Coverage gap: Texas has not expanded Medicaid. Adults earning below $15,960/year (100% FPL) who don't fit traditional categories may have no affordable coverage option. Those above 100% FPL qualify for marketplace subsidies.
Texas Medicaid Income Limits 2026
The following table shows the key income thresholds for Texas in 2026:
| Household Size | 100% FPL | 138% FPL | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,960 | N/A | $63,840 |
| 2 | $21,640 | N/A | $86,560 |
| 3 | $27,320 | N/A | $109,280 |
| 4 | $33,000 | N/A | $132,000 |
| 5 | $38,680 | N/A | $154,720 |
| 6 | $44,360 | N/A | $177,440 |
Because Texas has not expanded Medicaid, the 138% FPL threshold does not apply for adult eligibility. Adults earning between 0-100% FPL may fall into the coverage gap. Those earning between 100-400% FPL can access marketplace subsidies.
About Texas Medicaid
Who Qualifies in Texas
If you're a Texas resident trying to understand your health coverage options, it's important to know that Texas has not expanded its Medicaid program. This means that most low-income adults without children, a disability, or pregnancy will not qualify for Texas Medicaid, creating a "coverage gap." Currently, Texas Medicaid primarily serves children, pregnant women, very low-income parents, seniors, and individuals with disabilities. For instance, in 2026, a family of three would need a monthly income of approximately $230 to qualify as parents, while pregnant individuals can qualify with incomes up to about $4,398 per month, and children under one year old with a household income up to $2,647 per month. Children aged 1-5 have an income limit of about $1,942 per month, and those aged 6-18 have a limit of approximately 138% of the Federal Poverty Level. For seniors and disabled adults, the income limit for nursing home care is $2,982 per month, with an asset limit of $2,000 for a single person.
If You're Near the Income Line
If your income is too high for Texas Medicaid but still modest, you might qualify for subsidies on the federal marketplace, HealthCare.gov. For example, if your income is above the Medicaid threshold but below 100% of the Federal Poverty Level (FPL), you would fall into the coverage gap, meaning you wouldn't qualify for marketplace subsidies either. However, if your income is above 100% FPL, you could receive significant assistance. With a benchmark Silver plan costing around $527 per month, subsidies can drastically reduce your actual payment. It's crucial to report any income changes to the marketplace, as this can shift your eligibility between programs. Texas saw a significant number of individuals lose Medicaid coverage during the "unwinding" period after the COVID-19 public health emergency, with enrollment in 2024 at 4.55 million, down from a peak of 5.92 million in March 2023. If you lost coverage during this time, you can reapply for Medicaid or explore marketplace options.
What Texas Medicaid Covers
Texas Medicaid, often delivered through the STAR managed care program, covers essential health benefits. These include regular checkups with doctors and dentists, prescription drugs, vaccines, hospital care, X-rays, lab tests, vision and hearing care, and access to specialists and mental health care. There are also various Home and Community-Based Services (HCBS) waivers designed to help individuals with disabilities receive long-term care in their homes rather than in institutions. These waivers often have separate income eligibility rules, sometimes based only on the child's income, not the family's. Some Medicaid plans also offer "value-added services" like sports physicals, dental hygiene kits, or transportation to appointments. For those needing long-term care, Texas has an asset test, generally limiting countable assets to $2,000 for an individual, though a primary residence and one vehicle are typically exempt.
Options in the Coverage Gap
If you find yourself in the coverage gap—earning too much for Texas Medicaid but not enough for marketplace subsidies—there are still practical alternatives for accessing care. Community health centers often provide services on a sliding scale based on your income. Many hospitals offer charity care programs for uninsured residents who meet certain financial criteria. You can also look into county-specific indigent care programs, which vary by location. Free clinics are another valuable resource for basic medical needs. Texas has a high uninsured rate, with 21.6% of adults and 13.6% of children lacking health insurance in 2024, significantly higher than the national averages. This highlights the need to explore all available options. If your income increases and you move above 100% of the Federal Poverty Level, remember to recheck HealthCare.gov, as you would then become eligible for marketplace subsidies to help pay for your health insurance. While legislative proposals for Medicaid expansion, such as Senate Bill 232, have been introduced, they have not yet passed, and Governor Abbott has historically opposed expansion.
Marketplace Insurance in Texas
Texas residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in Texas costs approximately $527/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Texas might pay for a Silver plan after subsidies, based on the $527/month benchmark:
| Income Level | Annual Income | Your Cost | Monthly Subsidy |
|---|---|---|---|
| 150% FPL | $23,940 | ~$80/mo | $447/mo |
| 200% FPL | $31,920 | ~$173/mo | $354/mo |
| 250% FPL | $39,900 | ~$277/mo | $250/mo |
| 300% FPL | $47,880 | ~$392/mo | $135/mo |
| 400% FPL | $63,840 | ~$523/mo | $4/mo |
These estimates are for a 40-year-old individual on a benchmark Silver plan in Texas. Actual premiums depend on your age, household size, tobacco use, and plan choice. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays. Texas uses the federal marketplace at HealthCare.gov.
How to Get Coverage in Texas
Your path depends on your income:
- Income above $15,960/year (100% FPL): You qualify for marketplace subsidies. Apply through HealthCare.gov during open enrollment (Nov 1 – Jan 15) or after a qualifying life event.
- Income below $15,960/year: Check if you qualify for traditional Medicaid (children, pregnant women, disabled). Apply through Texas Medicaid.
- Children: Texas's CHIP program covers kids in families up to 200-300% FPL regardless of expansion status.
Calculate Your Subsidy in Texas
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Texas.
Frequently Asked Questions
Who qualifies for Texas Medicaid?
Texas has not expanded Medicaid, so there is no standard income limit for adults. Traditional Medicaid covers specific groups (children, pregnant women, disabled, very low-income parents). Income limits for these groups vary. Children are generally covered up to 200-300% FPL through CHIP.
Is Medicaid expanded in Texas?
No, Texas has not expanded Medicaid. This creates a coverage gap for adults earning below 100% FPL who do not qualify for traditional Medicaid categories.
How do I get help paying for health insurance in Texas?
Texas residents with household income between 100% and 400% FPL ($15,960 to $63,840 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the name of Texas's Medicaid program?
Texas's Medicaid program is known as Texas Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and certain other qualifying groups.
What happens if I lose Medicaid coverage in Texas?
If your Texas Medicaid coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
What are my options if I'm in Texas's Medicaid coverage gap?
If you're in the coverage gap (earning below $15,960/year but not qualifying for traditional Medicaid), look into community health centers in Texas that offer sliding-scale fees based on income. Many hospitals have charity care programs for uninsured patients. Free clinics and the 211 helpline can connect you with local resources. If your income changes, reapply — even small income increases could qualify you for marketplace subsidies.
Why didn't Texas expand Medicaid?
Medicaid expansion has been a politically contentious issue in Texas. The state legislature has not passed expansion legislation, leaving an estimated coverage gap for adults earning below 100% FPL. Advocacy groups continue to push for expansion, and several neighboring states have recently adopted it. Check with Texas's legislative updates for the latest status.