Navigating healthcare options can feel overwhelming, but Texas offers Medicaid to provide low-income individuals and families with access to essential medical services. As of April 10, 2025, this guide breaks down the steps to apply for Medicaid in Texas, eligibility requirements—including a clear income eligibility chart—and key resources, all with factual details and hyperlinked sources.

Who Qualifies for Medicaid in Texas?

Medicaid eligibility in Texas depends on income, household size, and specific categories like age, disability, or family status. The program is managed by the Texas Health and Human Services Commission (HHSC) under federal guidelines from the Social Security Act, Title XIX. Texas has not expanded Medicaid under the Affordable Care Act, so coverage for childless adults is limited unless they qualify through disability or other exceptions. Eligible groups include:

• Children: Under 19, with income limits tied to the Federal Poverty Level (FPL).
• Pregnant Women: Up to 198% of FPL for prenatal and postpartum care.
• Parents/Caretakers: With dependent children, income below strict limits (e.g., ~14% FPL).
• Seniors and People with Disabilities: Must meet income and asset tests, often linked to Supplemental Security Income (SSI).
• Former Foster Care Youth: Up to age 26 if in Texas foster care at 18.

Check eligibility details at HHSC’s Medicaid Overview.

Income Eligibility Chart

Income limits for Texas Medicaid are based on a percentage of the 2025 Federal Poverty Level (FPL), set by the U.S. Department of Health and Human Services. The FPL adjusts annually; for 2025, it’s $15,650 for an individual and $21,150 for a couple in the 48 contiguous states, with an additional $5,500 per person beyond two. Below is a simplified chart showing monthly income limits for key Medicaid categories in Texas:

Texas Medicaid Income Eligibility Chart (2025)

Notes: Monthly FPL = Annual FPL ÷ 12. 2025 FPL is $15,650 for one person, $21,150 for two, plus $5,500 per additional person. *Seniors/Disabled may have higher limits (e.g., $2,901/month for long-term care) per Medicaid Planning Assistance. Add ~$933/month per additional person beyond five. Verify at YourTexasBenefits.

Notes:

• Monthly FPL = Annual FPL ÷ 12. For example, 100% FPL for one person is $15,650 ÷ 12 = ~$1,304.
• *Seniors/Disabled may have higher limits (e.g., $2,901/month for long-term care) based on 300% of the Federal Benefit Rate (FBR), per Medicaid Planning Assistance.
• Add ~$933/month per additional person beyond five (based on 2025 FPL increment).

These are general thresholds; exact eligibility may vary by program or circumstances. Use the YourTexasBenefits Screening Tool for a personalized check.

What Does Medicaid Cover?

Texas Medicaid, detailed in the Texas Medicaid Provider Procedures Manual, covers:

• Doctor visits, hospital stays, and emergency care.
• Prescriptions and medical supplies.
• Preventive services (e.g., vaccines, checkups).
• Maternal and newborn care.
• Mental health and substance use treatment.

Coverage depends on the plan (e.g., STAR for kids, STAR+PLUS for seniors), assigned after approval.

Steps to Apply for Medicaid

Follow these steps to apply in Texas:

Step 1: Gather Required Documents

You’ll need:

• Proof of identity (e.g., birth certificate, ID).
• Texas residency (e.g., utility bill).
• Income (e.g., pay stubs, tax returns).
• Household details (e.g., birth certificates for kids).
• Social Security numbers.

See the full list at HHSC’s Application Checklist.

Step 2: Choose an Application Method

Options include:

• Online: YourTexasBenefits.com—quickest method.
• Phone: Call 2-1-1 or 1-877-541-7905 for help or a paper form.
• In Person: Visit an HHSC office—find one at Office Locator.
• Mail/Fax: Download from HHSC Forms and submit as directed.

Step 3: Submit Your Application

Submit online, by mail, or in person. Online tracking is available at YourTexasBenefits.com. Processing takes 45 days (90 for disability cases), per 42 CFR § 435.911.

Step 4: Receive a Decision

You’ll be notified by mail or email. If approved, select a health plan and get an ID card. If denied, appeal within 90 days via HHSC Appeals.

Tips for a Smooth Application

• Verify Income: Compare your income to the chart above or use the screening tool.
• Apply Early: Avoid delays by submitting promptly.
• Get Help: Call 2-1-1 or visit a Community Partner.

After You’re Approved

To keep coverage:

• Report changes (e.g., income, address) within 10 days at YourTexasBenefits.com.
• Renew annually when notified by HHSC.

Find providers via your plan’s directory or Texas Medicaid Provider Search.

Conclusion

Applying for Medicaid in Texas means meeting income limits—like those in the chart above—gathering documents, and submitting through YourTexasBenefits.com or other methods. With coverage for doctor visits, prescriptions, and more, Medicaid supports millions of Texans. Start by checking your eligibility today or call 2-1-1 for assistance—healthcare access is within reach!

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