How Does Medicaid Work In Texas


What Does Medicaid Offer Children With Disabilities Or Special Health Care Needs

How Does Texas Medicaid Work? | Texas Medicaid Works

Medicaid Buy-In for Children, Medicaid Buy-In for working adults with disabilities, STAR Health, STAR+PLUS, and the STAR Kids program are all designed to make sure children and adults with disabilities or special health care needs have health care coverage. Medicaid health coverage includes acute care services , behavioral health services, pharmacy services, and some long-term services and supports .

As we mentioned above, there are specific Medicaid programs, also known as waivers to help children with disabilities or special health care needs live and thrive in the community. These programs have long interest lists that might take many years. So, even if you dont think that your child would need the waiver services now, its a good idea to sign up as early as possible.

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.

Medically Needy Medicaid Texas

If you dont meet Texas Medicaid eligibility requirements based on your income level, you can still qualify based on spend down. This means that if you spend enough money on health care to put you below the qualifying limit, you can still qualify. However, that money that puts you below the line has to be going towards your healthcare costs.

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What Is Medicaid Called In Texas

The State of Texas manages the program Medicaid , also referred to as managed care. Women who are pregnant receive both Childrens Medicaid and Medicaid in the community. The government of the United States does not incur any cost to administer these programs. The medical expenses of people living in poverty who cannot afford health insurance.

The Texas Medicaid Wellness Program

Texas Medicaid Application Pdf 2020

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 .

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Potential Expansion Effects On Texas Economy

Most Texans in our survey thought that Medicaid expansion would help the states economy, while 11 percent said it would hurt . Previous research provides some support for this view. Multiple studies have shown that Medicaid expansion has reduced uncompensated care costs, suggesting expansion would improve financial conditions for Texas providers and hospitals.10

Expansion also has been associated with fewer rural hospital closures , where these entities account for 14 percent of total employment on average.11 Indeed, since 2013, 19 rural Texas hospitals have closed permanently or temporarily because of financial difficulties.12 In some locales, hospitals are becoming the default insurer of last resort, as uninsured rates and hospital closures continue to climb.13

Other studies of Medicaid expansion have found significant state budget savings from increased federal funding of Medicaid, reduced spending on the uninsured, and other offsetting reductions in state health care costs.14 Currently, government payments to hospitals offset some uncompensated care costs, but that funding does not cover all of the losses.15 Additionally, much of that offset is paid for under a special 1115 waiver demonstration project that is set to expire in 2021.16 It is unclear if this funding will be renewed and to what extent.

Apply For Medicaid In Texas

You can enroll through or the state Medicaid website. You can enroll by phone at 800-318-2596.

Eligibility: The aged, blind, and disabled. Also, parents with dependent children are eligible with household incomes up to 15% of FPL. Children are eligible for Medicaid or CHIP with household incomes up to 201% of FPL, and pregnant women are eligible with household incomes up to 198% of FPL.

Recommended Reading: Medicaid Provider Enrollment Phone Number

New Fact Sheet: Most Texas Adults With Serious And Chronic Illnesses Do Not Qualify For Medicaid

Texas Medicaid rules strictly limit which adults can get health coverage, and most adults who can work are ineligible. Most parents whose children get Medicaid cannot get Medicaid themselves . Many Texas adults with serious illnesses and complex chronic conditions do not qualify for Medicaid. Only those who get federal Supplemental Security Income disability benefits can get Medicaid.These are the adults Texas Medicaid covers today:

  • Low-income pregnant women .
  • Low-income women with Breast or Cervical Cancer .
  • Extremely low-income parents caring for children .
  • Former Foster Care Children
  • People age 65 and over, and people with disabilities, who are below or near poverty.

Most adults who can work cant get Texas Medicaid. To get SSI disability benefits, an adult must be so incapacitated by health conditions that even the simplest forms of employment are impossible. As long as a person can work even at a very reduced capacity, they will not get SSI disability payments, and in Texas that also means they will not get Medicaid.

