Medicaid provides health coverage to millions of eligible low-income individuals and families in Texas. To qualify for Medicaid, applicants must meet certain income limits that are based on the Federal Poverty Level (FPL). This article explains Medicaid eligibility in Texas, including the income limits for 2024.
What is Medicaid Texas?
Medicaid is a public health insurance program that provides coverage for healthcare services to low-income individuals and families. It is jointly funded by the state and federal government.
In Texas, the Medicaid program is administered by the Texas Health and Human Services Commission (HHSC). Medicaid serves various populations in Texas, including:
- Children
- Pregnant women
- Parents and caretaker relatives
- Older adults
- People with disabilities
Medicaid covers a comprehensive range of medical benefits like doctor visits, hospital care, prescriptions, mental health services, and more. Some Medicaid enrollees also get dental, vision, and transportation services.
Medicaid Income Limits in Texas 2024
To qualify for Medicaid in Texas, applicants must meet certain financial eligibility criteria, including income limits based on the Federal Poverty Level (FPL).
The income limits can vary depending on:
- Household size
- Age and pregnancy status
- Medicaid eligibility group
Below are the Medicaid income limits for common household sizes in Texas for 2024.
| Type of Medicaid | Household Size | Maximum Income Level (Per Year) | Maximum Income Level (Per Month) | Asset Limit |
|---|---|---|---|---|
| Nursing Home Medicaid | 1 | $33,948 | $2,829 | $2,000 |
| Nursing Home Medicaid | 2 | $67,896 | $5,658 | $3,000 |
| Medicaid Waivers / Home and Community Based Services | 1 | $33,948 | $2,829 | $2,000 |
| Medicaid Waivers / Home and Community Based Services | 2 | $67,896 | $5,658 | $3,000 |
| Regular Medicaid / Aged Blind and Disabled | 1 | $11,316 | $943 | $2,000 |
| Regular Medicaid / Aged Blind and Disabled | 2 | $16,974 | $1,415 | $3,000 |
Medicaid Income Limits for 2024
Below is the Texas medicaid eligibility income chart 2024.
| Household Size | Maximum Income Level (Per Year) | Maximum Income Level (Per Month) |
|---|---|---|
| 1 | $28,869 | $2,322 |
| 2 | $39,046 | $3,254 |
| 3 | $49,223 | $4,102 |
| 4 | $59,400 | $4,950 |
| 5 | $69,578 | $5,882 |
| 6 | $79,755 | $6,646 |
| 7 | $89,932 | $7,494 |
| 8 | $100,109 | $8,342 |
Income limits are based on 2024 Federal Poverty Level guidelines. Limits are updated annually.
- For a household size of 1, the maximum income level is $28,869 per year.
- For a household size of 2, the maximum income level is $39,046 per year.
- For a household size of 3, the maximum income level is $49,223 per year.
- For a household size of 4, the maximum income level is $59,400 per year.
- For a household size of 5, the maximum income level is $69,578 per year.
- For a household size of 6, the maximum income level is $79,755 per year.
- For a household size of 7, the maximum income level is $89,932 per year.
- For a household size of 8, the maximum income level is $100,109 per year.
As seen in the table, income limits increase with larger household sizes. For example, a family of 3 can earn up to $4,102 per month and still qualify for Medicaid.
In addition to income limits based on household size, there are special income rules for certain groups:
- Pregnant women – Up to 198% of FPL
- Children ages 1-5 – Up to 142% of FPL
- Children ages 6-18 – Up to 133% of FPL
- Parent/caretakers of dependent children – Up to 15% of FPL
- Adults with disabilities – Up to 74% of FPL
So pregnant women and children can qualify for Medicaid at higher income levels compared to other groups. Individuals receiving Supplemental Security Income (SSI) automatically qualify for Medicaid in Texas, regardless of income.
