Medicaid and CHIPS Information
Medicaid in Texas
Texas provides Medicaid services to the following groups:
- The "categorically needy" (blind, aged or disabled persons receiving assistance from federally-funded programs such as Supplemental Security Income (SSI))
- The "medically needy" program, which in Texas covers only low income families with dependent children
Medicaid covers the following basic services in all states:
- Inpatient hospital services
- Outpatient hospital services
- Laboratory and x-ray services
- Nursing facility services at a Medicaid certified facility
- Home health services for individuals 21 and older
- Physician services
- Screening, diagnosis and treatment of individuals less than 21 years of age
- Family planning services
- Federally-qualified health center services
- Medical and surgical services furnished by a dentist
- Nurse-midwife services
- Rural health clinic services
- Certified pediatric and family nurse practitioners' services
- Transport services and hospice services
In addition, Texas Medicaid covers part or all of:
- Services of a podiatrist, optometrist, chiropractor
- Clinic services, diagnostic services
- Physical therapy, rehabilitative services, or respiratory care
- Prescribed drugs
- Prosthetic devices, eyeglasses
- Intermediate care for individuals with mental retardation
- Nursing facility for individuals less that 21 years of age
- Emergency hospital, and transportation services
- Case management
Financial Eligibility
To receive Medicaid support, you must qualify for medical services both medically and financially. You apply for Medicaid with the Texas Department of Human Services. A quick guide to financial eligibility:
- You are qualified if you receive Supplemental Security Income (SSI)
- Or if your monthly income does exceed $1,656 for an individual or $3,312 for a couple. Resources do not exceed $2,000 for an individual.
Income = Social Security, veterans benefits, pensions or other retirement programs, interest, dividends, earnings, wages, etc.
Resources = Bank accounts and CDs, real estate, life insurance, stocks and bonds, oil, gas, mineral rights, jewelry, antiques, etc. (* Usually a house where you live, car necessary for work, and limited property are not counted as resources.)
Other Criteria
You must be a resident of Texas and a United States citizen, or a legalized alien or a permanent resident alien.
Who Should Apply?
Anyone may apply by filling out an application. Applications in English and Spanish can be found at TexCare. You should apply if you:
- Are pregnant and have a low income
- Have dependent children and a low income
- Have high medical costs in relation to income
HMOs
Texas supplies some Medicaid services through health maintenance organizations (HMOs). HMOs assure access to to doctors who provide primary care and refer patients to specialists for hospital care.
Under Medicaid, your selection process demands that your doctor or specialist be a Medicaid provider. Medicaid providers cannot charge co-payments for Medicaid services. It is important that you choose HMOs that cover hospitals and doctors you wish to have care for you or your children.
UTMB Children's Hospital and physicians are providers for the following Medicaid Star HMOs:
CHIPS
Parents who cannot financially qualify for Medicaid may be eligible for the Children's Health Insurance Program (CHIP). This program provides insurance for children for a nominal cost. More information and applications can be found at TexCare.
UTMB Children's Hospital and physicians are also Children's Health Insurance Program (CHIPS) providers for Choice One Chips.