Medicaid is a joint federal and state public assistance program for financing health care for low-income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long-term care services.
There are many pathways to being eligible for Medicaid. For example, most states provide Medicaid to anyone who is receiving benefits under the Supplemental Security Income (SSI) program. A number of states provide Medicaid to older adults or persons with a disability who have an income that is below 100 percent of the federal poverty level ($1,063 a month for an individual in 2020).
For the most part, to be eligible for Medicaid you must be one of the following:
• Be age 65 or older
• Have a permanent disability as that term is defined by the Social Security Administration
• Be blind
• Be a pregnant woman
• Be a child, or the parent or caretaker of a child
In addition, you must meet certain other requirements, such as:
• Be a U.S. citizen or meet certain immigration rules
• Be a resident of the state where you apply
• Have a Social Security number
Am I eligible for Medicaid?
Check with your state’s Medicaid office to see if you or your family members are eligible for benefits. In general, it depends on at least one or a combination of:
• Age
• Income level
• Number of people in your family
• If you are pregnant or have a disability
How do I apply for Medicaid?
There are two ways to apply for Medicaid:
• Contact your state Medicaid agency. You must be a resident of the state where you are applying for benefits.
• Fill out an application through the Health Insurance Marketplace.
Children’s Health Insurance Program (CHIP)
If your income is too high for Medicaid, your child may still qualify for the Children’s Health Insurance Program (CHIP). It covers medical and dental care for uninsured children and teens up to age 19.
To be eligible for CHIP, the child's family must have an income that is:
• Too high to qualify for Medicaid
• Too low to afford private coverage
Medicaid and CHIP program names are different in each state.
Is my child eligible for CHIP?
CHIP qualifications are different in every state. In most cases, they depend on income.
How do I apply for CHIP benefits?
You have two ways to apply for CHIP:
• Contact your state’s program or call the Health Insurance Marketplace at 1-800-318-2596.
• Fill out an application through the Health Insurance Marketplace.
What else do I need to know about CHIP?
• You can apply for and enroll in Medicaid or CHIP anytime during the year.
• Like Medicare and CHIP, the Basic Health Program (BHP) offers affordable, continued coverage. It's available to people with incomes that shift above and below Medicaid or CHIP levels.
• Get information on other types of health insurance, such as Medicare, and find help paying for medical bills.
Long-Term Care Medicaid Services
Long-term care Medicaid services include medical and non-medical care for people with a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care services assist people with activities of daily living, such as dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, or in a facility.
For purposes of Medicaid eligibility and payment, long-term care services are those provided to an individual who requires a level of care equivalent to that received in a nursing facility.
In Texas, Medicaid is a joint federal-state program that provides health care coverage to eligible low-income individuals, including the elderly, people with disabilities, pregnant women, children, and parents or caretakers of children. Eligibility for Medicaid in Texas is based on several factors, including age, income level, family size, pregnancy status, and disability status. Applicants must be U.S. citizens or meet certain immigration requirements, be residents of Texas, and have a Social Security number. To apply for Medicaid, individuals can contact the Texas Medicaid agency or fill out an application through the Health Insurance Marketplace. For children whose families have incomes too high for Medicaid but too low for private coverage, the Children’s Health Insurance Program (CHIP) is available. CHIP covers medical and dental care for uninsured children and teens up to age 19. Eligibility for CHIP varies by state and is generally based on income. Applications for CHIP can also be made through the state program or the Health Insurance Marketplace. Long-term care Medicaid services in Texas cover both medical and non-medical care for individuals with chronic illnesses or disabilities, and can be provided at home, in the community, or in facilities. To be eligible for long-term care services under Medicaid, an individual must require a level of care equivalent to that received in a nursing facility.
