{"id":60593,"date":"2023-10-10T14:33:15","date_gmt":"2023-10-10T18:33:15","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=60593"},"modified":"2025-12-09T18:17:17","modified_gmt":"2025-12-09T23:17:17","slug":"texas-medicaid-guide","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/texas-medicaid-guide\/","title":{"rendered":"Guide to Medicaid in Texas"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">As of August 2025, 4,161,101 were enrolled in Texas Medicaid and CHIP, which makes it a vital health insurance coverage option for the state. While Texas Medicaid has not expanded its program to cover low-income younger adults, as other states have, it does have options for children, pregnant women, older adults, and those with disabilities.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Read on to see what program requirements Texans must meet to access Medicaid, what it covers, and how to apply.<\/span><\/p>\n<h2 id=\"texas-medicaid-programs\"><b>Texas Medicaid Programs<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Because Texas, like other states, determines how its Medicaid program is administered, it references its programs by names only used in Texas. Qualified applicants will have at least two plans to choose from, depending on where in Texas they reside and which programs they are enrolled in. Programs include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">STAR: Available for children, infants, pregnant women, and select families<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">STAR Kids: Available for those 20 and younger with disabilities<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">CHIP: Available for children and infants who don\u2019t meet the low-income qualifications but can\u2019t afford insurance on their own<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">STAR+PLUS: Available for adults aged 65 and older, adults with disabilities, and women with certain types of cancer<\/span><\/li>\n<\/ul>\n<h2 id=\"eligibility-for-texas-medicaid\"><b>Eligibility for Texas Medicaid<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Who can receive Medicaid coverage in the Lone Star State? Even without expanded Medicaid, there\u2019s a possibility you can qualify.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Texas offers a range of healthcare programs, including standard Medicaid, Children&#8217;s Medicaid, and the Children&#8217;s Health Insurance Program (CHIP). Children&#8217;s Medicaid is for low-income families, while CHIP allows some children without health insurance to get covered if their families earn too much for Medicaid eligibility and they can&#8217;t afford to purchase it otherwise.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Texas extends its Medicaid coverage to cater to the healthcare needs of additional groups. This includes Medicaid for Breast and Cervical Cancer, which supports women with these specific types of cancers. Additionally, Texas offers Medicaid for qualified adults 65 and older and people with disabilities, even if they already have Medicare.<\/span><\/p>\n<h3 id=\"income-requirements\"><b>Income requirements<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">While income is not the only thing the state considers when a person applies, it\u2019s very important, even though Texas has not expanded Medicaid for all low-income applicants. Texas uses several factors to determine eligibility, including the household\u2019s modified adjusted gross income (MAGI). It\u2019s used for the Children\u2019s Health Insurance Program (CHIP) and some Medicaid programs. This income number is then matched against the federal poverty level (FPL) for the number of parents in the household, among other things.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Depending on the program, the applicant\u2019s income may not exceed a percentage of the FPL for their household size. <\/span><a href=\"https:\/\/www.medicaid.gov\/state-overviews\/stateprofile.html?state=Texas\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">The limits<\/span><\/a><span style=\"font-weight: 400;\"> are as follows:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">198% for ages 0-1<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">144% for ages 1-5<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">133% for ages 6-18<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">201% for children under the separate CHIP program<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">198% for pregnant women<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">14% for parents or related caregivers of eligible children<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Texas women who are either U.S. citizens or eligible immigrants aged 18-64 who need treatment for breast or cervical cancers may qualify for a special Medicaid program. They must not already be covered by health insurance and have a household income level below 200% FPL.<\/span><\/p>\n<h3 id=\"age-requirement\"><b>Age requirement<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Texas Medicaid only covers adults younger than 65 who are either pregnant or are caregivers of eligible children who fall below certain household income limits. Some adults may qualify through their disability designation or a special program for the treatment of breast and cervical cancers, however.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Unborn low-income children and children up to age 18 may qualify through either the Texas Children&#8217;s Health Plan (Medicaid) or CHIP.<\/span><\/p>\n<h3 id=\"disability-requirements\"><b>Disability requirements<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">In Texas, those receiving Supplemental Security Income (SSI) automatically receive Medicaid. Adults with disabilities may have the option to get Medicaid, even if they work; they can &#8220;buy in&#8221; through the Medicaid Buy-In for Adults program.<\/span><\/p>\n<h3 id=\"citizenship-or-immigration-status\"><b>Citizenship or immigration status<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Texas residency is a requirement for eligibility in both Medicaid and CHIP in Texas. Additionally, individuals must be either U.S. citizens or qualified non-citizens to meet the eligibility requirements for these programs.