Paul Sanchez
Texas has some of the strictest Medicaid eligibility requirements in the US, and it is one of only 14 states that do not provide Medicaid to adults in poverty. Texas has not expanded Medicaid under the Affordable Care Act (ACA), so adults under 65 who are not disabled or raising a child are ineligible for Medicaid, regardless of how low their income is. However, seniors, adults with disabilities, and some children with disabilities who don't have health insurance may be able to get coverage through the Medicaid for the Elderly and People with Disabilities program. Additionally, children from low-income families may be eligible for Medicaid or the Children's Health Insurance Program (CHIP).
| Characteristics | Values |
|---|---|
| Who is eligible for Medicaid in Texas? | Seniors, adults with disabilities, and some children with disabilities who don't have health insurance. Children from low-income families, aged 0-1, with a household income of up to 201% of the poverty line. |
| Who is not eligible for Medicaid in Texas? | Adults under 65 who aren't disabled or raising a child. Adults in poverty without dependent children, unless they have a serious or permanent disability, are elders in poverty, or have temporary maternity coverage. |
| What does Medicaid cover? | Doctor visits, medicine and vaccines, hospital care and services, x-rays and lab tests, vision and hearing care, access to medical specialists and mental healthcare, treatment of special health needs and pre-existing conditions. |
| How to enroll in Medicaid in Texas? | Enroll through HealthCare.gov or the state Medicaid website. You can also download and print a paper application or request one by mail. |
| Can you have private insurance and Medicaid? | Yes, Medicaid may pay for private health insurance costs for the entire family, not just the family members who get Medicaid. |
| Can you have Medicare and Medicaid? | Yes, many Medicare beneficiaries receive Medicaid's help with paying for Medicare premiums, prescription drug costs, and covering expenses not reimbursed by Medicare, such as long-term care. |
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What You'll Learn
Medicaid eligibility in Texas
Texas has not expanded Medicaid under the Affordable Care Act (ACA). This means that adults under 65 who aren't disabled or raising a child are ineligible for Medicaid, regardless of their income level. However, Texas does provide Medicaid coverage for some groups, including seniors, adults with disabilities, and children with disabilities who don't have health insurance. Additionally, children from low-income families may be eligible for either Medicaid or the Children's Health Insurance Program (CHIP).
Texas has the lowest income limit for parents to qualify for Medicaid in the United States. Parents with incomes between 18% and 100% of the federal poverty level are often left out of Texas Medicaid. However, if approved, Medicaid may pay for private health insurance costs for the entire family, not just the individual members who qualify for Medicaid. This is done through the Health Insurance Premium Payment (HIPP) Program.
Texas's decision to refuse federal funds for Medicaid expansion has resulted in the state missing out on billions of dollars in funding that could have provided medical care for low-income residents. The current estimate is that Texas is rejecting between $5 billion and $6 billion in federal funds annually by not implementing Medicaid expansion. This has contributed to Texas having the highest uninsured rate in the United States.
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Medicaid for seniors and people with disabilities
Texas has not expanded Medicaid under the Affordable Care Act (ACA), so adults under 65 who aren't disabled or raising a child are ineligible for Medicaid, regardless of their income level. However, seniors, adults with disabilities, and some children with disabilities who don't have health insurance may be able to obtain health coverage through the Medicaid for the Elderly and People with Disabilities (MEPD) program.
To be eligible for MEPD, you must be a Texas resident and a US citizen or qualified non-citizen. When you apply, you will be asked about your income, age, and disability to determine your eligibility. You can apply through HealthCare.gov or the state Medicaid website. If you already have Medicare, you may still be eligible for Medicaid to help pay for Medicare premiums, prescription drug costs, and expenses not reimbursed by Medicare, such as long-term care.
If you have a child with a disability who qualifies for MEPD, these services are typically provided by STAR Kids. You will choose a STAR Kids health plan from the options available in your service area. You may also be enrolled in traditional Medicaid, which means the state pays your doctors, nurses, and other caregivers directly.
Eligibility for Medicaid is determined by the Texas Health and Human Services Commission (HHSC) based on the information provided on the application, supporting documents, and any additional information you provide orally. The HHSC is required to review your circumstances at least once a year to ensure you remain eligible for Medicaid. It is your responsibility to inform the HHSC of any changes in your circumstances within 10 days, including changes in address, living arrangements, income, resources, and private health insurance premium amounts.
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Medicaid expansion in Texas
Texas has not expanded Medicaid under the Affordable Care Act (ACA). This means that adults under 65 who aren't disabled or raising a child are ineligible for Medicaid, regardless of their income level.
Texas's decision not to expand Medicaid has resulted in the state missing out on billions in federal funding. The current estimate is that Texas is rejecting between $5 billion and $6 billion in federal funds every year. This has led to hospitals and business groups across the state pressuring lawmakers to relent on their opposition to Medicaid expansion, as it would significantly reduce the amount of uncompensated care they provide.
Despite these calls for expansion, Republicans have long blocked Medicaid expansion in Texas, which has the highest uninsured rate in the nation. In April 2025, Texas lawmakers once again voted down a Democratic effort to expand Medicaid, with Republicans citing concerns about fraud and prioritising funding for property tax cuts.
