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Medicaid Requirements in Texas

The Medicaid program in Texas provides health insurance coverage to millions of low-income families in the state. The purpose of the program is to help improve health issues for those citizens who may otherwise go without care. The Texas government has a variety of requirements for Medicaid qualification, and considers many factors before placing someone into the program.

  1. STAR Medicaid Managed Care Program

    • STAR is the primary Medicaid managed care program in Texas. Anyone who is receiving cash assistance, is pregnant or has a limited income is eligible for the STAR program. Most people on Medicaid in Texas get their coverage through this program, which allows recipients to access their health plan through a chosen primary care provider. The provider will assist clients in choosing doctors and other services as needed. Medicaid provides a STAR ID card to clients upon approval for the program.

    Texas Medicaid Enhanced Program

    • Any individual who currently resides in the state, has a disability or receives Temporary Assistance to Needy Families (TANF); has medicaid payments made by Primary Care Case Management; and has asthma, diabetes, congestive heart failure, chronic obstructive pulmonary disease or coronary artery disease qualifies for the Texas Medicaid Enhanced Program. The program provides a more personalized experience by assigning a nursing care manager who monitors all aspects of a client's health. Clients can also use a dedicated Texas Medicaid phone number to talk to a nurse about any and all health concerns.

    Women's Health Program

    • The Texas Medicaid Women's Health Program provides low-income women with family exams, health screenings and assistance with birth control measures. In order to qualify for the program, a woman must be between the ages of 18 and 44, a United States citizen or permanent resident, a resident of Texas, not receiving any other assistance for medical bills, fertile, and meet the income requirements. The monthly countable income for a family of four may not exceed $3,400.

    Children's Medicaid Insurance Program

    • The Children's Medicaid Insurance Program, or CHIP, provides medical insurance to uninsured children in qualifying families. In order to qualify for the program, a child must be 18 or younger, a legal resident of Texas and a U.S. citizen or permanent resident, and meet the income guidelines for the program. As of 2010, the monthly income cutoff for a family of four is $3,675. The program offers many benefits, including individual choice of physicians, regular office visits, dental services, vaccines, hospitalization services, X-rays and eye care. First-time enrollment in the CHIP program has a 90-day waiting period.

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