Texas Medicaid Eligibility 2026: Income Limits & Apply
Last updated: February 2026
Disclaimer: This guide provides general information about Texas Medicaid and is not legal or financial advice. Eligibility rules can change, and individual circumstances vary. Always verify current requirements with the Texas Health and Human Services Commission before applying.
Understanding Texas Medicaid eligibility can be confusing, especially since Texas has stricter rules than most other states. With approximately 4.2 million Texans currently enrolled and the highest uninsured rate in the nation at 16%, knowing whether you qualify is essential for your family's healthcare access.
Here's the short answer: Texas Medicaid covers children, pregnant women, elderly individuals, and people with disabilities. Children qualify at higher income levels than adults. For example, a child under age 1 qualifies if the family earns up to 198% of the federal poverty level, which is about $4,957 per month for a family of four. However, parents face much stricter limits, qualifying only at approximately 12% FPL, or roughly $230 per month. Most adults without children do not qualify for Texas Medicaid at any income level.
Texas is one of ten states that has not expanded Medicaid under the Affordable Care Act. This creates what's called the "coverage gap," affecting over 617,000 Texans who earn too much for Medicaid but too little for ACA marketplace subsidies. Understanding these rules could mean the difference between having healthcare coverage and going without. This guide explains exactly who qualifies, current income limits, and what options exist if you don't.
Who Qualifies for Texas Medicaid
Texas Medicaid uses different eligibility rules depending on your age, family situation, and health status. The program is administered by the Texas Health and Human Services Commission (HHSC), and understanding which category you fall into is essential for determining whether you qualify.
Children have the most generous eligibility rules in Texas. Infants under age 1 qualify at income up to 198% of the federal poverty level. Children ages 1 through 5 qualify at 144% FPL, and children ages 6 through 18 qualify at 133% FPL. These limits cover millions of Texas children whose families cannot afford private health insurance. According to HHSC data, children make up the largest share of Texas Medicaid enrollment.
Pregnant women also receive favorable treatment under Texas Medicaid. If you're pregnant, you can qualify with income up to 198% FPL. Coverage includes all prenatal care, delivery services, and postpartum care for 12 months after giving birth. This expanded postpartum coverage was implemented in 2022 to improve maternal health outcomes in a state that has historically struggled with high maternal mortality rates.
Parents and caretaker relatives face significantly stricter rules than in most other states. If you're a parent caring for children, you must have income at or below approximately 12% of the federal poverty level to qualify. For a family of four, this means earning roughly $230 per month or less. This extremely low threshold leaves most working parents ineligible for Medicaid, even if they work multiple jobs.
Adults without dependent children generally do not qualify for Texas Medicaid. Unless you have a disability, are 65 or older, or meet another categorical requirement, you cannot receive Medicaid in Texas regardless of how low your income is. This is the primary reason Texas has the highest uninsured rate in the nation at approximately 16%.
Elderly and disabled Texans have additional pathways to Medicaid coverage. If you receive Supplemental Security Income (SSI), you are automatically enrolled in Texas Medicaid without needing a separate application. Those needing nursing home care or long term services may qualify under different rules with income limits around $2,982 per month for individuals.
Texas Medicaid Income Limits 2026
The following tables show current Texas Medicaid income limits. These limits use Modified Adjusted Gross Income (MAGI) for most categories.
Income Limits for Children and Pregnant Women
| Category | FPL Percentage | Monthly Income (Family of 4) |
|---|---|---|
| Children 0 to 1 | 198% FPL | $4,957 |
| Children 1 to 5 | 144% FPL | $3,600 |
| Children 6 to 18 | 133% FPL | $3,325 |
| Pregnant Women | 198% FPL | $4,957 |
| Parents/Caretakers | 12% FPL | $230 |
Income Limits for Elderly and Disabled Individuals
| Category | Monthly Income Limit | Asset Limit |
|---|---|---|
| SSI Recipients (Individual) | $994 | $2,000 |
| Nursing Home (Single) | $2,982 | $2,000 |
| Nursing Home (Couple, Both Applying) | $5,964 | $3,000 |
If you're already receiving Supplemental Security Income (SSI), you automatically qualify for Texas Medicaid. There is no separate application required. The Texas Health and Human Services Commission enrolls SSI recipients directly.
