How Do You Qualify For Medicaid In Texas


Services Covered By Medicaid And Chip

How To Mail A Texas Medicaid Application To Your Client In Less Than 1 Minute
  • Regular checkups at the doctor and dentist
  • Medicine and vaccines
  • Access to medical specialists and mental health care
  • Treatment of special health needs and pre-existing conditions

These services are provided by health plans. If your child gets Medicaid or CHIP, you will choose a plan from the ones available in your service area.

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:

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What Does Medicaid Cover For Adults

In addition to inpatient and outpatient hospital care, physician services, laboratory and x-ray services, and home health services are all included in the mandatory benefits package. Services such as prescription medicines, case management, physical therapy, and occupational therapy are available as optional benefits for employees.

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Medicaid For Texans In Nursing Homes

In 2018, the average monthly cost of a private room in a nursing home in Texas was approximately $6,540, or over $78,000 per year. Thus, most people cannot afford to pay their own nursing home expenses. Nursing homes are residential facilities that offer 24-hour skilled nursing care in addition to other supportive services.

If you already qualify for Texas Medicaid, then your Medicaid coverage includes nursing home care if you need it. Groups of people who can automatically qualify for Medicaid include SSI recipients, participants in the TANF program, and children in its foster care system. In addition, people who are 65 or older, disabled, or blind can qualify for Medicaid if they also meet income and resource limits.

Medicaid Penalties In Texas

Everything you Need to Know About Texas Medicaid

All Medicaid applicants seeking coverage for long-term care services are subject to a look-back period of five years. During the look-back period, any voluntary resource transfer may qualify as a gift, which can result in a penalty from Medicaid. If a person receives a penalty from Medicaid, they may received delayed benefits, or they may disqualify themselves entirely.

The length of a persons penalty period is entirely dependent on how many voluntary gifts they transferred prior to applying to Medicaid. As of 2017, anyone applying to Medicaid in Texas could divide the complete uncompensated value of gifts given during their look-back period by $172.65 . The resulting figure determines how long Medicaid will wait before they provide the applicant with coverage.

There is no limit on the value of gifts, meaning small holiday presents can count toward a persons eligibility. Therefore, its crucial for anyone considering Medicaid to plan their asset and income transfers carefully, as to maintain their eligibility for benefits.

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What Benefits Does Texas Have For Seniors

An assistance program for older people who are not eligible for Medicaid is provided by the state of Texas through one of its programs. This is the Community Care for the Elderly and Disabled program, which offers non-medical personal care services and assistance to nursing home eligible adults who want to live at home rather than in a nursing facility.

Texas Requirements For Medicaid Qualification

Qualification for Medicaid in Texas is more of a formula than a series of check-boxes. You have to meet certain income requirements. But the income limit varies depending on the number of people in the household, and the variety of Medicare for which you are applying.

Here is an example from the Texas HHS website:

  • If the monthly income is $1,784 or less, or the yearly income is $21,404 or less, you may qualify for Children’s Medicaid.
  • If the monthly income is $2,663 or less, or the yearly income is $31,951 or less, you may qualify for CHIP.

Not to be confused with Childrens Medicaid, CHIP stands for Childrens Health Insurance Program. The above figures only apply to a family of two. For Childrens Medicaid, the limit increases to $4,558 for a family of eight. Even these are not hard limits as there are circumstances where the limits could be higher.

Eligibility groups include, but are not limited to the following:

  • Women who are pregnant
  • Individuals who receive Supplemental Security Income
  • Anyone who currently receives adoptive assistance
  • Low-income households that have kids under the age of 19

The only way to truly determine your eligibility is to apply.

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What Is The Lowest Income To Qualify For Medicaid

Medicaid eligibility is based on meeting certain federal poverty levels. For the lower 48 states and the District of Columbia, the Federal Poverty Level is established by the number of people in a given family. It will cost $13,590 for a single adult person in 2022, $27,750 for a family of four, and $46,630 for a family of eight in 2022, according to the Bureau of Labor Statistics.

What Does Texas Medicaid Cover

How Do I Apply For Medicaid?

Traditional Medicaid in Texas covers a variety of services for its beneficiaries. That includes:

  • Services provided in a skilled nursing facility
  • Medical transportation
  • Prescription drugs

Older adults who are enrolled in the STAR+PLUS managed care program receive all the benefits of traditional Medicaid, as well as:

  • Physical therapy

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Resource Limits For Texas Medicaid

To qualify for Medicaid, you must have few resources. Resources are assets, like money in the bank, retirement accounts, land, and personal property like cars.

The resource limit for a single person to qualify for Texas Medicaid is $2,000, and for a married couple who both want to qualify for Medicaid, it is $3,000.

