Last Updated: November 2025
Texas Medicaid provides free health coverage to low-income families, children, pregnant women, seniors, and people with disabilities.
The program is run by Texas Health and Human Services (HHS). Over 5 million Texans receive Medicaid benefits each year.
Quick Facts About Texas Medicaid:
- Children under 19 can qualify with a family income up to 138%–203% of the Federal Poverty Level
- Pregnant women qualify with income up to 203% FPL (about $5,438/month for a family of 4)
- Postpartum coverage now lasts 12 months after delivery
- Children get 12 months of continuous coverage once approved
- No asset test for most Medicaid groups
- Texas has not expanded Medicaid to cover childless adults
Ready to see if you qualify? view the 2025 income limits by family size.
What Is Texas Medicaid?
Texas Medicaid is a state and federal health insurance program. It pays for medical care for people who meet income and category requirements.
Medicaid differs from Medicare. Medicare is for people 65 and older. Medicaid is for low-income residents of any age who fit specific groups.
Texas HHS manages the program. Most members join a managed care plan. These plans coordinate all your health services.
Who Qualifies for Texas Medicaid?
Texas Medicaid covers specific groups of people. You must fit into one of these categories to qualify.
Eligible Groups Include:
- Children under age 19
- Pregnant women
- Parents or caregivers with dependent children
- Adults age 65 and older
- People with disabilities
- Children and youth in foster care
- Former foster youth ages 18–25
Texas did not expand Medicaid. This means most adults without children do not qualify. This is true even if their income is very low.
Documents You May Need:
- Social Security numbers for all applicants
- Proof of income (pay stubs, tax returns)
- Proof of Texas residency (utility bill, lease)
- Birth certificates or proof of citizenship
- Immigration documents (if applicable)
Parents can also explore children’s coverage through CHIP.
Texas Medicaid Income Limits 2025
Income limits depend on your household size. They also depend on which group you belong to. Texas uses the Federal Poverty Level (FPL) to set limits.
2025 Monthly Income Limits by Household Size:
| Eligibility Group | % of FPL | 1 Person | 2 People | 3 People | 4 People |
|---|---|---|---|---|---|
| Children Under 1 | 203% | $2,647 | $3,578 | $4,508 | $5,438 |
| Children Ages 1–5 | 149% | $1,942 | $2,626 | $3,309 | $3,991 |
| Children Ages 6–18 | 138% | $1,799 | $2,432 | $3,064 | $3,697 |
| Pregnant Women | 203% | $2,647 | $3,578 | $4,508 | $5,438 |
| CHIP (Children) | 206% | $2,686 | $3,631 | $4,575 | $5,518 |
| Parents/Caregivers | ~17% | $168–$410 | Varies | Varies | Varies |
| Aged, Blind, Disabled | — | $994 | $1,491 | — | — |
| Nursing Home Care | — | $2,901 | $5,802 | — | — |
Key Points About Income:
- Texas uses MAGI (Modified Adjusted Gross Income) for most groups
- No asset test for children, pregnant women, or parents
- Parent income limits are very low (about 17% of FPL)
- Nursing home applicants have a $2,000 asset limit
View the complete 2025 Texas Medicaid income limits by family size.
How to Apply for Texas Medicaid
You can apply for Texas Medicaid in four ways. Online is the fastest method.
Online Application: Visit YourTexasBenefits.com. You can also use the Your Texas Benefits mobile app. The app is free on Google Play and iTunes.
By Phone: Call 2-1-1 (TTY 711). Select Option 2 for health benefits. Lines are open Monday–Friday, 8 a.m.–6 p.m. Central Time.
By Mail: Download the application from YourTexasBenefits.com. Mail it to: Texas Health & Human Services P.O. Box 149024 Austin, TX 78714-9024
In Person: Visit a local HHSC benefits office. Find locations at yourtexasbenefits.com or call 2-1-1.
Processing Times:
- Standard applications: 45 days (federal rule)
- Pregnancy Medicaid: 15 days
- Disability applications: 90 days
- Current average: 59–71 days due to backlogs
Get step-by-step help to apply for Texas Medicaid online.
Texas Medicaid Benefits & Coverage
Texas Medicaid covers a wide range of health services. Benefits vary slightly by plan and age group.
Medical Services Covered:
- Doctor visits (primary care and specialists)
- Hospital care (emergency and planned)
- Prescription drugs
- Lab tests and X-rays
- Mental health and counseling
- Substance abuse treatment
- Home health services
- Medical equipment
- Physical, occupational, and speech therapy
Preventive Care:
- Annual checkups
- Immunizations
- Well-child visits (Texas Health Steps)
- Family planning services
- Prenatal and postpartum care
Dental and Vision:
- Dental exams, cleanings, and extractions
- One pair of eyeglasses per year
- Eye exams for children
What Medicaid Does NOT Cover:
- Cosmetic procedures
- Most fertility treatments
- Experimental treatments
Review all Texas Medicaid covered benefits. Learn about dental coverage under Medicaid.
