Paul Sanchez
Texas has some of the strictest eligibility requirements for Medicaid in the US, and as of 2020, it was one of only 14 states not providing Medicaid to adults in poverty. Texas Medicaid is run by the Texas Health and Human Services Commission (HHSC) and covers low-income children, families, seniors, and people with disabilities. In addition to Medicaid, Texas also offers the STAR+PLUS plan, which covers adults with disabilities, people 65 and older, and women with breast or cervical cancer. Texas CHIP is another program for children and unborn children in families that earn too much to qualify for Medicaid but cannot afford private insurance.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicaid in Texas? | People with low incomes who are aged, blind, or disabled (receiving SSI benefits), and children and young adults in the state's foster care program. |
| Who is eligible for CHIP? | Children and unborn children in families that earn too much money to qualify for Medicaid but can’t afford private insurance. |
| Who is eligible for STAR+PLUS? | Adults with a disability, people 65 or older, and women with breast or cervical cancer. |
| Who is eligible for STAR? | Children, pregnant women, and some families. |
| Who is eligible for STAR Kids? | Children and adults 20 and younger with a disability. |
| How to apply for Medicaid in Texas? | Online at YourTexasBenefits.com, by calling the Texas Enrollment Broker Helpline at 1-800-964-2777, or by calling HealthCare.gov at 1-800-318-2596 (if you’re under 65 and don’t have Medicare). |
| How to apply for CHIP? | Create an account with the Health Insurance Marketplace and fill out an application. |
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What You'll Learn
Medicaid eligibility in Texas
Medicaid is a health care program for low-income individuals of all ages. In Texas, there are three categories of Medicaid long-term care programs with varying eligibility requirements. These are:
- Institutional/Nursing Home Medicaid: 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, or assisted living.
- Regular Medicaid: Allows you to stay in your home and get help with daily activities.
Texas requires that seniors have limited income and assets and a medical need to qualify for Medicaid long-term care. Each program has its own limits that vary depending on your filing status. For example, in 2025, a single applicant for Medicaid Nursing Home care must have an income of less than $2,901 per month and assets of less than $2,000. If you are married and only one spouse is applying, the income limit is $2,000 for the applicant and $154,140 for the non-applicant, while for Regular Medicaid, the income limit is $3,000.
Additionally, Texas has a 5-year Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers, during which all asset transfers are scrutinized to ensure no assets were sold under fair market value. The primary home is usually exempt from Medicaid's asset limit, but it is subject to Medicaid's Estate Recovery Program, which means it may be used to reimburse Medicaid for care costs after the beneficiary's death.
Texas also offers the Medicaid Buy-In (MBI) Program, which allows employed individuals with disabilities to receive Medicaid services by paying a monthly premium. Individuals with earnings of less than 250% of the federal poverty limits (FPL) may be eligible to participate.
To apply for Medicaid in Texas, you can start the process through HealthCare.gov, either online or by phone. You can also apply online at YourTexasBenefits.com or by calling the Texas Enrollment Broker Helpline at 1-800-964-2777 to choose a health plan.
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Texas Medicaid expansion
Texas is one of the only states in the US that has not expanded Medicaid, resulting in the highest uninsured rate in the nation. Texas's uninsured rate stood at more than 16% in 2023, considerably higher than the national rate of 8.6%. Nearly a quarter (24.3%) of Texans aged 19-64 were uninsured, and the state's diverse population in terms of geography, race, and ethnicity has resulted in significant racial and ethnic disparities in health insurance coverage.
The lack of Medicaid expansion in Texas means that adults under 65 who aren't disabled or raising a child are ineligible for Medicaid, regardless of their income. This has left many low-income adults without access to reliable and consistent healthcare, impacting their ability to get healthy before a pregnancy, detect and treat illnesses like cancer, and access mental health services.
Several attempts have been made to expand Medicaid in Texas, including the introduction of various bills in the state legislature in late 2024 and early 2025. Additionally, Republican John Zerwas sponsored HB3791 during the 2013 legislative session, which aimed to reform the state's Medicaid system while accepting federal funding to expand the program. However, these efforts have been unsuccessful due to the state's political leaders' lack of interest in expanding Medicaid.
The state's decision to not expand Medicaid has resulted in Texas rejecting an estimated $5-6 billion in federal funds annually. This has also led to a high financial burden on the state's emergency rooms, which provide $5.5 billion in uncompensated care each year to patients without health insurance.
Expanding Medicaid in Texas is crucial to ensuring that vulnerable populations have access to affordable healthcare. It would allow an estimated 1.4 million uninsured, low-wage Texans to become eligible for Medicaid, providing them with reliable and consistent healthcare coverage.
