Haris Ashley
Texas has some of the strictest eligibility requirements for Medicaid in the US, with only children, low-income families, seniors, and people with disabilities qualifying for the program. While Texas has not expanded Medicaid under the ACA, the state does offer a program called CHIP (Children's Health Insurance Program) for children in families that earn too much money to qualify for Medicaid but cannot afford private insurance. Additionally, Texas offers the Health Insurance Premium Payment (HIPP) program, which helps families pay for private health insurance if the total cost of that insurance is less than the total cost of care with Medicaid.
| Characteristics | Values |
|---|---|
| Can you have private insurance and Medicaid in Texas? | Yes, as long as you qualify to use the Marketplace. |
| Texas Medicaid eligibility | Children aged 0-1: 198% of the federal poverty level (FPL); Children are eligible if their household incomes are up to 201% of poverty; Adults with a disability, people 65 or older, and women with breast or cervical cancer; Pregnant women; Low-income families. |
| Texas CHIP eligibility | Children and unborn children in families that earn too much to qualify for Medicaid but can't afford private insurance; Children and teens up to age 19. |
| Texas Medicaid application process | Can be done online, by phone, or mail. |
| Texas Medicaid enrollment | Open year-round. |
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What You'll Learn
Texas Medicaid eligibility
Texas has not expanded Medicaid under the Affordable Care Act (ACA). This means that adults under 65 who are not disabled or raising a child are ineligible for Medicaid, regardless of their income level.
Texas Medicaid is run by the Texas Health and Human Services Commission (HHSC). The program provides health coverage for low-income children, families, seniors, and people with disabilities. The STAR+PLUS plan covers adults with a disability, people 65 or older, and women with breast or cervical cancer. The STAR plan covers children, pregnant women, and some families.
Texas has the lowest income limit for parents to get Medicaid in the US. Parents with incomes between 18% and 100% of the federal poverty income are left out of Texas Medicaid. Children are eligible for either Medicaid or CHIP if their household incomes are up to 201% of poverty.
Texas has a 5-year Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers that immediately precede one's application date. During this period, the state scrutinizes all asset transfers to ensure no assets were gifted or sold under fair market value. If so, a Penalty Period of Medicaid ineligibility will be calculated.
There are three categories of Medicaid long-term care programs with differing eligibility requirements:
- Institutional/Nursing Home Medicaid: For those requiring a Nursing Home Level of Care. Benefits are provided only in nursing homes.
- Medicaid Waivers/Home and Community-Based Services: Benefits are provided at home, adult day care, adult foster care home, or in assisted living. This is not an entitlement, and the number of participants is limited.
- Regular Medicaid: This does not fall under the Look-Back Rule, and the primary home is usually exempt from the asset limit. However, it is not exempt from Medicaid's Estate Recovery Program, which may use the home to reimburse Medicaid for providing care.
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Texas' Medicaid expansion
Texas is one of the only states in the US where workers with incomes below the poverty line have no viable health insurance options. This is because the state has chosen not to expand Medicaid, which was intended to cover adults below the poverty line. Texas has the highest uninsured rate in the nation, with 18% of Texans missing out on health coverage in 2021, compared to 8.6% nationwide.
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. Texas has the lowest income limit for parents to get Medicaid in the US, and only a handful of children on Medicaid have parents who qualify themselves.
In 2012, the Supreme Court ruled that states could not be penalized for opting out of Medicaid expansion, and Texas has chosen to keep its pre-2014 Medicaid eligibility rules. This means non-disabled adults without minor children are ineligible for Medicaid, regardless of how low their income is.
Texas qualifies for 90% federal funding for Medicaid expansion, and several bills have been introduced in the Texas legislature to expand Medicaid. However, previous legislative efforts to expand Medicaid in Texas have been unsuccessful, and political leaders in the state have remained mostly uninterested in expanding the program.
The lack of Medicaid expansion in Texas has been linked to reduced access to healthcare for low-income adults, particularly those from racial and ethnic minority backgrounds. Studies have found that Medicaid expansion is associated with reduced disparities by income or race/ethnicity in measures of affordability or financial security.