The Texas Coverage Gap Explained
The coverage gap is one of the most significant problems facing low income Texans. Approximately 617,000 residents fall into this gap and have no affordable health coverage options. This makes Texas home to more uninsured adults than almost any other state.
The coverage gap occurs because Texas has not expanded Medicaid under the Affordable Care Act. States that expanded Medicaid cover adults earning up to 138% of the federal poverty level, which is about $21,597 per year for an individual. Texas chose not to expand, leaving adult Medicaid at pre-ACA levels that cover only parents earning below roughly 12% FPL.
At the same time, ACA marketplace subsidies only help people earning at least 100% of the federal poverty level, which is $15,650 per year for an individual in 2026. If you earn less than 100% FPL, you don't qualify for subsidies to reduce your marketplace premiums. This creates a gap where adults earning between 12% and 100% FPL have neither Medicaid nor affordable marketplace options.
For a single adult, the coverage gap affects those earning between about $1,900 and $15,650 per year. For a family of four, it affects households earning between roughly $2,760 and $32,150 annually. Workers in low wage jobs without employer coverage are most affected, particularly those in retail, food service, and agriculture.
If you fall into the coverage gap, you may have limited options. Federally Qualified Health Centers (FQHCs) provide primary care on a sliding fee scale based on your income. These community health centers serve patients regardless of ability to pay. You can find Texas health centers at findahealthcenter.hrsa.gov.
Some hospitals offer charity care programs for uninsured patients. Harris Health in Houston, Parkland in Dallas, and JPS in Fort Worth all have financial assistance programs. The Texas 2-1-1 helpline can connect you with local resources including free clinics and prescription assistance programs.
CHIP: Coverage for Children Not Eligible for Medicaid
The Children's Health Insurance Program (CHIP) provides low cost health coverage for children in families that earn too much for Medicaid but cannot afford private insurance. Texas CHIP has helped millions of families access affordable healthcare for their children.
CHIP income limits are higher than Medicaid limits for children. A family of four can qualify for CHIP with monthly income up to $4,957, which is approximately 201% of the federal poverty level. This means a family of four earning up to about $59,500 per year can qualify. Unlike Medicaid, CHIP requires small monthly premiums and copays, though these costs are significantly lower than private insurance.
The enrollment fee for Texas CHIP ranges from $0 to $50 per year depending on your income level. Copays for services are also minimal, typically $3 to $5 for doctor visits and prescriptions. No family pays more than $50 per year in enrollment fees, making CHIP an affordable option for working families.
CHIP covers the same comprehensive services as Medicaid for children, including doctor visits for sick and well child care, hospital stays, prescription medications, dental care including preventive and restorative services, vision exams and glasses, mental health and behavioral health services, and immunizations. The program ensures that working families have access to the same quality healthcare available to children on Medicaid.
You can apply for CHIP through the same application you use for Medicaid. When you submit an application at YourTexasBenefits.com, the system automatically determines whether your children qualify for Medicaid, CHIP, or neither based on your income. There is no need to submit separate applications, and you can apply for both programs at once.
If your income changes during the year, your children may move between Medicaid and CHIP or become ineligible for both. Report income changes to HHSC so your coverage can be adjusted accordingly. Losing CHIP coverage may trigger a special enrollment period for marketplace plans.
How to Apply for Texas Medicaid
Applying for Texas Medicaid is straightforward once you know where to go. The Texas Health and Human Services Commission offers multiple application methods to accommodate different needs and preferences.
The fastest way to apply is online through YourTexasBenefits.com. This is the official state portal that handles applications for Medicaid, CHIP, SNAP, and TANF all in one place. You'll need to create an account, answer questions about your household, income, and citizenship status, and upload documentation. The online application typically takes 30 to 45 minutes to complete, and you can save your progress and return later if needed.
You can also apply by phone by calling 1-800-252-8263. This toll free number connects you to HHSC representatives who are available Monday through Friday to help you complete your application. This option works well if you have questions, need language assistance, or prefer speaking with a person rather than filling out online forms.
In person applications are accepted at local Texas Health and Human Services offices located throughout the state. You can find your nearest office by calling 2-1-1 or searching on the HHSC website. Bring identification, proof of income, and proof of Texas residency to your appointment. Staff can help you complete the application and answer questions about eligibility.
