Texas Medicaid Application and Qualifications

It is easy to confuse Medicaid with Medicare. The two programs are not without their similarities. One key difference is that Medicare is a federal program, whereas Medicaid is a state program with rules that vary depending on where you are. The other major difference is that Medicare is based largely on age and disability, while Medicaid is based largely on income.

Depending on your circumstances, you can be on both at the same time. Circumstances is the key word. Medicare tends to be long-term, if not permanent. Medicaid is often a shorter-term solution. There are other programs that are generally associated with Medicaid such as financial and grocery assistance. It is possible that if you have qualified for these other forms of assistance, Medicaid will be included.

Texas’ Requirements for Medicaid Qualification 

Qualification for Medicaid in Texas is more of a formula than a series of check-boxes. You have to meet certain income requirements. But the income limit varies depending on the number of people in the household, and the variety of Medicare for which you are applying.

Here is an example from the Texas HHS website:

  • If the monthly income is $1,784 or less, or the yearly income is $21,404 or less, you may qualify for Children's Medicaid.
  • If the monthly income is $2,663 or less, or the yearly income is $31,951 or less, you may qualify for CHIP.

Not to be confused with Children’s Medicaid, CHIP stands for Children’s Health Insurance Program. The above figures only apply to a family of two. For Children’s Medicaid, the limit increases to $4,558 for a family of eight. Even these are not hard limits as there are circumstances where the limits could be higher.

Eligibility groups include, but are not limited to the following:

  • Women who are pregnant
  • Individuals who receive Supplemental Security Income (SSI)
  • Anyone who currently receives adoptive assistance
  • Low-income households that have kids under the age of 19

The only way to truly determine your eligibility is to apply.

How to Apply for Medicaid in Texas

You can apply online for benefits. You will need to be prepared to answer questions about the following for each family member:

  • Social Security number and birth date
  • Citizenship or immigration status
  • Money from jobs and other sources
  • The value of cars and other property
  • Costs you pay for bills

You can also call 211 if you are in Texas. Alternatively, you can dial 1-877-541-7905 Monday to Friday, 8 a.m. to 6 p.m.

You can also visit a community partner in person. Printing and mailing a copy to HHS is also an option

Cost and Coverage of Medicaid in Texas: What Does Medicaid Cover in Texas? 

Medicaid covers the following, and much more:

  • Doctor and clinic visits
  • Hospital visits
  • Emergency care
  • Medical equipment and supplies
  • Glasses
  • Tests and X-rays
  • Family planning

You can find a complete list in the 2017 Your Health Care Guide from Texas HHS

Prescription Drugs with Medicaid in Texas? 

Most prescription drugs are covered. People 20 and under get unlimited medicines. All others are limited to three medicines per month. Prescriptions that help you quit smoking are not counted in that limit. Some medicines will need to be pre-approved. The pharmacist will take care of this, and will provide a 3-day supply pending approval.

How Much Does Medicaid Cost in Texas?

There are a variety of Medicaid programs in Texas from traditional Medicaid to a Medicaid Buy-in program. Like any health program, Medicaid is subject to copay and deductibles. But the Medicaid Buy-in program operates more like traditional insurance for the working disabled. The monthly premium depends on a variety of factors including income. There is no way to know the exact premium you will have to pay without first applying.

Which Medicaid Plan Is Best in Texas?

There is no best Medicaid program. There is only the program that is best for you. Again, this is something best determined by a consultation with someone from Health and Human Services. Medicaid and CHIP cover half of all children in Texas. If yours is a low-income family, or you are an individual that meets other Medicaid qualifications, there is a very good chance that one of the programs is right for you.