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Qualifications for Medicaid in Texas

Medicaid is health insurance provided for people who cannot afford their medical care or bills. Medicaid makes it possible for low-asset individuals to obtain medical care for themselves and their family even if they are not able to pay for it. Children, people with disabilities, pregnant women, and the elderly in need of nursing home care often fit this classification. Only those with limited income are eligible for Medicaid. Eligibility is determined based on state-specific guidelines.

  1. Financial Eligibility for Infants and Pregnant Women

    • Eligibility varies in Texas based on certain conditions and recipient age. Infants and pregnant women are eligible for assistance if household income is equal to or less than 185 percent of the federal poverty level. In 2009, the federal poverty level was defined as any amount less than $10,830 of annual income for a single individual. For each additional member of the household, add $3,740 in needed income to meet the federal poverty level. For a single child or pregnant woman in Texas, this 2009 eligibility is $20,035 or less.

    Financial Eligibility for Children and Parents

    • Children from ages 1 to 5 are eligible at 133 percent of poverty level, or in 2009, $14,404. Children from age 6 to 19 are eligible at 100 percent of poverty level. Non-working parents are eligible at 13 percent of poverty level ($1,407.90) and working parents are eligible at 27 percent ($2,924.10).

    Temporary Assistance for Needy Families (TANF)

    • Parents who are already receiving cash benefits from TANF are eligible for Medicaid. Children may also be qualified for coverage if total family income coincides with federal and state guidelines.

    Eligibility for People with High Medical Expenses

    • Some individuals in Texas may qualify for Medicaid assistance if determined to be medically needy. "Medically needy" is defined as a person with high medical expenses that when subtracted from his income would place him within the state guidelines for Medicaid assistance.

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