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Medicaid and Medicare
Medicaid is a federal-state partnership programme that provides free or low-cost medical benefits to people with low incomes. Each state has its own eligibility requirements, and in Texas, the programme is administered by the Texas Health and Human Services Commission (HHSC). Texas has not expanded its Medicaid programme, and so adults under 65 who are not disabled or raising a child are ineligible for Medicaid, regardless of their income.
Texas's Medicaid programme covers children, pregnant women, seniors, and people with disabilities. The STAR plan covers children, pregnant women, and some families, while the STAR+PLUS plan covers adults with disabilities, people 65 or older, and women with breast or cervical cancer. Texas also offers the Children's Health Insurance Program (CHIP), which covers children and unborn children in families that earn too much to qualify for Medicaid but cannot afford private insurance.
Medicare, meanwhile, is a federal programme that provides health insurance for people aged 65 and over, as well as some younger people with disabilities. In Texas, many Medicare beneficiaries receive Medicaid support with paying for premiums, prescription drug costs, and expenses not reimbursed by Medicare, such as long-term care.
Texas residents can apply for Medicaid online, by phone, or by mail. They can enrol through HealthCare.gov or the state Medicaid website.
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Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) are public insurance programs created under federal law and operated as federal-state partnerships. While Medicaid was created by Congress in 1965, the Children's Health Insurance Program (CHIP) was added in 1997. States have minimum federal standards that their Medicaid programs must meet, but they also have a lot of flexibility in terms of their options. Texas Medicaid, for example, is administered by the Texas Health and Human Services Commission (HHSC).
Medicaid provides health coverage for low-income children, families, seniors, and people with disabilities. The STAR+PLUS plan covers adults with a disability, people 65 or older, and women with breast or cervical cancer. The STAR plan covers children, pregnant women, and some families. In Texas, children aged 0-1 with incomes at 198% of the federal poverty level (FPL) are eligible for Medicaid. Children from families with incomes up to 201% of the poverty line are eligible for either Medicaid or CHIP. CHIP is designed for children and unborn children in families that earn too much to qualify for Medicaid but cannot afford private insurance.
In Texas, the decision to refuse federal funds for Medicaid expansion has had a disproportionate impact on uninsured Hispanic adults. Out of the 1.5 million uninsured Texas adults who could enroll under a Medicaid expansion, 57% are Hispanic. Texas has the lowest income limit for parents to qualify for Medicaid in the U.S., leaving out parents with incomes between 18% and 100% of the federal poverty income.
Texas has recently faced criticism for its handling of Medicaid and CHIP, with more than a million people being dropped from these programs. The state has been rechecking the eligibility of anyone on the Medicaid and CHIP rolls, requiring everyone to reapply for benefits. This has resulted in a return to pre-pandemic levels, with just over 4 million people still enrolled in the programs.
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Medicaid enrolment
Texas has some of the strictest eligibility requirements for Medicaid, and the state has not expanded Medicaid under the Affordable Care Act (ACA). As a result, adults under 65 who aren't disabled or raising a child are ineligible for Medicaid, regardless of their income.
The following populations are eligible for Medicaid in Texas:
- Children aged 0-19: 198% of the federal poverty level (FPL).
- Children are eligible for either Medicaid or CHIP if their household incomes are up to 201% of poverty.
- Pregnant women.
- Seniors.
- People with disabilities.
- Caretakers of dependent children.
- People with breast or cervical cancer.
Enrollment is open all year round and can be done online, by phone, or by mail. You can enroll 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.
Texas Medicaid is run by the Texas Health and Human Services Commission (HHSC). Texas leaders have chosen to refuse federal funds for Medicaid expansion, which is estimated to be around $10 billion per year. This disproportionately affects the Hispanic adult population in Texas, as well as working-poor Texas adults, as the state's Medicaid program is closed to them.
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Frequently asked questions
Medicaid is a federal-state partnership program that provides health coverage for low-income children, families, seniors, and people with disabilities.
Yes, it is possible to have both private insurance and Medicaid in Texas. The Health Insurance Premium Payment (HIPP) program is a Medicaid program that helps families pay for private health insurance. Medicaid will pay for the family's private health insurance if the total cost is less than the total cost of care under Medicaid.
You can apply for Medicaid in Texas online, by phone, or by mail. You can enroll through HealthCare.gov or the state Medicaid website. You can also download and print a paper application or request one by mail from the Texas Medicaid website.
