Who Can Get Medicaid
To get Medicaid in Texas, a person must:
- Be a U.S. citizen or have an acceptable immigration status.
- Live in Texas.
- Meet certain income rules.
Visit the website for Childrens Medicaid and Childrens Health Insurance Program or YourTexasBenefits.com to learn more.
In some cases, Medicaid might not consider all of your familys income. They might allow you to subtract certain expenses. Examples include certain expenses that can be claimed on your federal income tax return.
If your child is approved for Supplemental Security Income benefits to help with living expenses, they can also be approved for Medicaid.
How To Apply For Medicaid In Texas By Phone
While most people apply for Medicaid via the convenient online portal, there is a phone option for patients who either do not have access to the internet, or do not feel comfortable submitting such details through the web. To complete your Texas Medicaid application verbally, call 877-541-7905. You can receive TX Medicaid application assistance by phone Monday through Friday from 8 a.m. to 6 p.m.
Before you call in to apply for Medicaid by phone, it is important that you have all of the required information readily available. In the event you do not have all of the necessary details on hand, you can still submit your forms for Medicaid application, but expect a follow-up call to fill in any blanks.
After the representative has all the information he or she needs, you will be asked a few more questions to verify your identity. Once the Medicaid application process is complete, you will receive a phone call or a letter letting you know whether you qualify or not.
Discover all of the steps you must take when applying for Medicaid by .
How Do You Share Facts About My Health What Should I Do If Do Not Want You To Share Facts About My Health
HHSC shares facts about your health with doctors and other approved Medicaid providers. They can see this information on a secure website. With these facts, doctors will better understand your health history, which should mean better care for you.
If you do not want to share facts about your Medicaid health history with your doctors, then you can choose to opt-out or not share your health information. To let HHSC know if you want your health history shared or not shared, go to
YourTexasBenefits.com and follow these steps:
- From the home page click View my case.
- Follow the steps for setting up an account or logging in.
- Once youve logged in, click the Medicaid tab in the upper right part of the screen.
- Find your name and click the Share or Do not share button in the Share My Health Information column.
Or, you can call toll-free 1-877-518-0899 and follow the instructions.
Read Also: Therapists In Lansing Mi That Accept Medicaid
What Are The Income Requirements For Medicaid In Texas
What are the Medicaid application guidelines related to finances? Medicaid income requirements are important to the applicants Medicaid eligibility, since financial assistance is being requested due to low income. The income requirements for Medicaid in Texas vary depending on your Medicaid benefits eligibility group.
Chip And Children’s Medicaid Dental Services
Most children and teens with CHIP or Children’s Medicaid coverage get their dental services through a managed care dental plan. There are two dental plans to choose from.
Those with Medicaid who do not get their dental services through one of those two plans include:
- People with Medicaid age 21 and older.
- All people with Medicaid, regardless of their age, who live in facilities such as nursing homes, state supported living centers, or community-based Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions .
- Children and young adults in the state’s foster care program who get their dental services through STAR Health.
CHIP and Children’s Medicaid Dental Plans
You May Like: Medicaid And Weight Loss Surgery
Children’s Health Insurance Program Health Plans
Children in CHIP get services through a medical plan in their area. Some CHIP plans also offer services to mothers who are pregnant. This is called CHIP perinatal coverage.
You can find the CHIP health plans in your area by using the Find Your Medical Plan search tool. You can see how well some CHIP health plans perform by looking at the CHIP health plan report cards.
To learn more about CHIP, visit the CHIP and Children’s Medicaid website.
Texas Medicaid Wellness Program
The Texas Medicaid Wellness Program is a special health program for people who get Medicaid and have long-lasting or serious health conditions. These conditions can include asthma, diabetes, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease , and others.
People in this program can get help any time of day or night with:
- Getting an answer to a health question.
- Finding a main doctor.
- Managing their health between doctor visits.
- Learning more about their health conditions.
- Knowing how to take their medicines.
- Picking the best medical care for their health.
Learn more about the Wellness Program.
Read Also: Medicaid Exclusion List By State
Application And Renewal For Medicaid Coverage
- The patient/family must complete an application, provide supporting documentation, and have a face-to-face-interview with a benefits counselor before being approved for Medicaid coverage.
- Medicaid coverage must be renewed every six months. A childs coverage may lapse because of changes in the familys financial status, delayed or lack of application for renewal, and other causes. When coverage lapses and then the patient re-enrolls, the patient is not automatically assigned to the same PCP.
- Medicaid provides up to three months of retroactive coverage to new enrollees, including those who have re-enrolled following a lapse.
The State Childrens Health Insurance Program provides health coverage for children in families that earn too much to qualify for Medicaid but cannot afford private health-care coverage. Due to changes in family income status, many children transition from Medicaid to CHIP, or vice-versa. Unlike Medicaid, CHIP does not offer retroactive coverage. Under Texas law, the Department of State Health Services must assist a family whose child loses Medicaid eligibility in making a transition to CHIP without an interruption in coverage.