Texas Medicaid Managed Care Plans
Most Texas Medicaid members must join a managed care plan. Each plan is run by a health insurance company called an MCO.
STAR Program: For children, pregnant women, and parents. Covers basic medical, dental, and vision care.
STAR+PLUS Program: For adults with disabilities and seniors 65+. Includes long-term care services like nursing home care and home health aides.
STAR Kids Program: For children and youth under 21 with disabilities. Covers acute care plus therapies and medical equipment.
STAR Health Program: For children in foster care. Run by Superior HealthPlan statewide. Includes special services for foster youth.
Value-Added Benefits: Many plans offer extra perks. These may include:
- Extra dental coverage ($500–$750/year)
- Vision upgrades ($150/year)
- Over-the-counter allowances
- Rewards for health checkups
- Telehealth services
Compare Texas Medicaid managed care plans to find the best fit for your family.
Special Coverage Programs
Texas offers several specialized Medicaid programs for specific needs.
CHIP (Children’s Health Insurance Program): For children in families with slightly higher incomes. Covers kids up to 206% FPL. Low monthly premiums apply.
Pregnancy Medicaid: Covers prenatal care, delivery, and 12 months of postpartum care. Income limit is 203% FPL. No waiting period.
Emergency Medicaid: For people who need emergency care but don’t qualify for regular Medicaid. Covers life-threatening conditions only. Available to undocumented immigrants for emergencies.
Long-Term Care: For nursing home residents and people needing home-based care. Income limit is $2,901/month for individuals.
Learn about children’s coverage through CHIP, Texas Medicaid for pregnant women, and emergency Medicaid for urgent needs.
Find Texas Medicaid Providers
Once approved, you need to find doctors who accept Medicaid.
How to Find Providers:
- Log into your managed care plan’s website
- Use the “Find a Provider” search tool
- Search by location, specialty, or language
- Call the number on your Medicaid card for help
Provider Search Tools:
- Superior HealthPlan: superiorhealthplan.com
- Texas Children’s Health Plan: texaschildrenshealthplan.org
- TMHP Provider Lookup: opl.tmhp.com
About 65% of Texas doctors accept Medicaid patients. Rural areas may have fewer options.
Search for Medicaid doctors and dentists in your area.
Medical Transportation Services
Texas Medicaid provides free rides to medical appointments. This is called Non-Emergency Medical Transportation (NEMT).
What’s Covered:
- Rides to doctor visits, hospitals, and pharmacies
- Bus passes and mass transit
- Wheelchair-accessible vehicles
- Mileage reimbursement if you drive yourself
- Meals and lodging for long trips (children under 21)
How to Schedule:
- Book rides at least 2 days in advance
- STAR members: Call Modivcare at 1-866-824-1565
- Other plans: Call your MCO’s member services
Ambulance services are not included in NEMT. Learn more about Texas Medicaid transportation services.
Medicaid Renewal Requirements
Texas Medicaid requires annual renewal. You must respond to renewal notices to keep coverage.
Renewal Process:
- HHSC sends a yellow envelope marked “Action Required”
- You have 10 days to respond
- Renew online, by phone, mail, or in person
- Submit any requested documents
Continuous Coverage Rules:
- Children under 19 get 12 months of guaranteed coverage
- Adults must renew as scheduled
- Report income and household changes within 10 days
What Happens If You Don’t Renew: Your coverage will end. You must reapply to get benefits back.
Get help with renewing your Texas Medicaid coverage.
Frequently Asked Questions
What is the income limit for Medicaid in Texas?
Income limits vary by group. Children can qualify with family income up to $3,697–$5,438/month (family of 4). Parents have very low limits around $168–$410/month. Pregnant women qualify up to $5,438/month.
How long does Texas Medicaid approval take?
Federal rules require 45 days for most applications. Pregnancy Medicaid should take 15 days. Current wait times average 59–71 days due to backlogs.
Does Medicaid cover adults in Texas?
Only certain adults qualify. This includes parents with children, seniors 65+, and people with disabilities. Texas did not expand Medicaid to cover childless adults.
Can you have Medicaid and private insurance together?
Yes. Medicaid can work alongside private insurance. Medicaid often pays costs that private insurance doesn’t cover.
What does Medicaid cover for pregnant women?
Pregnancy Medicaid covers all prenatal visits, delivery, and 12 months of postpartum care. It also covers mental health services, prescriptions, and dental care.
Is there a waiting period for Texas Medicaid?
No. Coverage begins immediately after approval or the first of the next month.
Resources and Contact Information
Apply for Benefits:
- Website: YourTexasBenefits.com
- Phone: 2-1-1 (select Option 2)
- TTY: 711
Texas Health and Human Services:
- Website: hhs.texas.gov
- Medicaid information: hhs.texas.gov/services/health/medicaid-chip
Report Fraud:
- Phone: 1-800-436-6184
- Website: oig.hhsc.texas.gov/report-fraud
Need help with coverage? Check your eligibility now or apply for Medicaid today.
This guide uses official information from Texas Health and Human Services, TMHP, and Medicaid.gov. Always verify current requirements at YourTexasBenefits.com.
