Texas Medicaid Eligibility: The Categories That Exist, and the Ones That Do Not

Texas Medicaid asks which category you are in before it asks what you earn, and the categories the state operates are narrow: children, pregnancy, parents and caretaker relatives at a very low income, and pathways tied to age or disability. There is no general low-income adult category, because Texas is one of ten states that have not adopted the ACA Medicaid expansion, while 41 states including the District of Columbia have¹ (checked 30 July 2026).

I sit with people at YourTexasBenefits for a living, and the most common thing I have to unpick in the first five minutes is the assumption that Medicaid is a single program with a single income line. It is not, here or anywhere. Getting that straight changes what you apply for and what you bring. Nothing on this page is an eligibility determination: only the Texas Health and Human Services Commission can decide a Medicaid or CHIP case. This page tells you what HHSC publishes, where it published it, and when we last checked.

What Medicaid categories does Texas actually operate?

Six groupings cover almost every Texas Medicaid case, and HHSC identifies them internally by a Type Program code rather than by the name you would use. That matters because a notice will often quote the code.

• Children, by age band, under TP 43 (infants), TP 48 (ages 1 to 5) and TP 44 (ages 6 to 18).
• Pregnancy, under TP 40, Medicaid for Pregnant Women.
• Parents and caretaker relatives, at the lowest threshold in the country.
• Transitional Medicaid, TP 07, at 185% of the federal poverty level, for a household leaving the parent or caretaker category because earnings rose² (checked 30 July 2026).
• Pathways tied to age, blindness, or disability, which are assessed under different rules from the MAGI income tests above.
• CHIP and CHIP Perinatal, which are not Medicaid but sit on the same application and the same chart, under TA 84 and TA 85.

This site does not publish a figure for the age, blindness, and disability pathways, because it has not yet read one off HHSC’s own chart and dated it, and an approximate income limit is exactly the kind of number that stops someone applying for something they would have got. Ask HHSC directly or call 2-1-1³. Everything this page does publish is dated.

What are the published income limits?

These are HHSC’s own percentages, read from the Texas Works Handbook chart in C-130 Medical Programs, effective 1 April 2026². Every figure in this table was 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
Parents and caretaker relatives	about 15%	dollar standard

Five of those 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%⁴. Two sources, compiled years apart, on the same numbers.

The parents and caretaker relatives line works differently from the rest. Texas sets a dollar standard by household size, which federal and research tables then convert into a percentage, so the percentage moves every January whether or not Texas changes anything. KFF records it at 15% of the federal poverty level as of January 2026, the lowest parent eligibility threshold in the nation⁵ (checked 30 July 2026). Treat 15% as an indication of scale rather than a precise line you can measure yourself against.

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 guidelines² (checked 30 July 2026). KFF and MACPAC fold that five points into the headline limit, which is why their Texas figures read 203%, 149%, 138%, 206% and so on.

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 disregard then goes in prose, as it has here, rather than into the headline figure.

The practical consequence is the same under either convention, and it is the single most useful sentence on this page. The income a household can actually have is a little above the stated limit, so a gross figure a few dollars 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 your 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 example on the chart: a single person at 133% FPL must have income “not exceeding $1,769” a month² (checked 30 July 2026). That is 133% of $15,960, divided by twelve, which comes to $1,768.90.

There is a trap here, and it is the reason this site states percentages first and dollars second. As at 30 July 2026, HHSC is publishing two different poverty guideline vintages at the same time. The pregnancy program page computes against the 2026 guidelines while the Children’s Medicaid dollar table on the consumer site is still on the 2025 ones. Both look equally current on the page. So do not copy a dollar table off a consumer page and assume it is this year’s: take the percentage, apply the guideline year you can name, and say which year you used. Which income counts toward the calculation is a separate and genuinely error-prone question, worked through in what counts as income in Texas.

What if you are an adult with no children?

There is no Texas Medicaid category for a non-disabled, non-pregnant adult without dependent children, at any income level. This is not a threshold you have failed to fall under. There is no pathway to fall under.

The result is the coverage gap: about 605,000 poor uninsured Texan adults aged 19 to 64, by far the largest figure of any state⁷ (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 across the ten non-expansion states in its analysis published on 27 July 2026. Their income is above the categories Texas operates and below the 100% of FPL floor where Marketplace premium tax credits begin.

If that describes you, reapplying next year with the same income changes nothing, and understanding why saves a great deal of wasted effort: the Texas coverage gap. The productive next step is getting care without insurance in Texas, which is where the sliding scale, the free clinics, and the county program live. For the whole picture of what covers whom, see health coverage in Texas.

How long does pregnancy coverage last after the birth?

Twelve months on Medicaid, 60 days and two doctor visits on CHIP Perinatal. HHSC states that Medicaid coverage “lasts during pregnancy and up to 12 months after the baby is born”, and on the same page that CHIP Perinatal “covers care during pregnancy and two doctor visits within 60 days after the pregnancy ends”⁸ (checked 30 July 2026). The 12 month entitlement comes from House Bill 12 of the 88th Legislature, Regular Session, 2023, and applies to Medicaid.

I have watched this one cost people appointments. Somebody reads a headline about Texas extending postpartum coverage to a year, books a check-up at four months, and finds out at the desk that they were on CHIP Perinatal all along. Read the program name on the approval letter, not the headline. More in Medicaid for pregnant women in Texas and CHIP Perinatal.

What happens after a denial?

You have 90 days from the effective date of the HHSC action to request a fair hearing, and you can request it orally or in writing. HHSC’s rule, in its 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”⁹ (checked 30 July 2026).

Three things about that deadline are worth knowing before you rely on a generic national article.

• The clock runs from the effective date of the action, not from the day the letter reached you.
• Texas allows the federal maximum. Federal rules require states to allow not less than 20 and not more than 90 days, and Texas sits at the top of that range. A reader who has read a national guide and believes they had 30 days may have given up while still inside the window.
• Late is not automatically fatal. The handbook is explicit that only the hearings officer has authority to decide the timeliness of a filed appeal, and good cause for a delay can be accepted. Ask anyway. That is a reason to try, not a promise of an outcome.

An appeal is the right tool when the facts were wrong: income counted twice, a household member missed, a document that never got attached. It is the wrong tool when the answer is that the category does not exist. See appealing a denial in Texas, and if the denial was for the adults only, check what the rest of the household qualifies for in Texas health programs.

Where the decision is actually made

Every figure on this page describes a published rule, and a rule is not a decision about your household. Applications go through YourTexasBenefits, HHSC’s own portal, which is also where documents are uploaded and notices are delivered¹⁰. One application is screened against several programs, which is why a household often gets a split result: children approved, adult denied. That is a normal outcome here, not a sign the form was filled in wrong.

Two practical habits from the counselor’s side of the desk. Write down the date of every call and the name of whoever helped you, because a later appeal usually turns on what you were told and when. And when a phone call produces an answer that matters, ask for it in the account or in writing. The notice itself is the document to keep: the 90 day appeal clock above runs from the effective date printed on it⁹ (checked 30 July 2026), not from the day it arrived.

Free help exists and it is worth using: applying through YourTexasBenefits covers the account, the documents, the interview, and the timelines, and 2-1-1 Texas will point you at a local organization with certified counselors³. Texas Care Map is independent of the State of Texas, HHSC, and CMS, and cannot determine your eligibility for anything.