Medicaid Texas Eligibility: Texas is still not expanding Medicaid under the Affordable Care Act, even as of June 2025. Because of this decision, over 617,000 low-income adults in the state are left without any help.
They can’t get Medicaid, and they also don’t qualify for government help to buy private insurance. This situation has caused Texas to keep the highest uninsured rate in the whole country. More than 16% of people living in Texas do not have health insurance, and this number hasn’t changed in years.
The Affordable Care Act was supposed to give Medicaid to all adults earning up to 138% of the federal poverty level. But after the Supreme Court ruling in 2012, it became a choice for each state. Texas has always said no. That means many poor adults still don’t get coverage, even if they are working or trying to make ends meet. Lawmakers in Texas did try in late 2024 and early 2025 to pass some changes or new programs. But nothing has worked so far.
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Back in 2020, about 45% of Texas adults between 19 and 64 years old who were under the poverty line did not have any insurance. That’s almost half the low-income adult population going without care or coverage.
Who Can Get Medicaid in Texas Today?
Medicaid in Texas is only for a small group of people. Most adults won’t qualify unless they are pregnant, have a serious disability, or take care of children. Even parents with kids have to make extremely little money to qualify. For example, a single parent with two kids has to earn less than $230 each month. That is only around 12% of the poverty level. If they earn more than that, even by working a small part-time job, they lose eligibility.
Currently, the groups eligible for Medicaid in Texas include:
- Children and teens under 19 from low-income households
- Pregnant women
- Adults with disabilities
- Seniors aged 65 or older
- Parents and caretakers of children (subject to strict income rules)
As of October 2024, around 4.1 million Texans were on Medicaid or CHIP (Children’s Health Insurance Program). But that number used to be higher. After COVID-era protections ended, a big process called “unwinding” started. Nearly 2.5 million Texans lost their Medicaid coverage during this time. Most people got removed not because they were no longer eligible, but because they missed paperwork or didn’t respond on time.
How to apply for Medicaid or CHIP in Texas
Texans who believe they may qualify can start the application process through several options:
- Online: Visit YourTexasBenefits.com and click “Apply for new benefits.”
- Phone: Call 2-1-1 (or TTY 711) Monday through Friday, 8 a.m. to 6 p.m.
- Mail: Download or request a paper form and submit it by mail.
- In person: Visit a local Health and Human Services office or a community partner organization.
- Marketplace: Apply via HealthCare.gov; if deemed eligible, your application will be transferred to the Texas Medicaid office.
After getting approved, people will get a packet with details. They can pick a health plan like Superior HealthPlan. If they don’t choose one, the state will pick it for them.
Why Medicaid Expansion is Important?
By not saying yes to Medicaid expansion, Texas is losing a lot. First, it is missing about $6 billion every year in federal money. That money could have been used to give health insurance to up to 1.2 million more people.
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Studies have shown that states that expanded Medicaid had better health outcomes. More people saw doctors regularly, fewer hospitals lost money from treating uninsured patients, and the number of people without insurance dropped a lot.
Texas, however, has stayed at the bottom in national rankings when it comes to healthcare access and system performance. The state still struggles with health care needs, and refusing Medicaid expansion is part of the reason.
