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What is Texas Medicaid?
Medicaid is the state and federal cooperative venture that provides medical coverage to eligible needy persons. The purpose of Medicaid in Texas is to improve the health of people in Texas who might otherwise go without medical care for themselves and their children.
The mission of the program is to improve the health of Texans by:
- Emphasizing prevention.
- Promoting continuity of care.
- Providing a medical home for Medicaid recipients.
- Ensuring that each recipient can receive high quality, comprehensive health care services within the recipient’s community.
Who is eligible for Texas Medicaid?
To be eligible for Texas Medicaid, you must be a resident of the state of Texas, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:
- Pregnant, or
- Be responsible for a child 18 years of age or younger, or
- Blind, or
- Have a disability or a family member in your household with a disability.
- Be 65 years of age or older.
Texas Medicaid Income Limits 2023 Chart
| 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 households with more than eight people, add $10,177 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.
Texas Medicaid Income Limit 2023 for Children
Your income is the money you get paid before taxes are taken out. Find your family size on the table below. If your monthly income is the same or less, your child might get Children’s Medicaid.
| Family Members (Adults plus children) | Monthly Family Income |
|---|---|
| 1* | $1,616 |
| 2 | $2,186 |
| 3 | $2,756 |
| 4 | $3,325 |
| 5 | $3,895 |
| 6 | $4,465 |
| 7 | $5,035 |
| 8 | $5,604 |
| For each additional person, add: | $570 |
*A family of one might be a child who does not live with a parent or other relative.
If your income is higher than the limits listed above, check the limits below for CHIP.
Texas Medicaid Income Limit 2023 For CHIP
Your income is the money you get paid before taxes are taken out. Find your family size on the table below. If your monthly income is the same or less, your child might get CHIP.
| Family Members (Adults plus children) | Monthly Family Income |
|---|---|
| 1* | $2,443 |
| 2 | $3,304 |
| 3 | $4,165 |
| 4 | $5,025 |
| 5 | $5,886 |
| 6 | $6,747 |
| 7 | $7,608 |
| For each additional person, add: | $861 |
*A family of one might be a child who does not live with a parent or other relative.
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Children’s Texas Medicaid and CHIP
Children in Texas might be able to get low-cost or free health coverage through Children’s Medicaid or the Children’s Health Insurance Program. Children’s Medicaid is a health care program for children in low-income families. CHIP is a health care program for children without health insurance whose families earn too much to get Medicaid but cannot afford health insurance.
To get Medicaid or CHIP, a child must be age 18 and younger (in some cases children with disabilities age 19 and 20 can get Medicaid). They must also be a Texas resident and a U.S. citizen or qualified non-citizen. When you apply, we’ll ask about your family’s income to see which programs your child can get.
Services Covered by Texas Medicaid and CHIP
- Regular checkups at the doctor and dentist
- Medicine and vaccines
- Hospital care and services
- X-rays and lab tests
- Vision and hearing care
- Access to medical specialists and mental health care
- Treatment of special health needs and pre-existing conditions
These services are provided by health plans. If your child gets Medicaid or CHIP, you will choose a plan from the ones available in your service area.
Texas Medicaid Children with Disabilities
Children with disabilities can get long-term services and supports through Medicaid. These services can include:
- Home care and personal care, like having someone help monitor your child’s health and help them with daily activities.
- Having someone help take your child to their medical appointments.
- Nursing home care.
- A hospital for mental illnesses.
- A place of care for people with intellectual disabilities
Texas Medicaid Program Benefits
- Medicaid health care coverage for the adopted child. This benefit assists with the child’s medical and dental care, eye care, durable medical equipment and supplies, psychiatric/behavioral health care, and medical transportation.
- Reimbursement for certain one-time expenses relating to completing the adoption process (non-recurring adoption expenses). This benefit provides reimbursement up to $1,200 per adoption for reasonable and necessary adoption expenses directly related to completing the adoption process. These expenses may include fees paid directly to child placing agencies as well as court costs, attorney fees, and other fees directly related to the legal completion of the adoption.
