FAQ: TEXAS MEDICAID

1.  Does TX Medicaid cover unexpected medical emergencies?

Medicaid in Texas is a state and federally-funded health program for low-income individuals and families. Medicaid coverage includes preventative care and emergency care. Children and adults with Medicaid health insurance benefits are covered for hospital visits, x-rays, and any necessary lab tests.

2. What if a Medicaid participant does not have transportation to doctor appointments in Texas?

TX Medicaid participants that do not have reliable transportation to medical appointments are provided with rides to and from doctor visits as needed. Medicaid coverage ensures that individuals and families are able to receive proper medical care by attending regular doctor check-ups.

3. What if an individual in Texas was just diagnosed with a condition or disease that requires constant, long-term care?

TX Medicaid for long-term care is available to beneficiaries who are 65 years or older or individuals that have a condition that is expected to last a year or longer. Medicaid participants that are expected to need 30 days or more of constant, long-term care also qualify for this program.

4. Can children receive dental care under Texas Medicaid health insurance?

Children’s Medicaid in TX provides healthcare coverage for individuals under the age of 18 within low-income households. Dental care is included children’s Medicaid benefits, including any necessary dental work or procedures. Rides to dental appointments are available as needed.

5. Are prescription drugs covered under Medicaid of Texas?

Texas Medicaid is a healthcare program for low-income families, providing necessary health services to low-income households would otherwise not be able to afford it. Preventative care is an integral part of the program. Any necessary vaccines and drugs prescribed by a doctor are covered by the TX Medicaid.

6. Can a household purchase TX Medicaid if they do not meet the requirements?

The Texas Medicaid Buy-in program allows participants to purchase Medicaid by making monthly payments. Those who do not meet the income requirements for Medicaid are able to make monthly payments in order to have Medicaid coverage and access to healthcare services such as doctor visits, eye care, and dental care.

7. What if a Texas household’s annual income is above the income limit for Medicaid but a parent’s or caretaker’s employer does not offer health insurance options?

The Children’s Health Insurance Program (CHIP) in TX is offered to families that make too much money to qualify for Medicaid but do not have any health coverage. The cost is fifty dollars or less per year for qualifying TX families.

8. What if healthcare is too expensive through a Texas resident’s employer?

The TX Medicaid Buy-in program is for qualified residents that make too much money to participate in Medicaid coverage. Qualified participants make payments each month for Medicaid health coverage. This allows individuals to buy healthcare services, including doctor visits, x-rays, lab tests, and hospital care.

9.  Is there a Texas Medicaid program for pregnant women with no health insurance?

Medicaid for low-income pregnant women in Texas is a program that provides qualified women with healthcare for up to two months after giving birth. If a woman meets the income requirements she is covered for doctor visits, prescription medicines, lab tests, x-rays, and hospital care. Labor and delivery costs are also covered under this Medicaid program.

10. Does TX Medicaid cover medical expenses accrued before a long-term care participant receives coverage?

Medicaid for long-term care is a program that can cover up to three months of healthcare prior to the Texas resident applying for Medicaid coverage. This may include doctor visits, any necessary prescriptions, lab tests, x-rays, and hospital care.

11. If a participant’s income has changed, can he or she still receive TX Medicaid benefits?

Any changes to a participant’s original application, including citizenship status, residency, annual income, or cost of assets, must be reported to the Texas Health and Human Services Commission. If a household no longer qualifies for Medicaid they may be able to participate in the Texas Medicaid Buy-in program.

12. Do women diagnosed with breast cancer qualify for Medicaid benefits in Texas?

Texas Medicaid for women with breast and cervical cancer is available to women ages 18 through 64 who are not currently receiving any health insurance benefits. Women that meet the income requirements are covered for doctor visits, emergency care, home care, mental health care, and prescriptions under this Medicaid program.

13. Do women with pre-cancerous cells found on their cervix qualify for Medicaid in Texas?

Women with pre-cancerous or cancerous cells found on their cervix qualify for Medicaid benefits. Women who meet the income limits must have a doctor’s report stating that pre-cancerous or cancerous cells were found. Benefits include access to doctor visits, emergency care, home care, mental health care, lab tests, and x-rays.

14. Can the TX Medicaid application be completed in-person?

The Texas Medicaid application form can be completed in-person at a Texas Health and Human Services Commission community partner. Community partner organizations are local organizations that help residents complete their TX Medicaid application. This service is offered at no cost to qualified residents.

15. What if a child has a disability but their family makes too much money to qualify for Medicaid in Texas?

The Texas Medicaid Buy-in for Children program is for families who have a child with a disability but do not qualify for the regular Medicaid program. Qualified families can purchase Medicaid coverage by making monthly payments.

16. Do participants have to pay out-of-pocket for Texas Medicaid long-term care coverage?

A: Medicaid long-term care coverage in TX is available to those over the age of 65 or any individuals with a disability that requires thirty days or more of constant, long-term care. Participants must pay for a portion of the care received, based on their income.

17. Do residents receiving Supplemental Security Income qualify for TX Medicaid?

A: Texas residents who receive Supplemental Security Income qualify for the SSI Medicaid program. Coverage includes doctor visits, prescriptions, lab tests, x-rays, hospital care, vision care, and dental care. Qualified applicants may be able to pay for medical services received three months prior to applying for Supplemental Security Income.

18. Is TX Medicaid available for adults with mental, physical, or developmental disabilities?

The TX Medicaid Buy-in program for adults provides coverage for working adults with a physical, mental, or developmental disability. Qualified applicants can make monthly payments to purchase Medicaid coverage. Benefits include routine doctor visits, prescriptions, vision care, hearing care, and dental care.

19. Can former foster children get TX Medicaid?

Medicaid for Former Foster Children is a program for individuals between the ages of 18 to 25 that were in foster care or the Unaccompanied Refugee Minor Resettlement Program in Texas after the age of eighteen. Benefits include doctor visits, vaccines, prescription drugs, and dental care for children ages twenty and over.

20. Does Texas Medicaid cover the costs of labor and delivery for pregnant women?

Texas Medicaid for low-income pregnant women covers prenatal services and care for up to two months after the delivery of the baby. Labor and delivery is included under the Texas Medicaid for pregnant women program, ensuring the health of mother and baby.


What are benefits for Texas residents?

The State of Texas offers a wide array of benefits and services to the residents of Texas at home and abroad. These benefits include health care, housing assistance, unemployment assistance and a variety of programs for families to assist with food and health expense. Many individuals and families qualify for several of these programs. Complete the survey and download our guide to find helpful information on all of Texas Benefits along with details about eligibility and instructions for how to apply here.


Who is eligible for Texas benefits?

The State of Texas extends benefits to those who qualify. Families, individuals who have lost their job, persons with disabilities and elderly residents are usually those who will benefit the most from Texas’s social welfare programs. For a comprehensive list of the requirements for each of Texas’ programs please complete the survey and download our guide.