Medicaid Texas Eligibility 2024
To be eligible for Medicaid in Texas in 2024, individuals must meet certain criteria, including:
- Resident of Texas
- United States national, citizen, permanent resident, or legal alien
- Need for health care assistance
- Financial situation classified as low income or very low income
The income limits for Medicaid eligibility in Texas for 2024 are as follows:
| Household Size | Maximum Income Level (Per Year) |
|---|---|
| 1 | $28,869 |
| 2 | $39,046 |
| 3 | $49,223 |
| 4 | $59,400 |
| 5 | $69,578 |
| 6 | $79,755 |
| 7 | $89,932 |
| 8 | $100,109 |
For every additional person, add $10,177 to the maximum income level for the corresponding household size.
Medicaid Income Limits Texas For Seniors
So what is the income limit for seniors to qualify for Medicaid in Texas? The Medicaid income limits for seniors in Texas for 2024 vary depending on the specific Medicaid program and household size. For example, a single Nursing Home Medicaid applicant must meet the following criteria:
- Income under $2,829 per month
- Assets under $2,000
- Require a Nursing Home Level of Care
However, for the SLMB (Specified Low-Income Medicare Beneficiary) program, the monthly income must be more than 100 percent FPL (Federal Poverty Level) and less than 120 percent FPL. The monthly income limits for the SLMB program in Texas for 2024 are:
- $1,215.01 to $1,458 for individuals
- $1,643.01 to $1,972 for couples
Medicaid Income Limits Texas For Pregnant Women
In Texas, Medicaid for pregnant women has income limits as follows:
- Family Size: 3
- Monthly Family Income: $4,102
If a pregnant woman’s monthly income is equal to or less than $4,102, she may be eligible for Medicaid for Pregnant Women in Texas. After giving birth, a mother can continue receiving Medicaid coverage for herself and her newborn for up to 12 months, thanks to recent changes approved by the Centers for Medicare & Medicaid Services.
Medicaid Income Limits Texas For Disabled Individuals
In Texas, Medicaid income limits for disabled individuals vary depending on the specific program and household size. Here is a summary of the income limits for various programs:
| Medicaid Program | Household Size | Maximum Income Level (Per Year) | Maximum Income Level (Per Month) |
|---|---|---|---|
| STAR+PLUS | N/A | N/A | N/A |
| Medical Waivers | 1 | $33,948 | $2,829 |
| Medical Waivers | 2 | $67,896 | $5,658 |
| SSI | 1 | $10,092 | $841 |
| SSI | 2 | $15,108 | $1,261 |
| SSP | 1 | $10,092 | $841 |
| SSP | 2 | $15,108 | $1,261 |
STAR+PLUS: There isn’t a separate income limit for STAR+PLUS because it serves primarily individuals with disabilities or those aged 65 or older. However, to qualify for STAR+PLUS, an individual must meet the financial requirements for Medicaid, which includes being financially responsible for their own care.
Medical Waivers: For Medical Waivers, the income limit is $2,829 per month for an individual and $5,658 per month for a married couple living together.
Supplemental Security Income (SSI): An individual receiving SSI benefits qualifies for Medicaid in Texas. The SSI benefit amount varies, but as of December 2023, the maximum federal payment is $841 per month for an individual and $1,261 per month for a couple.
State Supplementary Payment (SSP) Program: This program offers supplemental cash benefits to SSI recipients. If an individual receives SSP benefits, they automatically qualify for Medicaid in Texas.
Please remember that meeting the income requirement alone does not guarantee Medicaid eligibility. Other factors, such as citizenship, residency, and need for long-term services and supports, come into play during the application process. Always consult the official sources for the most current information regarding Medicaid eligibility in Texas.
What Counts as Income for Medicaid?
When applying for Medicaid, it’s important to understand what types of income are counted. Medicaid in Texas primarily looks at Modified Adjusted Gross Income (MAGI) to determine eligibility.
Countable income sources under MAGI include:
- Wages
- Self-employment income
- Unemployment benefits
- Social Security benefits
- Spousal income
- Unearned income like interest and dividends
Some common non-countable income sources that are excluded from Medicaid eligibility determinations:
- Supplemental Security Income (SSI)
- Child support received
- Veterans benefits
- Workers compensation
For non-MAGI populations like persons with disabilities, different income rules may apply. It’s best to check with your local Medicaid office about the specific income counting rules.
