Loss of Medicaid Coverage: 3 Steps to Stay Covered in Texas
Millions of Americans are at risk of loss of Medicaid coverage.
There are at least 92 million people in the United States who will need to fill out paperwork in a short period of time, after receiving notice their Medicaid is ending.
The two main reasons behind the potential loss of Medicaid coverage are:
Loss of eligibility
Administrative churning
If you think you might be at risk of losing Medicaid, this article is for you. Our goal is to help you determine your next steps so that you can maintain your healthcare coverage. This article will be focused on those individuals who are located in Texas and want to stay covered.
Our offices are located in Corpus Christi, and I have already been able to help many Texas maintain their coverage. I want to help you do the same. I have been serving Texans for the past 38 years by providing them with affordable quality healthcare insurance to achieve the peace of mind they deserve.
It’s important, whether you maintain eligibility or not, that you take action today. Contact us as soon as you receive the notice that your Medicaid is ending.
Here are the overall steps you should take to stay covered:
Confirm if you are eligible to continue Medicaid by reapplying.
Submit paperwork (if you are eligible).
Get help to secure a marketplace plan (if you do not maintain eligibility).
In any of these cases: Call our office for assistance at (361) 852-8005
In the rest of the article, I will cover all of these steps and topics in detail.
Who is losing Medicaid coverage?
The main reason many Americans are losing Medicaid coverage is that the pandemic protections have expired.
If you receive notice that you have lost Medicaid or CHIP, you have the option to apply for health coverage through the Marketplace.
If you lost or lose Medicaid or CHIP coverage anytime between April 1, 2023 and July 31, 2024, you can visit HealthCare.gov and apply for coverage at any time, even if you learn you’ve lost Medicaid or CHIP coverage over two months after the fact.
Once you submit your Marketplace application, you’ll have 60 days to make a plan selection.
We can help if you need assistance applying for and selecting a plan. Call our office for assistance at (361) 852-8005
Essentially, the states were automatically renewing those on Medicaid. But that’s not happening anymore.
The two main reasons you might be at risk of loss of Medicaid coverage is that you either are not eligible anymore, or you are eligible but forget to enroll again.
Here are some general situations that would make you ineligible:
You earn too much
No longer pregnant
No longer under a certain age
Change in financial status
Failing to report a household change (marrying, adopting, or having children)
We will go into more detail about who is currently eligible for Medicaid in Texas below.
Here is what you can do to ensure the state accurately reviews your eligibility:
Respond to the notice you may receive from the state requesting additional information with the requested information
Submit the application, renewal packet, or request for information in any of these ways:
Online
Mail
Fax
Call
Visiting an office in person
Who is currently eligible for Medicaid in Texas?
In Texas, Medicaid is available to certain low-income individuals and families who meet the eligibility requirements.
Eligibility for Medicaid in Texas is based on income, family size, and other factors.
Medicaid is a vital healthcare program designed to provide support to low-income individuals and families. If you're currently caring for a child who is receiving Medicaid, you may be eligible to receive Medicaid for yourself.
To qualify for Medicaid, you must be a caretaker related to the child who is already receiving Medicaid (see list below). Additionally, the child must be living with you and be aged 17 or younger or aged 18 and attending school full time.
It's also important to meet the income guidelines for the program (see below), which may be subject to change. We understand that navigating the Medicaid program can be overwhelming, and we are here to assist you in every step of the way.
To be eligible, you must be someone who is taking care of a child who already has Medicaid. Being a related caretaker means you are:
A parent or step-parent.
A sibling or step-sibling.
A grandparent.
An uncle or aunt.
A nephew or niece.
A first cousin or the child of a first cousin.
Income Guideline for Medicaid
Your income is an important factor in determining your eligibility for Medicaid. Income refers to the money you receive before taxes are deducted.
To determine if you qualify for Medicaid, please refer to the table below and locate your family size. If your monthly income is equal to or less than the amount specified, you may be eligible for Medicaid.
Income Guideline for Medicaid
| Family size | One Parent | Two Parent |
|---|---|---|
| 1 | $103 | ------ |
| 2 | $196 | $161 |
| 3 | $230 | $251 |
| 4 | $277 | $285 |
| For each additional person, add: | $52 | $52 |
Source: Texas Health and Human Services
Children’s Medicaid & CHIP
In Texas, children may be eligible for affordable or free healthcare through either Children's Medicaid or the Children's Health Insurance Program (CHIP).
Children's Medicaid is a healthcare program that offers assistance to children from low-income families. CHIP is a healthcare program that supports children without health insurance whose families earn too much to qualify for Medicaid but cannot afford health insurance.
To qualify for either program, the child must be aged 18 or younger (in some cases, children with disabilities aged 19 and 20 may also qualify for Medicaid). Additionally, the child must be a Texas resident and a U.S. citizen or a qualified non-citizen.
