Understanding the Types of Medicaid in Texas
Medicaid is a health insurance program for people with low income, funded by both the state and federal government. In Texas, there isn’t just one kind of Medicaid — there are different programs depending on your age, health needs, and family situation.
Here’s a breakdown in plain language:
1. Medicaid for Children
Covers kids from birth to age 18 (sometimes up to 21 in special cases).
- Who it’s for: Children in low-income families.
- What it covers: Doctor visits, hospital care, dental care, vision, hearing, prescriptions, mental health care, and more.
2. Medicaid for Pregnant Women
Covers pregnancy and postpartum care.
- Who it’s for: Pregnant women who meet income requirements.
- What it covers: Prenatal visits, labor & delivery, postpartum checkups, and sometimes your baby’s care after birth.
- Length of coverage: Up to 12 months after the baby is born.
3. Medicaid for Parents or Caretaker Relatives
Covers adults who are caring for children.
- Who it’s for: Parents or certain relatives (like grandparents) who are the main caretakers of a child.
- What it covers: Medical visits, prescriptions, hospital stays, mental health care.
4. Medicaid for People with Disabilities
Special coverage for children and adults with disabilities.
- Who it’s for: People with a qualifying disability who meet income/resource limits.
- Includes:
- SSI Medicaid – automatically for people who receive Supplemental Security Income.
- Medically Needy Program – for people who have high medical bills but income above Medicaid limits.
5. STAR & STAR+PLUS Managed Care Programs
Texas uses managed care plans run by private insurance companies that work with Medicaid.
- STAR – For most children, pregnant women, and some families.
- STAR+PLUS – For adults with disabilities or those 65+ who need long-term services.
6. Medicaid for the Elderly
- Who it’s for: People age 65+ who meet income/resource limits.
- May include: Nursing home care or home health services.
Important Warning for Parents About CHIP
If your income is too high for Medicaid, your child might still qualify for CHIP (Children’s Health Insurance Program).
CHIP is low-cost and covers most basic medical and dental needs. BUT — very important — CHIP does not cover ABA therapy, speech therapy, occupational therapy, or most developmental/behavioral therapies.
If your child needs these services, you’ll need to look into other funding options.
NOTE: Marketplace & Medicaid Can’t Be Combined:
You cannot have both Medicaid and Marketplace (Healthcare.gov) insurance at the same time. If you qualify for Medicaid, you are not eligible for subsidies on a Marketplace plan.
Employer Insurance & Medicaid Can Work Together:
You can have both Medicaid and insurance from your job (or a family member’s job). However, employer insurance will always be your primary coverage, meaning it will be billed first. Medicaid is secondary and can help cover costs your employer plan doesn’t — like co-pays, deductibles, and certain uncovered services.
In-Network Rule for Medicaid as Secondary:
Medicaid will only help pay if the provider is in-network with your secondary Medicaid plan. Even if your primary employer insurance covers part of the visit, Medicaid will not pay the rest if the provider doesn’t accept your Medicaid plan. Always check both insurances before making appointments.
💡 Bottom Line:
Even if you think your income is too high for Medicaid, check anyway. For children with higher medical needs, Medicaid can cover services that CHIP will not — and that can make a huge difference for families.
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