We have scoured the internet to provide all you need to know about the Texas Medicaid Benefits.
Medicaid is a joint federal-state program that provides health insurance to low-income individuals who meet specific requirements, including kids, pregnant women, the elderly, and individuals with disabilities. Applying for Medicaid in person, via telephone, or online is simple.
This post will teach you all you need to learn about Medicaid in Texas.
Table of Contents
What is the Texas Medical Program?
Texas Medicaid is a service for people and families with income and resources that fall within specific parameters. Resources primarily apply to the elderly, blind, or disabled population within the bounds of specified rules.
Who is eligible for the Texas Medical Program?
Texas Medicaid offers limited Medicare beneficiaries who are not eligible for the entire Medicaid benefit package some partial financial help with Medicare premiums and copayments or coinsurance through the Medicare Savings Plan.
- Expectant mothers
- People who are blind or disabled or who have a spouse who is blind or disabled;
- People whom someone adopts;
- People whom someone adopted;
- People who are blind or disabled or have a spouse who is disabled.
The Annual Household Income Limits (before taxes)
| Household Size* | The Maximum Income Level (Per Year) |
| 1 | $26,909 |
| 2 | $36,254 |
| 3 | $45,600 |
| 4 | $54,945 |
| 5 | $64,291 |
| 6 | $73,637 |
| 7 | $82,982 |
| 8 | $92,328 |
*For households with more than eight people, add $9,346 per additional person.
How do I contact Medicaid in Texas?
Phone
800-335-8957
Mailing Address
1100 West 49th St. Austin, Texas 78756-3199
P.O. Box 149347
Fax: 1-877-447-2839
What are the Medicaid plans in Texas?
STAR
STAR provides low-income women and children with acute and primary healthcare services. The state has increased managed care coverage over time to include more people and services.
STAR+PLUS
For Medicaid clients who are elderly, blind, or disabled, STAR+PLUS includes acute care services and community-based long-term support and services. Over time, most of the state’s urban areas have received assistance from STAR and STAR+PLUS.
One of the two risk-based managed care systems is enrolled by about half of the Medicaid population.
Star Health
Star Health primarily covers children in foster care. Medicaid recipients are eligible to participate in multiple programs.
If they require behavioral health treatment, they are typically enrolled in NorthStar, which offers acute and ongoing services and is also one of the f three plans providing critical care.
Non-Emergency Medical Transportation (NEMT)
A fee-for-service waiver known as Nonemergency Medical Transportation (NEMT) gave the state the freedom to organize and guarantee the necessary, affordable NEMT in particular regions of the state. Demand Response Services were only available in the counties named in the waiver.
For more details regarding Medicaid plans in Texas, click here.
How do I apply for Texas Medicaid?
Call 800-335-8957 to enroll.
Apply in person at Texas Health and Human Services
Online: Download and print the application.
Mail: To 1100 West 49th St. Austin, Texas 78756-3199
P.O. Box 149347
Fax: 1-877-447-2839
What is covered by Texas Medicaid?
Texas Medicaid covers the following services:
| Ambulatory surgery | Hospital stays |
| Audiology services | Laboratory tests |
| Behavioral health services | Vision care |
| Women’s health care | Non-emergency transportation |
| Dialysis | Orthotic and prosthetic devices |
| Doctor visits | Occupational therapy |
| Smoking cessation services | Pharmacy (medications) |
| Emergency care | Physical rehabilitation |
| Family planning services | Preventive care |
| Hearing aids | Hospital outpatient care |
| Home health care | X-rays and other radiology services |
Can I have both Texas Medicaid and Medicare?
Adult dual-eligible members—those eligible for both Medicare and Medicaid—can get services from the Texas Health and Human Services Commission. The project aims to improve care coordination for those dual eligible members.
Texas Waiver
- CLASS Waiver
- DBMD Waiver
- HCS Waiver
- MDCP Waiver
- HCBS Waiver
- TxHmL Waiver
- YES Waiver
Copayments?
They do not have to pay a copayment. When a member is
- under 21 years old;
- pregnant;
- Held by the state
- Placed under government supervision
- Native American participants who qualify for Contract Health funding
- Services or Tribal Union of Indian Health Services
- The hospital (inpatient)
- A facility for skilled nursing
- A nursing home
What is not covered by Texas Medicaid?
Medicaid is not mandated in Texas to offer in-home caregiving services or private nursing coverage. Bandages, adult diapers, and other disposable items are frequently excluded from insurance coverage, as are cosmetic surgery and other elective procedures.
What is the highest income limit for Texas Medicaid?
The highest income limit for Texas Medicaid is $26,909 for an individual per year.
What if a person’s income is too high to qualify for regular Medicaid benefits?
If your income is too high, you may still be eligible for Texas Medicaid, thanks to the asset spend down option.
What documents do I need to apply for Medicaid?
The following documents are required with the application:
- The Social Security Number;
- Evidence of citizenship or authorized residency in the United States, such as a passport, driver’s license, birth certificate, green card, or job authorization card
- Evidence of all income sources, both legal and illegal
- Proof of origin
- Proof of residency
- Including the Medicare card, any insurance cards
- Pregnancy;
- When non-parents apply for Medicaid on their behalf, they must provide evidence of their financial position.
What is the best Medicaid in Texas?
The best plan for you is the one that meets your demands and offers the most benefits in terms of health insurance and monetary help because it varies from person to person.
Where do I find the letter showing the reason(s) for denial or discontinuance from Texas Medicaid?
By signing into your account at Portal, you can see the progress of your Texas Medicaid application.
