Texas Medicaid 2026: Income Limits, the Coverage Gap & How to Apply

Quick answer: Texas has not expanded Medicaid under the Affordable Care Act, so eligibility for adults is far more limited than in most states. Non-disabled adults without dependent children generally cannot qualify at any income level. Texas Medicaid mainly covers children, pregnant women, parents with very low income, seniors, and people with disabilities. It’s run by the Health and Human Services Commission (HHSC), and you apply through YourTexasBenefits.com.

Who This Is For

This guide is written for Texans who are trying to figure out whether they or a family member can get health coverage through Medicaid in 2026. Texas Medicaid — administered by the Health and Human Services Commission (HHSC) — currently covers roughly 4 to 5 million Texans, most of them children, pregnant women, and people with serious disabilities. If you are a working-age adult without children or a disability, this guide will give you a straight answer rather than send you on a runaround: in Texas, the rules are among the most restrictive in the country.

Texas’s eligibility rules are significantly narrower than those you’ll find described on national Medicaid overview pages. Many of those pages describe what expansion states offer — income-based coverage up to 138% of the Federal Poverty Level for any adult. Texas is not one of those states. Before you apply, it’s important to know which category you might fit into, because the income limit, the documentation required, and the program that covers you differ dramatically depending on whether you’re a child, a pregnant woman, a parent, a senior, or a person with a disability.

If you’re a low-income adult in Texas without children or a qualifying disability and you’re hoping Medicaid will cover you, the honest answer is: it almost certainly will not under current 2026 rules. However, this guide will also explain what alternatives exist, including Federally Qualified Health Centers and county programs, so you’re not left without options.

For a state-by-state comparison, see Medicaid income limits by state. For a general overview of the program nationwide, visit our Medicaid overview.

Texas Did Not Expand Medicaid — What That Means

Under the Affordable Care Act (ACA), states were given the option to expand Medicaid to cover adults earning up to 138% of the Federal Poverty Level — roughly $20,120 per year for a single person in 2026. As of July 2026, Texas is one of approximately 10 states that have not adopted this expansion. That decision has consequences that affect hundreds of thousands of Texans every single day.

In expansion states, a single adult earning $19,000 per year with no children and no disability would qualify for Medicaid. In Texas, that same person has no Medicaid pathway whatsoever — regardless of how low their income drops. The state’s eligibility rules were written before the ACA and have not been updated to include this new income-based adult category. Non-disabled adults without dependent children simply do not fit any of the coverage categories that Texas Medicaid recognizes.

This is not a budget shortage or a temporary freeze. It’s a structural policy choice made by the Texas legislature, which has rejected Medicaid expansion multiple times. Bills have been introduced and defeated in multiple sessions. As of the time this article was last reviewed (July 2026), there is no expansion in place and no confirmed legislative path to one in the near future. Any claim you see suggesting Texas expanded Medicaid is incorrect.

The result is that Texas has the largest Medicaid coverage gap in the nation. Adults who earn too little to qualify for ACA marketplace subsidies (which start at 100% FPL) but don’t fit any Texas Medicaid category are left without an affordable coverage option. This is not a gap in a technical or bureaucratic sense — it is a real barrier to care affecting an estimated 600,000 to 920,000 Texans, depending on the source and methodology. We use a range because the estimates vary across credible sources including the Kaiser Family Foundation and the Urban Institute.

Income Limits by Group (2026)

Because Texas didn’t expand, income limits vary sharply by category. The 2026 Federal Poverty Level for one person is approximately $15,960 per year (about $1,330 per month). Below are the income thresholds by group — all figures are gross monthly income unless noted otherwise:

• Children (Medicaid/CHIP): Up to about 200% FPL through Medicaid and CHIP combined. CHIP extends higher for some age groups. There is no asset test for children. A child can qualify for Medicaid or CHIP even if their parents earn too much to qualify themselves.
• Pregnant women: Roughly 198–203% FPL, with 12 months of postpartum coverage following the birth. This postpartum extension was added in recent years and is a meaningful improvement — coverage does not end the moment the baby is born.
• Parents and caretaker relatives: Only about 15–18% FPL — roughly $235 to $319 per month for a family of three. This is among the lowest parent income thresholds in the entire country. A parent working even a few hours per week at minimum wage will typically earn too much to qualify.
• Aged, Blind and Disabled (MEPD — Medicaid for the Elderly and People with Disabilities): Based on SSI rules. SSI recipients automatically qualify for Medicaid. The federal benefit rate (FBR) for SSI in 2026 is $994 per month for an individual — use this figure rather than the outdated $967 figure that appears in some older sources.
• Nursing home and long-term care (LTC): Income limit of approximately $2,982 per month for an individual. Asset limit is $2,000 for a single person. A community spouse (one who remains at home) may retain up to approximately $162,660 in assets under the spousal impoverishment protections. If your income exceeds the cap, a Miller Trust (also called a Qualified Income Trust or QIT) can allow you to structure income so you meet the eligibility threshold.