You can also apply through Healthcare.gov. When you complete a marketplace application, the system will check whether you qualify for Medicaid first. If you do, your application will be sent to Texas HHSC for processing. This is particularly useful during ACA open enrollment if you want to explore all your options at once.
After you submit your application, Texas HHSC will process it within 45 days. For pregnant women and children, processing may be faster due to expedited procedures. You'll receive a letter in the mail indicating whether you've been approved or denied and explaining the specific reasons. If denied, the letter includes instructions for appealing the decision.
Documents Needed for Your Application
Gathering your documents before you start will make the application process smoother and faster. Texas Medicaid requires several types of verification, and having everything ready can prevent delays in processing your application.
You'll need proof of identity for everyone applying. Acceptable documents include a driver's license, state ID, birth certificate, passport, or military ID. For children, a birth certificate is typically required. If you don't have these documents, you may be able to use alternative verification methods.
Proof of citizenship or immigration status is required. U.S. citizens can use a birth certificate, U.S. passport, or naturalization certificate. If you were born abroad to U.S. citizen parents, you may need a Consular Report of Birth Abroad or other documentation proving citizenship.
Proof of income must be provided for all household members who work or receive benefits. This includes recent pay stubs from the last 30 days, a letter from your employer stating wages and hours, last year's tax returns, or documentation of self employment income such as business records or profit and loss statements. If you receive Social Security, unemployment, child support, or other income, bring that documentation as well.
Proof of Texas residency shows you live in the state. Utility bills with your name and address, rental or lease agreements, property tax statements, mortgage documents, or official mail addressed to your Texas address all work for this purpose. If you live with family and don't have bills in your name, a statement from the person you live with may be accepted.
Immigration documentation is required for non citizens applying for Medicaid. Lawfully present immigrants may qualify for Medicaid after a five year waiting period, though pregnant women and children under 21 may qualify sooner. Refugees, asylees, and certain other immigration categories may qualify immediately. Undocumented immigrants are generally not eligible for full Medicaid benefits but may receive emergency Medicaid services for serious conditions.
If you're missing any required documents, don't let that stop you from applying. HHSC can sometimes verify information through federal databases. Submit your application with what you have and provide additional documentation as requested.
What Texas Medicaid Covers
Texas Medicaid provides comprehensive health coverage worth thousands of dollars per year. Understanding what's covered helps you know what to expect once you're enrolled and helps you plan your family's healthcare needs.
Hospital services are fully covered, including inpatient and outpatient care. If you need surgery, emergency room treatment, or an extended hospital stay, Medicaid covers these services without sending you a large bill. You may need prior authorization for some non emergency procedures, which your doctor's office typically handles for you.
Doctor visits and preventive care have no out of pocket cost under Texas Medicaid. This includes annual checkups, immunizations and vaccines, cancer screenings like mammograms and colonoscopies, and ongoing management of chronic conditions like diabetes, high blood pressure, and asthma. Regular preventive care can catch problems early when they're easier and less expensive to treat.
Prescription medications are covered through the Texas Medicaid formulary, which includes most common medications for treating a wide range of conditions. Some brand name drugs may require prior authorization, or your doctor may need to request an exception. Generic alternatives are typically available without restrictions and at no cost to you.
Mental health and substance use services are covered under Texas Medicaid. This includes outpatient counseling, psychiatric services, and treatment for substance use disorders. Mental health coverage has expanded significantly in recent years to address the growing need for behavioral health services across Texas.
Children receive additional benefits that adults do not under the EPSDT program (Early and Periodic Screening, Diagnostic and Treatment). This includes full dental care with cleanings, fillings, and orthodontics when medically necessary. Children also receive vision exams and glasses, hearing services and hearing aids, and comprehensive mental health treatment. The EPSDT program ensures children receive all medically necessary services.
Adult dental coverage is limited under Texas Medicaid. The program covers emergency dental services for adults but not routine cleanings or preventive dental care. Some managed care plans offer limited additional dental benefits as a value added service. Check with your assigned plan about what dental services may be available.
Texas Medicaid is delivered through managed care organizations (MCOs) in most parts of the state. After enrolling, you'll be assigned to an MCO or can choose one yourself. Each MCO has a network of doctors, hospitals, and specialists. You'll need to use providers within your network for covered services except in emergencies.
