Health Coverage in Texas: Every Route In, and Who Falls Between Them

Health coverage in Texas comes through six routes: an employer plan, Medicaid in one of the narrow categories the state operates, CHIP or CHIP Perinatal for children and pregnancies, Healthy Texas Women, a subsidized Marketplace plan, or Medicare at 65, and a large group of working-age adults reaches none of them. Texas has the highest uninsured rate in the country, 16.7% against a national 8.2% in 2024, which is roughly one in six Texans and about 5.2 million people¹ (checked 30 July 2026).

I am a Certified Application Counselor, which means my working day is opening YourTexasBenefits with somebody and finding out what their household is actually eligible for rather than what a search result told them. The sentence I have to say out loud most often, several times in a normal week, is that the denial letter in somebody’s hand is not about earning too much. In Texas it is usually the opposite: too little to reach the bottom of the subsidy range, with no adult Medicaid category underneath to catch them. People hear that and visibly relax, because it stops being a personal failing.

This page is the map I would draw for you at that desk: every route in, who each one is genuinely for, and what is left when none of them fit. It is not an eligibility determination and nothing on this site can be. Only HHSC and the Marketplace decide, and every figure below carries the date it was checked because Texas rules move.

What are the routes to health coverage in Texas?

There are six, and in Texas they leave a wider hole between them than in most states. Working through them in the order most households should:

1. An employer plan, if one is offered to you or to a spouse or parent.
2. Medicaid, but only through a category Texas operates: children, pregnancy, parents and caretaker relatives at a very low income, and pathways tied to age or disability. See Texas Medicaid eligibility.
3. CHIP and CHIP Perinatal, for children and for pregnancies in households above the Medicaid line. See CHIP and Children’s Medicaid in Texas.
4. Healthy Texas Women, a state program of women’s preventive and family planning services, covered in Texas health programs.
5. A Marketplace plan, with a premium tax credit if household income lands between 100% and 400% of the federal poverty level² (checked 30 July 2026).
6. Medicare, generally at 65, or earlier on certain disability grounds. See Medicare basics for Texans.

Two things that look like coverage are not. County indigent health care under Health and Safety Code chapter 61 is a county payment program for residents who meet a local standard, not an insurance card³. And a community health center’s sliding scale is a discount on that center’s charges, not coverage that travels with you. Both are genuinely useful, and both are covered in getting care without insurance in Texas.

Who does Texas Medicaid actually cover?

Texas Medicaid is category based, so the first question is never how much you earn, it is which category you are in. Texas is one of the ten states that have not adopted the ACA Medicaid expansion; 41 states including the District of Columbia have⁴ (checked 30 July 2026). That single decision produces the two facts that shape everything else on this site.

• A non-disabled, non-pregnant adult without dependent children has no Medicaid category in Texas at any income. There is no threshold to fall under, because there is no pathway.
• A parent or caretaker relative qualifies only up to about 15% of the federal poverty level, the lowest parent threshold in the nation⁵ (KFF, as of January 2026). Against the 2026 poverty guidelines that is roughly $4,100 a year for a household of three² (checked 30 July 2026). Texas actually sets a dollar standard by household size that federal tables convert into a percentage, so the percentage drifts every January whether or not Texas changes anything.

Categories tied to age, blindness, or disability are decided under different rules from the income tests above, and this site does not publish a figure for them until it has been read off HHSC’s own chart and dated. Ask HHSC or call 2-1-1. The reasoning behind the state’s position, and what expansion would change, is in why Texas did not expand Medicaid.

What do CHIP and Children’s Medicaid cover?

Children are where Texas eligibility is genuinely broad, and a household that has been denied for the adults very often still has approvable children. These are HHSC’s published limits as percentages of the federal poverty level, read from the Texas Works Handbook chart effective 1 April 2026⁶ (all checked 30 July 2026). Four of the five are independently matched by the federal eligibility standards table, which lists Texas children at 198%, 144%, and 133% and separate CHIP at 201%⁷.

Program	Limit, percent of FPL
Children’s Medicaid, infants under 1	198%
Children’s Medicaid, ages 1 to 5	144%
Children’s Medicaid, ages 6 to 18	133%
CHIP	201%
CHIP Perinatal	202%

Two notes that decide real cases. First, there is a standard MAGI income disregard of five percentage points of FPL listed separately on the same HHSC chart, worth $66.50 a month for one person plus $23.70 for each additional household member at the 2026 guidelines⁶ (checked 30 July 2026). That is why some published tables print every Texas limit five points higher than the ones above: they fold the disregard into the headline number and HHSC does not. Both conventions are correct, and the practical upshot is the same either way, which is that the income a household can actually have is a little above the stated limit. Second, each child is assessed separately by age, so siblings can land in different programs.

How income is counted is its own subject, and it is where most wrong denials come from: see what counts as income in Texas, then applying through YourTexasBenefits⁸ for where the decision is made.

What covers a pregnancy, and what happens after the birth?

Two different programs cover pregnancy in Texas, and they end at very different times, which is the single most consequential mix-up on this subject. Medicaid for Pregnant Women runs to 198% FPL and CHIP Perinatal to 202% FPL on HHSC’s chart⁶ (checked 30 July 2026).

• Medicaid: 12 months postpartum. HHSC states that coverage “lasts during pregnancy and up to 12 months after the baby is born”⁹ (checked 30 July 2026). That entitlement comes from House Bill 12 of the 88th Legislature.
• CHIP Perinatal: 60 days, and two visits. The same HHSC page states that CHIP Perinatal “covers care during pregnancy and two doctor visits within 60 days after the pregnancy ends”⁹.

A reader who hears “Texas now covers 12 months postpartum” and is actually enrolled in CHIP Perinatal is wrong by ten months, and will plan a postpartum appointment they have no coverage for. Check which program the approval letter names. The detail sits in Medicaid for pregnant women in Texas and CHIP Perinatal.

