Children make up the majority of those fully covered by Medicaid in Texas.
Medicaid, a U.S. health program that helps low-income families pay for medical expenses, is a federally created program that is managed individually by the states. Eligibility requirements, therefore, vary by state. In Texas, about 70 percent of people of Medicaid's full beneficiaries are children living near or below the federal poverty line, according to the Texas Health and Human Services Commission. The disabled, the elderly and even some other adults with low incomes also might qualify for coverage in the state.
Basic Requirements
Regardless of income, Medicaid covers only certain groups. Generally, to qualify for coverage, you must be pregnant, the parent or guardian of a child 18 years old or under, disabled or at least 65 years old. Teenagers living on their own also qualify for coverage, including children who have aged out of the foster care system up to the age of 21. You also must be a U.S. citizen or lawfully admitted immigrant to qualify for coverage. However, if you are not a legal citizen but your child is, your child might still qualify for coverage.
Income
Income eligibility for Medicaid is based largely on the federal poverty line, which as of 2010, is $18,310 per year for a family of three. Pregnant women and newborns with an income of up to 185 percent of the poverty line are eligible for full Medicaid coverage. Children aged 1 to 5 are eligible in families making up to 133 percent of the poverty line. Coverage for children aged 6 to 18 is limited to those at or below the poverty line. The groups together account for about two-thirds of Texas' full Medicaid beneficiaries, according to the Texas Health and Human Services Commission. Additionally, those eligible for the Temporary Assistance for Needy Families Program automatically are eligible for Medicaid. In Texas, this applies to adults and children in families making up to $188 per month. You can deduct certain "income disregards" for eligibility purposes, including work-related expenses and dependent care, and certain income such as tax refunds or scholarships is exempt.
Special Needs
Texas is one of the few states that does not supplement federal low-income disability assistance, Supplemental Security Income, with state funds. All people receiving such funds, however, are eligible for Medicaid coverage in Texas. Even if your income increases to the point that you no longer are eligible for SSI, you might still qualify for Medicaid. Texas' Medicaid program includes the Spend Down program for the medically needy, in which you can subtract medical bills from your income to determine eligibility.
Dual Eligibility
Even if you qualify for Medicare coverage, you might also be eligible in Texas for dual coverage by Medicaid as well. Medicaid can help pay for your Medicare premiums, co-pays and deductibles for hospital and doctor bills. Texas income limits for full Medicare-related Medicaid coverage is $623 per month, as of 2010. You might qualify for limited Medicaid coverage for Medicare bills, however, if your income is as much as 135 percent of the federal poverty line.
Tags: poverty line, qualify coverage, Medicaid coverage, federal poverty, federal poverty line, Medicaid Texas, Texas Medicaid
