Texas Medicaid 2026: Who Qualifies and How to Apply

Updated Nov 13, 202621 official sources

Quick Answer: Texas Medicaid and CHIP are run by the Texas Health and Human Services Commission (HHSC).

Full answer and how we checked it

They cover low-income children, pregnant women, some very low-income parents (a one-parent family of three qualifies only up to $230 a month), and people who are 65 or older, blind or disabled. Texas didn't expand Medicaid, so most adults 19 to 64 without children or a disability can't get full Medicaid at any income. Apply at YourTexasBenefits.com (opens in a new tab), in the Your Texas Benefits app, or by calling 2-1-1, Option 2. HHSC has 45 days to decide most applications and 15 business days for pregnancy.

This guide is for: Texans who need health coverage for a child, a pregnancy, an older parent or themselves, and who want to know which kind of Texas Medicaid fits, how to apply and what's changing in 2027.

Data note: Grantsights checked HHSC's Choosing a Health Plan page (opens in a new tab), Questions About Your Benefits page (opens in a new tab), Benefits Application Next Steps page (opens in a new tab), CHIP page (opens in a new tab), the STAR, STAR Kids, STAR+PLUS and STAR Health program pages, the Texas Works Handbook (A-140 (opens in a new tab), A-820 (opens in a new tab), A-830 (opens in a new tab), B-110 (opens in a new tab), C-130 (opens in a new tab), W-110 (opens in a new tab) and B-1020 (opens in a new tab)), Medicaid.gov's eligibility table (opens in a new tab) and CMS's April 2026 renewal guidance. Every fact was checked on November 13, 2026.

In this guide

Texas Medicaid and CHIP at a Glance (November 2026)
Who Qualifies for Texas Medicaid in 2026
What Texas Medicaid Covers and the Health Plans You Choose
How to Apply for Texas Medicaid or CHIP, Step by Step
Prior Coverage, Renewal and What Changes in 2027
What Texas HHSC Doesn't Tell You About Medicaid and CHIP
Common Mistakes and Red Flags
If HHSC Denies You or Ends Coverage
Other Help for Texas Families
FAQ: Texas Medicaid
Sources

Medicaid and CHIP are public health coverage, not grants, and HHSC doesn't charge anyone to apply. For every income line by household size, see our Texas Medicaid income limits guide.

Texas Medicaid and CHIP at a Glance (November 2026)

HHSC sorts Texas Medicaid into 5 types of coverage: Traditional Medicaid, STAR, STAR Kids, STAR Health and STAR+PLUS, plus CHIP for children whose families earn too much for Medicaid. Here's how the pieces fit, from HHSC's own pages on November 13, 2026:

Item	Texas rule
Agency and program	Texas Health and Human Services Commission; Texas Medicaid and the Children's Health Insurance Program (CHIP)
Expansion status	Not expanded. Medicaid.gov's table lists Texas's adult expansion as "No"
Adults 19 to 64 without children	No full Medicaid group based on income alone; Healthy Texas Women covers family planning for women 15 through 44
Parents and caretakers	Very low income only: $230 a month for a one-parent family of three (Texas Works chart C-131.2)
Children under 19	Children's Medicaid, then CHIP above the Medicaid line; Medicaid.gov lists CHIP up to 201% of poverty
Pregnancy	Medicaid for Pregnant Women up to 198% of poverty, with coverage through the 12th month after the pregnancy ends
Seniors and disability	SSI-linked Medicaid, STAR+PLUS for adults 65 and older or with disabilities, STAR Kids for disabled children and young adults through age 20, nursing home and waiver care
Income numbers	Full chart in our Texas Medicaid income limits guide
How to apply	YourTexasBenefits.com (opens in a new tab) or the app; 2-1-1 (or 877-541-7905), Option 2; a local HHSC benefits office; mail or fax
Decision time	45 days for medical programs (Texas Works B-112); 15 business days for pregnancy (A-140)
Cost	Medicaid is free; CHIP can carry an enrollment fee of $50 or less a year and small copays

Grantsights analysis of the Texas Works Handbook charts shows how far apart the lines sit for one family: in a one-parent family of three, the children stay covered by Medicaid up to $3,028 a month (ages 6 to 18) and by CHIP up to $4,577, while the parent loses Medicaid above $230. That's a gap of more than $4,300 a month between the child's line and the parent's line.

