Texas Medicaid is entering one of its most consequential periods of change in recent memory. Federal legislation passed in 2025, combined with state-level program shifts, is reshaping who qualifies, how long coverage lasts, and what services are available. If you or a family member relies on Medicaid in Texas, understanding what has changed and what is coming is critical to keeping coverage intact.
This guide covers the key changes taking effect in 2026 and 2027, current income limits, waiver program updates, and steps you can take right now.
What Changed in Texas Medicaid for 2026
Several changes are already in effect or will take hold by the end of 2026.
Dual Demonstration Program Ended
The Medicare-Medicaid Plan (MMP), also called the Dual Demonstration Program, ended in January 2026 in Bexar County (San Antonio) and Dallas County. This program served people who are eligible for both Medicare and Medicaid. Former MMP members were automatically transitioned to standard STAR+PLUS managed care. If you were in the MMP in either county, your coverage did not end, but your plan and some covered services may have changed. Contact your new STAR+PLUS health plan to confirm your benefits.
STAR+PLUS HCBS Residency Rule Update
Effective February 20, 2026, members receiving STAR+PLUS Home and Community Based Services (HCBS) may now live alone, with family members, or with others at locations of their choice. This clarification expands where people can receive waiver services and is a positive change for enrollees who want more flexibility in their living arrangements.
Retroactive Coverage Window Shortening (Takes Effect January 2027)
Under the One Big Beautiful Bill Act (OBBBA), signed into federal law on July 4, 2025, Texas will be required to shorten its retroactive Medicaid coverage window. Starting January 1, 2027, retroactive coverage will extend back two months before the month of application, down from the current three-month lookback. This means if you have unpaid medical bills from the period just before you applied, fewer of those bills may be covered.
Community Engagement Requirements Coming in Late 2026
Starting in December 2026, certain Medicaid enrollees, specifically low-income adults who are not elderly, pregnant, or disabled, will be required to meet "community engagement" requirements to maintain Medicaid eligibility. This means at least 80 hours per month of employment, job training, education, or volunteer activities. Texas has not yet published its implementation plan for this requirement. People who cannot meet these requirements due to a disability or caretaking responsibilities should document their exempt status carefully.
Texas Medicaid Income Limits 2026
Texas has not expanded Medicaid under the Affordable Care Act, so most healthy adults between ages 19 and 64 do not qualify regardless of income. The coverage gap remains a major issue, affecting an estimated 617,000 Texans who earn too little to get ACA marketplace subsidies but too much to qualify for Medicaid.
Below are the current income limits by eligibility group for 2026.
| Eligibility Group | Income Limit (% FPL) | Approximate Monthly Income (1 person) |
|---|---|---|
| Infants under age 1 | 198% FPL | up to approximately $2,580/month |
| Pregnant women | 198% FPL | up to approximately $2,580/month |
| Children ages 1 to 5 | 144% FPL | up to approximately $1,878/month |
| Children ages 6 to 18 | 133% FPL | up to approximately $1,734/month |
| CHIP (children) | 201% FPL | up to approximately $2,619/month |
| Parents and caretakers | approximately 12% FPL | approximately $230/month |
| Seniors and people with disabilities | income cap of $2,982/month | $2,982/month individual |
| Couples (both applying, seniors/disabled) | income cap of $5,964/month | $5,964/month combined |
The 100% FPL baseline for 2026 is approximately $1,304 per month for a single person. Add approximately $442 per month for each additional household member.
If you are not sure whether you qualify, run a free check at Benefits Navigator. The screener covers Medicaid and 11 other programs at once.
Texas Medicaid Waiver Programs in 2026
Texas operates several Section 1915(c) Home and Community Based Services (HCBS) waiver programs. These programs provide services that allow people with disabilities or chronic conditions to live at home instead of in a nursing facility. The major waiver programs include:
- STAR+PLUS HCBS for adults with disabilities or those age 65 and older
- DBMD (Deaf Blind with Multiple Disabilities)
- HCS (Home and Community-based Services) for people with intellectual and developmental disabilities
- MDCP (Medically Dependent Children Program)
- TxHmL (Texas Home Living)
Waiting Lists Remain Very Long
The STAR+PLUS HCBS program is not an entitlement. Approximately 24,000 people per year can be served through the program. Close to 195,000 Texans are currently on interest lists (waiting lists) for various HCBS waivers. The anticipated wait to be invited to apply can stretch to many years for some programs.
If you have a family member who needs waiver services, add their name to the interest list as soon as possible, even if they do not currently need services. Placement is based on the date the name was added, not the date services are needed.
To request placement on a waiver interest list, contact Texas HHS at 2-1-1 or visit the Texas HHS website directly.
Federal Funding Risk for HCBS
The OBBBA creates a risk for future HCBS funding. While nursing home Medicaid has stronger federal protections, home and community based services are considered more vulnerable to future federal funding reductions. Texas advocates and health policy groups have flagged this as an area to watch through 2027.
What the One Big Beautiful Bill Act Means for Texas
The OBBBA, signed into law in July 2025, contains several provisions that directly affect Texas Medicaid enrollees.
