Orlando Harmon
Texas is one of 14 states that does not provide Medicaid to adults in poverty. However, Texas residents can apply for Medicaid and see if they are eligible. The first step is to create an account with the Health Insurance Marketplace and fill out an application. If it looks like you qualify for Medicaid, your information will be sent to your state agency, which will contact you about enrollment. You can also apply through the Medicaid website maintained by the Texas Health and Human Services Commission, or by downloading and printing a paper application.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicaid in Texas? | Low-income children, families, seniors, and people with disabilities |
| Who is not eligible for Medicaid in Texas? | Adults in poverty without dependent children (unless they have a serious or permanent disability, are elders in poverty, or get temporary maternity coverage that ends 2 months after the birth) |
| How to apply for Medicaid in Texas | Online or by phone through HealthCare.gov (if you're under 65 and don't have Medicare), through the Medicaid website maintained by the Texas Health and Human Services Commission, or by downloading, printing, or requesting a paper application |
| Other information | Texas has refused Medicaid expansion under the ACA and is therefore missing out on billions in federal funding that would provide medical care for low-income residents |
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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 Texas has forgone billions in federal funding that would have been used to provide medical care for low-income residents. As a result, Texas hospitals provide billions in uncompensated care each year to patients who are uninsured.
Despite this, Texas residents can still apply for Medicaid. To be eligible for Medicaid in Texas, you must be a resident of the state and meet certain income and asset limits. Texas offers multiple pathways toward eligibility, and the criteria change annually and vary with marital status. In 2025, a single Medicaid Nursing Home applicant in Texas must meet the following criteria:
- Income under $2,901 per month
- Assets under $2,000
- Require a Nursing Home Level of Care
Texas also has a 5-year Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers. 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.
You can check your eligibility for Medicaid in Texas by visiting the Your Texas Benefits website and using the Prescreening Tool. You can also call 2-1-1 (TTY 711) toll-free Monday through Friday from 8 a.m. to 6 p.m. Central time for more information. If you are eligible, you can apply through the Medicaid website maintained by the Texas Health and Human Services Commission. You can also download and print a paper application or request that one be mailed to you through the Texas Medicaid website.
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Applying for Medicaid in Texas
Medicaid is a federal-state partnership program that provides health coverage for low-income children, families, seniors, and people with disabilities. Texas has specific eligibility requirements and application processes for Medicaid enrollment. Here is a guide on how to apply for Medicaid in Texas:
Eligibility:
Texas has specific eligibility criteria for Medicaid, which include income, age, family size, and health status. To be eligible for Medicaid in Texas, you must be a low-income resident with dependent children, a serious or permanent disability, or qualify as an elder in poverty. Texas Medicaid also provides temporary maternity coverage that ends 2 months after birth. Additionally, the Children's Health Insurance Program (CHIP) is available for children who do not qualify for Medicaid.
Application Process:
To apply for Medicaid in Texas, you can follow these steps:
- Check Eligibility: Visit the Texas Health and Human Services Commission (HHSC) website or the Health Insurance Marketplace to check if you or your family members meet the eligibility requirements for Medicaid in Texas. Each state has its own criteria, so it's important to refer to the specific guidelines for Texas.
- Gather Information: When applying for Medicaid, you may need to provide certain information and documentation. This can include proof of identity, income verification, residency documentation, and details about your current health status or medical conditions.
- Apply Online or by Phone: You can start the application process by visiting HealthCare.gov or calling 1-800-318-2596. This method is suitable if you are under 65 and don't have Medicare. If you qualify, you will be directed to the Texas Medicaid agency for further enrollment steps.
- Enroll through the Texas Medicaid Website: The Texas Health and Human Services Commission (HHSC) manages the Medicaid program in Texas. You can enroll through their Medicaid website, where you can also find options to download and print a paper application or request one by mail.
- Await State Agency Contact: Once you have submitted your application, your information will be reviewed by the state agency. They will contact you regarding enrollment and may request additional information or documentation to determine your eligibility.
It is important to note that Texas has not expanded its Medicaid program under the Affordable Care Act (ACA). This means that there may be limitations on coverage for certain populations, such as adults in poverty without dependent children. However, Texas does qualify for 90% federal funding for Medicaid expansion, which could provide additional resources for uninsured Texans.
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Texas Medicaid expansion
Texas is one of ten states that have not expanded Medicaid under the Affordable Care Act (ACA). This means that, regardless of their income, Texans under 65 who are not disabled or a child are ineligible for Medicaid. Texas has the highest uninsured rate in the country, with 16.6% of residents uninsured in 2022.
In 2013, Republican John Zerwas sponsored HB3791, which would have directed the state to craft a "Texas solution" to Medicaid expansion. The bill called for reforming the state's Medicaid system while also accepting federal funding to expand the program. However, it did not pass. In the same year, Republican lawmakers in Texas passed a measure that requires the state Health and Human Services Commission to receive approval from the legislature before any future Medicaid expansion decisions can be made. This means that even if a governor were to support Medicaid expansion, the decision rests with the Texas Legislature.