What changed on the Marketplace for 2026?

The enhanced premium tax credits expired at the end of 2025, they are not in force for plan year 2026, and the 400% FPL subsidy cliff is back. This reversed the rules that had applied since 2021, and it is the most volatile fact on this site.

What that means in practice, all figures from KFF’s analysis of 2026 enrollment¹⁰ and checked on 30 July 2026:

• Premium payments net of tax credits rose by 58% on average for people who signed up for 2026 coverage, which KFF elsewhere puts at about $780 more than the previous year.
• National enrollment fell for the first time in seven years.
• In Texas, sign-ups rose by about 206,000 (a 5% increase), and effectuated enrollment then fell by about 146,000 (a 4% decrease). Those two numbers belong together. The sign-up rise on its own reads as good news; the effectuated fall is the number that reflects who could actually afford to keep the plan once the first premium came due.

So the operative rule for 2026 is the pre-2021 one: premium tax credits run from 100% to 400% of the federal poverty level, and above 400% you pay the full premium². In a state with no Medicaid expansion that squeezes from both ends, nothing below 100% and nothing above 400%. The mechanics are in how Marketplace subsidies work, the plan choice in picking a Marketplace plan and cost sharing reductions, and what is actually sold here in Marketplace plans in Texas.

The position for plan year 2027 was still open when this page was last checked on 30 July 2026. We say the credits expired at the end of 2025, with that date attached, and we do not tell you they will never come back.

When can you enroll?

Marketplace open enrollment starts 1 November and closes 15 January; Medicaid and CHIP can be applied for at any time of year. Enroll by 15 December for coverage starting 1 January, and a sign-up between 16 December and 15 January starts on 1 February¹¹ (checked 30 July 2026).

Outside that window you need a special enrollment period, which a qualifying life event opens: see special enrollment periods. Losing a job is the common one, and the arithmetic between COBRA and a Marketplace plan is worked in coverage if you lose your job. If what you are being sold is not a Marketplace plan at all, read short-term plans and health shares before you buy.

Who do none of these routes reach?

About 605,000 poor uninsured Texan adults aged 19 to 64 sit in the coverage gap: too much income for the categories Texas operates, too little to reach the bottom of the premium tax credit range. That is by far the largest figure of any state¹² (KFF estimates based on the 2024 American Community Survey, checked 30 July 2026), and roughly half the national coverage gap, which KFF put at about 1.2 million people across the ten non-expansion states in its coverage gap analysis published on 27 July 2026.

The gap is not the whole uninsured population, which is much larger. In 2024 Texas recorded 21.6% of adults aged 19 to 64 uninsured and 13.6% of children under 19, both the highest in the country, with the children’s rate up 1.7 points from 11.9%¹ (2024 data, checked 30 July 2026). Texas holds about 19% of all uninsured people in the United States while holding about 9% of the country’s population¹.

The thing to understand about the gap, and the reason applying again next year with the same income changes nothing, is that it is structural. It is not a mistake on your form. The Texas coverage gap sets out the mechanism, and if a decision has already come back wrong on the facts, appealing a denial in Texas covers the fair hearing.

What is left when nothing covers you?

Quite a lot, and none of it requires coverage, but you have to know the names to ask for. This is the half of the subject that state pages tend to stop before.

• Federally funded community health centers. Every health center funded under the federal Health Center Program must run a sliding fee discount schedule based on household size and income, with a full discount at or below 100% of the poverty guidelines unless the center elects a nominal charge, partial discounts in at least three pay classes between 100% and 200%, and no discount above 200%. The manual’s operative line: the center “must operate in a manner such that no patient shall be denied service due to an individual’s inability to pay”¹³ (HRSA, page last reviewed November 2025, checked 30 July 2026). The discount applies to the health center’s own charges, so labs, imaging, specialty referrals, and prescriptions may be priced separately. Texas had 71 reporting health center organizations serving 1,859,052 patients in 2024, of whom 624,629 (33.60%) were uninsured¹⁴ (2024 data, checked 30 July 2026). See community health centers in Texas.
• County indigent health care. Counties must run a program with a net income eligibility level of at least 21% of the federal poverty level, and may set a more generous standard³ (checked 30 July 2026). What your county actually does is a county question: county indigent health care program.
• The emergency room, on the terms EMTALA sets. A Medicare-participating hospital offering emergency services must provide a medical screening examination and stabilizing treatment regardless of ability to pay¹⁵ (CMS page last modified 10 March 2026, checked 30 July 2026). It is not free care, it does not reach clinics or urgent care, and it covers screening and stabilization rather than the follow-up treatment an emergency reveals you need. Read EMTALA and the emergency room for all three limits, and go anyway if it is an emergency.

If a bill has already arrived, start at medical bills in Texas, because the order you do things in changes the outcome.

How the numbers on this page are kept current

Every figure here is a slot with a named source and a check date, and the two dates that matter most are January and September. In January the federal poverty guidelines are reissued and every percentage-derived limit on this site moves with them, so nothing carries a prior-year figure past 31 January. In September the open enrollment dates and the subsidy structure for the coming plan year are re-checked before any enrollment copy is written.

Between those windows, anything can move on an event: a legislative session, a federal change to premium tax credits, a court decision. When a figure passes its window without being re-confirmed, this site flags it as out of date and links the source, rather than leaving it sitting there looking current. That is the whole basis on which you should trust a number here, and it is why each one above carries a date rather than a vague “currently”.

Texas Care Map is independent. It is not affiliated with the State of Texas, the Texas Health and Human Services Commission, the Texas Department of Insurance, or the Centers for Medicare and Medicaid Services, and it cannot decide your case.