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Monthly payments to assist with the child’s needs. The monthly adoption assistance payments are determined based upon the child’s special needs and the adoptive family’s circumstances. Assistance is considered for the following types of special needs:
- Exceptional initial placement expenses.
- Special maintenance.
- Child care.
- Supportive educational needs.
- Maintaining sibling/other family contact.
- Routine maintenance when needed.
Sources of Adoption Assistance
Texas medicaid income limits 2023 chart for child : DFPS provides adoption assistance from two sources. The first source is the:
- federal Title IV-E of the Social Security Act and
- Texas’ own state adoption assistance.
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Title IV-E Eligibility Requirements
Texas medicaid income limits 2023 chart for child : The following five requirements must be met for a child to be eligible for Title IV-E funded adoption assistance:
- The child must qualify as “special needs,” as described below, at the time the adoptive placement agreement is signed.
- Reasonable efforts must be made to place the child without adoption assistance, except when to do so is contrary to the child’s best interest.
- The child must be placed for adoption by DFPS, or a private, licensed, non-profit child-placing agency. For both relative and non-relative placements, the adoptive home must meet all of the requirements for approval under licensing minimum standards, including the criminal-records check.
- The child must be in an adoptive placement and meet one of the following four conditions:
- The child is eligible for Supplemental Security Income (SSI) benefits, as determined by the Social Security Administration (SSA) during the adoptive placement,
- the child is AFDC eligible both in the month that court proceedings began that resulted in the order removing the child from the home and in the month the adoption petition is filed,
- the child was determined eligible for Title IV-E foster care assistance both at the time the child entered care and in the month the adoption petition is filed, or
- the child lives with a minor parent in foster care, and the child’s costs are included in the Title IV-E foster care payments being made on behalf of the minor parent.
- The adoption assistance agreement must be signed before the adoption is consummated.
State Adoption Assistance Requirements
Texas medicaid income limits 2023 chart for child : The following six requirements must be met for a child to be eligible for state adoption assistance:
- The child must not be eligible for Title IV-E adoption assistance.
- The child must qualify as “special needs,” as described below at the time the adoptive placement agreement is signed.
- Reasonable efforts must have been made to place the child without adoption assistance, except when to do so was contrary to the child’s best interest.
- The child must be placed in an approved adoptive placement with DFPS as the child’s managing conservator. For both relative and non-relative placements, the adoptive home must meet all of the requirements for approval under licensing minimum standards, including criminal records checks.
- The child’s resources must be less than $10,000.
- The adoption assistance agreement must be signed before the adoption is consummated.
Requirements for Non-recurring Adoption Expenses
These expenses may include fees paid directly to child placing agencies as well as court costs, attorney fees, and other fees directly related to the legal completion of the adoption. Children who meet Title IV-E or state adoption assistance eligibility requirements automatically qualify for reimbursement of non-recurring adoption expenses.
However, reimbursement will not be made until the adoption is consummated. A separate request for adoption assistance is not necessary. For adoptions that do not qualify for Title IV-E or state adoption assistance, the following four requirements must be met to gain reimbursement for non-recurring adoption expenses.
- The child must qualify as having “special needs” at the time an adoptive placement agreement is signed.
- The adoptive placement must occur in accordance with relevant state and federal laws relating to child placement.
- The adoptive parents must be residents of Texas.
- The adoptive parents must sign an agreement to receive reimbursement for non-recurring adoption expenses prior to consummation of the adoption.
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Step Parent Adoptions | Texas Medicaid Income Limits 2023 Chart
Texas medicaid income limits 2023 chart for child : By federal policy, stepparent adoptions do not qualify for nonrecurring adoption expense reimbursement.
International Adoption | Texas Medicaid Income Limits 2023
An international adoption may qualify for this benefit if the child is a “special needs” child at the time of adoptive placement and the adoption assistance agreement is signed prior to consummation of the adoption.
