Texas Medicaid Office
Find Texas Medicaid contact information, eligibility requirements, income limits, and how to apply.
Texas Medicaid agency
- Agency
- Texas Health and Human Services Commission (HHSC)
- Website
- https://www.hhs.texas.gov/services/health/medicaid-chip
- Phone
- 2-1-1 (877-541-7905)
- Address
- P.O. Box 13247 Austin, TX 78711-3247
- Hours
- 2-1-1 benefits help line: 7 days a week (interpreter services available)
Texas Medicaid office (HHSC)
Texas Medicaid is administered by the Texas Health and Human Services Commission (HHSC). Day-to-day application and enrollment work runs through the YourTexasBenefits portal and the 2-1-1 phone line — HHSC does not operate Medicaid-specific walk-in offices, but local benefits offices accept paper applications and in-person help statewide.
How to reach Texas Medicaid
- Benefits help line — dial 2-1-1 from any Texas phone, or 877-541-7905 from outside Texas. Choose your language, then Option 2. Interpreter service available in 150+ languages.
- YourTexasBenefits.com — apply for and manage Medicaid, CHIP, SNAP, TANF, and Medicare Savings. Also available as the Your Texas Benefits mobile app.
- Office of the Ombudsman (HHSC complaints, Medicaid managed care issues) — 877-787-8999. Relay Texas: 7-1-1 or 800-735-2989.
- Medicare help (HICAP) — 800-252-9240 for Medicare options, Extra Help, and Medicare Savings Programs.
- Aging and Disability Resource Center — 855-YES-ADRC (855-937-2372).
- Report Medicaid fraud — HHS Office of Inspector General at 800-436-6184.
- Civil Rights Office — 888-388-6332 / HHSCivilRightsOffice@hhs.texas.gov.
HHSC mailing address: P.O. Box 13247, Austin, TX 78711-3247. To find the nearest benefits office in person, use the HHSC Services Office Locator at resources.hhs.texas.gov/pages/find-services.
Who qualifies for Texas Medicaid?
Texas has not adopted the ACA Medicaid expansion. That choice — held by every legislature since 2014 — defines Texas Medicaid eligibility for adults more than any other factor. Working-age adults without children generally cannot qualify for Texas Medicaid no matter how low their income, and parents qualify only at extremely low income levels.
Adult eligibility in a non-expansion state
Parents and caretakers can qualify for Texas Medicaid, but the income limit is among the strictest in the country. A single parent caring for one Medicaid-enrolled child qualifies only if monthly income is at or below $103 (about 13% of the federal poverty level). For a family of four, the cap is $277 monthly. A childless adult under 65 who is not disabled generally cannot qualify.
Who can qualify for Texas Medicaid
- Children under 19 — qualify through Children's Medicaid (STAR) at higher income thresholds, or through CHIP if income is too high for Medicaid.
- Pregnant individuals — Medicaid for Pregnant Women covers pregnancy and 12 months postpartum at higher income limits than parent-caretaker Medicaid (see the income limits section).
- Parents and related caretakers — must care for a child receiving Medicaid; income limits are strict.
- People age 65+ and people with disabilities — qualify through Medicare Savings Programs or full Medicaid based on SSI status. STAR+PLUS delivers benefits for SSI-eligible adults.
- Women diagnosed with breast or cervical cancer — Medicaid for Breast and Cervical Cancer covers treatment for uninsured women screened through the program.
- Former foster youth — eligible through age 26 regardless of income.
Coverage groups beyond traditional Medicaid
The Healthy Texas Women program provides family planning and women's health services up to 204% FPL for women not eligible for full Medicaid. CHIP and CHIP Perinatal extend coverage to children and pregnancies above the Medicaid income limit. The Medicaid Buy-In for Children and Medicaid Buy-In programs let working people with disabilities (and their families) pay a small premium for Medicaid services.
Texas Medicaid income limits
Texas Medicaid income limits depend entirely on which program you apply through. Limits for parents and caretakers are unusually low — about 13–17% of the federal poverty level — because Texas has not expanded Medicaid. Limits for pregnancy, children, and CHIP run much higher.
Medicaid for parents and caretakers (monthly income cap)
| Family size | One-parent household | Two-parent household |
|---|---|---|
| 1 | $103 | — |
| 2 | $196 | $161 |
| 3 | $230 | $251 |
| 4 | $277 | $285 |
| Each additional person | +$52 | +$52 |
To put those figures in context, $277 a month is roughly $3,300 a year for a family of four — a small fraction of the federal poverty level. Most working parents in Texas earn above this cap. The "coverage gap" — adults too poor for marketplace subsidies and too rich for Texas Medicaid — affects roughly 1 million Texans.