Difference Between STAR and STAR+PLUS Medicaid in Texas
STAR covers general Medicaid populations with basic benefits, while STAR+PLUS is tailored to seniors and disabled residents with extra long-term care benefits. Both utilize managed care plans.
- STAR covers low-income families, children, and pregnant women. STAR+PLUS serves people who have disabilities or are age 65+.
- STAR provides basic Medicaid benefits like doctor visits, hospital care, etc. STAR+PLUS offers these plus long-term services like nursing home care.
- Income limits for STAR are based on modified adjusted gross income (MAGI). STAR+PLUS income limits involve other criteria like disability benefits.
- STAR uses managed care health plans that beneficiaries must enroll in. STAR+PLUS also uses managed care plans but adds service coordinators.
- Children on STAR have certain benefits not covered for adults, like vision and dental services. STAR+PLUS may include extra benefits like meal delivery.
- Families must re-enroll children in STAR periodically. STAR+PLUS enrollees maintain eligibility as long as they meet requirements.
How to Apply for Medicaid in Texas
You can apply for Medicaid through multiple channels in Texas:
- Online – Visit www.YourTexasBenefits.com to apply through the online application.
- By phone – Call 2-1-1 (866-566-8989) to reach the Texas Health and Human Services Commission. You can start an application over the phone.
- In person – Make an appointment to apply at your local HHSC benefits office.
- By mail – Request an application be mailed to you and submit by mail.
No matter how you apply, you will need to provide proof of income, identity, citizenship or immigration status. Social Security numbers are required for all household members applying for Medicaid.
What to Expect After Applying
After submitting a Medicaid application in Texas:
- You will receive a letter requesting any missing documentation within 30 days. Provide documents as soon as possible.
- The office may contact you for clarification or to complete an interview.
- You will get a final eligibility determination letter within 45 days of applying. This will indicate if you are approved and steps to take next.
- If approved, you can select a Medicaid health plan and start using your benefits.
- Medicaid coverage can be backdated up to 3 months if you have unpaid medical bills.
If your application is denied, you can file an appeal and may qualify for temporary coverage while your appeal is reviewed. Get help appealing from Texas Legal Services organizations.
Where to Get Help with Medicaid Applications
The Medicaid eligibility process can be complicated. Here are some organizations that can help answer questions and assist with applications:
- Texas Health and Human Services Commission – 1-800-252-8263
- 2-1-1 Texas – Community health and human services referrals.
- Texas Children’s Health Insurance Program – 1-800-647-6558
- Texas Legal Services Center – Free legal help with denials and appeals.
- Texas Legal Aid Organizations – Various local legal aid groups that assist with Medicaid.
- Area Agencies on Aging – Help with Medicaid for seniors.
Reaching out to an assister can help ensure you complete all Medicaid requirements and submit accurate documentation.
Medicaid in Texas Eligibility For Adults
To establish Medicaid eligibility for adults in Texas, consider the following criteria:
- Resident of Texas
- United States citizen, national, permanent resident, or legal alien
- Need for health care/insurance assistance
- Financial situation characterized as low income or very low income
- Meet specific population categories, such as being a caregiver of children or adult relatives, receiving Supplemental Security Income (SSI), or having a disability.
For adults without dependents, Medicaid eligibility in Texas is limited to individuals with disabilities or those caring for children or adult relatives earning less than 14% of the Federal Poverty Level (FPL). However, Texas has not expanded its Medicaid program under the Affordable Care Act (ACA), meaning that healthy adults without dependents or disabilities remain ineligible for Medicaid.
If you meet the eligibility criteria, you can apply for Medicaid through HealthCare.gov or directly via the Texas Health and Human Services Commission (HHSC) website. Keep in mind that income levels change every year, so it’s essential to consult current guidelines when applying. Additionally, note that Medicaid eligibility is subject to periodic review, and recipients may lose coverage if they no longer meet the qualifications.
How do I verify my Medicaid eligibility in texas?
To verify Medicaid eligibility in Texas, there are several methods available:
- TexMedConnect: Providers may verify a patient’s eligibility through TMHP’s TexMedConnect, accessible from the Provider home page on the TMHP website.