<\/span><\/p>\n<h2 id=\"texas-medicaid-benefits\"><b>Texas Medicaid benefits<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Medicaid in Texas is a comprehensive medical and health <\/span><a href=\"https:\/\/www.hhs.texas.gov\/sites\/default\/files\/documents\/your-health-care-guide-2022.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">coverage plan<\/span><\/a><span style=\"font-weight: 400;\"> that offers many services a member would need from a health insurance provider.<\/span><\/p>\n<h3 id=\"medical-services-covered\"><b>Medical services covered<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Texas Medicaid covers medically necessary services and treatments for low-income Texans, including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Doctor and dentist visits<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hospital stays and services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Mental health treatment and professional services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pregnancy care, birth control, and well-woman services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/app.contentharmony.com\/l\/42731bf41f0aab23b8215f23f3f6661d\/%E2%80%A2%09https%3A\/www.singlecare.com\/blog\/prescription-drugs-in-america\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Prescription medicine<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some over-the-counter products, including electrolytes, diabetic supplies, and wheelchair rentals<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Vaccines<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Treatment for diseases and special health issues, including pre-existing conditions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">X-rays and other diagnostic testing<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Vision and hearing services<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Those with disabilities may qualify for some long-term care services and health support, including home health care, long-term care, occupational or physical therapies, and group home fees.<\/span><\/p>\n<h3 id=\"prescription-drug-coverage\"><b>Prescription drug coverage<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Like most Medicaid programs, Texas offers comprehensive prescription drug coverage for covered children and adults. Choosing a pharmacy that accepts the chosen Medicaid plan is the best way to ensure it&#8217;s paid for at the full amount. Some patients may have to pay a copay or partial payment.<\/span><\/p>\n<h3 id=\"dental-coverage\"><b>Dental coverage<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">The Medicaid for Children program covers regular checkups, cleaning, X-rays, and treatment for dental problems that kids up to age 20 may have. Adults may only be covered for emergency dental procedures as part of other healthcare services, such as treatment from an accident.<\/span><\/p>\n<h3 id=\"vision-coverage\"><b>Vision coverage<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Children and those with disabilities are eligible for vision care, including glasses and eye exams. This varies by program, with children getting the most coverage. The Health Steps program covers children up to age 20 for developing eye care issues and ensures they can see a vision care provider at least annually.<\/span><\/p>\n<h3 id=\"mental-health-and-substance-abuse-coverage\"><b>Mental health and substance abuse coverage<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Texas Medicaid provides coverage for mental health and substance abuse services. This includes a wide range of services such as evaluations, counseling, tests, medication, emergency care, and hospital stays. If treatment at a facility is recommended, it is also covered by Texas Medicaid.\u00a0<\/span><\/p>\n<h2 id=\"how-to-apply-for-texas-medicaid\"><b>How to apply for Texas Medicaid<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">There are currently three ways to apply for the Texas Medicaid programs, and one application will get you access to all available programs. By coming prepared with your paperwork, you can save time and get your application processed quicker.<\/span><\/p>\n<h3 id=\"required-documents-for-application\"><b>Required documents for application<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">When applying for Medicaid in Texas, you should have all relevant information readily available and be prepared to provide documentation if requested.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">This includes:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Birthdate<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Citizenship or immigration status<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Income earned from jobs, child support, and other sources<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Social Security Number (SSN)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Total of your bills paid each month<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Value of your property, including cars and homes<\/span><\/li>\n<\/ul>\n<h3 id=\"online-application-process\"><b>Online application process<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">To start your online application, create an account at <\/span><a href=\"https:\/\/yourtexasbenefits.com\/Learn\/Home\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">yourtexasbenefits.com<\/span><\/a><span style=\"font-weight: 400;\">. You\u2019ll be able to answer questions and provide proof of your financial situation to help process your application.<\/span><\/p>\n<h3 id=\"paper-application-process\"><b>Paper application process<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">If you don\u2019t wish to go online, you can download forms for each type of Medicaid and print them yourself. The <\/span><a href=\"https:\/\/www.yourtexasbenefits.com\/Learn\/GetPaperForm?lang=en_US\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Texas Medicaid website<\/span><\/a><span style=\"font-weight: 400;\"> lists the forms available and tells you where to mail them. If you don\u2019t have access to a printer, call the office and request that they mail one to you.