What are the guidelines for Medicaid eligibility in Texas? Since Medicaid eligibility requirements are determined on a state-by-state basis, applicants must learn the specifics prior to applying for government-sponsored healthcare.
Medicaid benefits eligibility is contingent upon several factors. There are general requirements for Medicaid applicants must meet, with the candidate’s citizenship status playing an important role in how to qualify for Medicaid in Texas. Medicaid income requirements must be met as well.
Who meets the requirements for Medicaid in Texas?
Are you eligible for Medicaid as a patient who resides in the state of Texas? Medicaid benefits eligibility apply to many different groups. However, note that Medicaid eligibility is a state-specific decision, so a petitioner must ensure that he or she meets all of the requirements determined by the Lone Star State.
You can explore the different Medicaid requirements by downloading our informative guide.
The following groups are able to qualify for Medicaid benefits in Texas:
- Children – Parents can opt into Children’s Medicaid, the Children’s Health Insurance Program (CHIP) or the Medicaid Buy-In for Children.
- Women & pregnant women – both low-income and those interested in CHIP perinatal coverage – can qualify for Medicaid coverage in TX. In addition, women with cervical cancer or breast cancer can receive Medicaid benefits. Still, there is a program entitled Healthy Texas Women in which you may be able to enroll.
- Young adults and families – If the applicant is are an adult caring for a child, a former child of foster care or a transitioning foster care child, you are eligible for Medicaid in Texas.
- The elderly and the disabled – The Medicaid eligibility requirements for patients of this nature apply to programs for long-term care, those who receive Supplemental Security Income (SSI) and both the Medicaid and Medicare Buy-In Programs.
What are the Requirements for Medicaid in Texas?
The requirements for Medicaid in Texas apply to any and all of the above groups seeking Medicaid benefits. Once an applicant has confirmed that he or she belongs to a Medicaid eligibility group, he or she must then qualify for Medicaid through the state health department’s mandatory standards.
The general Medicaid requirements may seem familiar, as they are the standard in many other states. In addition, these requirements for Medicaid will also help determine if a candidate qualifies for additional benefit programs in Texas. The basic Medicaid qualifications are as follows:
Applicant must currently reside in Texas – In order to opt into Medicaid benefits in the state of Texas, petitioners must first be able to prove that they reside within state borders. Note that there is no reciprocity when it comes to Medicaid eligibility. This means that even though a candidate may qualify for Medicaid as another state resident, he or she must re-qualify if he or she has moved to Texas, as each state’s Medicaid requirements vary.
Applicant must be a U.S. citizen – The applicant’s United States citizenship is a mandatory factor in deciding his or her Medicaid eligibility in TX. If the petitioner does not have documentation to support his or her U.S. citizenship, then he or she must have papers to confirm legal status in the country, instead.
Applicant must have a Social Security Number – Because Medicaid is funded and overseen by both the state of Texas and the federal government, applicants must have an identification element that spans both governmental bodies. With income being a major determination regarding Medicaid eligibility, earnings through tax statements will be confirmed via the applicant’s Social Security Number.
In addition, benefits – whether as medical assistance, cash assistance or food stamp assistance – will all be administered through use of the Social Security Number.
What are the Income Requirements for Medicaid in Texas?
What are the Medicaid application guidelines related to finances? Medicaid income requirements are important to the applicant’s Medicaid eligibility, since financial assistance is being requested due to low income. The income requirements for Medicaid in Texas vary depending on your Medicaid benefits eligibility group.
Download our helpful guide to learn about the different income requirements.
Children in need of Medicaid can qualify for Children’s Medicaid or for CHIP. The income limits of a household varies from $1,366 monthly (for Children’s Medicaid) to $2,039 (for CHIP) for a household of one. Income slightly increases based on the federal poverty level guidelines and the size of the applicant’s household.
Women seeking Medicaid benefits have varying income limits. For those that are low-income and pregnant, a household of one may earn no more than $1,991 per month to qualify for Medicaid. Those looking for CHIP prenatal coverage can earn no more than $2,000 per month in a household of one. Women with breast cancer or cervical cancer meet Medicaid eligibility standards if they earn only $1,915 per month in a single-person home.
Note: Numbers fluctuate and slightly rise as a household grows in size.
Texas families in need of Medicaid benefits, including adults and relative caretakers, can qualify financially if earnings in a one-parent home are no more than $152 per month. When the household accommodates two parents, income levels cannot exceed $227 per month. These numbers grow as households increase. Former foster care children under age 26 qualify for Medicaid in TX regardless of income.
If a petitioner is elderly or disabled, his or her income limits and resource allotments vary depending on the medical condition and the amount of aid required.