Applying For Medicaid In Texas
If youre living in Texas and need to apply for Medicaid benefits, you will need to apply online at the Your Texas Benefits website. You can also print off and fill in a paper application form, and then mail it to the center.
Before you apply for this program, seniors are encouraged to double check that they are truly eligible for the program they are applying for. If you need to meet certain requirements then you will need to make sure all of that information is in order before applying.
If you have income or assets over the allowed limit for qualifying, it is encouraged that you consider something called Medicaid Planning. This is a program run by volunteers and professionals to help individuals to prepare for applying for Medicaid.
This could include getting all the right documents in order, or restructuring their finances so that they meet the eligibility requirements. Sometimes finances become complicated when it comes to Medicare and Medicaid so that is why professionals help individuals to financially plan and prepare for Medicare.
What Is Texas Medicaid
Texas Medicaid encompasses a variety of programs to provide financial health care coverage to eligible individuals throughout the state. Providing coverage for families, individuals and older adults, Texas Medicaid strives to preserve the well-being of Texans by providing quality health care services that can be accessed within beneficiaries communities.
In Texas, there are five types of Medicaid coverage:
- Traditional Medicaid
Each of the STAR programs provides managed care for recipients. While STAR, STAR Kids and STAR Health offer services for families, kids and pregnant women, STAR+PLUS features managed care for those aged 65 and older and individuals who are living with disabilities. Traditional Medicaid covers individuals who arent eligible for managed care.
What Is The Texas Health Information Counseling And Advocacy Program
If you are eligible for Medicare, the Texas’ Health Information, Counseling and Advocacy Program can help you enroll, find information and provide counseling about your options. This partnership between the Texas Health and Human Services system, Texas Legal Services Center and the Area Agencies on Aging trains and oversees certified benefits counselors across the state.
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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
Who Meets The Requirements For Medicaid In Texas
Are you eligible for Medicaid as a patient who resides in the state of Texas? Medicaid benefits eligibility apply to many different groups. However, note that Medicaid eligibility is a state-specific decision, so a petitioner must ensure that he or she meets all of the requirements determined by the Lone Star State.
You can explore the different Medicaid requirements by downloading our informative guide.
The following groups are able to qualify for Medicaid benefits in Texas:
- Children Parents can opt into Childrens Medicaid, the Childrens Health Insurance Program or the Medicaid Buy-In for Children.
- Women & pregnant women both low-income and those interested in CHIP perinatal coverage can qualify for Medicaid coverage in TX. In addition, women with cervical cancer or breast cancer can receive Medicaid benefits. Still, there is a program entitled Healthy Texas Women in which you may be able to enroll.
- Young adults and families If the applicant is are an adult caring for a child, a former child of foster care or a transitioning foster care child, you are eligible for Medicaid in Texas.
- The elderly and the disabled The Medicaid eligibility requirements for patients of this nature apply to programs for long-term care, those who receive Supplemental Security Income and both the Medicaid and Medicare Buy-In Programs.
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Where To Submit Your Medicaid Application
You can submit your application in the following ways.
- Mail The PO Box is found on the 1st page of the Medicaid application.
- Fax You can also find the fax number on the 1st page of the application.
- In-person Refer to the section below to find a Houston Medicaid office, call 211 or visit Your Texas Benefits.
- Online If you change your mind and want to complete the Medicaid application online, visit Your Texas Benefits.
- Phone You also call 877.541.7905 to apply for Medicaid.
Note: If you do not feel safe visiting a Medicaid office due to COVID 19, consider applying by mail or online.
Can My Parents Kick Me Out If I Get Pregnant Or If I Get Someone Else Pregnant
In Texas, parents are legally responsible for their children, including providing for their childrens basic needs, such as housing, clothing, medical care, and food. A parent cannot neglect his or her child because the child becomes pregnant, gets another person pregnant, or becomes a parent. If so, that parent would be subject to neglect of a child, which is subject to criminal laws and an investigation by Child Protective Services .
If you are fearful about what your parent might do if they find out you are pregnant or that you got someone else pregnant, visit Janes Due Processs extensive list of resources and information here.
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Gather Information About Your Family And The People You Live With
You might be single. You might live with your spouse and children. You might care for your grandchildren, nieces or nephews. Maybe you pay child support to minors who live in another city or state.
Every living situation is different. Thats why the application asks for information about your family, children under age 21 and others in the household.
The information you provide to Texas Health and Human Services:
- determines what type of healthcare or insurance you qualify for
- lets them know if you can get help paying for healthcare
- is kept private and secure
Use this application for:
- your childreneven if you are not eligible
- anyone who has coveragethey might qualify for lower-cost care
- family members who are immigrants
What if you do not have some of the information requested on the form? Just leave that part blank. Someone from Texas Health and Human Services will be in touch with you within a few weeks to go over your application.