Definition of Special Needs | Texas Medicaid Income Limits 2023
The child must be younger than 18 years old and meet one of the following criteria when the adoptive placement agreement is signed:
- The child is at least six years old;
- the child is at least two years old and a member of a racial or ethnic group that exits foster care at a slower pace than other racial or ethnic groups;
- the child is being adopted with a sibling or to join a sibling; or
- The child has a verifiable physical, mental, or emotional disabling condition, as established by an appropriately qualified professional through a diagnosis that addresses: (a) what the condition is; and (b) that the condition is disabling.
The state must determine that the child cannot or should not be returned to the home of his parents. A reasonable effort must be made to find an adoptive placement without providing adoption assistance, unless doing so is against the child’s best interests.
Children under DFPS Jurisdiction | Texas Medicaid Income Limits
DFPS is responsible for determining eligibility and negotiating the adoption assistance agreements for children who are placed for adoption under varying circumstances. Foremost among these responsibilities are determinations for children who are in the managing conservatorship of DFPS, regardless of the location of the placement.
These responsibilities also extend to children who are in the legal care of and placed for adoption by a licensed, non-profit child-placing agency when the child is placed with a family that resides in Texas. The child-placing agency need not be licensed in Texas but at least must be licensed/certified by another state to provide adoption placement services.
DFPS also determines eligibility and negotiates agreements for children who previously received Title IV-E adoption assistance or state adoption assistance and whose adoption terminated because of the death of the adoptive parents or termination of their parental rights and at the same time are not in the care of another state’s public child welfare agency.
DFPS will also assume responsibility for children who have subsequent adoptive parents who resided in Texas at the time of the adoptive placement. If the child received prior state adoption assistance, DFPS will assume responsibility regardless of the adoptive parents’ state of residence.
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Payment Ceilings for Adoption Assistance
The payment ceilings are established by the DFPS Board and are based upon two separate amounts. For children whose service level is Basic at the time of adoptive placement the ceiling is $400 per month. For children whose service level is Moderate or higher, the payment ceiling is $545 per month. The payment ceilings cannot be exceeded and are not automatically provided to any child.
Requests for Adoption Assistance
Requests for adoption assistance are made through the regional adoption assistance eligibility units. Ask your worker for the Request for Adoption Assistance forms.
Additional Medicaid Information
All Medicaid benefits are provided through Texas Health and Human Services (HHS), the Medicaid state agency for Texas. The adoptive parent will receive a Medicaid managed care enrollment packet with information about health plan(s) the child is eligible for and how to pick a plan.
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State Adoption Assistance Contact
Latasha Henry
Texas Department of Family & Protective Services
2525 Ridgepoint Drive
Austin, Texas 78754
Phone (713) 767-2651
Fax (512) 339-5927
Texas Medicaid Income Limit 2023 For Programs Women
Medicaid for Pregnant Women and CHIP Perinatal
Pregnant women might be able to get free health coverage during their pregnancy through Medicaid for Pregnant Women or the CHIP Perinatal program. Medicaid provides health coverage to low-income pregnant women during pregnancy and up to two months after the birth of the baby. CHIP Perinatal provides similar coverage for women who can’t get Medicaid and don’t have health insurance.
To get Medicaid for Pregnant Women or CHIP Perinatal, you must be a Texas resident. You must be a U.S. citizen or qualified non-citizen to get Medicaid for Pregnant Women. If you have other health insurance, you are not eligible for the CHIP Perinatal program. When you apply, we’ll ask about your family’s monthly income to see if you can get Medicaid or CHIP Perinatal.
Services Covered by Medicaid and CHIP Perinatal
Both programs cover services like:
- Prenatal doctor visits.
- Prenatal vitamins.
- Labor and delivery.
- Checkups and other benefits for the baby after leaving the hospital.
These services are provided by health plans. If you get Medicaid or CHIP Perinatal, you will choose a health plan from the ones available in your service area.
