Texas Medicaid has income limits and category requirements that determine who can enroll

Texas Medicaid is run by the Health and Human Services Commission (HHSC). To get coverage, you must meet both an income limit and fall into a category the state covers. Texas does not cover all adults — it covers children, pregnant people, parents of dependent children, people over 65, and people with disabilities. Your household income must fall below a set percentage of the federal poverty level, which varies by category. A single adult with no children and no disability typically does not may have access to in Texas, even at very low income.

The application process happens through HHSC's online portal, by mail, or in person at a local HHSC office. You will need to provide proof of income, citizenship or immigration status, and residency in Texas. Processing usually takes 30 days, though expedited coverage for pregnant people can happen within 7 days. Once approved, coverage starts on the first day of the month you applied or the month after, depending on when your application was received.

Key Takeaways

  • Texas Medicaid covers children, pregnant people, parents of dependent children, seniors over 65, and people with disabilities — not all low-income adults.
  • Income limits vary by category; a family of three must earn less than roughly $2,900 per month to may have access to as a parent-caregiver group, but limits are lower for other groups.
  • You apply through the HHSC website, by mail, or at a local HHSC office, and you will need proof of income, citizenship or immigration status, and Texas residency.
  • Processing takes about 30 days for most people, but pregnant people can receive coverage within 7 days if they meet the requirements.
  • If you are denied, you can request a hearing within 30 days and provide additional information to support your case.

Income limits for each Medicaid category in Texas

Texas Medicaid income limits are set as a percentage of the federal poverty level and change each year. For children under 19, the limit is 200% of the federal poverty level — roughly $3,500 per month for a family of three. For pregnant people and parents of dependent children, the limit is 138% of the federal poverty level — roughly $2,400 per month for a family of three. For people over 65 or with disabilities, the limit is 100% of the federal poverty level — roughly $1,100 per month for an individual.

Income includes wages, self-employment earnings, Social Security, unemployment benefits, and child support. Some income does not count: the first $90 of monthly earnings, certain student aid, and some types of assistance. HHSC will ask you to report all household members and their income. If you are unsure whether your income qualifies, you can use the HHSC pre-screening tool on their website or call your local HHSC office to ask before you submit a full application.

Documents you need to bring or upload

When you apply, you will need to show proof of income, citizenship or immigration status, and residency in Texas. For income, bring recent pay stubs (usually the last 30 days), tax returns, or a letter from your employer stating your wages. If you receive Social Security, unemployment, or other benefits, bring the award letter or benefit statement. If you are self-employed, bring tax returns and bank statements showing business income.

For citizenship or immigration status, you can provide a birth certificate, passport, or permanent resident card. If you are not a U.S. citizen, you may still may have access to if you have a valid immigration status; HHSC will tell you which statuses may have access to. For residency, bring a utility bill, lease, or mortgage statement dated within the last 60 days. If you apply online through the HHSC portal, you can upload images of these documents. If you apply by mail or in person, bring originals or certified copies.

How to apply online, by mail, or in person

Online: Go to YourTexasBenefits.com, create an account, and select "Apply for Benefits." You will answer questions about your household, income, and category. The system will tell you immediately if you appear to may have access to. You can upload documents or mail them later. Processing takes about 30 days from the date HHSC receives all required documents.

By mail: Download the application form from the HHSC website or request one by phone at 211 (dial 2-1-1 from any Texas phone). Fill it out, attach copies of your documents, and mail it to your local HHSC office. The address is on the form. Mail takes longer than online, so allow extra time for delivery and processing.

In person: Find your local HHSC office using the office locator on the HHSC website. Bring original documents or certified copies and the completed application form. Staff can help you fill it out and submit it on the spot. This is the fastest route if you have all documents ready.

What happens after you submit your application

HHSC will send you a letter within 30 days telling you whether you are approved, denied, or need to provide more information. If approved, the letter will say when your coverage starts — usually the first day of the month you applied or the month after. You will receive a Medicaid card in the mail within 7 to 10 business days. You can use your coverage at any doctor, hospital, or pharmacy that takes Texas Medicaid.

If HHSC asks for more information, they will tell you what documents they need and give you a deadline to send them — usually 10 days. If you miss the deadline, your application may be denied, but you can reapply. If you are denied, the letter will explain why. You have 30 days from the date of the denial letter to request a hearing and present more information to challenge the decision.

Special rules for pregnant people and children

Pregnant people can get coverage faster than other groups. If you are pregnant and meet the income limit, HHSC can approve you within 7 days. Medicaid covers prenatal care, delivery, and postpartum care for 60 days after birth. You do not need to prove citizenship if you are pregnant; a statement that you believe you are a U.S. citizen is enough. After the 60-day postpartum period ends, your coverage will stop unless you meet another category — for example, if you become a parent of a dependent child.

Children under 19 have a higher income limit than adults — 200% of the federal poverty level. If a child is born to a Medicaid-covered mother, the child is automatically covered for the first month of life. After that, you must apply for the child's own coverage. Children can stay on Medicaid through age 18 as long as the household income stays below the limit. Texas also covers some children whose parents do not may have access to, so even if you are denied, your child may still be covered.

What to do if you are denied or your coverage ends

If your application is denied, read the denial letter carefully — it will say which requirement you did not meet. Common reasons include income above the limit, not meeting a category requirement, or missing documents. You can request a hearing within 30 days by calling the number on the denial letter or mailing a written request to your local HHSC office. At the hearing, you can present new documents or explain your situation to an HHSC representative.

If your coverage ends because your income increased or your circumstances changed, you can reapply at any time. If you lose coverage and need to know whether you still may have access to, call your local HHSC office or use the pre-screening tool on the HHSC website. Some people who lose Medicaid coverage may may have access to for marketplace insurance through Healthcare.gov, which may have lower costs if you earn between 100% and 400% of the federal poverty level.

Frequently Asked Questions

Can I get Medicaid if I am unemployed?

Unemployment alone does not make you may be able to access in Texas. You must also fall into a covered category — child, pregnant person, parent of a dependent child, senior over 65, or person with a disability. If you are unemployed and meet one of these categories and your household income is below the limit, you can apply. Unemployment benefits count as income, so they may affect whether you may have access to.

Do I need to be a Texas citizen to get Medicaid?

You must be a U.S. citizen or have a may have access to immigration status. Pregnant people do not need to prove citizenship — a statement that you believe you are a citizen is enough. Other groups must provide a birth certificate, passport, or permanent resident card. Some immigration statuses may have access to; HHSC will tell you during the application whether your status is acceptable.

What if my income is slightly above the limit?

If your income is above the limit, you do not may have access to for Texas Medicaid. However, you may may have access to for marketplace insurance through Healthcare.gov. You can also check whether you may have access to for other assistance programs by calling 211 or visiting the 211 website. Some employers offer health insurance; if that is an option, it may be worth exploring.

How long does Medicaid coverage last once I am approved?

Medicaid coverage lasts as long as you remain in a covered category and your income stays below the limit. HHSC will ask you to recertify your may be able to access every 12 months. You will receive a notice in the mail telling you when to recertify. If you do not recertify by the deadline, your coverage will end. If your circumstances change — you get a job, move out of state, or your income increases — you must report the change to HHSC.

Can I use my Medicaid card right away after I am approved?

Your coverage starts on the date listed in your approval letter, usually the first day of the month you applied or the month after. You should receive your Medicaid card in the mail within 7 to 10 business days. If you need care before the card arrives, you can give the doctor or hospital your case number from the approval letter, and they can verify your coverage in the system.