Texas Health Steps: What a Child on Texas Medicaid Is Entitled To

Texas Health Steps is the Texas name for the federal EPSDT benefit, and it gives children and young people enrolled in Medicaid checkups, dental care, and case management without a separate application and without a second income test. It is not a program a family signs up for. It arrives with the Medicaid enrollment, HHSC publishes it as part of Medicaid¹, and that is exactly why so many households never find out they have it.

A mother came to see me to ask how much a checkup was going to cost, because the school had sent a form home and she had been putting off making the call. Her two children had been on Children’s Medicaid for a little over two years. The words Texas Health Steps were printed inside the health plan handbook that arrived in the mail with the cards, which she had kept in a drawer and never opened, and she had never heard anybody say the phrase out loud. She had spent two years treating checkups and dental care as things she would have to find the money for. That conversation is the reason this page exists, and it is the most common version of it I have.

Nothing here is an eligibility determination. Only HHSC decides whether a child is enrolled in Medicaid, and only the child’s health plan can tell you what it provides. Every figure below carries its source and the date it was last checked.

What is Texas Health Steps, and what does it cover?

It is Texas’s implementation of the federal EPSDT benefit, Early and Periodic Screening, Diagnostic and Treatment, covering checkups, dental care, and case management for children and young people enrolled in Medicaid¹ (checked 30 July 2026). EPSDT is a federal Medicaid benefit for children, and each state runs it under its own name and its own operational rules. In Texas the name is Texas Health Steps, and it is the reason a Medicaid card in a child’s household is worth more than most families realize.

The context is a state where children’s coverage is both the broadest part of the system and a persistent gap. Texas recorded 13.6% of children under 19 uninsured in 2024, the highest rate in the country and up 1.7 points from 11.9% the year before² (2024 data, checked 30 July 2026). Some of that is children who are not enrolled in a program they qualify for. A separate slice of it, and the slice this page is about, is children who are enrolled and whose families do not know what the enrollment already includes.

Why is there no separate application?

Because it is a benefit inside Medicaid rather than a program next to it. The gate is the Medicaid enrollment. Once a child is enrolled, the benefit is there, and there is no second form, no second income test, and no second determination that could go the wrong way. The one income test that does happen is the Children’s Medicaid test on the original application, against limits of 198% of the federal poverty level for infants under 1, 144% for ages 1 to 5 and 133% for ages 6 to 18 on HHSC’s chart effective 1 April 2026³ (checked 30 July 2026). Clear that, and nothing further stands between the child and this benefit.

The catch is that nothing announces it. In my experience the phrase reaches a parent in one of three ways: buried in the health plan handbook that comes with the cards, said by a clinic that already knows the name, or from somebody like me. It is very rarely on the approval notice in a way a busy person would notice. So the single practical instruction on this page is to treat the enrollment as the trigger: if a child is on Texas Medicaid, call the number on the card and ask what the plan provides under Texas Health Steps.

That also means the productive question, if a family has nothing, is not about this benefit at all. It is about whether the children can be enrolled in the first place, which is the next section and is worked in applying through YourTexasBenefits⁴.

What does HHSC actually list under the Texas Health Steps name?

HHSC publishes the contents of the benefit on the program’s own page, and the list is wider than the word “checkups” suggests. In HHSC’s own framing, Texas Health Steps benefits include medical checkups, dental checkups, health education for the parent and the child, health care “that is made to fit your child’s needs”, health screenings for healthy growth, and rides to the doctor or dentist¹ (checked 30 July 2026). Four of those six are things families routinely assume they must arrange and pay for themselves.

Two of them are separately named HHSC programs, which matters because you get a faster answer by asking for a program by its name than by describing what you need.

• Case Management for Children and Pregnant Women. HHSC describes this as available to children on Medicaid who “have health problems” or “are at a high risk for getting health problems”, and to pregnant women on Medicaid. A case manager works out which services the family needs, finds services near where they live, teaches the family how to find and get other services, and checks that the services are actually arriving. HHSC lists three routes to a referral: the Texas Health Steps line, the person’s Medicaid managed care organization, or a referral form sent to Texas Health Steps¹ (checked 30 July 2026). Nobody hands this to you. It is requested.
• The Nonemergency Medical Transportation Program. HHSC runs a separate transportation program for Medicaid members and their children, covering rides “to a doctor’s office, dentist’s office, hospital, drug store or any place that provides covered health care services”, with the types of ride including public transportation, a taxi or van service, and commercial transit to another city for an appointment⁵ (checked 30 July 2026). For a household without a car, this is frequently the difference between a booked appointment and a missed one.

What this page still does not give you is when each checkup falls due, and that gap has its own section further down. The contents of the benefit are published; the schedule is the part this site has not yet read off HHSC and dated.

Who is enrolled in the first place?

Children’s Medicaid is decided by age band and household income, and the limits are the thing that decides whether any of this applies to your household. On HHSC’s chart in the Texas Works Handbook, effective 1 April 2026³ (checked 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

The federal eligibility standards table independently lists Texas children at 198%, 144% and 133% with separate CHIP at 201%⁶, which is two sources compiled years apart landing on the same numbers.