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Texas Medicaid and CHIP
Texas has strict eligibility requirements for Medicaid, and the state's rejection of federal funding to expand the program has resulted in a high uninsured rate. Texas Medicaid provides health coverage for low-income children, families, seniors, and people with disabilities. The program covers doctor visits, hospital stays, and prescription drugs. Texas Children's Health Insurance Program (CHIP) is a part of Medicaid and provides coverage for children in families that earn too much to qualify for Medicaid but cannot afford private insurance. CHIP covers medical and dental care for uninsured children and teens up to age 19, and the maximum fee a family will pay is $50 per year.
UnitedHealthcare offers the Texas STAR plan, which covers all Texas Medicaid benefits, and the STAR+PLUS plan, which covers adults with disabilities, seniors, and women with breast or cervical cancer. The STAR Kids program covers children and adults 20 and younger with disabilities. UnitedHealthcare also provides extra services, such as sports and school physicals for children.
Applying for Medicaid in Texas can be done online, by phone, or by mail. Individuals can apply through HealthCare.gov or directly through the Texas Medicaid agency. The Texas Enrollment Broker Helpline can assist with choosing a health plan. To apply for CHIP, individuals can create an account with the Health Insurance Marketplace and fill out an application.
It is important to note that Texas Medicaid and CHIP have specific income requirements and restrictions that may vary by plan. Individuals should check with the Texas Health and Human Services agency to understand the eligibility criteria and required documentation for enrollment.
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Texas STAR+PLUS plan
The Texas STAR+PLUS plan is a Medicaid-managed care program for Texans aged 65 or older with disabilities. The program provides healthcare and long-term services and support through a health plan chosen by the individual. STAR+PLUS allows eligible Texans to receive care at home, in adult foster care, or in assisted living residences.
STAR+PLUS differs from other Texas Medicaid programs as services are provided by managed care organizations (MCOs). Participants can select their preferred provider from a list of specific MCOs in each county. The program also offers "value-added services", which are extra services not covered by Medicaid, such as extra vision care, cell phones, and home-delivered meals.
STAR+PLUS covers adults with a disability, people aged 65 or older, and women with breast or cervical cancer. Enrollment is open year-round and can be completed online, by phone, or by mail.
The program includes a range of services, such as family planning, long-term services and supports (LTSS), personal attendant services, day activity and health services, nursing services, therapies, home modifications, dental services, medical supplies, respite services, and financial management services.
STAR+PLUS also offers specific benefits for pregnant women, including nutritional visits with a registered dietitian, rewards for healthy activities related to pregnancy and delivery, and a Start Smart® program.
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Applying for Medicaid in Texas
Texas has stringent eligibility requirements for Medicaid, and the state has also not expanded Medicaid. This means Texas has the highest uninsured rate in the US. However, applying for Medicaid in Texas can be done in several ways and is described as easy.
Eligibility
Medicaid in Texas provides health coverage for low-income children, families, seniors, and people with disabilities. The following populations are eligible for Medicaid in Texas: those with low incomes who are aged, blind, or disabled (receiving SSI benefits), and children and unborn children in families that earn too much money to qualify for Medicaid but can't afford private insurance.
How to Apply
You can apply for Medicaid in Texas online, by phone, or by mail. If you are under 65 and don't have Medicare, you can start the process through HealthCare.gov, either online or by phone at 1-800-318-2596. If you are eligible for Medicaid, you will be directed to the Texas Medicaid agency. Alternatively, you can apply through Your Texas Benefits by choosing "Apply for new benefits." You can also call 2-1-1 (TTY 711) toll-free Monday through Friday from 8:00 a.m. to 6:00 p.m. Central Time, or print and submit a paper form by mail.
Health Plans
Once you are approved, you will need to choose a health plan. If you don't choose one, an enrollment broker will choose one for you. Texas has several health plans, including the STAR plan, which covers children, pregnant women, and some families, and the STAR+PLUS plan, which covers adults with disabilities, people 65 and older, and women with breast or cervical cancer. The STAR Kids program covers children and adults 20 and younger with a disability. Texas also has a Children's Health Insurance Program (CHIP), which is for children in families that earn too much to qualify for Medicaid but can't afford private insurance.
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Frequently asked questions
Medicaid is a public insurance program created under federal law in 1965 and operated as a federal-state partnership. It provides health coverage for people with low incomes who are aged, blind, or disabled, or have young children.
CHIP is a federal-state partnership program that was added to Medicaid in 1997. It provides health coverage for children in families that earn too much money to qualify for Medicaid but cannot afford private insurance.
Yes, it is possible to have both Texan Plus insurance and Medicaid. The Health Insurance Premium Payment (HIPP) program is a Medicaid program that helps families pay for private health insurance, such as Texan Plus.
To apply for Medicaid in Texas, you must be a resident of the state and meet certain income and eligibility requirements. You can apply online at HealthCare.gov or by calling 1-800-318-2596. You may also need to provide information about any current insurance plans you have.