Two important methodological notes: most non-elderly categories use MAGI (Modified Adjusted Gross Income) rules, which means certain income types are counted differently than you might expect — for example, child support received by the household counts as income, but some deductions apply. The MEPD and LTC categories use non-MAGI rules with different income counting methods and strict asset tests.

There is also a 5% FPL disregard that applies to MAGI-based categories — in practice, this means the effective income limit is slightly higher than the stated percentage, typically adding about $66 per month per person to the threshold. Children frequently qualify even when their parents do not. If you have children, apply for them even if you believe you personally won’t qualify.

Because thresholds update annually and some figures conflict slightly across sources, always confirm current exact figures with HHSC directly at hhs.texas.gov or by calling 2-1-1. For a broader comparison, see our guide on Medicaid income limits by state.

The Texas Coverage Gap

The Texas Medicaid coverage gap refers to the population of adults who earn too much to qualify for Texas Medicaid under any current category but also earn too little to receive subsidized insurance through the ACA marketplace. Marketplace subsidies (premium tax credits) become available to people earning at or above 100% FPL — about $15,960 per year for a single adult in 2026. Below that threshold, adults were intended by the ACA architects to be covered by Medicaid expansion. In states that didn’t expand, those adults fall through.

Estimates of the Texas coverage gap population range from approximately 600,000 to 920,000 Texans. The variation depends on what data year is used, how the population is defined, and which income thresholds are applied. Credible sources including the Kaiser Family Foundation and the Texas Policy Foundation have documented this gap extensively. Texas consistently accounts for a larger share of the national coverage gap than any other single state — by a significant margin.

If you are in the coverage gap, here are the realistic options available to you in 2026:

• Federally Qualified Health Centers (FQHCs): These federally funded clinics provide primary and preventive care on a sliding-fee scale based on your income. You can find one near you at findahealthcenter.hrsa.gov. FQHCs serve patients regardless of ability to pay and are one of the most important safety-net resources for uninsured Texans.
• County indigent care programs: Many Texas counties operate their own programs for low-income residents who don’t qualify for Medicaid. These vary considerably by county — some provide comprehensive care, others cover only emergencies. Contact your county health department for specifics.
• Hospital charity care: Texas hospitals that accept Medicare and Medicaid are required to have financial assistance policies. If you receive a large hospital bill, ask the billing department about charity care or financial assistance programs before assuming you must pay in full.
• ACA marketplace plans (if income is at or above 100% FPL): If your income is at or above approximately $15,960 per year (100% FPL) for a single person, you may qualify for substantial subsidized coverage through HealthCare.gov. Enhanced subsidies under current law have made plans much more affordable than in earlier years.

Being in the coverage gap is not a permanent condition — income changes, life circumstances change, and the law itself could change. If your situation changes at any point, recheck eligibility at YourTexasBenefits.com.

Texas Medicaid Programs (Managed Care)

Texas delivers nearly all of its Medicaid services through managed care organizations (MCOs) — private health plans that contract with HHSC to provide care. This means that when you qualify for Texas Medicaid, you will typically be assigned to or choose from a set of health plans in your area. Understanding the major programs helps you know what type of plan you’ll be navigating:

STAR is the primary managed care program for children, pregnant women, and some low-income families. Once enrolled, STAR members choose a health plan and a primary care provider. Benefits include doctor visits, hospital care, prescriptions, dental, vision, and behavioral health for qualifying members.

STAR+PLUS serves adults with disabilities and seniors who need both acute care and long-term services and supports (LTSS). This program coordinates medical care with home and community-based services, making it especially important for older Texans or those with complex health needs who want to remain in their homes rather than entering a nursing facility.

STAR Kids is designed for children with disabilities, including those who receive SSI. It was created to give this population more coordinated, disability-focused care than the general STAR program could provide. STAR Kids plans assign each child a service coordinator who helps manage their care plan.

STAR Health covers children and young adults in foster care or the conservatorship of the Department of Family and Protective Services (DFPS). It provides specialized behavioral health, dental, and medical services tailored to the needs of children in the child welfare system.

After you are approved for Texas Medicaid, HHSC will notify you about which program applies to your situation and which health plans are available in your area. You’ll typically have a window to choose a plan; if you don’t choose, one will be auto-assigned. You can usually switch plans once per year or more frequently under certain circumstances.