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Who Qualifies for Texas Medicaid in 2026

Texas Medicaid isn't one program; it's 6 doors, and you need to fit through one of them. HHSC's program pages describe them this way:

Children's Medicaid and CHIP: children 18 and under. Children's Medicaid has a 12-month continuous certification period under Texas Works A-825, so a child normally stays covered for the full year even if family income rises.
Medicaid for Pregnant Women: full Medicaid during pregnancy, lasting through the end of the 12th month after the pregnancy ends (A-825, Revision 26-1, effective January 1, 2026). CHIP Perinatal covers prenatal care for the unborn child of a woman who can't get Medicaid, including because of immigration status.
Parents and caretaker relatives: an adult caring for a child, but only at very low income.
People 65 or older, blind or disabled: SSI recipients get Medicaid, and others may qualify through Medicaid for the Elderly and People with Disabilities programs, including nursing home and community waiver care.
Former foster care youth: STAR Health covers young people 20 and younger who aged out of DFPS care, and children in state conservatorship.
Medicaid for Breast and Cervical Cancer: women who need treatment for those cancers and meet the program rules; HHSC enrolls them in STAR+PLUS.

Healthy Texas Women isn't full Medicaid, but it matters for adults left out above. According to the Healthy Texas Women program rules in Texas Works W-110, women 15 through 44 who aren't pregnant and have income at or below 204.2% of poverty get a 12-month certification for family planning exams, birth control, treatment of some sexually transmitted infections and related visits. HTW Plus adds some postpartum care.

Income is counted before taxes, using federal MAGI rules for children, pregnancy, parents and CHIP. Seniors and people with disabilities face a resource limit. Our Texas Medicaid income limits guide walks through each chart, and the national Medicaid income limits guide compares Texas with expansion states.

What Texas Medicaid Covers and the Health Plans You Choose

Most Texas Medicaid members and every CHIP member get care through a managed care health plan, according to the HHSC Medicaid and CHIP members page. STAR covers most children, pregnant women and families. STAR+PLUS covers adults with disabilities and adults 65 and older, and adds long-term services such as help at home with daily activities, home changes for safety and short breaks for caregivers. STAR Kids covers children and young adults 20 and younger with disabilities. People not in any of these get Traditional Medicaid.

CHIP services listed by HHSC include checkups with the doctor and dentist, medicine and vaccines, hospital care, X-rays and lab tests, vision and hearing care, specialists and mental health care, and treatment of pre-existing conditions. CHIP has a cap on dental services, and care beyond it needs the dental plan's approval first.

STAR health plans HHSC listed on November 13, 2026:

STAR plans (by service area)	STAR+PLUS plans	STAR Kids plans
Aetna Better Health; Blue Cross and Blue Shield of Texas; Community First Health Plans; Community Health Choice; Cook Children's Health Plan; Dell Children's Health Plan; Driscoll Children's Health Plan; El Paso First Health Plans; Molina Healthcare; Parkland HEALTHfirst; Superior HealthPlan; Texas Children's Health Plan; United Healthcare Community Plan; Wellpoint	Community First Health Plan; Community Health Choice; El Paso Health Plan; Molina Healthcare of Texas; Superior HealthPlan; UnitedHealthcare Community Plan; Wellpoint	Aetna Better Health; Blue Cross Blue Shield of Texas; Community First Health Plans; Cook Children's Health Plan; Driscoll Health Plan; Superior HealthPlan; Texas Children's Health Plan; United Healthcare Community Plan; Wellpoint

Source: HHSC Questions About Your Benefits page (opens in a new tab), checked November 13, 2026. Not every plan serves every region; the service area map (opens in a new tab) shows which ones serve your county.