You will need information and documents such as:
- Social Security numbers
- document numbers for legal immigrants
- employer information, such as address and phone number
- income information, such as pay stubs, W-2 forms, or wage and tax statements
- policy numbers for any health insurance you or others have
- birth dates for yourself and any children on the application
- your total current income from jobs and other sources
- the approximate value of things you own, such as car or house
- how much money you pay each month for bills
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 .
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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 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
What Services Does The Partnership Provide
- Medicare and Medicaid information and education
- Help with original Medicare eligibility, enrollment, benefits, complaints, rights and appeals
- Explain Medicare Supplemental insurance policy benefits and comparisons
- Explain Medicare Advantage and provide comparisons and help with enrollment and disenrollment
- Explain Medicare Prescription Drug coverage, help compare plans and search for other prescription help
- Information about long-term care insurance
The partnership also helps with the following programs. Benefit Counselors are specially trained to help you understand all the fine print to find and apply to a plan that works for you. They advocate for you with these programs and help you get the services you need.
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How To Apply For Medicaid And Chip
The new year is almost here. Will your health insurance needs change in 2021?
You might be pregnant and need help with doctor bills. Maybe you lost your joband your health insuranceduring the pandemic. Your employer might be raising the amount you have to pitch in for insurance, doctor visits or medication next year.
If you want help with health care costs, help is here. You and your family might be able to receive free or low-cost health care through the Texas Medicaid and Childrens Health Insurance Program .
Ready to learn more? Here are the steps to follow.
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What Does Medicaid Offer Children With Disabilities Or Special Health Care Needs
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.
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Mothers Find Their Own Stopgaps In The Face Of Crisis
The urgent need to fix the gaps in postpartum care has captured the attention of national reformers, who see it as a critical step toward narrowing racial disparities in maternal mortality. Several 2020 Democratic presidential candidates have proposed federal legislation to extend pregnancy Medicaid to a full year postpartum, and state lawmakers have introduced a wave of similar bills. Missouri passed a limited extension last year and Illinois a far more sweeping one this past July both plans are awaiting federal approval.
The enthusiasm extended to Texas, where a broad coalition, led by the maternal mortality review task force, came together this past legislative session to support a full-year extension. The effort passed the House but stalled in the Senate. All the oxygen in the room this session was taken up by school finance reform, the legislative priority of the states top Republicans, said Tim Schauer, an Austin-based lobbyist on womens health issues.
The five-year cost of extending postpartum coverage was estimated at nearly $1 billion in state and federal funds, according to Politico. Rep. Shawn Thierry , who introduced one of the extension bills, had to counter skeptics who thought that the states alarming maternal mortality numbers were, as she said, kind of a hoax and that increasing benefits for new mothers was just a stealth tactic aimed at expanding Medicaid more widely.
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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 Are My Next Steps
If you would like to apply or reapply for Medicaid, your next step is to get a QIT.
Medicaid may cover past medical expenses, schedule a consultation to see if you can have those expenses reimbursed. If you have all the documentation, we can prepare your application in a matter of days.
If you need Medicaid for long-term care and dont want to be denied, Holman Law provides expert advice on Qualified Income Trusts and long-term care planning. Schedule a free consultation today.
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What Is Defined As Income
When you are applying for Medicare and Medicaid benefits, one of the most important components that will be reviewed is your income. Income level is what qualifies or disqualifies a person, usually, for these benefits.
When it comes to applying for Medicaid, any income a person receives from any source is counted as income for this type of benefit. This included employment wages, alimony payments, pension payments, social security income or even investment dividend income.
If only one spouse in a couple is applying for these benefits then only that spouses income will be counted for the application. The spouse that is not applying may be able to get an allowance that will prevent spousal impoverishment from happening.
There are income limits in Texas on the non-applicant spouse, though. In order to determine if you are eligible for non-applicant spousal benefits or allowance, you will need to contact your Medicaid center to talk about your specific situation.
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What Is Medicaid Buy
There are 2 Medicaid Buy-In programs:
- Medicaid Buy-In for Children allows families who meet income requirements to buy Medicaid coverage for children age 18 or younger with disabilities or special health care needs.
- Medicaid Buy-In allows adults age 19 and older who have disabilities or special health care needs and earn a certain amount of income through a job to buy Medicaid coverage.
How Many People Are On Medicaid
According to the Centers for Medicare & Medicaid Services, as of November 2020, here are the number of people enrolled in Medicaid and Chip in the entire United States:
- 78,521,263 individuals were enrolled in Medicaid and CHIP
- 72,204,587 individuals were enrolled in Medicaid
- 6,695,834 individuals were enrolled in CHIP
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People Who Have Both Medicare & Medicaid
People who have both Medicare and full Medicaid coverage are dually eligible. Medicare pays first when youre a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.
If you choose to join a Medicare Advantage Plan, there are special plans for dual eligibles that make it easier for you to get the services you need, include Medicare coverage , and may also cost less, like:
- Special Needs Plans
- Medicare-Medicaid Plans
- Program of All-Inclusive Care for the Elderly plans can help certain people get care outside of a nursing home