Navigating the Texas Medicaid application process can feel complicated, especially when eligibility rules differ based on your age, family situation, and income. If you're trying to figure out how to apply for Medicaid in Texas, understanding who actually qualifies is the most important first step.
Here's what you need to know upfront: Texas has not expanded Medicaid under the Affordable Care Act, which means eligibility is much more limited than in most other states. Children can qualify with household incomes up to 144% to 198% of the federal poverty level depending on their age. Pregnant women qualify at 198% of poverty. However, parents only qualify at about 12% of the federal poverty level (roughly $230 per month for a family of four), and most adults without children do not qualify at all regardless of income.
For those who do qualify, the Texas Medicaid application is free and can be completed online at YourTexasBenefits.com. The application takes about 30 to 45 minutes, and Texas Health and Human Services typically processes applications within 45 days. Approximately 4.2 million Texans currently receive Medicaid coverage.
Disclaimer: This guide provides general information about Texas Medicaid and is not legal or financial advice. Eligibility rules can change, and individual circumstances vary. Always verify current requirements with the Texas Health and Human Services Commission before applying.
This guide walks you through who qualifies for Texas Medicaid, the income limits by category, what documents you need, and how to complete the state of Texas Medicaid application successfully.
Who Qualifies for Medicaid in Texas
Texas Medicaid eligibility depends on which category you fall into. Unlike the 40 states that have expanded Medicaid to cover all low-income adults, Texas limits coverage to specific groups with very strict income requirements.
Children have the broadest eligibility. Infants under age one qualify at 198% of the federal poverty level. Children ages one through five qualify at 144% of poverty. Children ages six through eighteen qualify at 133% of poverty.
Pregnant women qualify for pregnancy Medicaid in Texas at 198% of poverty. Coverage includes prenatal care, delivery, and postpartum care for 12 months. If you want to apply for pregnancy Medicaid Texas offers, use the same application at YourTexasBenefits.
Parents face much stricter limits. To qualify, parents must have income below approximately 12% of poverty, roughly $230 per month for a family of four. This extremely low threshold means most working parents do not qualify.
Adults without dependent children generally cannot qualify for Texas Medicaid regardless of income. This creates the "coverage gap" where adults earn too little for ACA subsidies but don't qualify for Medicaid. Approximately 617,000 Texans fall into this gap.
Elderly and disabled individuals have separate eligibility pathways through SSI-related Medicaid, nursing home Medicaid, and other programs.
Understanding the specific income thresholds helps you determine whether applying makes sense for your situation.
Texas Medicaid Income Limits 2026
Income limits for Texas Medicaid vary significantly depending on your category. Children and pregnant women have relatively high limits, while parents face the lowest thresholds in the country.
Income Limits for Children and Pregnant Women
| Category | FPL Percentage | Monthly Income (Family of 4) |
|---|---|---|
| Children ages 0 to 1 | 198% FPL | $4,957 |
| Children ages 1 to 5 | 144% FPL | $3,600 |
| Children ages 6 to 18 | 133% FPL | $3,325 |
| Pregnant women | 198% FPL | $4,957 |
These income limits apply to Modified Adjusted Gross Income (MAGI), which is used for most Medicaid eligibility determinations for children, pregnant women, and parents.
Income Limits for Parents
| Household Size | Maximum Monthly Income (12% FPL) |
|---|---|
| 2 | $141 |
| 3 | $177 |
| 4 | $230 |
| 5 | $268 |
These parent income limits are among the lowest in the nation, which is why most Texas parents do not qualify for Medicaid unless they have very little or no income.
Income Limits for Elderly and Disabled
Elderly and disabled individuals seeking Medicaid in Texas face different rules based on their situation.
| Category | Monthly Income Limit | Asset Limit |
|---|---|---|
| SSI-related (individual) | $994 | $2,000 |
| Nursing home (single) | $2,982 | $2,000 |
| Nursing home (married, both applying) | $5,964 | $3,000 |
For Texas nursing home Medicaid applications, additional rules apply including a 60-month look-back period for asset transfers and specific spousal protection allowances. Married couples where only one spouse needs nursing home care can protect up to $162,660 in assets and $4,066.50 in monthly income for the community spouse.
If you're interested in QMB Medicaid application Texas options, the Qualified Medicare Beneficiary program helps low-income Medicare recipients pay for Medicare premiums, deductibles, and copays. QMB has an income limit of 100% of the federal poverty level.
Children who don't qualify for Medicaid may qualify for CHIP, which covers children in families earning up to about 201% of poverty.
Now let's look at what you need to gather before starting your application.
Documents You Need for Your Texas Medicaid Application
Having the right documents ready before starting your Texas Health and Human Services Medicaid application makes the process much smoother. Missing documents are one of the most common reasons applications get delayed.
Required Documents
You'll need to prove your identity with a driver's license, state ID, birth certificate, or passport. Social Security numbers are required for all household members applying for coverage.
For income verification, gather pay stubs from the last 30 days or a letter from your employer. Self-employed individuals should bring tax returns or bank statements. Include Social Security award letters, pension statements, and child support records if applicable.
Proof of Texas residency is required. A utility bill, lease agreement, or mortgage statement works for this purpose.
Pregnant women should bring documentation of pregnancy from a healthcare provider. For nursing home Medicaid applications, documentation of assets and any asset transfers from the past 60 months is required.
If you want to apply for Texas Medicaid and food stamps at the same time, gather expense documentation including rent, utilities, and childcare costs. The YourTexasBenefits system accepts combined SNAP and Medicaid applications.
With documents ready, you can proceed to the application itself.
How to Apply for Medicaid in Texas Online
The fastest way to submit your Texas Medicaid application is online through YourTexasBenefits.com. The Texas medicaid application online process takes about 30 to 45 minutes for most applicants.