This strict limit may be the right choice for determining who gets cash disability benefits. However, it is a disastrous choice for letting adults who want to work be as productive as they possibly can be, and empowering them to be the best parents they possibly can be.

Can Adults Get Medicare In Texas

Texas Medicaid Works for Joseph #3 | Texas Medicaid Works

What are the eligibility requirements for etween Medicare in Texas? Medicare is normally available to people over 65 years of age. Disability benefits may be awarded for less than two years of age and recipients of disability for less than two years may be eligible to receive benefits. People who are suffering from end-stage renal disease or Amyotrophic Lateral sclerosis may qualify for this treatment.

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Medicaid Expansion In Texas: Potential Economic And Employment Implications

  • Low-income adults in Texas were much more likely to be uninsured and to report financial barriers to care than their counterparts in three Southern states that have expanded Medicaid

  • More than half of low-income Texans said Medicaid expansion would help the states economy

  • Low-income adults in Texas were much more likely to be uninsured and to report financial barriers to care than their counterparts in three Southern states that have expanded Medicaid

  • More than half of low-income Texans said Medicaid expansion would help the states economy

Texas Medicaid Eligibility Income Chart

The only way to truly determine your Texas Medicaid eligibility is to apply. There are four main eligibility groups: pregnant women, people recieving SSI , those receiving adoptive assistance, and households with kids under the age of 19. If you fit into one of those categories, you may qualify based on your household income. On the most basic level, your income as of should be below the following:

Also Check: How Do I Find Out What Medicaid I Have

How Do I Apply For Medicaid For My Child

In Texas, Medicaid programs are managed by the Health and Human Services Commission . You can apply for any program for your child by visiting your local HHSC office. You can find that office by calling 2-1-1 or visiting 2-1-1 Texas online. You can also get free help applying for Medicaid services for your child from a community partner organization. When you apply for Medicaid, you may need to show or send:

  • Proof of money you and each family member who lives with you earns from a job or other sources. Pay stubs or earning statements are most common, but there are other documents that can be used too.
  • Social Security numbers or immigration document numbers.
  • Details about current health insurance or any job-related health insurance that might be available to you.

If you and your child dont want to go apply in person, there are other choices:

  • Apply for Medicaid online on the Your Texas Benefits website. You will have a chance to show proof of income, Social Security numbers, and insurance after you apply.
  • Apply by phone by calling 2-1-1. They will start the application over the phone and mail it to you to sign.
  • and fill it out.

Once you have filled out the application and gathered your other proof, you can:

  • Take it to an HHSC benefits office. Call 2-1-1 to find an office near you.
  • Fax it to 1-877-447-2839. If your form is 2-sided, dont forget to fax both sides separately.
  • Mail it to the state office at:
  • Health and Human Services CommissionP.O. Box 149024

How Can Tanf And Medicaid Affect My Child Support

Everything you Need to Know About Texas Medicaid

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.

Read Also: If You Are On Disability Are You Eligible For Medicaid

Services Covered By Medicaid And Chip

  • Regular checkups at the doctor and dentist
  • Medicine and vaccines

Learn about Medicaid programs for children and adults with disabilities.

CHIP does not cover long-term services and supports.

If you have a child with a disability and make too much money to get Medicaid, you might be able to get coverage through the Medicaid Buy-In for Children program. MBIC allows families of children with disabilities to make a monthly payment to get Medicaid coverage.

Learn about other programs and services for people with disabilities.

Potential Expansion Effects On Personal Finances And Employment

Forty-two percent of low-income Texans currently not enrolled in Medicaid felt that gaining Medicaid would help their financial situation, compared with only 9 percent who said it would worsen their financial situation . This finding is consistent with evidence supporting that Medicaid expansion reduces out-of-pocket medical expenditures and medical debt, improving individuals personal finances.8

Most low-income Texans said gaining Medicaid would have no impact on whether they work. Only 3 percent of low-income Texans felt that gaining Medicaid would make them less likely to work or keep working, while 19 percent said it would make them more likely to work.

