CHIP and Children's Medicaid in Texas: The Age Bands That Decide Which One

CHIP and Children’s Medicaid are two programs on one application, and which one a Texas child lands in is decided first by the child’s age and then by household income. HHSC’s chart effective 1 April 2026 puts Children’s Medicaid at 198% of the federal poverty level for infants under 1, 144% for ages 1 to 5 and 133% for ages 6 to 18, with CHIP above all three at 201%¹ (checked 30 July 2026).

The notice I remember best listed four people. Two children approved, on two different program lines with two different codes, a third child approved on a third line, and the mother’s name at the bottom with a denial beside it. She had brought it in because she assumed a document that said four different things could not be right. It was right. Her nine year old had been measured against a lower band than the baby, which put him in CHIP while the baby went to Children’s Medicaid, and her own line was decided under a rule that has almost nothing to do with the children’s rules. We spent the appointment on the codes, and she left knowing which card would arrive for which child.

This page explains that structure: the bands, the codes, why siblings split, and why the published figures differ between sources. It is not an eligibility determination. Only the Texas Health and Human Services Commission can decide a Medicaid or CHIP case, and every figure below carries the date it was checked.

What is the difference between CHIP and Children’s Medicaid?

Children’s Medicaid covers children in lower income households, CHIP covers children just above those lines, and HHSC assesses both from a single application. They are not competing programs and a household does not choose between them² (checked 30 July 2026).

The practical differences a household notices:

• Income position. Children’s Medicaid sits below CHIP on the same scale, and the exact line depends on the child’s age. CHIP is the program for children whose household income is above the Medicaid band for their age but at or below 201% of the federal poverty level¹.
• Cost to the family. Children’s Medicaid does not involve family cost sharing in the way CHIP does. CHIP does involve some, and this page publishes no figure for it, for the reason given further down³.
• What comes with Medicaid. A child enrolled in Medicaid also has Texas Health Steps, the Texas name for the federal EPSDT benefit, covering checkups, dental care and case management⁴ (checked 30 July 2026). It is not a separate application. See Texas Health Steps.

Both programs are applied for in the same place and at any time of year, unlike a Marketplace plan: see applying through YourTexasBenefits.

What are the age bands and the program codes?

HHSC states each limit as a percent of FPL against a Type Program or Type Assistance code, not against the program name a family would use, and the code is what appears on the notice. This is the chart, from the Texas Works Handbook C-130, effective 1 April 2026¹, every figure checked on 30 July 2026.

Program	Percent of FPL	HHSC code
Children’s Medicaid, infants under 1	198%	TP 43
Children’s Medicaid, ages 1 to 5	144%	TP 48
Children’s Medicaid, ages 6 to 18	133%	TP 44
CHIP	201%	TA 84
CHIP Perinatal	202%	TA 85
Medicaid for Pregnant Women	198%	TP 40
Healthy Texas Women	204.2%	TA 41
Transitional Medicaid	185%	TP 07

The shape of that list is worth reading before the numbers. The band drops sharply as a child gets older: an infant is measured against 198%, the same child at two years old against 144%, and at six against 133%. Nothing about the household changes on those birthdays, but the line the household is measured against does, which is why a family can be approved one year and moved to a different program the next on the same income.

Five of these percentages are independently confirmed by the federal eligibility standards table, which lists Texas children at 198%, 144% and 133%, separate CHIP at 201% and pregnant women at 198%⁵. Two sources compiled years apart give the same numbers, which is about as much corroboration as an eligibility figure gets.

Why can siblings end up in different programs?

Because each child is assessed separately against the band for their own age, not once for the household as a group. One application, one household income, several different tests.

Worked through, on a single household at a fixed income:

• A baby is measured against 198% under TP 43, the most generous band, and is the most likely of the children to reach Children’s Medicaid.
• A four year old is measured against 144% under TP 48.
• A nine year old is measured against 133% under TP 44, the narrowest band.
• Any child above the band for their own age is then considered for CHIP at 201% under TA 84¹ (checked 30 July 2026).

So a household sitting between 133% and 144% can have a four year old on Children’s Medicaid and a nine year old on CHIP at the same time. Different program names on one notice are usually correct. What is worth checking is that every child in the household appears on the notice at all, because a missing child is a different problem from a child in a different program, and it is one an appeal can fix.

Why do other tables print Texas limits five points higher?

Because of where the MAGI income disregard is placed, and both conventions are correct. HHSC’s chart lists a “Standard MAGI Income Disregard: Five Percentage Points of FPL” as a separate line, worth $66.50 a month for one person plus $23.70 for each additional household member at the 2026 poverty guidelines¹ (checked 30 July 2026).

KFF and MACPAC fold those five points into the headline limit. That is why their Texas figures read 203% for infants, 149% for ages 1 to 5, 138% for ages 6 to 18 and 206% for separate CHIP: every one is exactly five points above the HHSC number for the same program. Neither table is wrong, and the two describe the same rule from different ends.

This site publishes HHSC’s percentage, for one reason: HHSC is the agency that decides, and its number is the one that will appear on a Texas notice. The rule that follows from that is do not mix the conventions and never average them. The consequence for a household is the same under either: the income a family can actually have is a little above the stated limit, so a gross figure slightly over the line is not a reason to skip the application.

How do the percentages turn into dollars?

Multiply the percentage by the current federal poverty guideline for the household size, then divide by twelve for a monthly figure. The 2026 annual guidelines for the 48 contiguous states are $15,960 for a household of 1, $21,640 for 2, $27,320 for 3, $33,000 for 4, $38,680 for 5, $44,360 for 6, $50,040 for 7 and $55,720 for 8, adding $5,680 for each additional person⁶ (checked 30 July 2026).