Texas Medicaid Income Limit 2023 for Pregnant Women
Your income is the money you get paid before taxes are taken out. Find your family size on the table below. If your monthly income is the same or less, you might get Medicaid.
| Family Size | Monthly Family Income |
|---|---|
| 1 | $2,406 |
| 2 | $3,254 |
| 3 | $4,102 |
| 4 | $4,950 |
| 5 | $5,799 |
| For each additional person, add: | $849 |
Texas Medicaid Income Limit 2023 for CHIP Perinatal
Your income is the money you get paid before taxes are taken out. Find your family size on the table below. If your monthly income is the same or less, you might get CHIP Perinatal.
| Family Size | Monthly Family Income |
|---|---|
| 1 | $2,455 |
| 2 | $3,320 |
| 3 | $4,185 |
| 4 | $5,050 |
| 5 | $5,916 |
| For each additional member, add: | $866 |
I’m pregnant and need health insurance, but I can’t get Medicaid.
CHIP Perinatal is a similar program for pregnant women who can’t get Medicaid and don’t have health insurance. CHIP Perinatal includes prenatal visits, prenatal vitamins, labor and delivery and postpartum care. To find out if you can get CHIP Perinatal, apply for Medicaid and we’ll determine if you qualify.
Texas Medicaid for Children and Adults with Disabilities
Medicaid can provide free or low-cost health care and long-term services and supports to low-income children and adults with disabilities.
Children and adults with disabilities who get Medicaid usually are in one or more of the following groups:
- They have little or no money.
- They get Supplemental Security Income. In Texas, people on SSI can automatically get Medicaid.
- They “buy-in” to Medicaid through the Medicaid Buy-In for Adults or Medicaid Buy-In for Children programs.
- They could be or have been placed in a nursing facility or care facility for people with intellectual disabilities.
- They already get home and community-based services through a waiver program like Home and Community-based Services (HCS) or Texas Home Living (TxHmL).
Children with Disabilities
To get Medicaid for the Elderly and People with Disabilities, children with disabilities must be age 20 and younger. Children with disabilities can also be covered through Children’s Medicaid. When you apply, we’ll ask you about your income and your child’s disability to help determine which programs your child might be able to get.
If you have a child with a disability and make too much money to get Medicaid, you might be able to get coverage through the Medicaid Buy-In for Children program. MBIC allows families of children with disabilities to make a monthly payment to get Medicaid coverage.
Adults with Disabilities
Adults with disabilities who qualify will get Medicaid for the Elderly and People with Disabilities. If you have a disability and work, you might be able to get the Medicaid Buy-In for Adults program.
Texas Medicaid Income Limits 2023 Chart for seniors
I’m looking for long-term care services, and I want to know what my options are.
Call 2-1-1, our hotline service for people looking to get help and find the services they need. Aging and Disability Resource Centers (ADRCs) can help you find and apply for long-term care programs for seniors and people with disabilities. Texas Health Information, Counseling and Advocacy Program can help you find information and enroll in Medicare, Medicaid, and long-term care. Area Agencies on Aging (AAA) can help you find services for people age 60 and older and their family members and caregivers.
I am 65 or older, don’t have health insurance and need help in the home.
Medicaid for the Elderly and People with Disabilities (MEPD) provides health coverage to adults who are aging or who have disabilities, including long-term care services.
Medicaid for the Elderly and People with Disabilities
Seniors, adults with disabilities and some children with disabilities who don’t have health insurance might be able to get health coverage through the Medicaid for the Elderly and People with Disabilities program. You might be able to get Medicaid even if you’re already on Medicare. If you need help paying your Medicare premiums, click here.
To learn more about all your options, contact your local Aging and Disability Resource Center or call 2-1-1. To get MEPD, you must be a Texas resident and a U.S. citizen or qualified non-citizen. When you apply, we’ll ask about your income, your age, and your disability to see if you qualify.
Services Covered by MEPD
MEPD covers health care services, including:
- Regular checkups at the doctor.
- Medicine and vaccines.
- Hospital care and services.
- X-rays and lab tests.
- Vision and hearing care.
- Access to medical specialists and mental health care.
- Treatment of special health needs and pre-existing conditions.
MEPD also covers long-term services and supports, including:
- Home care and personal care, like having someone help monitor your health and help you with daily activities.