Dental plans: HHSC's plan page lists DentaQuest, MCNA Dental and United Healthcare Dental. Your enrollment packet tells you if you can pick one.

Plans that left in 2026: HHSC's STAR page says FirstCare and RightCare Scott & White Health Plans left STAR on August 31, 2026, in the Central Texas and West Texas/Lubbock areas. FirstCare also left CHIP in the Lubbock area that day, and its CHIP members moved to Superior HealthPlan on September 1, 2026.

Changing plans: if you're in a Medicaid plan, HHSC says you can change at any time; CHIP members can change only in their first 90 days, and CHIP Perinatal members in their first 120 days. Changes take 15 to 45 days. Call the Texas Enrollment Broker Helpline at 800-964-2777 or use your Your Texas Benefits account.

Costs: HHSC describes STAR, STAR Kids and STAR+PLUS as free coverage. CHIP is the one with costs: according to the HHSC CHIP program page, enrollment fees are $50 or less per family a year, and copays for doctor visits and medicine run $3 to $5 for lower-income families and $20 to $35 for higher-income families.

How to Apply for Texas Medicaid or CHIP, Step by Step

One application covers Medicaid, CHIP and other HHSC benefits, and Texas gives you 4 ways to send it.

Step 1: Gather your proof

HHSC's application next steps page says you don't have to send everything, and it'll tell you which items it needs. For Medicaid or CHIP, the items it lists include:

Income: for children's coverage, your last two pay stubs, an employer statement or self-employment records; for an adult or pregnant woman, two pay stubs from the last 60 days
Medical bills from the past three months that you haven't paid
Citizenship: a U.S. passport, naturalization certificate, birth certificate (front and back), hospital birth record or Medicare card; HHSC may be able to look up a Texas birth record
Identity: a driver's license or DPS ID card
Immigration papers, front and back, if they apply
Texas residence: a utility bill, ID, rent receipt or a landlord letter (not from a relative)

Step 2: Apply

Method	Details from HHSC
Online	YourTexasBenefits.com (opens in a new tab) or the Your Texas Benefits app, where you can also check status and upload documents
Phone	2-1-1 or 877-541-7905; pick your language, then Option 2
In person	A local HHSC benefits office; call 2-1-1 to find the nearest one
Mail or fax	HHSC, P.O. Box 149027, Austin, TX 78714-9027; fax 877-447-2839

Step 3: Answer requests and choose a plan

When HHSC approves you, it mails a packet naming your program and at least 2 health plans in your area. If you don't choose, HHSC picks one for you. If you have no plan yet and need help, HHSC lists a Medicaid Helpline at 800-335-8957.

How long it takes

The Texas Works Handbook (section B-112) requires HHSC to send a decision by the 45th day after the file date for medical programs. Pregnant women get a faster track: section A-140 (Revision 26-4, effective October 1, 2026) requires a decision within 15 business days, and lets the applicant postpone all proof except identity until day 30. Federal rules at 42 CFR 435.912 (opens in a new tab) allow 90 days for disability-based applications.

For example, one applicant in El Paso, a 26-year-old pregnant woman living with her partner and earning $3,900 a month together, is a household of three once the baby is counted. That's under the 198% pregnancy line ($4,508 for three under the March 2026 chart), so she'd qualify for Medicaid for Pregnant Women, get a decision within 15 business days and stay covered through the 12th month after delivery (an illustration from HHSC's figures, not a real case). Her partner, with no disability and no other child, wouldn't qualify for Medicaid himself.

