An estimated 617,000 Texans fall into what policy researchers call the Medicaid coverage gap. These adults earn too little to qualify for subsidized marketplace plans under the Affordable Care Act, but Texas's strict Medicaid rules leave them ineligible for that program too. The result: no affordable path to health coverage at all. Texas accounts for roughly 42% of all people in the coverage gap nationally, making it the single largest contributor to the country's uninsured crisis.
This article explains exactly who falls into the gap, which counties are hardest hit, what income thresholds create the trap, and what options exist for people caught in it.
What Is the Texas Medicaid Coverage Gap?
The coverage gap exists because Texas has not expanded Medicaid under the ACA. In the 40 states that did expand, adults earning up to 138% of the federal poverty level (FPL) qualify for Medicaid. Texas held its eligibility rules at pre-ACA levels, which means most adults without dependent children are completely ineligible regardless of how low their income falls.
At the same time, ACA marketplace subsidies only apply to people earning at least 100% FPL (about $15,650 per year for a single adult in 2026). So adults earning below that threshold get nothing from the marketplace either.
The income band creating the gap for most adults:
| Household Size | Income Too Low for Marketplace Subsidies | Too High for Texas Medicaid (Parents) |
|---|
| 1 person | Below $15,650/year | Above $3,113/year (~20% FPL) |
| 2 people | Below $21,150/year | Above $4,209/year |
| 3 people | Below $26,650/year | Above $5,304/year |
| 4 people | Below $32,150/year | Above $6,400/year |
Single adults without children face an even harder cut. Texas Medicaid does not cover non-disabled adults without dependents at all, no matter how low their income is. A childless adult earning $5,000 per year, or $500 per year, or nothing at all does not qualify.
Texas Medicaid Eligibility in 2026
Texas Medicaid has separate income thresholds depending on who you are:
| Category | Income Limit | FPL Equivalent |
|---|
| Children under 1 | $5,445/month (family of 4) | 198% FPL |
| Children ages 1-5 | $3,960/month (family of 4) | 144% FPL |
| Children ages 6-18 | $3,658/month (family of 4) | 133% FPL |
| Pregnant women | Up to 203% FPL | ~$2,965/month individual |
| Parents/caretaker relatives | Approximately 18% FPL | ~$235/month individual |
| Non-disabled adults without children | Not eligible | No income limit applies |
| CHIP (children) | Up to 206% FPL | ~$5,518/month (family of 4) |
The parent income limit of roughly 18% FPL is one of the lowest in the country. A parent of two earning $300 per month can still be ineligible. That is what makes Texas's gap so large.
Who Is in the Coverage Gap?
Research from the Kaiser Family Foundation and Center on Budget and Policy Priorities provides a clear demographic picture of the roughly 570,000 to 617,000 adults in Texas's gap (estimates vary slightly by year and methodology):
- 68% live in families where at least one person works
- 51% are workers themselves, typically in service, retail, or construction jobs
- 73% have no dependent children
- 74% are people of color
- The majority are between ages 19 and 64
These are not people who have dropped out of the workforce. Most are employed in low-wage jobs that do not offer employer-sponsored insurance and pay wages that fall just below the poverty line. The coverage gap is primarily a working-poor problem.
Texas Uninsured Rates by County
Texas has an overall uninsured rate of roughly 16.4%, the highest in the nation. But rates vary significantly by county. The coverage gap is concentrated in certain regions:
Most Populous Counties and Estimated Uninsured Residents
| County | Approximate Uninsured Population | Uninsured Rate |
|---|
| Harris (Houston) | 700,000+ | ~18.7% |
| Dallas | 370,000+ | ~16.3% |
| Tarrant (Fort Worth) | 290,000+ | ~16.9% |
| Bexar (San Antonio) | 280,000+ | ~15% |
| Hidalgo (McAllen) | 250,000+ | ~30% |
| El Paso | 130,000+ | ~20% |
| Travis (Austin) | 130,000+ | ~14% |
Note: These are total uninsured figures, not just coverage gap adults. A portion of each county's uninsured population consists of individuals who could qualify for Medicaid or CHIP but are unenrolled, undocumented individuals, and those in the coverage gap. Researchers estimate 15% of uninsured Texans under 65 are already eligible for Medicaid or CHIP but not enrolled.
Highest Uninsured Rates by County
Border and rural counties have the highest rates, often exceeding 30%:
| County | Uninsured Rate |
|---|
| Hidalgo | ~30% |
| Dallam | ~36% |
| Bailey | ~34% |
| Hudspeth | ~34% |
| Presidio | ~30%+ |
| Starr | ~28% |
| Webb (Laredo) | ~25% |
These counties combine deep poverty with Texas's restrictive Medicaid rules, leaving a disproportionate share of their populations with no coverage option.
Why Texas Has Not Expanded Medicaid
Texas lawmakers have repeatedly declined to expand Medicaid, citing concerns about long-term state budget obligations and ideological opposition to ACA participation. Several expansion bills were introduced in the Texas legislature in early 2025. All of them failed by mid-2025.
The federal government originally offered states enhanced matching funds, covering 90% of expansion costs permanently. Every dollar Texas spends on expansion draws roughly $9 in federal matching funds. Despite this, the Texas legislature has not moved forward.
Neighboring states that expanded Medicaid, including New Mexico, Arkansas, and Louisiana, saw their uninsured rates fall sharply in the years after expansion. Texas's uninsured rate has remained the highest in the country.