Currently, many states are considering implementing work requirements in their Medicaid programs. Advocates of work requirements in Medicaid argue that they will improve health and increase employment. However, recently published evidence from our survey shows that Arkansass implementation of work requirements in 2018 led to a significant loss of coverage without an increase in employment, and more than 95 percent of individuals subject to the policy were already meeting or exempt from the work requirements.9 Since then, the courts have blocked work requirements in Arkansas, Kentucky, and New Hampshire because of concerns about loss of coverage in Arkansas and whether work requirements are in keeping with the stated goals of Medicaid.

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Common Questions And Answers About A Qualified Income Trust

Q: Do I have to deposit all of my income into the trust?

A: No, in Texas, you dont have to deposit your entire income. You can deposit a portion of your income thereby bringing your eligible income below the cap. However, you do have to deposit the entirety of income from any single source.

Q: What about any income I dont deposit into the trust?

A: If you put only a portion of your income into a QIT, you generally wont be keeping the remainder. As with the fund, you are allowed a small personal needs allowance and a contribution to your spouses MMNA, but the rest is going to go towards your nursing home bill.

Q: Do nursing homes and assisted living communities accept Medicaid?

A: Yes, most nursing homes and assisted living facilities accept Medicaid.

Q: Will a QIT help me protect my assets?

A: Not exactly. A QIT is a solution for income above Medicaid limits. Assets raise a separate issue. The QIT can help you avoid spending down your assets on care, but its not a way to shelter assets.

There are a number of ways to manage assets outside of the QIT. A Ladybird deed, for example, allows you to transfer ownership interests in real estate upon the death of the owners and protect this interest from Medicaid recovery efforts. You might want to use options like this in conjunction with a QIT.

Q: What can I do if my assets are too high for Medicaid?

The Texas Medicaid Application

What Is Texas Medicaid? | Texas Medicaid Works

To apply for Texas Medicaid, go to 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.

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Medicaid Spending In Texas

This article does not contain the most recently published data on this subject. If you would like to help our coverage grow, consider donating to Ballotpedia.

Medicaid spending in Texas
  • 9Footnotes
  • Texas’Medicaid program provides medical insurance to groups of low-income people and individuals with disabilities. Medicaid is a nationwide program jointly funded by the federal government and the states. Medicaid eligibility, benefits, and administration are managed by the states within federal guidelines. A program related to Medicaid is the Children’s Health Insurance Program , which covers low-income children above the poverty line and is sometimes operated in conjunction with a state’s Medicaid program. Medicaid is a separate program from Medicare, which provides health coverage for the elderly.

    This page provides information about Medicaid in Texas, including eligibility limits, total spending and spending details, and CHIP. Each section provides a general overview before detailing the state-specific data.


  • Texas had not expanded Medicaid under the Affordable Care Act as of June 2017.
  • Texas GovernorGreg Abbott expressed opposition to Medicaid expansion in 2015 when he called it a “massive expansion of an already broken and bloated Medicaid program.”
  • Missing Out On Billions In Federal Funding

    By refusing Medicaid expansion under the ACA, Texas has already missed out on billions in federal funding that would otherwise have flowed to the state to provide medical care for their low-income residents. And in addition, the states emergency rooms are providing $5.5 billion in uncompensated care each year, treating patients who dont have health insurance. If Medicaid eligibility had been expanded, uncompensated care would have dropped considerably, so hospitals and business groups across the state have been pressuring lawmakers to relent on their opposition to Medicaid expansion.

    Because Texas has refused to expand Medicaid, the federal government has warned the state that continued access to federal funding to help cover uncompensated care is in jeopardy . But Governor Greg Abbott has continued to reject Medicaid expansion, and described the federal governments tactics as coercive .

    Since residents in states not expanding Medicaid still have to pay federal taxes, there has been a significant outflow from Texas residents to fund Medicaid expansion in other states. Over a decade , Texas residents will pay $36.2 billion in federal taxes that will be used to pay for Medicaid expansion in other states.

    This is by far the highest of any state the next highest is Florida, where residents will pay just over $20 billion to pay for other states Medicaid expansion by 2022 .

    Read Also: Medicaid For Kids With Special Needs


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