Prior Coverage, Renewal and What Changes in 2027

Texas Medicaid can reach back 3 months before the month you apply. The Texas Works Handbook's A-830 section says HHSC certifies those months only if you met every rule then and have unpaid bills for covered services, and you ask on Form H1113. Mention unpaid bills on the application so the worker gives you the form.

The 2027 retroactive cut. Section 71112 of Public Law 119-21 shortens that look-back for applications made on or after January 1, 2027. CMS's April 2026 slides (opens in a new tab) say expansion adults get at most 1 month and that more guidance is coming; for other groups, the federal law sets a 2-month limit. Texas has no expansion group, so its applicants fall under the 2-month rule. HHSC's handbook still showed 3 months when Grantsights checked it on November 13, 2026. Grantsights analysis of those dates suggests a simple move: a Texan with unpaid medical bills from the fall of 2026 should apply before January 1, 2027.

Renewal. HHSC's benefits page says it mails a letter when it's time to renew. If you need to sign a renewal form, you can sign it electronically on Your Texas Benefits or call 2-1-1 to have a paper form mailed. Children's Medicaid renews on a 12-month cycle.

Work requirements don't reach Texas's current groups. The federal community engagement rule, published in the Federal Register on June 3, 2026 (opens in a new tab), requires 80 hours a month of work or similar activity from expansion adults starting by January 1, 2027. Texas covers no expansion adults, so the rule doesn't apply to its children, pregnant women, parents or aged, blind and disabled members. The 6-month renewal schedule in section 71107 is also aimed at expansion adults. HHSC hadn't posted any Texas-specific 2027 work rule when Grantsights checked its member pages on November 13, 2026.

What Texas HHSC Doesn't Tell You About Medicaid and CHIP

HHSC's member pages are accurate on the basics, but 6 points take some digging:

The CHIP page shows older numbers. HHSC's CHIP member page listed $4,464 a month for a family of three on November 13, 2026, while the Texas Works Handbook chart effective March 1, 2026 shows $4,577. Go by the handbook (and our income limits guide); a family between those two figures should still apply.
The parent line hasn't kept up. The $230 one-parent limit for three is a fixed dollar chart, not a poverty percentage, so it doesn't rise with the yearly poverty update the way the children's lines do.
Plan lists differ by page. The plan-choice page still listed FirstCare and RightCare, which left STAR on August 31, 2026. Trust your packet and the service area map.
Siblings can end up in different programs. Different age bands mean a 4-year-old can be on Medicaid while a 9-year-old is on CHIP, with different cards, plans and change rules.
CHIP plan changes lock fast. After the first 90 days, a CHIP family can't switch plans just because it wants to, unlike Medicaid members.
Adult dental is limited. HHSC's member pages describe dental plans and checkups for children and CHIP; adults should check their health plan's value-added services chart for any extra dental or vision help before choosing.

Common Mistakes and Red Flags

A common mistake is skipping a children's application because "Texas doesn't cover adults." That's true for most adults, not children. A family of four can earn well over $5,000 a month and still have kids eligible for CHIP.

Other mistakes that cost Texas families coverage:

Missing HHSC mail or app messages. HHSC's letters asking for proof carry a due date, and an application with missing proof can be denied; upload what it asks for in the app the same day.
Not counting the unborn baby. A pregnant woman's household includes the expected baby, which raises the income line she's measured against.
Not reporting income or address changes. Report changes through your Your Texas Benefits account so a renewal letter doesn't go to an old address.
Underestimating Healthy Texas Women. Women over the parent line often qualify for HTW's family planning coverage without realizing it.
Applying for the wrong route at 65. Older Texans should ask about SSI, STAR+PLUS and the Medicare Savings Programs rather than a family Medicaid category.

Red flags: avoid anyone who charges a fee to apply, promises approval, or texts asking for your Your Texas Benefits password or Medicaid ID number. Real applications go only through YourTexasBenefits.com, the app, 2-1-1 Option 2, a benefits office, mail or fax.

