Texas Medicaid in Texas

Texas Medicaid is Texas's Medicaid program — free or low-cost health coverage for low-income residents. It is administered by the Texas Health and Human Services Commission (HHSC).

Who qualifies for Texas Medicaid?

Texas has not expanded Medicaid. Coverage is more limited than in expansion states. Groups who may qualify:

• Children: Up to 198% FPL through Medicaid / CHIP
• Pregnant women: Up to 196% FPL
• Parents / caretakers: Very low income threshold (varies)
• Seniors and people with disabilities: SSI recipients qualify automatically
• Most adults without children: Do not qualify regardless of income

Texas covers children up to 198% FPL through Medicaid and CHIP (Children's Health Insurance Program). Pregnant women may qualify up to 196% FPL. Low-income parents may qualify at very low income levels. If you don't qualify for Texas Medicaid, check HealthCare.gov for marketplace subsidies.

How to apply for Texas Medicaid

You can apply through Texas's official portal, by phone, by mail, or in person at your local Texas Health and Human Services Commission (HHSC) office.

• Online: Apply at YourTexasBenefits.com →
• Processing time: Most applications are processed within 45 days (90 days for disability-based applications)
• Coverage start: If approved, coverage typically begins the first day of the month you applied
• Renewal: Medicaid eligibility is reviewed annually — respond to renewal notices to avoid losing coverage

What does Texas Medicaid cover?

Medicaid in Texas covers a comprehensive set of services, including:

• Doctor visits and preventive care
• Hospital stays (inpatient and outpatient)
• Emergency services
• Mental health and substance use treatment
• Prescription drugs
• Lab tests and X-rays
• Prenatal care and delivery
• Long-term care (nursing home and home-based services)

Most services are covered at no cost or very low cost. Some plans may charge small copays for non-emergency services.

What documents do I need?

• Proof of identity (driver's license, state ID, or passport)
• Proof of Texas residency (utility bill, lease, or bank statement)
• Proof of income (pay stubs, tax returns, or employer letter)
• Social Security numbers for all household members applying
• Proof of citizenship or immigration status

Common questions about Texas Medicaid

Can I keep my doctor on Texas Medicaid?

Texas Medicaid is often provided through managed care plans. When you enroll, you will choose a plan and a primary care provider. If your current doctor accepts Texas Medicaid, you can stay with them. Call your doctor's office to confirm before enrolling in a plan.

What if my income changes?

Report income changes to Texas Health and Human Services Commission (HHSC) within 10–30 days. If your income rises above the limit, you may qualify for marketplace coverage with subsidies instead — coverage is typically available without a gap.

Can I have both Medicaid and private insurance?

Yes. If you have employer coverage, Texas Medicaid can act as secondary insurance, covering costs your primary insurance doesn't pay. This is called "dual coverage" and can significantly reduce your out-of-pocket costs.

I don't qualify for Medicaid in Texas — what else can I do?

If Texas Medicaid doesn't cover you, check the ACA Health Insurance Marketplace at HealthCare.gov — subsidies are available for incomes 100–400% FPL, and for some in the "coverage gap" (below 100% FPL), subsidies may still apply in non-expansion states. Community health centers also provide sliding-scale care regardless of insurance.