Some property does not count toward the resource limit. In Texas, the home you live in is excluded from the resource calculation as long as it is worth less than $585,000 . There are other excluded resources, including one car.

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Do You Reside Within The Community Health Choice Service Area

  • 20 counties in Southeast Texas
  • Only individuals living in our plans service area are eligible to enroll in Community Health Choices plan.

If your category of Medicaid eligibility changes, your eligibility for this plan will change. You will have a 6-month grace period to achieve Medicaid redetermination and will continue to be covered under this plan. During this grace period, you will be responsible for the costs of your Medicare benefits, which will be the same as if you were on Original Medicare.

Not sure if you qualify? One of our representatives can help you!

H9826_IT_10045_092919_M Last updated October 4, 2021. ***Pending CMS Approval***

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The Texas Medicaid Wellness Program

The Texas Medicaid Wellness Program is exclusively for those who have Medicaid and suffer from long-lasting and serious health conditions. In most cases, if you are eligible for the Texas Medicaid Wellness Program, you will receive a letter and phone call notifying you of your eligibility. Some people within the Texas Medicaid Wellness Program can join Weight Watchers for free. Everyone in the program has access to special nurses who can help with care management, learning about health conditions and medications, and selecting the best medical care. These nurses are available at any time at 1-800-777-1178 .

Texas Healthy Women Program


Lost your Medicaid benefits? The Texas Healthy Women Program provides family planning exams, related health assessments, and birth control to women ages 18 to 44 whose family income is at or below the programs income limits . of poverty).

You must apply to find out if you can receive services through this program. Visit this site for more information.

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How Does Medicaid Work For Children With Disabilities

Medicaid is a government program that provides medical services for people who meet certain income or disability requirements. It covers medically necessary services such as: doctor’s visits , dental care, therapies , mental health and substance use disorder, medical equipment and supplies, some prescriptions, transportation to doctor’s visits or to pick up medicine, and more. There are a number of programs that fall under the Medicaid umbrella. These include:

  • Medicaid Buy-In and Medicaid Buy-In for Children: allow people who have certain disabilities or special health care needs and do not meet Medicaid income requirements to purchase Medicaid coverage. Rates are set on a sliding scale based on either the persons income or the family income. See our page on Medicaid Buy-In Programs to learn more.
  • Medicaid Waiver Programs: Medicaid-funded programs that help people with disabilities or special health care needs get services and supports that allow them to live and thrive in community settings. These programs consider only your childs income, even if your child is age 17 or younger. Many children who are not approved for other Medicaid programs are able to get waivers. See our Waivers page to learn more.
  • What Are The Basic Eligibility Requirements For Long

    There are five basic requirements that must be satisfied in order to receive nursing home Medicaid services. The requirements are as follows:

    1. Nationality and Residency. The Medicaid applicant must be either a U.S. citizen or an alien with qualified alien status. Additionally, the applicant must be a resident of Texas. There is no length of residence requirement. The applicant merely needs to reside in Texas and intend to remain or return to Texas.

    2. Medicaid Facility, Medicaid Bed. To receive long-term care Medicaid, the applicant must be in a Medicaid certified facility and in a Medicaid bed for at least 30 consecutive days.

    3. Medical Necessity. The Medicaid applicant must have medical necessity for nursing home care. The individuals medical condition must be sufficiently serious that it requires the services of licensed nurses in an institutional setting. The medical services must be ordered by a physician and the conditions requiring regular skilled nursing care must be documented.

    5. Resources. Resources are categorized as countable and excluded for eligibility purposes. The resource eligibility limits, like the income limits, depend on whether the Medicaid applicant is married, married with an ineligible spouse, or has a spouse who is also applying for Medicaid benefits. Countable resources are counted as of 12:01 a.m. on the first day of the month.

    Other Frequently Asked Questions

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    Medicaid For The Elderly & People With Disabilities

    Seniors, adults with disabilities and some children with disabilities who don’t have health insurance might be able to get health coverage through the Medicaid for the Elderly and People with Disabilities program.

    You might be able to get Medicaid even if you’re already on Medicare. If you need help paying your Medicare premiums, click here.

    To learn more about all your options, contact your local Aging and Disability Resource Center or call 2-1-1.

    To get MEPD, you must be a Texas resident and a U.S. citizen or qualified non-citizen. When you apply, we’ll ask about your income, your age, and your disability to see if you qualify.

    MEPD covers health care services, including:

    • Regular checkups at the doctor.
    • Medicine and vaccines.
    • Access to medical specialists and mental health care.
    • Treatment of special health needs and pre-existing conditions.

    MEPD also covers long-term services and supports, including:

    • Home care and personal care, like having someone help monitor your health and help you with daily activities.
    • Having somebody take your child to their medical appointments.
    • Nursing home care.
    • A hospital for mental illnesses.
    • A place of care for people with intellectual disabilities.