How to Apply for Texas Medicaid (Step by Step)

Applying for Texas Medicaid is free, and you can start the process in several ways. Here is the step-by-step process for 2026:

1. Apply online at YourTexasBenefits.com — This is the fastest method and allows you to apply for multiple programs (including SNAP food benefits and other assistance) in a single application. Create an account, complete the Your Texas Benefits application, and submit it. You can save your progress and return if needed.
2. Call 2-1-1 or 1-800-252-8263 — The 2-1-1 helpline can connect you with local HHSC offices and help you understand your options before or during the application. You can also request a paper application by phone.
3. Visit a local HHSC benefits office — Walk-in and scheduled appointments are available. Bring your documentation (see the next section). Staff can help complete Form H1200, the primary Medicaid application form.
4. Apply through HealthCare.gov — If you start at the federal marketplace, the system will screen for Medicaid eligibility and route you to Texas HHSC if you appear potentially eligible. This pathway is particularly useful if you’re not sure whether you qualify for Medicaid or a subsidized marketplace plan.
5. After submission: HHSC will typically request a verification interview by phone, usually within 10 days of your application. Attend this interview — missing it can delay or deny your application. HHSC must provide notice and opportunity to reschedule, but the interview is a required step.
6. Decision timeline: Processing takes up to 45 days for most categories. Applications involving disability determinations (MEPD) can take up to 90 days. Due to ongoing backlogs in the HHSC system, the average processing time has run closer to 54 days. If you have not received a decision after 45 days, you have the right to request a status update.
7. If denied: You have 90 days from the denial notice to request a fair hearing and appeal the decision. Do not assume a denial is final without reviewing the reason and your appeal rights, which must be included in the denial notice.

After approval, report changes in income, household size, or address within 10 days at YourTexasBenefits.com or by calling 2-1-1. Failing to report changes can result in overpayments that HHSC may seek to recover. For a broader guide on the process, see our page on how to apply for Medicaid.

Required Documents

Gathering your documents before you apply will make the process significantly faster. For most Texas Medicaid categories, you will need:

• Identity: Texas driver’s license, state ID, U.S. passport, birth certificate, or another government-issued document with your name and date of birth.
• Social Security Number (SSN): Required for each person applying. If you don’t have an SSN, you may need to apply for one. Certain immigration categories are exempt from the SSN requirement.
• Texas residency: A utility bill, lease agreement, bank statement, or official mail showing your Texas address.
• Income verification: Recent pay stubs (typically last 30 days), employer letters, or self-employment records. If you receive Social Security, SSI, or other benefits, bring your award letter.
• Immigration status (if applicable): Lawful permanent residents, certain visa holders, refugees, and other qualifying non-citizens may be eligible for Texas Medicaid. Bring documentation of your immigration status. Undocumented individuals are generally not eligible for full Medicaid but may qualify for emergency Medicaid.
• For MEPD and long-term care applicants: Asset documentation is required, including bank statements for the past 3–5 years, property records, insurance policies, and investment account statements. The lookback and verification requirements for LTC Medicaid are more intensive than for other categories.

You do not need to have all documents in hand to start your application — HHSC can accept applications and request documents during the process. However, having them ready from the start reduces delays.

Important 2026–2027 Changes to Know

Several changes are affecting Texas Medicaid in 2026 and into 2027 that current and prospective enrollees should be aware of:

Six-month renewals beginning December 2026: Starting in December 2026, most Texas Medicaid enrollees will shift to 6-month renewal cycles. Previously, most enrollees had annual renewals. More frequent renewals mean more opportunities for coverage to lapse if your information is not current. Keep your contact information, income, and household details updated in YourTexasBenefits.com so that renewal notices reach you and you have adequate time to respond. Missing a renewal can result in a gap in coverage even if you still qualify.

Federal Medicaid funding changes: Broader federal policy discussions in 2025 and 2026 have included proposals to change how the federal government funds Medicaid — including block grant or per-capita cap structures that would shift more financial risk to states. As of July 2026, these proposals have not yet been enacted in a way that changes current coverage, but Texans should watch for updates from HHSC and advocacy organizations, as federal changes can ripple into state programs over a 12–24 month window.

Cost-sharing adjustments: Some Medicaid managed care plans have adjusted their copayment structures for non-emergency ER use and certain services. These are program-level changes within STAR and STAR+PLUS, not eligibility changes. Your health plan will notify you of any cost-sharing updates that apply to your coverage.

These changes do not alter the fundamental non-expansion structure of Texas Medicaid. The core categories, the coverage gap, and the basic eligibility rules described above remain in effect for 2026. See also our guide on Texas assistance programs for other support programs that may be available to you.

