Last Update: 26 December by Akash Biswas
Medicaid in Texas offers health coverage to people with low income who fit certain groups. It pays for doctor visits, hospital stays, and other care.
The rules for 2026 matter because income limits and other details update each year based on federal guidelines. Texas keeps tight rules since it has not expanded Medicaid under federal law.
This means not everyone with low income qualifies. Eligibility depends on your category, like being a child, pregnant, or disabled. It also looks at your income, household size, and sometimes assets.
A larger household often means a higher income limit. Age plays a role too, with kids having looser rules than adults.
Always check your own situation, as rules can vary. No one gets automatic coverage; you must apply and meet all tests.
What Is Medicaid in Texas?
Medicaid is a state and federal program that helps pay for health care. In Texas, it’s run by the Health and Human Services Commission. It serves millions of people each year.
The program covers basics like check-ups, prescriptions, and emergency care. Some get extra help for long-term needs.
Texas Medicaid focuses on specific groups with the greatest needs. This includes kids, pregnant women, families with low income, older adults, and those with disabilities.
It does not cover most working adults without kids. Texas has not expanded Medicaid to include more adults, unlike many other states.
This keeps eligibility narrow. The goal is to support vulnerable people while controlling costs. If you qualify, it can save you money on medical bills.
Has Texas Expanded Medicaid for 2026?
No, Texas has not expanded Medicaid for 2026. It remains one of the states that chose not to broaden coverage under the Affordable Care Act.
This means most adults without children or disabilities do not qualify based on income alone. Expansion would cover adults up to 138% of the federal poverty level, but Texas sticks to older, stricter rules.
Lawmakers have debated it, but no change happened by late 2025. This affects millions who might get help in other states.
If you are an adult with low income but no qualifying category, look at other options like marketplace plans.
Who Is Eligible for Medicaid in Texas in 2026?
Texas Medicaid groups people by categories. You must fit one and meet income rules for your household size. Here are the main groups:
- Children: Kids under 19 often qualify if family income is up to certain levels tied to the federal poverty level (FPL). Babies under 1 can qualify at a higher income than older kids.
- Pregnant women: Coverage lasts through pregnancy and 12 months after birth. Income limits are higher than for other adults, often around 198% of FPL.
- Parents and caretakers: This covers adults caring for kids under 19. Income must be very low, often below 17% of FPL for a family. Not all parents qualify.
- Seniors (65 and older): They must have low income, around 74% of FPL, and limited assets. This group often needs help with nursing home care.
- People with disabilities: Adults or kids with disabilities can qualify if they meet income and asset tests. Disability must be verified by Social Security or state rules.
Remember, meeting a category is just the start. Income, household size, and residency matter too. U.S. citizens or certain immigrants can apply. Check official sites for your case.
How Household Size Affects Medicaid Eligibility in Texas
Household size means the number of people who live together and share finances. Medicaid, it often includes parents, spouses, and children under 19.
Siblings and stepparents count too if they file taxes together. Grandparents or other relatives might not, unless they claim the person on taxes.
A bigger household raises the income limit. For example, a family of four can earn more than a single person and still qualify. Limits are based on federal poverty levels, which adjust by size.
A household of one might need an income under a low amount, while a household of five gets a higher cap.
Rules vary by program. For kids’ Medicaid, it looks at the child’s household. For parents, it’s the whole family. Report your household right to avoid mistakes. Wrong info can lead to denial or loss of benefits. Use state tools to figure your size.
Medicaid Income Limits in Texas in 2026
Income limits tie to your eligibility group and household size. They are percentages of the federal poverty level (FPL), which updates yearly. Texas has some of the lowest limits in the U.S. because of no expansion.
For kids, limits range from 133% to 198% of FPL based on age. Pregnant women often qualify up to 198% FPL.
Parents face stricter rules, around 17% FPL. Seniors and disabled people need income below about 74% FPL or SSI levels.