    Medicaid For Texans In Assisted Living Facilities

    You CAN Qualify for Medicaid in Texas

    Assisted living facilities provide food, personal care services like help with bathing or dressing, and medication administration. Historically, Medicaid did not pay for ALFs. However, Texas has a program offering Medicaid payment for assisted living facilities, if you meet specific criteria.

    If you are otherwise eligible for Medicaid and if you can show that a nursing home is medically necessary for you , then you may qualify for STAR+PLUS Waiver services. This program pays for home- and community-based services, including assisted living facilities, for people who would otherwise have to be institutionalized in a nursing home. The STAR+PLUS Waiver program has limited enrollment and there may be a waiting list for certain services. For more information, contact the ALF program staff of Texas Health and Human Services.

    Texas also offers continuing care retirement communities , which combine independent living, assisted living, and nursing home care in one residential setting. CCRCs, which are regulated by the Texas Department of Insurance, typically charge entrance and monthly fees. Once in a CCRC, you can use long-term care insurance, private insurance, Medicare, or Medicaid to pay for some of your health care, depending on your coverage options and the types of services you require.

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    Assets Which Are Not Counted In Determining Financial Eligibility For A Medicaid

    Personal residence. Equity of up to $603,000 is excluded. The residence must generally be in the same state in which the person applies for Medicaid. Texas Medicaid policy manuals and Texas Medicaid practice is that the intent to return home is sufficient. Some other states require proof of the likelihood of returning home.

    Transferring your home may result in a penalty period during which you will not be eligible for Medicaid unless you transfer it to:

    • A child of any age who is blind or disabled
    • A trust for a disabled person under 65
    • A sibling who already has an equity interest in the home and has lived there for at least one year before you apply or
    • An adult child who lived with you for at least two years before you applied and took care of you, postponing your application for Medicaid.

    One vehicle to transport the applicant a second if made handicapped-accessible. Sometimes a third is allowed if needed to transport the spouse to work.

    Livestock which is part of a trade or business or exclusively for home consumption, including two horses.

    Property used in the applicants trade or business if essential to self-support, previously used, and expected to be used in the future IF the applicant materially participates in the business

    Real property essential to self-support such as rental property, leased farm property and income-producing mineral rights producing up to $6,000 per year with a net annual return of at least 6%.

    Personal property worth up to $60,000.

    Texas Has Not Accepted Federal Medicaid Expansion

    • 5,355,045 Number of Texans covered by Medicaid/CHIP as of March 2022
    • 1,748,000 Number of additional Texas residents who would be covered if the state accepted expansion
    • 771,000 Number of people who have NO realistic access to health insurance without Medicaid expansion
    • $6 billion Federal money Texas is leaving on the table in 2022 by not expanding Medicaid

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    Medicaid Breast Pumps Texas

    Texas Medicaid offers special healthcare for new mothers. Let us look a little bit more into it.

    Texas Medicaid eligibility plan offers breast pumps coverage for women, although they may not be hospital-grade or quality. Many plans may allow you to own or rent a double-electric breast pump, but this will require you to get a prescription from your attending doctor.

    If you are an expecting or new mother, you may be eligible to apply for Medicaid breast pumps Texas on your Medicaid Insurance. However, Medicaid will only process your payment and ship the pump after the baby is born.

    Medicaid Managed Care In Texas

    Income Qualifications For Medicaid In Texas

    Most Medicaid recipients in Texas get services through a managed care system. The most common system is called the State of Texas Access Reform Managed Care. In managed care, Medicaid recipients pick a medical plan from a list of plans available in their area and choose a primary physician who works under that plan. The plans are operated by private companies that contract with Texas to provide Medicaid services.

    STAR+PLUS is Texas’ Medicaid managed care program for people who have disabilities or who are 65 and over. Through STAR+PLUS, enrolled individuals receive Medicaid healthcare and long-term care support and services through their chosen managed care plan. Previously limited to elderly and disabled individuals who didn’t need nursing home care, since 2014, STAR+PLUS plans cover nursing home and in-home care.

    If you have a problem getting your managed care plan to pay for services that you need, make sure to appeal the written denial notice that you get. In addition, you can follow the separate complaint procedure for your plan. If you have a problem with your Medicaid managed care program, you can also file a complaint with Texas’ Health and Human Services Commission Ombudsman at 877-787-8999.

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    Income Guidelines For Children’s Medicaid

    Your income is the money you get paid before taxes are taken out. Find your family size on the table below. If your monthly income is the same or less, your child might get Children’s Medicaid.

    Family Members Monthly Family Income
    For each additional person, add: $791

    *A family of one might be a child who does not live with a parent or other relative.


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