For questions or information about Medicaid eligibility, patients should contact their caseworker or the local HHSC office. on Medicaid Eligibility and Enrollment that may be used to assist patients in finding online and telephone resources.
Reference Guide to Information on Medicaid Eligibility and Enrollment
How Much Does Medicaid Cost In Texas
There are a variety of Medicaid programs in Texas from traditional Medicaid to a Medicaid Buy-in program. Like any health program, Medicaid is subject to copay and deductibles. But the Medicaid Buy-in program operates more like traditional insurance for the working disabled. The monthly premium depends on a variety of factors including income. There is no way to know the exact premium you will have to pay without first applying.
You May Like: Mississippi Division Of Medicaid Application
Is My Child With Disability Eligible To Apply For Chip
Is my child with disability eligible to apply for Chip?
If your child has a disability, you may be able to apply for long-term support and service through CHIP. These include the following:*Apply to have someone help you take care of the child and take them to the medical appointments. *Personal and home care such as helping monitor your childs health and assist them in performing daily activities. *Nursing home care*Hospital services for your childs mental illness*A place that provides care for children with intellectual disabilities.
Is there an Income Criteria to Qualify for CHIP?
Yes, there is an income limit for the parents of kids with disabilities to qualify for Texas Medicaid for children. Medicaid Eligibility in Texas is easy to figure out. The chart below gives you an overview of the maximum household income limit to help determine your eligibility. For any additional person, add $504 to the last figure, and that will be your maximum income limit per month. There is an enrollment fee that may cost you up to a maximum of $50. If you are a low-income family, your co-pay for each doctors visit and medication is around $3 to $5. This cost increases and costs between $20 and $35 for high-income families.
How To Apply For Medicaid Online In Texas
You can apply for Medicaid online in TX through the health exchange. Once you are there, you need to create a unique username and password to access data for your region. Then, you will be asked a series of questions. Note that all Medicaid application methods require specific documents and/or information to be transmitted to the states health department.
Certain items are non-negotiable when it comes to completing Texas Medicaid application forms. Whether you are filing a Medicaid online application or not, you must have the following handy:
- Your Social Security Number
- Proof of your legal name
- Your income records
- Information on any assets you have acquired
- The size of your household
If your TX application for Medicaid is on behalf of your family, you must also provide all of the above information for each member. To make sure you are fully prepared for the application process, .
If you already have health insurance, you will have to answer questions about your current medical coverage. You may still be able to qualify for Medicaid depending on your circumstances.
People with disabilities and minors have eligibility for TX healthcare benefits. If you have a disability, be sure to mention it on your Texas Medicaid application forms . Finally, you will be asked to verify all the information you have entered and to sign your application for Medicaid electronically.
You May Like: How To Find Case Number For Medicaid
What Is A Qualified Income Trust
The Qualified Income Trust was designed to address the growing disparity between Medicaid caps and the high cost of long-term care for the elderly. It allows you to legally divert income into a Trust, reducing the amount of your income that gets counted against Medicaid caps.
A QIT is a special type of trust for seniors in need of long-term care whose income exceeds Medicaid caps. A trust allows a third party to hold assets on behalf of a beneficiary.
Here, you set up a special account for the Trust which will receive the income necessary to make sure the applicant falls under the income eligibility limit. You deposit income to the Trust, and the Trust then directs how funds are dispersed each monthcommon disbursements of Trust funds include:
- A small personal needs allowance .
- Medical expenses not reimbursed by Medicaid.
- Minimum Monthly Need Amounts to a spouse, if applicable.
- Lastly, a nursing home co-payment.
Once the QIT is established the State will determine how much of your remaining income will be used to contribute to your long-term care as a co-pay, or applied income amount.
Medicaid is considered a payor of last resort, so a Medicaid recipient is generally going to pay everything they have first and Medicaid will pay the difference. As with the fund, you are allowed a small personal needs allowance and a contribution toward a spouses MMNA. Upon death, the State becomes the beneficiary and uses any remaining funds to recover against Medicaid benefits paid out.
How Can Tanf And Medicaid Affect My Child Support
Federal law requires all parents who receive TANF or Medicaid benefits through the Texas Health and Human Services Commission to cooperate with the Office of the Attorney Generals efforts to identify the childs noncustodial parent, establish paternity, settle child support orders, complete child support modifications and enforce child support.
TANF recipients assign their right to child support collections to the state. This means the family will receive the first $75 collected during any month that a current child support payment is made. The remainder of the child support payment made will be applied toward reimbursing the state and federal governments for the TANF benefits received by the family. When the family no longer receives TANF, all current support payments made will be sent to the custodial parent.
Parents who receive certain types of Medicaid assign their right to cash medical support collections to the state. This money will be redirected to the Texas Health and Human Services Commission to reimburse the state and federal governments for the Medicaid benefits received by the family.