Limits rise with household size. Count gross income before taxes, like wages and benefits. Some income does not count, like certain aid.
Check the latest FPL chart on the state website for exacts, as they change each year. Always verify with official sources.
Asset Limits for Texas Medicaid (Seniors and Disabled)
Asset rules apply mainly to seniors and people with disabilities. These are things you own that count toward limits.
A single person can have up to $2,000 in countable assets. For couples, it’s $3,000 if both apply.
Countable assets include bank accounts, stocks, and extra cars. Exempt items are your home, one car, and personal items. For married couples, the healthy spouse can keep more, up to about $162,660 in 2026. This protects them from poverty.
Kids and pregnant women usually have no asset test. If assets are over, you might need to spend down. Get advice from experts.
Who Does NOT Qualify for Medicaid in Texas?
Many people do not qualify, even with low income. Adults without kids or disabilities often miss out due to no expansion.
If your income tops the limit for your group and household size, you are out. Non-citizens without qualifying status cannot get full benefits.
People who do not live in Texas full-time are ineligible. Those with too many assets, like seniors over $2,000, get denied. False info on applications leads to rejection.
Texas rules are strict, so many working adults turn to other help. Always apply if unsure, denial does not hurt.
Special Medicaid Programs in Texas
Texas has extra programs beyond basic Medicaid. CHIP covers kids in families too rich for Medicaid but still low-income. Limits go up to 201% FPL for some ages.
Pregnancy Medicaid helps women during and after birth, with higher income caps. It covers prenatal care and more.
Long-term care programs aid seniors and disabled at home or in facilities. Waivers like STAR+PLUS offer services to stay out of nursing homes. Income and assets apply here too.
These programs fill gaps. Ask about them when you apply.
How to Check Medicaid Eligibility in Texas
Use the state’s online tool at YourTexasBenefits.com to screen yourself. Answer questions on income, household, and category. It gives a quick idea if you might qualify.
Call 2-1-1 for help or visit a local office. They can explain rules. Bring ID, pay stubs, and household info. Checking first saves time on applications.
How to Apply for Medicaid in Texas
Apply online at YourTexasBenefits.com, it’s fast and easy. You can also call 2-1-1 or 877-541-7905. Mail a paper form or go to a county office.
Gather Social Security numbers, birth dates, income proof, and residency docs. Immigrants need status papers. The state reviews in 45 days or less for most.
Track your case online. If approved, pick a health plan. Renew yearly to keep coverage.
What to Do If You Are Not Eligible
Look at CHIP if you have kids, it has higher income limits. For adults, try Affordable Care Act marketplace plans at HealthCare.gov. You might get subsidies.
Community clinics offer low-cost care. Programs like county indigent health help too. Do not skip check-ups; find free screenings. Reapply if your situation changes, like income drops.
Frequently Asked Questions (FAQs)
How is household size figured for Medicaid?
It includes you, your spouse, and kids under 19 you claim on taxes. Relatives like grandparents may not count unless dependent.
What are the income limits?
They vary by group. Kids can qualify up to 198% FPL, but parents much lower. Check state charts for your household.
Can adults without kids get Medicaid?
Usually no, unless disabled or over 65 with low income. Texas’s rules are tight.
Does pregnancy help with eligibility?
Yes, pregnant women get coverage up to higher income levels, lasting 12 months after birth.
What about assets for seniors?
Seniors can have $2,000 in countable assets. Homes and cars are often exempt.
How often do rules change?
Income limits update yearly with FPL. Texas has no expansion plans for 2026.
What if I’m an immigrant?
Some qualify after five years in the U.S., but rules vary. Emergency care is open to more.
Can I appeal a denial?
Yes, request a fair hearing within 90 days. Get free help from advocates.
Key Takeaways
Texas Medicaid bases eligibility on categories like kids or the disabled. Household size raises income limits for bigger families. Rules are strict with low caps. Always verify your info and apply to check.