- Form H1027-A: This form is used in various situations to verify Medicaid eligibility, such as when a newly certified individual needs immediate medical care.
- Phone and Web: You can also verify your Medicaid eligibility by phone or through the web. By calling toll-free numbers or visiting YourTexasBenefits.com, you can check your Medicaid status and access available health information.
- Automated Inquiry System: Providers can verify client eligibility using the Automated Inquiry System by entering specific client information.
It’s important to keep in mind that Medicaid eligibility in Texas is based on various factors, including income, family size, and specific program requirements.
Frequently Asked Questions
Q: I currently have Medicaid benefits. Do I need to reapply to keep my coverage?
A: If you already have Medicaid coverage in Texas, you shouldn’t have to reapply each year. Texas conducts automatic renewals for existing beneficiaries to continue benefits without gaps in coverage. You will be notified if any action is required from you to renew Medicaid eligibility.
Q: What if my income changes – does that impact my Medicaid eligibility?
A: Yes, income changes can affect Medicaid eligibility. If your household income goes up significantly, it could make you ineligible for Medicaid based on the income limits. You are required to report income changes to the Medicaid office within 10 days. A decrease in income could potentially make you newly eligible for Medicaid.
Q: I was denied Medicaid for having an income over the limit. Are there any options for assistance?
A: Even if your income exceeds the Medicaid limits, you may still qualify for subsidized private health insurance through the Affordable Care Act Marketplace. You can search plans and enroll at Healthcare.gov. Based on your income, you may qualify for premium tax credits and cost-sharing reductions that lower your out-of-pocket costs for health insurance.
Q: Where can I find out the most current Medicaid income limits?
A: Texas Medicaid income limits are updated each year. You can find the latest eligibility criteria published online at YourTexasBenefits.com. The Texas Health and Human Services Commission also publishes current Medicaid income limits online. Contact a local Medicaid office directly to ask about updated limits each year.
Q: What resources are available for understanding Medicaid rules and eligibility?
A: Texas Health and Human Services has an extensive online Medicaid resource center with policy manuals, income limits, application guides and more. You can also contact 2-1-1 Texas to speak with a community health representative who can explain Medicaid eligibility clearly. Local organizations like food banks and legal aid offices often hold Medicaid education events as well.
Useful Resources for Medicaid Texas:
Government Websites:
- Texas Health and Human Services Commission (HHSC):https://www.hhs.texas.gov/services/health/medicaid-chip
- Provides information on all Medicaid programs in Texas, including eligibility, benefits, and enrollment.
- Offers online applications and resources for finding local providers.
- Your Texas Benefits:https://www.yourtexasbenefits.com/
- A one-stop portal for applying for various state benefits, including Medicaid and CHIP.
- Allows users to pre-screen for eligibility and manage their benefits online.
- Medicaid.gov:https://www.medicaid.gov/
- The official website of the federal Medicaid program.
- Provides general information about Medicaid, eligibility requirements, and resources for finding state-specific programs.
Other Resources:
- Texas Medicaid Managed Care Organizations (MCOs):https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/star-medicaid-managed-care-program
- Each MCO has its own website with information about their specific plans, benefits, and provider networks.
- Examples of MCOs in Texas include Aetna Better Health, Superior HealthPlan, and Wellcare.
- Federally Qualified Health Centers (FQHCs):https://findahealthcenter.hrsa.gov/
- Community-based health centers that offer primary care and other health services to Medicaid beneficiaries at low or no cost.
- Search for FQHCs near you using the online directory.
- Benefits.gov:https://www.benefits.gov/
- A federal website that helps users find government benefits they may be eligible for, including Medicaid.
- Users can answer a questionnaire to see if they qualify for Medicaid and other programs.
Additional Resources:
- Texas Legal Aid:https://www.trla.org/
- Provides free and low-cost legal assistance to eligible individuals, including help with Medicaid applications and appeals.
- 211 Texas:https://www.211texas.org/
- A statewide information and referral service that can connect individuals with resources for Medicaid and other social services.