policies, processing times can be long. Patience and follow-through are essential.
Step 1: Gather Your Information and Documents
Having your documents ready will save time and help prevent delays. You will need the following for everyone in your household who is applying:
Step 2: Choose Your Application Method
Texas offers several ways to apply.
Step 3: After You Apply – What to Expect
Once your application is submitted, the review process begins.
After you are approved, you must choose a health plan to manage your care. This decision affects which doctors you can see and what extra benefits you receive. If you don't choose one, the state will assign one to you.
A. Understanding the Enrollment Packet
B. How to Compare Health Plans
Review your options carefully to find the best fit for your family.
C. Making Your Choice Official
Once you decide, you must formally enroll.
Texas Medicaid provides health coverage primarily to specific groups with very low incomes. This includes eligible children, pregnant women, parents of eligible children, and adults with disabilities. Unlike in some other states, eligibility for low-income adults without dependent children is extremely limited.
Both programs cover children, but they serve different income levels. Texas Medicaid is for children in the lowest-income households. The Children’s Health Insurance Program (CHIP) covers children in families who earn too much to qualify for Medicaid but cannot afford private health insurance.
Yes, there are very strict income limits that depend on your household size and the program you are applying for. The income thresholds for parents are significantly lower than for children or pregnant women, based on a percentage of the Federal Poverty Level.
Absolutely. Pregnant women are a primary eligibility group for Texas Medicaid. The program provides comprehensive health coverage throughout the pregnancy and for at least 12 months postpartum, provided the applicant meets the specific income requirements for this category.
The most efficient way to apply is online through the YourTexasBenefits.com website. You can also apply by calling 2-1-1, downloading a paper application to mail or fax, or by visiting a Texas Health and Human Services Commission (HHSC) office in person.
Yes. Children and young adults under age 21 who are enrolled in Texas Medicaid receive comprehensive dental and vision services through the Texas Health Steps program. This includes regular checkups, preventative care, glasses, and other medically necessary treatments.
Generally, no. Because Texas has not expanded its Medicaid program, eligibility for adults is very restricted. Childless adults typically do not qualify unless they are aged 65 or older, have a disability that meets Social Security standards, or are receiving other specific federal benefits.
STAR+PLUS is a managed care program for specific Texas Medicaid recipients, such as adults aged 65 or older and adults with disabilities. It is designed to coordinate both acute medical care and long-term services and support (LTSS) to help members live in their communities.
Yes, you must renew your eligibility for Texas Medicaid to maintain health coverage. The HHSC will send you a renewal form before your coverage ends, typically once every 12 months. It is crucial to complete and return this information promptly to avoid losing your benefits.
When you apply, be prepared to provide proof of Texas residency, identity, U.S. citizenship or qualified immigration status, and household income (like pay stubs). Having these documents ready can help ensure your application for Texas Medicaid is processed without delays.
Craving the convenience of grocery delivery but worried about your EBT card? Well, fret no more! Instacart has joined the movement to make fresh food accessible to everyone, now accepting EBT payments in most U.S. states. Dive in to learn exactly how to utilize your benefits for hassle-free online grocery shopping!
The Vermont Mortgage Relief Program delivers critical financial grants to homeowners who experienced pandemic-related economic hardship and are struggling with overdue housing expenses. Discover how this essential program provided up to tens of thousands in assistance for mortgage, utility, and tax payments, helping to stabilize Vermont households and prevent foreclosure.
Imagine a child's face lighting up on Christmas morning, unwrapping a gift they truly wished for, thanks to the generosity of toy assistance programs. These initiatives work tirelessly to ensure that every child, regardless of their family's financial circumstances, experiences the magic of the holiday season.