- Having somebody take your child to their medical appointments.
- Nursing home care.
- A hospital for mental illnesses.
- A place of care for people with intellectual disabilities.
How MEPD Services Are Provided
If you’re an adult with a disability and qualify for MEPD, these services are typically provided by STAR+PLUS. You will choose a STAR+PLUS health plan from the ones available in your service area. If you have a child with a disability who qualifies for MEPD, these services are typically provided by STAR Kids.
You will choose a STAR Kids health plan from the ones available in your service area. You might also be enrolled into traditional Medicaid. Traditional Medicaid just means the state pays your doctors, nurses and other caregivers directly.
Texas Medicare Help Line
Texas has a free helpline to guide residents through the complexities of Medicare. Call 800-252-9240.
- Do you need help finding and sorting through all the Medicare options available in Texas?
- Are you looking for free benefits counseling from a trusted and unbiased source?
- Do you need help paying Medicare premiums, co-pays and prescription medicines?
The Texas Health Information, Counseling and Advocacy Program can help you.
What is the Texas Health Information, Counseling and Advocacy Program?
If you are eligible for Medicare, the Texas’ Health Information, Counseling and Advocacy Program can help you enroll, find information and provide counseling about your options. This partnership between the Texas Health and Human Services system, Texas Legal Services Center and the Area Agencies on Aging trains and oversees certified benefits counselors across the state.
What services does the partnership provide?
- Medicare and Medicaid information and education
- Help with original Medicare eligibility, enrollment, benefits, complaints, rights and appeals
- Explain Medicare Supplemental (Medigap)insurance policy benefits and comparisons
- Explain Medicare Advantage (Part C) and provide comparisons and help with enrollment and disenrollment
- Explain Medicare Prescription Drug (Part D) coverage, help compare plans and search for other prescription help
- Information about long-term care insurance
The partnership also helps with the following programs. Benefit Counselors are specially trained to help you understand all the fine print to find and apply to a plan that works for you. They advocate for you with these programs and help you get the services you need.
Medicare Savings Programs
Medicare Saving Programs helps pay for all or some of the Medicare monthly payments, co-pays and deductibles (money owed to the doctor if Medicare doesn’t cover the entire bill).
Eligibility as a Qualified Medicare Beneficiary (QMB)
Must be entitled to Medicare Part A
Income – Maximum gross monthly income
- $1,215 Individual limit
- $1,643 Couple limit
Resource Limits
- $9,090
- $13,630
Eligibility as Specified Low-Income Medicare Beneficiaries (SLMB)
Must be entitled to Medicare Part A
Income – Maximum gross monthly income
- $1,215.01 to $1,458 Individual limit
- $1,643.01 to $1,972 Couple limit
Resource Limits
- $9,090
- $13,630
Eligibility for the Qualifying Individuals Program (QI-1)
- Must be entitled to Medicare Part A.
- Must not otherwise be receiving Medicaid.
- Income range for a person is equal to a minimum monthly amount of $1,458 to a maximum monthly amount of less than $1,640.
- Income range for a couple is equal to a minimum monthly amount of $1,972 to a maximum monthly amount of less than $2,219.
Resource Limits
- $9,090
- $13,630
Qualified Disabled and Working Individuals Program (QDWI)
- Must be entitled to enroll in Medicare Part A.
- Must be under age 65 and not otherwise receiving Medicaid.
Income – Maximum gross monthly income
- $2,430 Individual Limit (Resource limit $4000) Effective March 1, 2023
- $3,287 Couple Limit (Resource limit $6000) Effective March 1, 2023
Low-Income Subsidy
The Low-Income Subsidy (also called “Extra Help”) is available under the Medicare Prescription Drug (Part D) coverage. Medicare recipients with limited income and assets may qualify for extra help with the costs of their prescription medicines. Visit the National Council on Aging.
Medicare Preventive Services
Maintaining health and wellness is important, and Medicare preventive services are available at no cost. The National Council on Aging provides a list of Medicare Preventive Services that are available through the Affordable Care Act.
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