If the children receive Medicaid benefits, but the adult does not, the adult has the option to request child support services.
Also Check: How Do I Qualify For Medicare And Medicaid
Wic Program Benefits And Texas Snap
The WIC Program in Texas provides support to pregnant women and their newborn babies up until the childs fifth birthday. The program includes special breastfeeding assistance and nutritional classes . To be eligible, you must be considered at risk by a healthcare professional.
The WIC Program is similar to the SNAP program, which is the food stamp program for those in need. If you are eligible for SNAP, you can get your SNAP benefits installed right on your Lone Star Card, which you can then use like a credit card at stores that accept SNAP. SNAP is only for Texans with low income. It cannot be used to purchase tobacco, alcohol, or anything that you cant eat or drink. Most people can only receive SNAP benefits for three months every three years. If you work for at least 20 hours a week or are in job training, or if you are unable to work for any reason, you may be able to receive an extension.
These are the amounts of SNAP you can qualify for:
Medicaid For Transitioning Foster Care Youth
Medicaid for Transitioning Foster Care Youth is available for former foster youth who are under the age of 21 and who are not eligible for the Former Foster Care Children program. This is because they were not receiving Medicaid at the time they aged out of care. These young adults will receive STAR Health. To be eligible for the Medicaid for Transitioning Foster Care Youth program, the young adult must:
- Be age 18 through 20
- Have been in Texas foster care on his or her 18th birthday or older
- Not have other health coverage
- Meet program rules for income and
- Be a US citizen or have a qualified alien status, such as a green card.
You May Like: Can You Have Both Medicare And Medicaid
The Texas Medicaid Application
To apply for Texas Medicaid, go to yourtexasbenefits.com and click apply for new benefits. Youll be asked to create an account to proceed. From there, you can apply for TX Medicaid, SNAP, TANF cash Help, WIC Food Benefits, and other support. You can also online and send it to the HHSC (Health and Human Services or visit your local HHSC office.
If you need help completing your TX Medicaid application, visit your local HHSC office and ask for assistance. You can also complete your TX Medicaid application verbally by calling 877-541-7905, Monday through Friday from 8 AM to 6 PM.
What You Can Keep
Texas is one of the unlucky 13 states with a Medicaid eligibility income cap with no allowance for medical expenses. In 2019 it is $2,313/month. The average Texas nursing home cost greatly exceeds this. For almost everyone in between $2,313 and the cost of nursing home care, even selling every last thing does not help for long.
And those with an income of $2,314/month will never meet the eligibility cap. They may qualify medically. They may need Medicaid for nursing home or home health care. But they will not qualify for it financially.
Since income is defined more broadly than for federal income tax purposes, many people who think they qualify based on income may not. The rules can be complicated.
Fortunately, in 1993 the federal Omnibus Budget and Reconciliation Act allowed people to transfer part or all of their income to a Qualified Income Trust.
A Qualified Income Trust pays a personal needs allowance for someone receiving Medicaid benefits . It pays for unreimbursed medical expenses such as dentistry and health insurance premiums. It pays up to $3,160.50 per month to maintain the spouse who remains in the community, and then pays a co-pay to the nursing home. There is rarely enough to pay the nursing home in full. Medicaid, funded by taxes collected by Texas and the federal government, pays the rest.
Don’t Miss: How To Apply For Medicaid In Houston
What Does Medicaid Cover In Texas
The Medicaid program in Texas places an emphasis on preventative care, continuity of care, and high-quality services. There are four different types of Texas Medicaid coverage that cover most of your healthcare needs:
- STAR: For most Texas Medicaid eligibles
- STAR+PLUS: For those over 65 and/or disabled
- STAR Kids: For low-income and/or disabled children
- STAR Health: For low-income and/or disabled foster children
Preventive Caretexas Health Steps
Early and Periodic Screening, Diagnosis, and Treatment is Medicaids comprehensive preventive child health service for children and youth birth through 20 years of age. In Texas, it is called the Texas Health Steps Program, which includes the preventive care components or Early and Periodic Screening of total EPSDT service.
Preventive Care Medical Checkups are a benefit of Texas Health Steps for patients who are birth through 20 years of age when performed by enrolled Texas Health Steps providers and all required components are completed. An incomplete checkup is not a benefit. The Texas Health Steps Periodicity Schedule specifies screening procedures recommended at each stage of the patient’s life, to assure that health screenings occur at age appropriate points.
The Periodicity Schedule requires 11 checkups for children birth through age 2 and annually for patients from 3 through 20 years of age. Checkup components include history, physical exam, assessments and screenings, immunizations, laboratory tests, health education, anticipatory guidance, and dental referrals.
- Obtains valid written consent for services from the patients parent or legal guardian within the one-year period prior to the date the services are provided.
- Encourages parental involvement in, and management of, the health care of the children receiving services from the clinic, program, or facility.
Don’t Miss: How To Become A Medicaid Consultant