However, it is still possible for some Texans to be eligible for Medicaid, even without the expansion. Medicaid in Texas covers low-income children, families, seniors, and people with disabilities. Children aged 0-1 with an income of up to 198% of the federal poverty level (FPL) are eligible for Medicaid, and children from households with incomes up to 201% of poverty are eligible for either Medicaid or the Children's Health Insurance Program (CHIP). Additionally, seniors and adults with disabilities who don't have health insurance may be able to obtain coverage through the Medicaid for the Elderly and People with Disabilities program.
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Applying for Medicaid in Texas
Medicaid and the Children's Health Insurance Program (CHIP) provide health coverage for low-income children, families, seniors, and people with disabilities in Texas. The state has not expanded Medicaid under the Affordable Care Act (ACA), so adults under 65 who aren't disabled or raising a child are generally ineligible for Medicaid, regardless of their income. However, seniors, adults with disabilities, and some children with disabilities who don't have health insurance may still be able to get coverage through the Medicaid for the Elderly and People with Disabilities program.
To apply for Medicaid in Texas, you can use one of the following methods:
- Visit the Texas Benefits website and choose "Apply for new benefits."
- Call 2-1-1 (TTY 711) toll-free, Monday through Friday from 8:00 a.m. to 6:00 p.m. Central Time.
- Print or request a paper form and submit it by mail.
- Go to a Texas Health and Human Services (HHS) benefits office near you. You can find one by calling 2-1-1 or visiting the "Find an Office" page on their website.
- Visit a community partner near you.
If you are under 65 and don't have Medicare, you can also start the process through HealthCare.gov, either online or by phone at 1-800-318-2596. If you are eligible, they will direct you to the Texas Medicaid agency. You can also enroll through the Medicaid website maintained by the Texas Health and Human Services Commission.
Keep in mind that Texas has stringent eligibility requirements for Medicaid. In addition to those with low incomes who are aged, blind, or disabled and receiving SSI benefits, the following populations are eligible for Medicaid in Texas:
- Children aged 0-1: 198% of the federal poverty level (FPL)
- Children are eligible for either Medicaid or CHIP if their household incomes are up to 201% of the poverty level
Texas's decision not to expand Medicaid has resulted in the state missing out on billions in federal funding that could have provided medical care for low-income residents. As a result, Texas's emergency rooms are providing a significant amount of uncompensated care, and hospitals and business groups have been pressuring lawmakers to expand Medicaid eligibility.
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Medicaid and CHIP
In Texas, Medicaid and the Children's Health Insurance Program (CHIP) provide health coverage for low-income children, families, seniors, and people with disabilities. Texas has not expanded Medicaid under the Affordable Care Act (ACA), so adults under 65 who are not disabled or raising a child are ineligible for Medicaid, regardless of their income. However, seniors, adults with disabilities, and some children with disabilities who don't have health insurance may still be able to get coverage through the Medicaid for the Elderly and People with Disabilities program.
Children from families with higher incomes than those covered by Medicaid but who still cannot afford health insurance are covered by CHIP. CHIP is available in seven service areas in Texas through Superior HealthPlan. Enrollment fees are $50 or less per family, per year, and fees vary based on income. There are no copays for pregnancy-related assistance, and Native Americans and Alaskan Natives are not subject to cost-sharing.
Texas has a history of restrictions on access to CHIP coverage, including a three-month waiting period for children who lose their coverage and want to apply for CHIP, and cutting off coverage if a family fails to pay a fee. However, new federal policies aim to eliminate barriers to Medicaid and CHIP access for Texans by streamlining the application, eligibility determination, enrollment, and renewal processes. These policies are intended to reduce the "churn" of people moving on and off insurance coverage due to issues with paperwork, agency processes, and data-sharing.
By refusing Medicaid expansion under the ACA, Texas has missed out on billions in federal funding for providing medical care for low-income residents. As a result, the state's emergency rooms are providing a significant amount of uncompensated care for patients without health insurance.
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Frequently asked questions
Yes, you may be able to get Medicaid even if you already have insurance. Many Medicare beneficiaries receive Medicaid's help with paying for Medicare premiums. If approved, Medicaid may pay the private health insurance costs for the entire family and not just for the family members who get Medicaid.
In Texas, seniors, adults with disabilities, and some children with disabilities who don't have health insurance might be able to get health coverage through the Medicaid program. Texas Medicaid also covers adults in poverty with dependent children, those who are elders in poverty, or those who get temporary maternity coverage. Children are eligible for either Medicaid or CHIP if their household incomes are up to 201% of poverty.
You can apply for Medicaid in Texas through HealthCare.gov or the state Medicaid website. You can also download and print a paper application or request that one be mailed to you through the Texas Medicaid website.
CHIP stands for the Children's Health Insurance Program. It is a public insurance program created under federal law and operated as a federal-state partnership. It covers medical and dental care for uninsured children and teens up to age 19.
No, Texas has not expanded Medicaid under the ACA and has refused federal funding for Medicaid expansion. This means that adults under 65 who aren’t disabled or raising a child are ineligible for Medicaid regardless of how low their income is.