If HHSC Denies You or Ends Coverage

A Texas fair hearing request is due within 90 days of the date HHSC's action takes effect, per the Texas Works Handbook section B-1020. Saying it out loud to a worker counts as much as writing it, and a request can't be turned away at the desk as late; that decision belongs to the hearings officer.

Check the household size and income HHSC used. Errors there are the easiest to fix.
Health plan problems: HHSC tells members to contact the health plan first with questions about care; its phone number is on your plan ID card.
Reapply after a change. If your hours drop or a baby is on the way, a new application can open a different door.
Over the limit: adults at or above the poverty level can usually get subsidized Marketplace coverage through HealthCare.gov.

Other Help for Texas Families

Medicaid handles health care; food, rent and nutrition programs fill other gaps. A Texas family on Medicaid or CHIP often qualifies for these too:

Food: our Texas food stamps guide and the Texas SNAP benefits guide.
Pregnancy and young children: our Texas WIC income limits guide and the national WIC guide.
Housing: the rental assistance programs guide.

Grantsights' free eligibility checker lists official programs you may want to look at next. It can't approve Medicaid or CHIP; HHSC makes that call.

FAQ: Texas Medicaid

How do I apply for Medicaid in Texas?

Online or in the app at Your Texas Benefits, by calling 2-1-1 Option 2, at a local HHSC office, or by mail or fax.

Can a single adult get Medicaid in Texas?

Usually not, because Texas didn't expand Medicaid. Healthy Texas Women covers family planning for women 15 through 44.

How long does Texas Medicaid take to approve?

Up to 45 days for most applications and 15 business days for pregnancy.

Does Texas Medicaid have work requirements?

No. The 2027 federal rule targets expansion adults, and Texas has none.

What health plans does Texas Medicaid use?

It depends on your program and area; HHSC listed 14 STAR plans and 7 STAR+PLUS plans on November 13, 2026.

Does Texas CHIP cost money?

Up to $50 a year in enrollment fees per family, plus $3 to $35 copays depending on income.

Can Texas Medicaid pay bills from before I applied?

Up to 3 months back today with Form H1113; federal law shortens it for applications from January 1, 2027.

Sources

HHSC: Choosing a Health Plan (opens in a new tab), checked November 13, 2026
HHSC: Questions About Your Benefits (renewals, 5 types of Medicaid, plan lists) (opens in a new tab), checked November 13, 2026
HHSC: Benefits Application Next Steps (opens in a new tab), checked November 13, 2026
HHSC: Medicaid and CHIP Members (opens in a new tab) and CHIP (opens in a new tab), checked November 13, 2026
HHSC program pages: STAR (opens in a new tab), STAR Kids (opens in a new tab), STAR+PLUS (opens in a new tab), STAR Health (opens in a new tab)
Texas Works Handbook, A-140 (pregnancy processing) (opens in a new tab), Revision 26-4, effective October 1, 2026
Texas Works Handbook, A-820 and A-825 (coverage periods) (opens in a new tab), Revision 26-1
Texas Works Handbook, A-830 (prior months) (opens in a new tab)
Texas Works Handbook, B-110 and B-112 (deadlines) (opens in a new tab)
Texas Works Handbook, C-130 income charts (opens in a new tab), Revision 26-2, effective April 1, 2026
Texas Works Handbook, W-110 Healthy Texas Women (opens in a new tab)
Texas Works Handbook, B-1020 fair hearing deadline (opens in a new tab)
Medicaid.gov: Texas and other states' eligibility levels (opens in a new tab), as of December 1, 2023
CMS: section 71107 renewal slides, April 2026 (opens in a new tab)
Federal Register: the June 3, 2026 work rule Texas sits outside (opens in a new tab)
eCFR: 42 CFR 435.912 timeliness standards (opens in a new tab)

Last updated November 13, 2026. Published by Grantsights from public sources. See our editorial policy, how we build and check guides, corrections and how we make money.