Medicaid - Texas

Medicaid is a government health insurance program that helps certain people get health care services at a lower cost. This includes people who are older, blind, or living with a disability.

What does Texas Medicaid cover?

Medicaid pays for medical services such as:

• Visits to health care providers (including physicians and nurse practitioners)

• Inpatient and outpatient hospital services

• Prescription drug coverage (only available in certain cases)

• Lab tests

• X-rays

• Medical transportation

• Nursing home care

• Home health services

• Family planning services

Most states also cover optional services such as:

• Physical, respiratory, and occupational therapy

• Home- and community-based care

• Case management

• Prescription drugs

• Dental and vision care

• Hearing services

• Podiatry services

• Hospice care

Since the program serves those with limited income and resources, people with Texas Medicaid pay few to no out-of-pocket costs for their benefits. To get coverage once you are enrolled, you must go to health care providers that take part in the Texas Medicaid program.

In Texas, Medicaid is run by the Texas Health and Human Services Commission (HHSC). Call 1-877-541-7905 to learn more about the coverages provided.

How do I know if I qualify for Medicaid in Texas?

In general, to be eligible for Medicaid, you must:

• Be a Texas resident

• Be a U.S. citizen or a qualified non-citizen

• Meet the income and/or asset limit for your coverage group

You can get help from the Medicaid program if your income and resources fall below a certain amount. Some resources may not be counted when determining whether you meet the program guidelines. These include your home, car, and certain portions of life insurance and burial accounts.

If you are a U.S. citizen and meet the other Medicaid guidelines, you may get help from this program. Some people who are not U.S. citizens may also take part in the program. Contact your local office for more information about Medicaid citizenship rules.

What are the different Medicaid programs in Texas?

You may be able to get health coverage if you fall into one of the following categories.

Medicaid Nursing Facility Program

The Medicaid Nursing Facility program in Texas provides health care and support services in a nursing home or other medical facility. In addition to room and board, you may get other benefits such as:

• Nursing care

• Rehabilitation services

• Social services

• Medical equipment and supplies

• Prescription medications

• Personal care items such as hair care and clothing

You may be able to get this coverage if you have limited income and resources. You must also have a medical condition that requires the skills of a licensed nurse on a regular basis.

Medicaid Day Activity and Health Services

This Texas Medicaid program offers health care and daytime support services Monday through Friday so you can stay in your own home and avoid having to move into a nursing home. This program can help you take care of your daily needs by providing services like nursing and personal care, physical rehabilitation, and meals and snacks.

Medicaid Primary Home Care (PHC)

This Texas Medicaid program offers health care and support services so you can stay in your own home. It provides assistance like personal care, homemaking, and escort services (to and from medical appointments).

STAR+PLUS Home and Community-Based Services (HCBS)

Medicaid HCBS waiver services provide long-term care services in your home or community rather than in a nursing facility. Services include personal assistance services, in-home or out-of-home respite care, home nursing services, emergency response services (emergency call button), and home-delivered meals.

Texas Medicaid Buy-In for Adults

If you have a disability and are working, the Medicaid Buy-In for Workers with Disabilities (MBIWD) program may provide you with health care benefits. In some situations, working and earning money could prevent you from getting public benefit programs such as Medicaid. Texas MBIWD lets you work, keep money in savings, and still get health care coverage. You may have to pay a monthly premium.

How do Medicare and Medicaid work together?

If you get Medicare, you may also be able to get help from Texas Medicaid. This is called being “dual eligible.” Medicaid pays for some services not covered by Medicare such as eyeglasses, hearing aids, and dental care.

If you have Medicare and qualify for full Medicaid coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums.

Depending on the level of Texas Medicaid you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments

• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

In addition, if you are dual-eligible for Medicare and Medicaid:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.

• You may be able to get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048 (TTY).

How do I prepare to apply for Texas Medicaid?

When you apply for Texas Medicaid, you’ll be asked for important information to help determine if you qualify for benefits.

Before you start, gather some basic information to make your application process easier:

• A document that shows your age, such as your birth certificate or driver’s license

• Your Social Security card

• Pay stubs for anyone in your household who has earned income

• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)

• Information about your financial assets, such as bank account or investment account statements

How do I apply for Medicaid in Texas?

There are a few different ways you can apply for Medicaid in Texas. Read below to learn more about which option might be right for you.

Apply Online

The quickest and easiest way to apply for Medicaid in Texas is online through the Your Texas Benefits website. All your personal information is kept 100% confidential and protected by special security technology.

Apply through Your Texas Benefits website

Apply by Phone or in Person

Call 2-1-1 (TTY 711) or 1-877-541-7905 to apply for Texas Medicaid or request an application.

You can also download and print the application form and mail it to your local office or stop by in person. Find your local office here.

How can I get help with my Texas Medicaid application?

There are a few ways to get help filling out your Medicaid application:

• Call 2-1-1 (TTY 711) or 1-877-541-7905.

• Contact a Texas Community Partner near you.

• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.

• NCOA also has a HelpLine you can call to get free support. Call [1-800-794-6559](tel:+18007946559) anytime Monday–Friday, from 8 a.m. to 7 p.m. EST.