Texas Medicaid provides free or low-cost health coverage to specific groups: children, pregnant women, seniors, and people with disabilities. Unlike many states, Texas has not expanded Medicaid under the Affordable Care Act, which means most non-disabled adults without dependent children cannot qualify regardless of how low their income is. That single fact shapes nearly everything about how the program works in the state.
Who Qualifies for Texas Medicaid
Eligibility in Texas is tied to both your income and which category you fall into. Simply being low-income is not enough. You need to be a child, a pregnant woman, a parent or caretaker of a dependent child, age 65 or older, or have a qualifying disability. You also need to be a Texas resident and either a U.S. citizen or qualified non-citizen.
For children’s Medicaid, income limits are based on family size. A family of four can earn up to $3,564 per month (roughly $42,768 per year) and still qualify. A family of two has a limit of $2,345 per month. Each additional family member adds about $610 to the threshold. Children must be 18 or younger, though children with disabilities can qualify up to age 20.
If your family earns too much for children’s Medicaid but still needs help, the Children’s Health Insurance Program (CHIP) has higher income limits. A family of four can earn up to $5,386 per month for CHIP, and a family of two up to $3,543. CHIP charges small copays and premiums, while children’s Medicaid is generally free.
For adults, the picture is much narrower. Parents and caretaker relatives can qualify, but at extremely low income thresholds, often well below the federal poverty level. Adults 65 and older or those with disabilities qualify through separate programs with their own income and asset tests. There is also a Medicaid Buy-In for Children (MBIC) program that lets families of children with disabilities pay a monthly premium for Medicaid coverage even if they exceed the standard income limits.
The Coverage Gap for Adults
Texas is one of 10 states that has not adopted the ACA’s Medicaid expansion, which would cover nearly all adults earning up to about $21,597 per year for an individual. Because Texas chose not to expand, there is a well-known “coverage gap.” Adults in this gap earn too much for Texas Medicaid (which has very low income cutoffs for non-disabled adults) but too little to qualify for subsidized insurance on the ACA marketplace, which starts at 100% of the federal poverty level. If you’re a non-disabled adult without dependent children, you likely cannot get Medicaid in Texas at any income level.
Three Managed Care Programs
Texas delivers most Medicaid services through managed care, meaning you enroll in a health plan run by a private insurance company rather than using a traditional fee-for-service model. The state runs three main managed care programs, each designed for a different population.
STAR covers children, newborns, pregnant women, and some families. This is the program most Medicaid-enrolled Texans use. It includes regular doctor and dentist checkups, prescription drugs, vaccines, hospital care, X-rays and lab tests, vision and hearing care, mental health services, and treatment for pre-existing conditions.
STAR+PLUS serves adults with disabilities, people 65 and older, and women diagnosed with breast or cervical cancer. It combines acute medical care with long-term services and supports, such as help with daily activities in the home.
STAR Kids is specifically for children and young adults age 20 and younger who have disabilities. It coordinates medical care, therapy, and other specialized services through a single health plan.
When you enroll, you choose a health plan within your managed care program. Each plan has its own network of doctors and hospitals, plus extra benefits that vary by plan. If you don’t choose, one is assigned to you.
What Texas Medicaid Covers
Children on Texas Medicaid receive comprehensive benefits. Covered services include regular checkups, dental visits, prescription medications, vaccines, hospital stays, lab work, vision and hearing care, mental health treatment, and access to specialists. Children’s coverage is notably more generous than what most adults receive.
Adults on STAR+PLUS get medical services plus long-term supports like personal attendant care, home modifications, and nursing facility care when needed. For adults who qualify, prescription drugs, hospital care, and doctor visits are covered, though certain services like dental care are more limited than they are for children.
Texas also operates waiver programs for people with intellectual disabilities who live at home. The Texas Home Living (TxHmL) waiver, for example, serves Texas residents who have an IQ of 69 or below (or 75 or below with a related condition), show deficits in daily living skills, are Medicaid-eligible, and are not enrolled in another waiver. These waiver programs often have long waiting lists.
How to Apply
You can apply for Texas Medicaid online through YourTexasBenefits.com, by phone at 2-1-1, by fax, by mail, or in person at a local Health and Human Services (HHSC) office. The online portal is the fastest route. You’ll need to provide proof of identity, income, residency, and citizenship or immigration status. Pay stubs, tax returns, utility bills, and birth certificates are commonly requested documents.
Texas law requires the state to process Medicaid applications within 45 days for most categories and 90 days for disability-based applications. In practice, timelines can vary depending on whether the state needs additional documents from you. Responding quickly to any requests for verification helps avoid delays.
Finding a Doctor Who Accepts Medicaid
If you’re in a managed care plan (STAR, STAR+PLUS, or STAR Kids), your health plan maintains its own provider directory. You can search for doctors, specialists, dentists, and hospitals through your plan’s website or by calling the number on your Medicaid card. The state also offers an Online Provider Lookup tool through the Texas Medicaid and Healthcare Partnership (TMHP), where you can search by health plan, provider type, ZIP code, and specialty.
Provider availability varies significantly by region. Urban areas like Houston, Dallas, and San Antonio tend to have more Medicaid-accepting providers, while rural parts of the state may have limited options, particularly for specialists.
Renewals and the Post-Pandemic Unwinding
Texas Medicaid requires annual renewals. Each year, you must verify that you still meet income and eligibility requirements. If you don’t complete your renewal on time or fail to respond to requests for information, your coverage can be terminated even if you’re still eligible.
This became a major issue after the pandemic. During the COVID-19 public health emergency, a federal rule kept everyone enrolled in Medicaid continuously, regardless of changes in income or circumstances. That rule ended on March 31, 2023, and Texas began redetermining eligibility for its entire Medicaid population. The results were dramatic: nearly 1.2 million children lost Medicaid coverage during the unwinding process. Nationally, over 25 million people were disenrolled, many for procedural reasons like not returning paperwork rather than actually being ineligible. A federal policy now requires 12-month continuous enrollment for children, which provides some protection against gaps in coverage due to short-term income changes.
If you’re currently enrolled, watch your mail and your YourTexasBenefits.com account closely around your renewal date. Missing a notice is one of the most common reasons people lose coverage they still qualify for.
How to Appeal a Denial
If your application is denied or your benefits are reduced or terminated, you have the right to request a fair hearing. You’ll receive a Notice of Case Action explaining what happened and why. From the date of that notice, you have 90 days to file an appeal. If the decision was made by your managed care health plan rather than the state directly, you get 120 days. Appeals filed after these deadlines are reviewed for good cause, but there’s no guarantee they’ll be accepted.
You can request a fair hearing in writing, by calling 2-1-1, or by visiting a local HHSC office. If you file your appeal before the effective date of the change, your benefits may continue at their current level while the hearing is pending. If you win, coverage is restored. If you lose, you may have to repay benefits received during the appeal period.