Medicaid is a public health program, the largest in the state, providing free health insurance and medical services to a variety of groups. Eligibility groups are divided into children, families, and pregnant women; and elderly, blind, or disabled persons. Medicare beneficiaries with a low income may also receive assistance from Medicaid with their healthcare costs if they meet the criteria. Income guidelines vary from one group to the next. Typically, children and pregnant women (who receive temporary coverage throughout their pregnancy) are the largest covered group with the highest percentage of Federal Poverty Level allowed by the program. This is essential, as the Medicaid program has long emphasized the importance of keeping mother, infants and children healthy. Parents must have a much lower income to qualify for Medicaid in Texas. Adults under age 65 without children are unable to receive Medicaid, due to the state’s resistance to expanding the program.
To qualify, you must be a legal resident or have been born in the U.S., and reside in Texas. Most requirements for Medicaid are income-centered, with a corresponding percentage of FPL to each group. Depending on age, household size, disability, and pregnancy, your income must be less than or equal to the group that best fits your description.
Texas Medicaid Eligibility Guidelines
Regardless of whether you are married or single, if you are pregnant, Medicaid in Texas is a great solution. Both you and your newborn will be covered by Medicaid after delivery, giving your child up to a year of comprehensive coverage.
Pregnant Women & Infants 185%
Family of 2: $2,333 monthly, $27,991 yearly
Family of 3: $2,943 monthly, $35,317 yearly
Family of 4: $3,554 monthly, $42,643 yearly
Family of 5: $4,164 monthly, $49,969 yearly
Children & Young Adults
If you are a parent or caretaker of a child under age 19, and you are unable to afford health insurance, look into Texas Medicaid. Additionally, if your child has a medical condition of any sort it will be covered by the program, including home health care. Teenagers who do not live with a parent also have the ability to enroll in the program, applying for themselves or with assistance from an adult.
Ages 1-5 133%
Family of 1: $1,238 monthly, $14,856 yearly
Family of 2: $1,639 monthly, $19,699 yearly
Family of 3: $2,068 monthly, $24,817 yearly
Family of 4: $2,497 monthly, $29,965 yearly
Ages 6-19 100%
Family of 1: $938 monthly, $11,170 yearly
Family of 2: $1,260 monthly, $15,130 yearly
Family of 3: $1,590 monthly, $19,090 yearly
Family of 4: $1,920 monthly, $23,050 yearly
Adults with children, both working and nonworking, have access to full Medicaid benefits if their income is very low. Texas income guidelines for parents are some of the lowest in the nation, not allowing many adults to obtain coverage. Despite how dire your financial state may be as a childless adult, you still will not qualify for Medicaid in this state.
Parent (unemployed) 12%
Family of 1: $112 monthly, $1,340 yearly
Family of 2: $191 monthly, $1,816 yearly
Family of 3: $175 monthly, $2,291 yearly
Family of 4: $231 monthly, $2,766 yearly
Parent (employed) 26%
Family of 1: $242 monthly, $2,904 yearly
Family of 2: $328 monthly, $3,934 yearly
Family of 3: $414 monthly, $4,963 yearly
Family of 4: $499 monthly, $5,993 yearly
Aged, Blind, and/or Disabled
Medicaid is also a great resource for those who have a low income and are 65 years of age or older, blind, or disabled. People in need of hospice services for terminal illness or long term care are also encouraged to apply. Home and Community-Based Service programs are also provided for those who require nursing but prefer to live at home. Depending on your resources/assets and income level, you may qualify for a multitude of benefits.
Single Aged, Blind, or Disabled 75%
$698 monthly, $8,377 yearly
*$2,000 Asset Limit
Couple Aged, Blind, or Disabled 83%
$1,046 monthly, $12,558 yearly
*$3,000 Asset Limit
Medicaid-Medicare Dual Eligibles
Based on your income, if you are at least 65 and enrolled in Medicare, you maybe be able to get help with your premiums, coinsurance, and out-of-pocket payments. Those who are covered by Medicare Part A and Part B, yet have a low income, may be able to receive state assistance.
Qualified Medicare Beneficiaries (QMB) 100%
Medicaid covers your premiums, coinsurance, and deductibles.
Single: $938 monthly, $11,170 yearly
Couple: $1,260 monthly, $15,130 yearly
Specified Low-Income Medicare Beneficiaries (SLMB) 120%
Medicaid covers your premiums only.
Single: $1,117 monthly, $13,404 yearly
Couple: $1,513 monthly, $18,156 yearly
What health services does Texas Medicaid cover? A number of medical, dental, and vision services are included in full Medicaid coverage. As long as you use the services of a Medicaid provider, your health care is 100 percent free and available statewide. Services include primary care, prevention, hospital services, emergency and non-emergency medical transportation, supplies, home health care, and special treatment for conditions among many others. Contact the HHSC for more specifics on what services you can obtain as a Medicaid member.
2-1-1 in Texas
2-1-1 is a toll-free resource to find out about available public benefits in your area, open 24 hours a day, 7 days a week. Both Texas state programs and regional county programs will be searched on your behalf when calling. Press “1″ and find out about assistance programs for food, housing, child care, after-school programs, services for the elderly, disaster relief, and taxes. Press “2″ and receive information about Medicaid, Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and the Children’s Health Insurance Program (CHIP). Press “3″ to speak directly with a representative. You may also continue to search our public assistance section for resources, or call East Coast Health Insurance at 888 803 5917.
Apply for Medicaid
The application provides instructions on how to correctly fill out the form and all the information you need to include. This typically consists of proof of income, household size, Social Security numbers of yourself and family members, and proof of pregnancy or disability, if applicable. You can download and print a form, then send or deliver it to an HHSC benefits office. Application assistance is also available by visiting an HHSC benefits office or contacting one in the event that you are unable (due to distance, weather, or illness) to come to the office personally. Dial 2-1-1 or locate an HHSC benefits office to take the next step and apply for Medicaid.
Contact Texas Medicaid:
Apply for CHIP or Children’s Medicaid:
HHSC Office of the Ombudsman:
877-787-8999 or 888-425-6889 TTY