<\/span><\/p>\n<h3 id=\"in-person-application-process\"><b>In-person application process<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Find an office near you to visit in person, get forms, and ask questions. Not all offices service all programs, so use the <\/span><a href=\"https:\/\/www.yourtexasbenefits.com\/Screener\/FindanOffice\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">find an office<\/span><\/a><span style=\"font-weight: 400;\"> tool to ensure you have the right location before you stop by.<\/span><\/p>\n<h2 id=\"cost-of-texas-medicaid\"><b>Cost of Texas Medicaid<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Children covered by Children\u2019s Medicaid pay nothing to receive treatment or other covered services. Their healthcare is free.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Children and pregnant women covered by CHIP may pay an enrollment fee of $50 or less per family each year. This is based on the family&#8217;s income. Copays for services, ranging from $3 to $35, may also apply. Lower-income families will pay less than those making more money.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Adults older than 65 and those with disabilities may get free coverage for basic health services as well as long-term care services under the Medicaid for the Elderly and People with Disabilities Program. It is free and available for some adults who are already covered by Medicare.\u00a0<\/span><\/p>\n<h2 id=\"additional-texas-medicaid-resources\"><b>Additional Texas Medicaid resources<\/b><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.yourtexasbenefits.com\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Yourtexasbenefits.com<\/span><\/a>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Learn about available programs, download the app, and apply for services online.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.medicaid.gov\/state-overviews\/stateprofile.html?state=Texas\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Medicaid.gov<\/span><\/a>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">See what the income requirements are for Texas Medicaid programs.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2 id=\"texas-medicaid-faq\"><b>Texas Medicaid FAQ<\/b><\/h2>\n<h3 id=\"how-do-i-find-a-doctor-who-accepts-medicaid\"><b>How do I find a doctor who accepts Medicaid?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Not all healthcare providers in Texas accept Medicaid. Check the benefits guide that came with your coverage plan, visit the doctor finder tool on the insurer&#8217;s website, or call the number on the back of your Medicaid card to find a provider near you that accepts Medicaid. You can also call the healthcare provider directly and ask. This may be the best way since providers can discontinue Medicaid affiliation, though it may not be updated immediately on patient resource listings.<\/span><\/p>\n<h3 id=\"how-do-i-renew-medicaid-coverage\"><b>How do I renew Medicaid coverage?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Texas Medicaid no longer automatically renews. You\u2019ll need to pay attention to the mailings or emails you receive about your health plan and respond promptly with new information to maintain your coverage. You can also check your account online at yourtexasbenefits.com to see information about your status and important dates to complete the renewal process.<\/span><\/p>\n<h3 id=\"how-do-i-appeal-a-denied-claim\"><b>How do I appeal a denied claim?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">If you believe you should have received coverage or payment for services but didn&#8217;t get it, you can use your Right to a Fair Hearing. This is an opportunity to share the reasons you think you should have gotten a service. Start by mailing a letter explaining that you couldn&#8217;t get a service, then ask for a hearing within 90 days. Do this by calling 800-414-3406 or sending a letter to Texas Medicaid &amp; Healthcare Partnership (TMHP) Attention: Fair Hearings P.O. Box 204270, Austin, TX, 78720-4270.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You will receive a response with a date and time for your hearing, along with the information you need to appear at your hearing in person or by phone. An interpreter may be provided if you let them know in advance. Within 90 days of the hearing, a decision about your claim will be made, and you&#8217;ll be notified of the results.<\/span><\/p>\n<h3 id=\"how-do-i-report-medicaid-fraud\"><b>How do I report Medicaid fraud?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Medicaid fraud comes in many forms, from someone using a Medicaid card that isn\u2019t theirs to lying about the services they need. If you suspect fraud, contact the Texas Office of the Inspector General (OIG) online or by calling their fraud hotline at 800-436-6184. Your report will be anonymous. However, there is a possibility that you may be requested to provide information about the individual involved in the fraudulent activity, such as their name, address, phone number, birth date, or Social Security Number. Any information that might be helpful to an investigator can be shared.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>As of August 2025, 4,161,101 were enrolled in Texas Medicaid and CHIP, which makes it a vital health insurance coverage option for the state. While Texas Medicaid has not expanded its program to cover low-income younger adults, as other states have, it does have options for children, pregnant women, older adults, and those with disabilities. [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":60597,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[16],"coauthors":[8861],"class_list":["post-60593","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-medicaid","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Guide to Medicaid in Texas | SingleCare<\/title>\n<meta name=\"description\" content=\"Everything you need to know to receive free or low-cost health services from Texas Medicaid, including how to apply, including eligibility, restrictions, coverage, and more.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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