HHSC’s own worked figure on the chart is a single person at 133% FPL, whose income must be “not exceeding $1,769” a month¹ (checked 30 July 2026), which is 133% of $15,960 divided by twelve, or $1,768.90. As an illustration of scale for a family, 201% of the 2026 guideline for a household of three is about $54,900 a year, or roughly $4,576 a month. That figure is computed here from the 2026 guidelines rather than copied from anywhere, and it is an illustration rather than your line.

There is a specific trap behind that caution. As at 30 July 2026, HHSC is publishing two different poverty guideline vintages at once: its pregnancy program page computes against the 2026 guidelines while the Children’s Medicaid dollar table on its consumer site is still on the 2025 ones. Both look equally current. So take the percentage from the handbook chart, apply a guideline year you can name, and treat any dollar table you find elsewhere with suspicion until you know its vintage. Which income counts in the first place is its own subject, and the most common source of a wrong self-assessment: what counts as income in Texas.

What does CHIP cost, and why is there no figure here?

CHIP involves some family cost sharing and this page publishes no amount for it, because no verified figure sits in this site’s set. That gap is deliberate and it is named here rather than filled.

What is known and safe to say: Children’s Medicaid and CHIP differ on this point, CHIP amounts vary with household income, and the schedule is published by HHSC rather than set by an insurer³ (checked 30 July 2026). What this page does not state is any enrollment fee, any copay, any annual cap, or how any of them scale with income.

The reasoning is the same one that governs every empty slot on this site, and it cuts differently from the way people expect. A cost figure that is too low reads as a promise and produces an unpleasant surprise. A cost figure that is too high is worse, because a parent who reads it decides the program is unaffordable and never applies, and nobody ever finds out that the child could have been covered for less. Where the number lives: the CHIP pages on hhs.texas.gov, the materials that arrive with a decision, and a certified counselor working from the current schedule, who you can find through 2-1-1 Texas⁷. Ask before you conclude anything about affordability.

What happens when the children are approved and the adults are not?

That is the normal Texas outcome, not a defect in the application. Children’s eligibility reaches 198% and 201% of the federal poverty level while adult eligibility here is far narrower: there is no Medicaid category at all for a non-disabled, non-pregnant adult without dependent children, and the parent and caretaker relative standard is the lowest in the nation.

Two things follow, and they are separate.

• Use the children’s approval immediately. It is a real decision and it does not depend on the adult outcome. Note the program name and the code beside each child’s name, because that determines the card, the network and whether Texas Health Steps comes with it⁴.
• Treat the adult line as its own question. If the denial was for having too little income rather than too much, that is the coverage gap, which holds about 605,000 poor uninsured Texan adults aged 19 to 64⁸ (checked 30 July 2026). Reapplying with the same income will not change it. The mechanism is in the Texas coverage gap, and the productive next step for an adult with no pathway is getting care without insurance in Texas. What the adults may still reach is in Texas health programs and Healthy Texas Women, and the full category structure is in Texas Medicaid eligibility.

For context on why children’s coverage is worth chasing hard even when the adults get nothing: 13.6% of Texas children under 19 were uninsured in 2024, the highest rate in the country and up 1.7 points from 11.9%⁹ (2024 data, checked 30 July 2026).

What about a pregnancy in the household?

Pregnancy is assessed under its own programs, and the two of them end at very different times. Medicaid for Pregnant Women runs to 198% of the federal poverty level under TP 40 and CHIP Perinatal to 202% under TA 85 on the same HHSC chart¹ (checked 30 July 2026).

The difference that catches people is at the other end. HHSC states that Medicaid coverage “lasts during pregnancy and up to 12 months after the baby is born”, an entitlement created by House Bill 12 of the 88th Legislature, Regular Session, 2023, while CHIP Perinatal “covers care during pregnancy and two doctor visits within 60 days after the pregnancy ends”¹⁰ (checked 30 July 2026). The 12 month figure belongs to Medicaid. Somebody on CHIP Perinatal who plans around it is wrong by ten months. Read the program name on the approval letter, then CHIP Perinatal or Medicaid for pregnant women in Texas.

Where the decision is made, and what to do with a wrong one

One application at YourTexasBenefits is screened against Medicaid, CHIP and Healthy Texas Women together, and HHSC delivers the notices there¹¹. Keep every notice, and read three things on each: the program name, the code, and the effective date.

That effective date matters because it starts the appeal clock. You have 90 days from the effective date of the HHSC action to request a fair hearing, orally or in writing, in HHSC’s own words: “Individuals have the right to appeal within 90 days from the effective date of any Texas Health and Human Services Commission (HHSC) action”¹² (checked 30 July 2026). The clock runs from that date, not from the day the envelope was opened, and federal rules require states to allow between 20 and 90 days, so Texas sits at the maximum. Late is not automatically fatal either: only the hearings officer has the authority to decide the timeliness of a filed appeal, and good cause can be accepted, so ask anyway rather than assuming the door is shut. The full process is in appealing a denial in Texas.

An appeal is the right tool when a child was left off, income was counted twice or a document never attached. It is the wrong tool when the answer is that the category does not exist, which is an adult problem rather than a children’s one. For how these two programs sit against everything else available here, start at health coverage in Texas, and call 2-1-1 Texas for a certified counselor near you⁷.

Texas Care Map publishes independently. It has no connection to the State of Texas, HHSC, the Texas Department of Insurance or the Centers for Medicare and Medicaid Services, and it cannot approve or deny anybody’s application.