Medicaid for Pregnant Women (monthly income cap)
| Family size | Monthly family income |
|---|---|
| 1 | $2,634 |
| 2 | $3,571 |
| 3 | $4,508 |
| 4 | $5,445 |
| 5 | $6,383 |
| Each additional person | +$938 |
CHIP Perinatal (when pregnancy income exceeds Medicaid)
| Family size | Monthly family income |
|---|---|
| 1 | $2,687 |
| 2 | $3,643 |
| 3 | $4,599 |
| 4 | $5,555 |
| 5 | $6,512 |
| Each additional member | +$957 |
Dollar figures change annually each January when the federal poverty level updates. Verify the latest chart on HHSC's site before relying on a specific number.
How to apply for Texas Medicaid
One application — at YourTexasBenefits.com — covers Texas Medicaid, CHIP, SNAP food benefits, TANF cash assistance, and Medicare Savings. The state recommends online application because it's faster and provides immediate eligibility screening.
Apply online through YourTexasBenefits
yourtexasbenefits.com accepts applications in English and Spanish. You can apply for yourself, your family, or someone else. The Your Texas Benefits mobile app provides the same features on iOS and Android.
Apply by phone
Dial 2-1-1 from any Texas phone, or 877-541-7905 from outside Texas. Choose your language, then Option 2. The 2-1-1 language line provides interpreters in 150+ languages, including Vietnamese, Mandarin, Farsi, Somali, Arabic, and French.
Apply in person or by mail
Visit a local HHSC benefits office — use the Services Office Locator at resources.hhs.texas.gov/pages/find-services. You can also download paper Form H1205 (Application for Health Coverage and Help Paying Costs) from the YourTexasBenefits Learn pages and mail it to your local HHSC office.
What happens after you apply
HHSC has 45 days to make a decision on most Medicaid applications. Pregnancy and emergency Medicaid get faster handling. Disability-based determinations can take up to 90 days. Texas Medicaid coverage can be retroactive up to three months before the application date if you incurred medical bills you would have qualified for during that window.
Long-term care applications (STAR+PLUS, nursing facility, HCBS)
Adults applying for long-term services and supports — including the STAR+PLUS Home and Community-Based Services program — submit the same financial application through YourTexasBenefits, but also complete a medical-necessity assessment. HHSC and managed-care organizations coordinate the medical evaluation after the financial eligibility decision.
What Texas Medicaid covers
Texas Medicaid delivers benefits through managed care plans. Members choose a plan in their service area, and that plan coordinates doctor visits, hospital care, prescriptions, and behavioral health. The plan structure depends on your eligibility group.
Texas Medicaid managed care programs
| Program | Who it covers | What it adds |
|---|---|---|
| STAR | Low-income children, pregnant women, families | Standard Medicaid benefit set |
| STAR+PLUS | Adults 21+ on SSI or qualified by disability | Long-term services and supports (LTSS); STAR+PLUS HCBS |
| STAR Kids | Children and adults under 21 with disabilities | Community-based LTSS, service coordination |
| STAR Health | Children in DFPS conservatorship (foster care) | Trauma-informed care, medical consenter support |
| CHIP | Children whose family income is above Medicaid | Premium-based coverage with copays |
Standard medical benefits for STAR members
- Regular checkups, vaccines, and preventive care
- Doctor and specialist visits, hospital care, surgery, lab and imaging
- Prescription drugs through the Vendor Drug Program
- Vision and hearing exams, eyeglasses for children
- Mental health and substance use treatment
- Prenatal, delivery, postpartum, and newborn care
- Non-emergency medical transportation to covered appointments
Children under 21 — Texas Health Steps (EPSDT)
Texas Health Steps is the state's Early and Periodic Screening, Diagnostic, and Treatment program for Medicaid members under 21. It pays for any medically necessary service for a child even when adult Medicaid doesn't cover the same service. Texas Health Steps includes well-child checkups, dental care, vision, hearing, and medical case management.
Long-term services and supports
STAR+PLUS and STAR Kids cover personal attendant services, day activity and health services, nursing facility care, and adaptive aids and home modifications for people who meet medical-necessity criteria. The STAR+PLUS Home and Community-Based Services (HCBS) program lets eligible adults receive nursing-facility-level care in their own homes or community settings instead of an institution.
Special-population programs
- Medicaid for Breast and Cervical Cancer (BCC) — covers treatment for uninsured women diagnosed through the Breast and Cervical Cancer Services screening program.
- Healthy Texas Women — family planning, women's preventive care for women 18–44 up to 204% FPL who aren't eligible for full Medicaid.
- Health Insurance Premium Payment (HIPP) — when employer insurance costs less than direct Medicaid, HHSC pays the employee premium.