Despite efforts by Democrats to expand Medicaid in Texas, Republicans have long blocked expansion, citing concerns about fraud and prioritising funding for other areas such as property tax cuts. In April 2025, the Texas House voted down a measure to expand Medicaid eligibility to the fullest extent permitted by federal law. The measure, which failed 85 to 63, would have directed the state to expand eligibility to include every category of person for whom the federal government matches funds. The federal government would have covered 90% of the cost of expansion, amounting to billions of dollars in federal funding that Texas is missing out on by not implementing Medicaid expansion.
To enrol in Medicaid in Texas, individuals can start the process through HealthCare.gov, either online or by phone. If an individual is under 65 and doesn't have Medicare, they will be directed to the Texas Medicaid agency if HealthCare.gov believes they are eligible for coverage. They can then enrol through the Medicaid website maintained by the Texas Health and Human Services Commission or by downloading and printing a paper application from the Texas Medicaid website.
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Texas Health and Human Services Commission
The Texas Health and Human Services Commission (HHSC) manages hundreds of programs and services that help improve the lives of Texans. The HHSC includes the Texas Health and Human Services Commission and the Texas Department of State Health Services. The HHSC manages programs that assist families with food, health care, safety, and disaster services.
Some of the programs managed by the HHSC include the Women, Infants, and Children (WIC) program, the Children's Medicaid program, and the Supplemental Nutritional Assistance Program (SNAP). The HHSC also offers the Children's Health Insurance Program (CHIP), which provides health insurance for children, and the Healthy Texas Women Program, which offers low-income women family planning services, health screenings, and birth control.
Advisory Committees, such as the Policy Council for Children and Families and the Aging and Disability Resource Center Advisory Committee, assist the HHSC in developing and implementing policies and programs that meet the needs of Texans.
To apply for Medicaid in Texas, you can start by visiting HealthCare.gov online or calling them at 1-800-318-2596. If you are under 65 and don't have Medicare, they will direct you to the Texas Medicaid agency if you are eligible for that coverage. You can also enroll through the Medicaid website maintained by the Texas Health and Human Services Commission. Additionally, you can download and print a paper application or request to have one mailed to you through the Texas Medicaid website.
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Medicaid Insurance alternatives in Texas
Texas offers several alternative health plans to Medicaid. These plans are usually sought after by consumers looking to save money. However, it is important to note that these plans may not be regulated by the state and do not follow federal Affordable Care Act (ACA) rules. They may not cover all injuries or illnesses, including pre-existing and chronic conditions, and may have waiting periods for joining. Here are some of the alternative plans available:
Short-term plans
These plans last 12 months or less but can sometimes be renewed for up to 3 years. They typically offer fewer benefits and lower coverage amounts than major medical plans.
Accident plans
These plans will only pay a portion of your bills for certain injuries.
Disease plans
Disease plans, such as cancer insurance, will only pay a portion of your bills for a specific illness.
Fixed-indemnity plans
Fixed-indemnity plans will only pay a set amount, such as a fixed amount per day if you are hospitalized.
Subscription plans
Also known as direct care or concierge care plans, members of subscription plans typically pay a monthly or annual fee to use a doctor or service included in the plan. There may be additional fees for each visit, lab work, or other services.
Discount plans
Members of discount plans pay monthly fees to get reduced rates on specific healthcare services, such as vision, hearing, or pharmacy services.
Medicare Advantage
Medicare Advantage is a bundled alternative to Medicare sold by private insurance companies. It is available to people aged 65 and older and offers benefits such as dental and vision coverage. Medicare Advantage plans offer more benefits than Original Medicare and are often cheaper. However, they offer less flexibility as you need to get care from within the plan's network of providers.
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Frequently asked questions
You can apply for Medicaid insurance in Texas by creating an account with the Health Insurance Marketplace and filling out an application. If it looks like you qualify for Medicaid, your information will be sent to your state agency, and they will contact you about enrollment. You can also apply through the Medicaid website maintained by the Texas Health and Human Services Commission, or by downloading and printing a paper application from the Texas Medicaid website.
Eligibility for Medicaid in Texas depends on a number of factors. In general, Medicaid eligibility depends on income level, with the program providing free or low-cost medical benefits to low-income children, families, seniors, and people with disabilities. Texas Medicaid also covers adults in poverty with dependent children, those with serious or permanent disabilities, elders in poverty, and people with temporary maternity coverage that ends 2 months after birth.
Medicaid insurance provides free or low-cost medical benefits to eligible individuals, helping to cover expenses such as prescription drug costs and long-term care. Many Medicare beneficiaries receive Medicaid’s help with paying for Medicare premiums and covering expenses not reimbursed by Medicare.