Step 1: Create an Account
Visit YourTexasBenefits.com and create an account. You'll need a valid email address. The account lets you save progress, upload documents, and check application status.
Step 2: Start the Application
Log in and select the option to apply for benefits. Choose Medicaid, and optionally select SNAP if you want to submit a combined food stamps and Medicaid application through the same form.
Step 3: Enter Household Information
Provide information about everyone in your household including names, dates of birth, Social Security numbers, and relationships. Household size affects income limits, so be accurate about who lives with you.
Step 4: Report Income and Resources
Enter all income sources for each household member including wages, Social Security, pensions, and child support. Elderly or disabled applicants also report assets like bank accounts and property.
Step 5: Upload Documents
You can upload digital copies of documents through the website, or mail, fax, or drop them off at your local HHSC office after submitting.
Step 6: Review and Submit
Review all information for accuracy before submitting. Save your confirmation number to track your application.
If you prefer not to apply online, other options are available.
Other Ways to Apply for Medicaid in Texas
Not everyone prefers the online application. Texas Health and Human Services provides alternative methods to apply for Medicaid benefits in Texas.
Call the Texas HHSC benefits line at 1-800-252-8263 to apply by phone, or call 2-1-1 for assistance. You can also visit your local Texas Health and Human Services office to apply in person with staff assistance.
Healthcare.gov checks Medicaid eligibility when you apply for marketplace insurance. If you appear eligible, your application is forwarded to Texas HHSC. Many community organizations and hospitals also have certified application counselors who provide free help with Medicaid applications.
After submitting your application, the waiting period begins.
What Happens After You Apply
Texas Health and Human Services has up to 45 days to process your Medicaid application. HHSC may contact you to request additional documentation. Respond promptly to avoid delays.
Unlike SNAP, most Medicaid applications do not require an interview. You'll receive a written decision by mail. If approved, you'll get a Medicaid ID card containing your Medicaid number for healthcare visits.
Medicaid coverage can be retroactive up to three months before your application date if you were eligible during that time. This retroactive coverage can help with outstanding medical bills.
Before going through the full application, a quick eligibility check can help you understand your options.
Check Your Eligibility First
A free eligibility screening takes just a few minutes and shows whether you likely qualify for Medicaid in Texas based on your situation. These screenings also check for other programs you might be eligible for.
Tools like Benefits USA screen for Medicaid, CHIP, SNAP, tax credits, and other assistance programs simultaneously. You'll see estimated benefit values and clear next steps for each program you may qualify for.
Eligibility screeners aren't official applications, but they help you understand what's available before spending time on paperwork. If you don't qualify for Medicaid, the screener might show you qualify for CHIP, marketplace insurance with subsidies, or other programs.
Given Texas's strict Medicaid limits, checking eligibility first helps you avoid spending time on an application you're unlikely to be approved for.
What If You Don't Qualify for Texas Medicaid?
Because Texas has not expanded Medicaid, many low-income adults don't qualify. Several alternatives may be available.
CHIP provides low-cost coverage for children in families earning up to about 201% of poverty when they don't qualify for Medicaid. If your income is above 100% of poverty, you may qualify for subsidized marketplace insurance through Healthcare.gov.
Federally Qualified Health Centers provide care on a sliding fee scale regardless of insurance status. Many hospitals also have charity care programs for uninsured patients.
Even if you don't qualify for Medicaid, you might qualify for SNAP food benefits. A family of four can qualify for SNAP with gross income up to $4,420 per month.
Frequently Asked Questions
How long does it take to get approved for Medicaid in Texas?
Texas HHSC has up to 45 days to process your Medicaid application from the date they receive it. Pregnant women may receive faster processing. If your application is delayed, you can call 1-800-252-8263 to check status.
Can I apply for Medicaid and SNAP at the same time?
Yes. The YourTexasBenefits website allows you to apply for multiple programs including Medicaid, SNAP, and TANF on the same application. This saves time and reduces duplicate paperwork.
I'm pregnant. How do I apply for pregnancy Medicaid in Texas?
Apply through YourTexasBenefits.com and select Medicaid. Pregnant women qualify at 198% of the federal poverty level, which is about $4,957 per month for a family of four. Bring documentation of your pregnancy from a healthcare provider.
My elderly parent needs nursing home care. How do I apply for nursing home Medicaid?
Texas nursing home Medicaid applications involve additional steps including asset documentation and a 60-month look-back period review. Consider consulting a Medicaid planning specialist, as the rules are complex. Applications are still submitted through YourTexasBenefits or at a local HHSC office.
What is the YourTexasBenefits Medicaid application website?
YourTexasBenefits.com is the official Texas Health and Human Services portal where you can apply for Medicaid, SNAP, TANF, and other benefits. The site allows you to create an account, submit applications, upload documents, and check application status.
Can I get Medicaid if I'm an adult without children?
In most cases, no. Texas has not expanded Medicaid, so adults ages 19 to 64 without dependent children generally do not qualify for Medicaid regardless of income. Exceptions exist for pregnant women, people with disabilities, and certain other categories. This creates a coverage gap affecting over 617,000 Texans.
Next Steps
If you fall into an eligible category, applying for Medicaid in Texas is straightforward. Start by checking your eligibility using a free screening tool, then gather your documents and apply through YourTexasBenefits.com.
For children and pregnant women, Texas Medicaid provides comprehensive coverage at no cost. The income limits are relatively generous for these groups, so moderate-income families may qualify for their children.
Texas has some of the strictest Medicaid eligibility rules in the country. If you don't qualify, explore CHIP for children, marketplace insurance for adults, or community health centers for affordable care. Approximately 4.2 million Texans receive Medicaid coverage, and if you qualify, the program provides valuable healthcare at no cost.