Check Your Eligibility
Before spending time on a full application, you can quickly check whether you might qualify for Texas Medicaid and other benefit programs. A few minutes of screening can save you hours of paperwork if you know your likely eligibility upfront.
Free eligibility screening tools ask a few questions about your household size, income, and situation, then show you which programs you may qualify for. Tools like Benefits USA check eligibility for Medicaid, CHIP, SNAP, WIC, and other programs all at once, typically taking about five minutes to complete.
These screeners are not official applications, but they give you a good idea of your options before you invest time in the formal application process. The screener will estimate your potential benefit amounts and explain which programs you likely qualify for based on your answers.
If the screener indicates you likely qualify for Medicaid, you can then apply through the official YourTexasBenefits portal or call 1-800-252-8263 to apply by phone. Many families discover they qualify for multiple programs beyond just Medicaid, including SNAP food benefits and energy assistance.
Even if you've been denied for Medicaid in the past, it's worth checking again. Your eligibility depends on your current income and household situation. Job changes, new household members, pregnancy, or turning 65 can all affect your eligibility for different Medicaid categories.
Frequently Asked Questions
Can I get Texas Medicaid as an adult without children? Unfortunately, most adults without children do not qualify for Texas Medicaid, regardless of income. Texas has not expanded Medicaid under the Affordable Care Act. Adults without children may qualify only if they have a disability or meet other categorical requirements.
What is the Texas Medicaid coverage gap? The Texas coverage gap affects adults who earn too much to qualify for Medicaid but too little (under 100% FPL) to qualify for ACA marketplace subsidies. This affects approximately 617,000 Texans. If you fall in the gap, you may need to explore community health centers or charity care programs.
How long does Texas Medicaid approval take? Texas Medicaid applications are typically processed within 45 days. For children and pregnant women, approval may come faster. You can apply online at YourTexasBenefits.com or by calling 1-800-252-8263.
Does Texas Medicaid cover dental and vision? Texas Medicaid provides full dental and vision coverage for children under 21. Adults on Medicaid receive emergency dental services only. Some managed care plans may offer additional limited dental benefits.
Can I apply for Texas Medicaid if I'm pregnant? Yes. Pregnant women in Texas can qualify for Medicaid with income up to 198% of the federal poverty level, which is approximately $4,957 per month for a family of four. Coverage includes prenatal care, delivery, and postpartum care for 12 months after birth.
Renewing Your Texas Medicaid
Once enrolled in Texas Medicaid, you'll need to renew your coverage periodically. Understanding the renewal process helps you maintain continuous coverage for your family.
Texas Medicaid requires annual renewals for most recipients. About 60 days before your renewal date, you'll receive a form in the mail asking you to verify your information. Review the form carefully and return it by the deadline, updating any information that has changed such as income, household members, or address.
Many renewals happen automatically through what's called "ex parte" renewal. The state checks available databases to verify your information. If everything can be verified automatically, your coverage continues without you needing to take action. You'll receive a notice confirming your renewal.
If your renewal cannot be completed automatically, you must respond to the renewal request. Failing to respond can result in losing your coverage even if you're still eligible. Keep your contact information current with HHSC to ensure you receive all notices.
Report changes to your income or household promptly throughout the year. If your income increases, you may transition from Medicaid to CHIP or need to find other coverage. If your income decreases, you may qualify for additional benefits.
Next Steps
If you think you or your family might qualify for Texas Medicaid, the next step is to check your eligibility and apply. Children and pregnant women have the best chances of qualifying due to their higher income limits.
Start by using a free eligibility screener to see what programs you may qualify for. This takes about five minutes and covers Medicaid plus other programs like SNAP and CHIP that could help your family save money.
If you likely qualify, gather your documents and apply online at YourTexasBenefits.com. The application covers Medicaid, CHIP, SNAP, and TANF, so you only need to apply once to be considered for multiple programs. This saves time and ensures you don't miss any benefits you're entitled to receive.
Texas Medicaid provides essential healthcare coverage worth thousands of dollars per year in medical care. Even if you've been denied before, it's worth checking again if your income or household situation has changed. A new baby, a job loss, or a change in work hours could make you eligible when you weren't before.