What Coverage Options Exist for Gap Adults in Texas?
If you fall into the coverage gap in Texas, your options are limited but not zero:
1. Community Health Centers (Federally Qualified Health Centers)
FQHCs operate on a sliding-fee scale based on income. Adults earning below poverty can sometimes receive care for very low or no cost. Locate one at findahealthcenter.hrsa.gov.
2. County Indigent Health Care Programs
Texas counties are required to provide some level of indigent health care. Each county sets its own rules, income limits, and covered services. Harris County has one of the larger programs (Harris Health System). Contact your county health department to ask about local indigent care programs.
3. ACA Marketplace Plans With Subsidies
If your income is at or above 100% FPL (about $15,650 for a single adult in 2026), you may qualify for subsidized marketplace plans. Enhanced subsidies passed in 2021 have made premiums as low as $0 for some lower-income enrollees. You can check eligibility at healthcare.gov or use the screener at BenefitsUSA.
4. Texas Children's Medicaid and CHIP
If you have children, your children likely qualify even if you do not. Children under 18 with family incomes up to 200% FPL can get free or low-cost coverage through Medicaid or CHIP. Apply at yourtexasbenefits.com.
5. Medicaid for Pregnant Women
Pregnant Texans qualify for Medicaid at up to 203% FPL. This covers prenatal care and delivery. Coverage extends 12 months postpartum under a 2023 rule change.
6. Charity Care at Hospitals
Texas hospitals receiving federal funds are required to provide emergency care regardless of ability to pay. Many have charity care programs for uninsured patients. Ask the financial assistance office at any hospital.
Texas Medicaid Application Steps
If you think you may qualify for any category of Texas Medicaid:
- Go to yourtexasbenefits.com and create an account or log in.
- Start a new application for health coverage.
- Enter your household size, income, and information for each household member.
- Answer questions about citizenship, residency, and other eligibility factors.
- Submit the application. You will receive a notice within 45 days (some categories process faster).
- If approved, you will receive a member ID and information about your managed care plan.
- If denied, you have the right to appeal within 90 days. Request a fair hearing through HHSC.
You can also apply by phone at 2-1-1 (Texas Health and Human Services) or in person at your local HHSC benefits office.
Impact of Federal Legislation in 2025-2026
Proposed federal budget legislation in 2025 raised concerns about potential cuts to Medicaid funding and ACA subsidies. Analysis from the Texas Tribune indicated that as many as 1.7 million Texans could lose health coverage if enhanced ACA tax credits expired and proposed Medicaid funding changes took effect. The status of these proposals was still developing as of mid-2026. If ACA enhanced subsidies expire, people currently getting $0 premium plans just above the poverty line could lose their coverage and potentially fall back into the coverage gap from above.
Checking Your Options Now
The fastest way to see what you may qualify for is to run a free screening. The BenefitsUSA screener checks Medicaid, CHIP, ACA subsidies, SNAP, and other programs based on your household and income. It takes about three minutes and tells you what programs you may be eligible for and how to apply.
You can also visit the Texas benefits page for more detail on all state-specific programs.
Frequently Asked Questions
What is the Texas Medicaid coverage gap?
The coverage gap refers to adults who earn too little to qualify for ACA marketplace subsidies (below 100% FPL, or about $15,650 per year for a single adult) but who do not qualify for Texas Medicaid because Texas has not expanded the program. These adults have no subsidized path to health coverage.
How many people are in the Texas Medicaid coverage gap in 2026?
Estimates range from approximately 570,000 to 617,000 adults, depending on the data source and year of the estimate. KFF's analysis puts the figure at around 570,000 using 2023 data. Texas accounts for about 42% of all coverage gap adults nationally across the ten non-expansion states.
Which Texas counties have the most uninsured residents?
Harris County (Houston) has the largest total uninsured population, with over 700,000 uninsured residents. Dallas, Tarrant, Bexar, and Hidalgo counties also each have very large uninsured populations. By percentage, border counties like Hidalgo, Dallam, and Webb have the highest uninsured rates in the state, some exceeding 30%.
Can adults without children get Medicaid in Texas?
Generally no. Texas Medicaid does not cover non-disabled adults without dependent children regardless of income. The only exceptions are for pregnant women, people 65 and older (Medicare-Medicaid), and individuals with qualifying disabilities.
What is the income limit for Texas Medicaid for parents in 2026?
Parents and caretaker relatives can qualify for Texas Medicaid at approximately 18% of the federal poverty level. For a family of three, that is roughly $400 per month. This is one of the lowest parent income thresholds in the country.
Has Texas expanded Medicaid?
No. As of mid-2026, Texas has not expanded Medicaid under the ACA. Multiple expansion bills introduced in the 2025 legislative session failed. Texas remains one of ten states that have not adopted expansion.
What should I do if I fall in the Texas coverage gap?
Start by checking whether your income is at or above 100% FPL. If so, you may qualify for subsidized marketplace coverage, potentially at very low cost. If your income is below that, explore county indigent care programs, federally qualified health centers, and hospital charity care. The BenefitsUSA screener can help identify which programs may be available to you.
Will Medicaid expansion happen in Texas?
Legislative efforts have stalled repeatedly. The 2025 Texas legislature did not pass expansion. Some advocates point to potential fiscal pressure from federal changes as a new argument for expansion, but no expansion is expected in the immediate near term.