Three things about that table change what households actually do.

• Each child is assessed separately by age, so siblings routinely land in different programs on one application.
• A standard MAGI income disregard of five percentage points of FPL is a separate line on the same chart, worth $66.50 a month for one person plus $23.70 for each additional household member at the 2026 poverty guidelines³ (checked 30 July 2026), so the income a household can have runs a little above the stated limit.
• Percentages turn into dollars against the current guidelines, which for 2026 start at $15,960 a year for a household of one and $27,320 for a household of three⁷ (checked 30 July 2026). Which dollars count is its own subject: what counts as income in Texas.

The full picture of the children’s programs is in CHIP and Children’s Medicaid in Texas, and the category rules behind them in Texas Medicaid eligibility.

Texas Health Steps and CHIP are not the same benefit

A child on CHIP is not on Texas Health Steps. CHIP is a separate program with its own benefit design, run by HHSC alongside Medicaid rather than inside it⁸ (checked 30 July 2026), and its limit is 201% of the federal poverty level under the code TA 84 on the same chart³.

That distinction is not academic in a real household. Because each child is assessed separately by age, a family can easily have one child on Children’s Medicaid at the 133% line and another, younger, on Medicaid at 144% or 198%, or a child above the Medicaid line and on CHIP at 201%. The parents get two cards, two handbooks, and two sets of rules, and the phone call that works for one child does not necessarily work for the other.

Before you call a clinic, know which child is on which program. It changes what is covered, which network list you should be working from, and what you are entitled to ask for by name.

What this page does not publish: the checkup schedule

HHSC sets the Texas Health Steps checkup schedule, and this site does not publish it, because it has not been read off an HHSC source and stamped with a date. No schedule appears anywhere on this page, in the takeaways, or in the FAQ, and that is deliberate rather than an omission.

The reasoning is the same one that governs every empty slot on this site, and here it cuts sharply. A parent told a checkup is not due yet does not book one, and nobody ever calls to correct them, so a wrong interval in the strict direction is invisible: it produces a missed appointment that never becomes a complaint. A wrong interval the other way only wastes a trip. Given that asymmetry, an approximate schedule is worse than none, so the slot stays empty until it can be filled from the agency’s own page with a date attached.

Ask for it by name, and the phrasing matters because it gets you to the right list quickly:

• Call the member services number on the child’s Medicaid card and ask for the Texas Health Steps checkup schedule for a child of that age.
• Ask HHSC, whose Texas Health Steps page is the source of record for the program¹.
• Call 2-1-1 Texas, on 2-1-1 or (877) 541-7905, for a local organization that can walk through it with you⁹ (checked 30 July 2026).

What to ask the plan, and what to do when a dentist will not take it

Most of what a family needs from here is a plan question rather than a state question, so put it to the plan. Texas Medicaid is largely delivered through managed care, so the card usually names a health plan, and that plan holds the network list, the member handbook and the help lines. Three questions are worth one call: which providers near you are in network for the child’s checkups, and whether the plan will book one; which card or plan covers the child’s dental care, since that decides which network list you work from; and whether case management is available for a child with an ongoing condition. For children with a qualifying condition there is also a separate state program, children with special health care needs. Note the date of every call and the name of whoever you spoke to.

If no dentist will take the plan, call the plan and ask it to find you one, because a network problem is the plan’s problem to solve and asking creates a record. That is the step families skip and the one with leverage in it. If it stalls, widen the search rather than paying a private fee. Federally funded community health centers must run a sliding fee discount schedule based on household size and income: 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%, with the standing requirement that a center “must operate in a manner such that no patient shall be denied service due to an individual’s inability to pay”¹⁰ (HRSA, page last reviewed November 2025, checked 30 July 2026). Texas had 71 reporting health center organizations serving 1,859,052 patients in 2024, of whom 583,800 (31.40%) were on Medicaid or CHIP¹¹ (2024 data, checked 30 July 2026), so a center already billing Texas Medicaid is a realistic option.

The wider set of routes, including dental school clinics, is in dental care without insurance, and the discount mechanics in how the sliding scale works. A health center’s discount applies to that center’s own charges, so anything sent out can be billed separately.

If the Medicaid enrollment itself is the problem

Then the question is not about this benefit, it is about the enrollment, and that has a deadline attached. If a child’s Medicaid application is denied and the facts look wrong, HHSC’s rule is that “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 the effective date printed on the notice rather than from the day it arrived, a request can be made orally or in writing, and a late request is not automatically dead, because only the hearings officer has authority to decide timeliness. See appealing a denial in Texas.

If no children’s program fits, that is a real answer with its own map: getting care without insurance in Texas. And for how this benefit sits against everything else the state runs, see Texas health programs and health coverage in Texas.

Where the decision is made, in one line: HHSC decides the enrollment, the child’s managed care plan decides the network and the arrangements, and this page decides nothing at all. Texas Care Map is independently published and holds no affiliation 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.