Texas Medicaid

Last verified: June 2026

What is Texas Medicaid and who administers it?

Texas Medicaid is the state's joint federal-state health coverage program for low-income Texans who meet specific eligibility criteria. The Texas Health and Human Services Commission (HHSC) administers the program. As of mid-2026, Texas Medicaid and CHIP together cover approximately 4 million enrollees, per CMS enrollment data — down from a pandemic-era peak of roughly 5.9 million in 2023 before the Medicaid unwinding reduced rolls by approximately 32%.

Unlike California, New York, and most other large states, Texas did not accept the ACA Medicaid expansion. That decision means the income threshold for most working-age adults is extremely low. Parents and caretakers of dependent children qualify at approximately 15% of the Federal Poverty Level (FPL) — the lowest income limit for parents in the country, per Every Texan. Non-disabled adults without children do not qualify at any income level.

Children, pregnant women, the elderly, and people with disabilities face more accessible standards. Children qualify up to 201% FPL through Medicaid and CHIP combined. The program is applied for online at YourTexasBenefits.com or by calling 2-1-1.

How Texas Medicaid is delivered: STAR, STAR+PLUS, and STAR Kids

Texas delivers nearly all Medicaid and CHIP services through managed care organizations (MCOs) under three main programs. Which program a member is enrolled in depends on their age, disability status, and coverage category.

Members are automatically assigned to an MCO if they do not choose one within the required timeframe. Enrollment is managed through the Texas Enrollment Broker (Maximus), reachable at 1-800-964-2777.

The coverage gap: who falls between Medicaid and ACA marketplace subsidies

Texas's decision not to expand Medicaid creates a coverage gap affecting adults who earn too much to qualify for Texas Medicaid but too little to receive ACA premium tax credits. ACA marketplace subsidies begin at 100% FPL ($15,060/year for a single adult in 2026). Texas Medicaid covers parents only up to approximately 15% FPL (roughly $2,260/year for a family of three). Non-disabled adults without children are ineligible at any income.

Adults falling in this gap — earning between roughly $0 and $15,060 annually and not qualifying for Texas Medicaid — have no subsidized coverage option under current law. Per KFF estimates, hundreds of thousands of Texas adults fall into this gap. It is one of the most-discussed policy issues in state health coverage debates.

Who qualifies for Texas Medicaid in 2026?

Texas Medicaid eligibility is more restricted than in expansion states. The main qualifying groups are:

• Children ages 0–18 in families meeting income guidelines (up to 201% FPL through Medicaid and CHIP combined)
• Pregnant women — full Medicaid coverage up to 198% FPL; CHIP Perinatal for unborn children up to approximately 202% FPL
• Parents and caretaker relatives of dependent children — at approximately 15% FPL, the lowest parent income limit in the country
• Adults 65 and older — through Medicaid for the Elderly and People with Disabilities (MEPD), subject to income and asset rules
• Adults with disabilities (any age) — through MEPD, must meet Social Security disability or functional criteria
• Medicare-Medicaid dual eligibles — for help with Medicare premiums, copays, and additional services

Adults who do not fall into one of these groups — specifically, non-disabled, non-elderly adults without qualifying children — do not qualify for Texas Medicaid at any income level. This is the defining characteristic of Texas's non-expansion status.

Texas Medicaid topics

Texas Medicaid eligibility at a glance

Source: HHSC. See the income limits page for full monthly figures by household size.