Understanding Medicaid Eligibility in Texas
When you have a low-income household, finding healthcare can be stressful. That’s why programs such as Medicaid are designed to ensure you receive the care and benefits you need. Medicaid eligibility in Texas is determined by age, income, and disability status. Let’s go over what Medicaid is and how to enroll in Texas.
What is Medicaid in Texas?
To start, Texas Medicaid is the state and federal program that provides medical coverage for eligible individuals in need. The idea behind Medicaid is to give coverage to those who otherwise might not seek out care. Medicaid eligibility in Texas is how you’ll know if you qualify for services.
According to the Medicaid website, the mission of the program is to emphasize prevention and ensure that those eligible receive the care and benefits that they need. Before you apply for Texas Medicaid, it’s important to figure out your eligibility.
Who is Eligible for Medicaid in Texas?
There are several groups of people that can receive Medicaid eligibility in Texas. To be eligible, you must be:
- A resident of the state of Texas
- A U.S. National
- U.S Citizen
- Permanent resident
- Legal alien
To qualify, your household must be low-income, as well. If you receive supplemental security income (SSI), you will also qualify for Medicaid. The Texas Medicaid website has a calculator to determine that number. You must also be:
- Pregnant
- Guardian of a child 18 years or younger
- Blind
- Be 65 years or older
- Have a disability or a family member with a disability
Simply put, low-income adults with disabilities or who have a child with a disability will qualify. There are several different Medicaid programs available in Texas, depending on which demographic you’re in.
Children
If you are a low-income parent and need health insurance for children with disabilities, Texas offers the children’s Medicaid program that includes:
- Doctor visits
- Dental care
- Medication and vaccines
The Texas Children’s Health Insurance Program (CHIP) is another option for parents who may not qualify for Texas Medicaid themselves but need health coverage for their children.
Pregnant Women
Healthy Texas women who are low-income, as well as those with disabilities, are eligible for Medicaid. Pregnant women can apply for the Medicaid for Pregnant Women program. The program provides free healthcare for women during their pregnancy and two months after birth.
Adults Over 65 or Adults With Disabilities
Medicaid for the Elderly and People with Disabilities (MEPD) is a program that provides health insurance to those who are aging or have disabilities. One thing that concerns elderly adults is eligibility if they qualify for Medicare.
The good news is that if you qualify for both Medicare and Medicaid, you may still be able to get Medicaid. If you have questions on whether you’ll qualify, you can call 2-1-1 for information.
Does Medicaid Coverage Vary Based on Family Size?
Medicaid coverage will not vary based on family size, but your income determines eligibility. For example, the amount considered low-income for a family with two children is going to be lower than for a family with five children. The Medicaid in Texas application will determine your family’s eligibility based on income and other factors.
Can I Enroll in Medicaid if I’m Homeless in Texas?
If you are homeless, you will only qualify for Texas Medicaid if you have a disability. There are, however, other human services available to you for housing and mental health. Homeless individuals who have a disability may qualify for Medicaid for health benefits.
What is Covered Under Medicaid in Texas?
Once you have Texas Medicaid benefits, it’s important to go over what’s covered. Knowing your healthcare needs ahead of time will help you determine if Medicaid benefits are the right choice for you. Texas Medicaid benefits typically cover:
- Regular doctors visits
- Regular dental care
- Medications
- Vaccines
- X-rays
- Lab testing
- Hospital services
- Medical specialists
- Mental health care
- Special health needs treatment
- Pre-existing conditions
If you are an elderly person receiving MEPD benefits, healthcare services also include the following:
- Long-term home care
- Nursing home care
- Mental health hospital care
- Child support to take children to medical appointments
- Assisted living.
How Do You Enroll in Texas Medicaid?
If you believe you qualify for Texas Medicaid, it’s time to start the enrollment process. They’ve made the process for potential Medicaid enrollees very simple. Everything is online, and you can complete a pre-screening process on their website before taking the time to enroll.
Once you’ve figured out your eligibility, you can start applying. There are a few options to do so.
Applying for Texas Medicaid
Online
You’ll need to head over to the Texas Benefits website and click on the “apply for new benefits” button under your program.
By Phone
If you want to enroll over the phone, you can call 2-1-1 for information as well as enrollment. Their hours are 8 am to 6 pm Central Time.
By Mail
You can also print out the forms and mail them in.
In-Person
You can apply for Medicaid in person at your local Texas Health and Human Services (HHS) benefits office by looking for it here. If you have a lot of questions or need assistance filling out your application, in person may be your best option.
How Trajector Can Help
To qualify for Medicaid in Texas, you or someone in your family must have a disability. When applying, you’ll need documentation of this. Trajector Disability can help you apply for disability in Texas to ensure your Medicaid eligibility.