Key provisions and timelines:
| Provision | Effective Date |
|---|---|
| Enhanced federal funding for new Medicaid expansion eliminated | January 2026 |
| Retroactive coverage shortened from 3 to 2 months | January 2027 |
| Eligibility checks increased to every 6 months (expansion states) | January 2027 |
| Community engagement requirements for certain adults | December 2026 |
Texas did not expand Medicaid, so the provision eliminating enhanced expansion funding does not directly affect current Texas Medicaid enrollees. However, it further reduces the likelihood Texas will expand Medicaid in the near future.
Researchers and advocacy groups estimate that the full range of OBBBA Medicaid changes could result in approximately 200,000 Texans losing Medicaid coverage and up to 430,000 more uninsured Texans when accounting for all health care provisions in the bill.
Who Is Most Affected by These Changes
The changes landing in 2026 and 2027 fall hardest on specific groups.
Working-age adults with low income. The community engagement requirement, starting in December 2026, creates a new paperwork burden and potential loss of coverage for people who cannot easily document 80 hours per month of qualifying activity.
People who rely on HCBS waiver services. Future federal funding reductions could shrink program capacity, making the already long waiting lists even longer.
People who recently applied and have outstanding medical bills. The retroactive coverage shortening in January 2027 means fewer months of backward coverage.
People newly diagnosed or applying near year-end. The shortened retroactive window affects people who incur health care costs before completing their Medicaid application.
How to Apply for Texas Medicaid in 2026
Applications are handled through Texas HHS. Here are the steps.
Step 1: Gather your documents. You will need proof of identity (state ID, driver's license, or passport), proof of income (pay stubs, tax returns, or a letter from an employer), proof of Texas residency (utility bill or lease), Social Security numbers for all household members, and proof of citizenship or immigration status.
Step 2: Choose your application method.
- Online at YourTexasBenefits.com
- By phone at 2-1-1
- In person at a local Health and Human Services office
- By mail using a paper application
Step 3: Submit and track your application. After submitting, you can track your application status on the Your Texas Benefits portal. Standard processing time is up to 45 days, though applications for pregnant women and children may be processed faster.
Step 4: Respond promptly to requests. If HHS needs additional information, you will receive a notice. Failing to respond within the deadline can result in denial. Check your mail and online account regularly.
Step 5: After approval, choose a managed care plan. Most Texas Medicaid enrollees receive care through managed care organizations (MCOs). You will be given a choice of health plans in your area and typically have 90 days to pick one. If you do not choose, one will be assigned.
If you want to check your eligibility before applying, the free Benefits Navigator screener can give you an estimate in a few minutes without creating an account.
Keeping Your Coverage After Approval
Texas conducts annual eligibility renewals. Starting in 2027, the OBBBA will require more frequent checks for people covered under Medicaid expansion in other states, though Texas-specific renewal timelines will be set by HHS.
To avoid losing coverage at renewal:
- Keep your address current with HHS by logging into Your Texas Benefits
- Respond to any renewal notice within the deadline
- Report income changes within 10 days
- If community engagement requirements take effect for your category, document your qualifying activities monthly
Frequently Asked Questions
Does Texas have Medicaid expansion in 2026?
No. Texas has not expanded Medicaid under the ACA and remains one of 10 states that has not done so. This means most adults ages 19 to 64 without a qualifying disability or dependent children do not qualify, even with very low income. The OBBBA makes future expansion less likely by eliminating the enhanced federal funding match for states that expand for the first time.
What are the Texas Medicaid income limits for adults in 2026?
Most healthy adults do not qualify. Parents and caretakers can qualify at approximately 12% of the Federal Poverty Level, which is roughly $230 per month for one person. Adults with disabilities or those age 65 and older qualify up to approximately $2,982 per month in income.
What is the Texas Medicaid community engagement requirement?
Starting in December 2026, certain Medicaid enrollees must log at least 80 hours per month of employment, job training, education, or community service. Elderly individuals, people with disabilities, and pregnant women are generally exempt. Texas has not yet published its full implementation guidance for this requirement.
What happened to the Texas Medicaid Dual Demonstration Program?
The Medicare-Medicaid Plan (MMP) in Bexar and Dallas counties ended in January 2026. Former participants were automatically moved to STAR+PLUS managed care. Their Medicaid coverage continued, but their health plan and some covered services may have changed.
How do I get on the HCBS waiver waiting list in Texas?
Call 2-1-1 or contact Texas HHS directly to request placement on an interest list for the relevant waiver program. Placement is based on the date you are added, so apply as early as possible. The wait for some programs is several years.
Can I get retroactive Medicaid coverage in Texas?
Yes, currently up to three months before the month you applied, if you were eligible during that period. Starting January 1, 2027, this will shorten to two months retroactive coverage.
What is the coverage gap in Texas?
The Texas coverage gap affects adults who earn too much to qualify for Medicaid (above approximately 12% FPL for parents, or nothing for childless adults) but too little to qualify for ACA marketplace subsidies (which start at 100% FPL). Approximately 617,000 Texans fall into this gap and have limited options for affordable coverage.
Where can I check my Texas Medicaid eligibility?
You can check your eligibility through the Texas HHS portal at YourTexasBenefits.com, by calling 2-1-1, or by using the free Benefits Navigator screener, which checks Medicaid and 11 other programs simultaneously.
