Texas Medicaid covers people in specific income and family situations, not everyone who needs health insurance

Texas Medicaid is not open to all low-income people. The state sets strict income limits and requires you to fit into one of a few categories: you must be a child, a parent or caregiver of a child, pregnant, elderly, or disabled. Even if your income is low, you do not get Medicaid unless you meet one of these group requirements. Texas has chosen not to expand Medicaid to cover all adults under 65 with income below a certain threshold, which means many working-age adults without children fall through a gap.

The income limits themselves vary by family size and by which category you fall into. A single parent with one child might have a different limit than a pregnant person or an elderly person. The state updates these numbers each year. Because the rules are specific and the limits change, the fastest way to know whether you meet the requirements is to check with your local health department or call the Texas Health and Human Services Commission directly rather than trying to calculate it yourself.

Key Takeaways

  • Texas Medicaid requires you to be in a specific group: a child, a parent or caregiver of a child, pregnant, elderly, or disabled — income alone does not make you may be able to access.
  • Income limits vary by family size and category and change each year, so you cannot assume last year's limit still applies.
  • Texas has not expanded Medicaid to cover all low-income adults, which means many working-age people without children do not may have access to.
  • You can check your situation through your county health department, by phone with HHSC, or through the online Texas Medicaid portal without cost or obligation.

Children and teenagers under 19

Texas covers children through Medicaid if their household income is below a set limit. For a single child, the income limit is higher than it is for an adult in the same situation. A family with two children has a different limit than a family with four. The state counts income from all household members when deciding whether a child meets the limit.

Children do not have to be citizens of the United States to get Medicaid in Texas, but they do have to have a Social Security number or an Individual Taxpayer Identification Number (ITIN). Lawfully present immigrants, including those with a green card or work visa, can get coverage. Undocumented children cannot.

Pregnant people

Texas covers pregnant people through Medicaid regardless of immigration status, as long as they meet the income limit. The income threshold for pregnant people is higher than the limit for a single adult without children. Coverage begins as soon as the pregnancy is confirmed and continues for 60 days after the birth or end of pregnancy, even if your income changes during that time.

You do not need to be a citizen or have a green card to get Medicaid while pregnant. Undocumented pregnant people can receive coverage. You will need to provide proof of pregnancy — usually a letter from a doctor or clinic — and proof of income.

Parents and caretakers of children

A parent or legal guardian caring for a child under 19 can get Medicaid if the household income is below the limit set for that family size. The income limit for a parent is lower than the limit for a child in the same household, which means a family might have coverage for the children but not for the parent. Texas counts only the income of the parent or caregiver and the children in the household when deciding may be able to access.

You must be the parent, stepparent, grandparent, or other relative with legal custody of the child. Foster parents and legal guardians also may have access to. If you are caring for a child but do not have legal custody, you do not meet this requirement.

Elderly and disabled people

People 65 and older can get Medicaid if their income and assets are below the limits. Texas also covers people under 65 who are disabled and meet the income and asset limits. Disability is defined by the Social Security Administration's rules, not by Texas alone — you typically need to be receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), or have been denied those benefits and appealed.

Asset limits for elderly and disabled people are stricter than income limits. You can have only a small amount of savings, property, or other resources. A house you live in and one car do not count toward the limit, but bank accounts, stocks, and other property do. If your assets are above the limit, you do not may have access to, even if your income is low enough.

People who do not fit these categories

If you are a working-age adult without children, not pregnant, and not disabled, Texas Medicaid does not cover you, no matter how low your income is. This is the coverage gap created by Texas's decision not to expand Medicaid. You may have other options: you can look for coverage through the federal marketplace at Healthcare.gov, where you might find a plan with a lower premium if your income qualifies you for a tax credit. You can also check whether you meet the requirements for other state programs like CHIP (the Children's Health Insurance Program) if you have children.

Some community health centers offer sliding-scale fees based on income and can provide care even if you do not have insurance. Local 211 services can connect you to clinics and programs in your area.

How to check whether you meet the requirements

The Texas Health and Human Services Commission (HHSC) runs Medicaid. You can check your situation in three ways. First, you can call HHSC at 1-800-252-8263 and speak to someone who can tell you whether you meet the requirements based on your household size and income. Second, you can visit your county health department in person — staff there can walk you through the rules and help you understand the income limits that apply to your situation. Third, you can use the online Texas Medicaid portal to see information about the current income limits by category and family size.

When you contact HHSC or your health department, have your household size, monthly income, and the names and ages of anyone in your household ready. If you are pregnant, have a letter from your doctor confirming the pregnancy. If you are disabled, have information about your Social Security status. The process is free and does not commit you to anything.

Frequently Asked Questions

Does Texas Medicaid cover undocumented immigrants?

Texas Medicaid covers undocumented pregnant people and undocumented children. Undocumented adults who are not pregnant and do not have a disability do not may have access to. Lawfully present immigrants in any category can get coverage if they meet the income and group requirements.

What counts as income when Texas decides if I may have access to?

Income includes wages from a job, self-employment income, Social Security, child support, and unemployment benefits. It does not include food stamps or housing assistance. Texas counts the income of everyone in your household, not just your own income. If you are self-employed, you report your net income after business expenses.

Can I get Medicaid if I have a job?

Yes, if your job income is below the limit for your household size and you fit into one of the covered groups. Many people on Medicaid work part-time or full-time. Your income limit does not change based on whether you work — only on your household size and which category you fall into.

What if my income is just above the limit?

If your income is above the limit, you do not may have access to for Medicaid through the regular program. You may be able to get coverage through the federal marketplace at Healthcare.gov, where you might receive a tax credit to lower your premium. Some community health centers also offer services on a sliding scale based on income.

How long does it take to learn about I may have access to?

HHSC aims to make a decision within 30 days of receiving your information. If you call or visit in person, staff can often tell you on the spot whether you meet the basic requirements. If you need to provide documents like proof of income or pregnancy, the timeline may be longer.