Common Mistakes to Avoid

These are the most frequent errors Texans make when trying to navigate Medicaid eligibility — understanding them upfront can save you significant time and frustration:

• Assuming Texas expanded Medicaid: It did not. Articles and tools that describe income-based adult coverage up to 138% FPL are describing expansion states. Do not apply assuming you’ll qualify as a childless adult based on income alone.
• Assuming childless non-disabled adults can qualify at any income: This is the most common misconception. In Texas, there is no income threshold at which a non-disabled adult without dependent children becomes eligible for Medicaid. This has nothing to do with how low your income is.
• Not applying for children or CHIP because you don’t think you qualify: Your children’s eligibility is evaluated separately from yours. A child can qualify for Medicaid or CHIP even if both parents earn too much for Medicaid themselves. Always apply for your children even if you’re certain you personally won’t qualify.
• Missing the 6-month renewal starting December 2026: Under the new renewal cycle, you will need to verify your eligibility more frequently. Missing a renewal notice — especially if your address or contact info is outdated — can result in losing coverage even if you still meet the income requirements.
• Missing the verification interview: HHSC requires a phone interview as part of the application process. Missing it without rescheduling can result in your application being closed. If you miss a call, contact HHSC promptly to reschedule.
• Not exploring the FQHC option: Many uninsured Texans who don’t qualify for Medicaid don’t know that Federally Qualified Health Centers offer sliding-scale primary care regardless of insurance status. These clinics can provide a meaningful healthcare safety net even for those in the coverage gap.

Frequently Asked Questions

Did Texas expand Medicaid in 2026?

No. Texas has not adopted ACA Medicaid expansion. Non-disabled adults without dependent children do not qualify for Texas Medicaid regardless of income. Texas is one of approximately 10 states that have chosen not to expand as of July 2026.

What is the income limit for Texas Medicaid in 2026?

It varies by group: children up to approximately 200% FPL, pregnant women roughly 198–203% FPL, parents/caretaker relatives only about 15–18% FPL (approximately $235–$319 per month for a family of three), and long-term care approximately $2,982 per month with a $2,000 asset limit. There is no income-based pathway for non-disabled childless adults.

Can a single adult get Medicaid in Texas?

Generally only if they are pregnant, disabled and qualify for SSI/MEPD, age 65 or older, or a very-low-income parent or caretaker relative. Non-disabled childless adults have no Texas Medicaid pathway under current 2026 rules.

What is the Texas Medicaid coverage gap?

Adults who earn too much for Texas’s strict Medicaid categories but under 100% FPL (too little for ACA marketplace subsidies) fall into a coverage gap with no affordable health insurance option. An estimated 600,000 to 920,000 Texans are in this gap. Options include Federally Qualified Health Centers (findahealthcenter.hrsa.gov), county indigent care programs, and hospital charity care.

How do I apply for Texas Medicaid?

Apply online at YourTexasBenefits.com (recommended), call 2-1-1 or 1-800-252-8263, or visit a local HHSC benefits office. You can also start at HealthCare.gov and be routed to Medicaid if eligible. Processing takes up to 45 days for most categories (90 for disability determinations).

Does Texas Medicaid cover dental and vision?

Yes — dental and vision benefits are included for children enrolled in STAR. Adult dental and vision benefits are more limited and depend on your specific Medicaid program and health plan. Check with your assigned managed care plan for the current benefit list.

What is a Miller Trust and do I need one?

A Miller Trust (also called a Qualified Income Trust or QIT) is a legal tool used by nursing home and long-term care Medicaid applicants whose income exceeds the monthly income cap of approximately $2,982. By directing income above the cap into the trust, the individual can meet the eligibility threshold. This is a legal arrangement that requires an attorney familiar with Texas Medicaid planning.

What happens to Texas food stamps if I don’t qualify for Medicaid?

SNAP (food stamps) and Medicaid have separate eligibility rules. You may qualify for SNAP even if you don’t qualify for Medicaid. See our guide on Texas food stamps for 2026 income limits and how to apply.

Official Sources

• Texas Health and Human Services Commission (HHSC) — hhs.texas.gov
• YourTexasBenefits.com — apply online
• HealthCare.gov — for those at or above 100% FPL seeking marketplace coverage
• Medicaid.gov — Texas
• Find a Health Center (HRSA) — FQHCs for those in the coverage gap

Last reviewed: July 2026. Not affiliated with any government agency. Medicaid rules and figures change — confirm your situation directly with Texas HHSC at hhs.texas.gov or by calling 2-1-1.