Income Guidelines for Children's Medicaid
| Family Members (Adults plus children) | Monthly Family Income |
|---|---|
| 1* | $1,510 |
| 2 | $2,034 |
| 3 | $2,559 |
| 4 | $3,083 |
| 5 | $3,607 |
| 6 | $4,132 |
| 7 | $4,656 |
| 8 | $5,180 |
| For each additional person, add: | $525 |
*A family of one might be a child who does not live with a parent or other relative.
If the income is more than the amounts mentioned, please refer to the limits mentioned below to check if you qualify for CHIP.
Income Guidelines for CHIP
| Family Members (Adults plus children) | Monthly Family Income |
|---|---|
| 1* | $2,277 |
| 2 | $3,067 |
| 3 | $3,858 |
| 4 | $4,649 |
| 5 | $5,439 |
| 6 | $6,230 |
| 7 | $7,020 |
| For each additional person, add: | $791 |
*A family of one might be a child who does not live with a parent or other relative.
IMPORTANT: These income guidelines were updated on 04/11/2023. Always check the Texas Health and Human Services website for updated guidelines.
What is the highest income to qualify for Medicaid?
The Federal Poverty Level is a measure of income set by the government for people living in the lower 48 states and the District of Columbia.
In 2023, these annual income limits are:
$14,580 for a single person,
$30,000 for a family of four, and
$50,560 for a family of eight.
These limits determine whether a person or family is eligible for Medicaid, which is a program that helps low-income individuals and families pay for medical services.
It is always best to check government resources for these types of guidelines.
If your family’s annual income is above these amounts, you may be eligible for a marketplace plan where four out of five can enroll in a plan for less than $10 a month.
Call or text us today for more information (361) 852-8005
What is the Texas Medicaid income limit?
The Texas Medicaid income limit will depend on the type of Medicaid you want to apply for.
Above, we have shared the tables with income limits for adults’ Medicaid, children’s Medicaid, and CHIP.
What does Medicaid cover in Texas?
All Medicaid programs cover basic medical care, such as:
Inpatient hospital care
Doctors services
Outpatient hospital or clinic care
Lab and X-ray services
Short-term skilled nursing, rehab, and home health care
Ambulance service
Pediatric care
Some Medicaid programs may also cover other medical care such as prescriptions, vision, and dental care.
In Texas, there are five types of Medicaid:
STAR
STAR+PLUS
START Kids
STAR Health
Traditional Medicaid
The type you get will depend on where you live and the kind of health issues you have. Learn more about each of these on the “Questions About Your Benefits” section of the Texas Health and Human Services website.
Does Texas have free Medicaid?
In Texas, children’s Medicaid is free. And CHIP fees will vary depending on your income.
Enrollment fees and co-pays are determined by your family’s income.
Enrollment cost: Typically, these are $50 or less per family, per year.
Co-pays: For families with lower incomes, the cost to see a doctor or buy medicine is between $3 and $5. For families with higher incomes, the cost is between $20 and $35. These are called co-pays.
Can adults get Medicaid in Texas?
Adults can get Medicaid in Texas if they are eligible.
As we’ve mentioned before,to be eligible, you must be someone who is taking care of a child who already has Medicaid. Being a related caretaker means you are:
A parent or step-parent.
A sibling or step-sibling.
A grandparent.
An uncle or aunt.
A nephew or niece.
A first cousin or the child of a first cousin.
You also have to be within the income levels we shared in the tables at the beginning of this article.
Medicaid phone number in Texas
The Medicaid phone number in Texas, for general help, is (800) 252-8263
You can find more ways to contact the Texas Health and Human Services on their Contact Us page.
Will I lose Medicaid?
You might lose Medicaid coverage if you are no longer eligible, or if you are eligible and forget to reply when you receive a notice from the state that your Medicaid is ending.
If you receive notice that you have lost Medicaid or CHIP, you have the option to apply for health coverage through the Marketplace.
If you lost or lose Medicaid or CHIP coverage anytime between April 1, 2023 and July 31, 2024, you can visit HealthCare.gov and apply for coverage at any time, even if you learn you’ve lost Medicaid or CHIP coverage over two months after the fact.
Once you submit your Marketplace application, you’ll have 60 days to make a plan selection.
We can help if you need assistance applying for and selecting a plan. Call our office for assistance at (361) 852-8005
So, what can you do to make sure you stay covered?
Be on the lookout for the state’s notice
If are eligible for Medicaid, re-apply.
If you have reapplied and have been denied, or if you are not eligible for Medicaid, call us so we can help you get a marketplace plan.
We can help you get a marketplace plan with similar coverage as Medicaid, where four out of five can get a plan for less than $10 a month.
Is Texas Medicaid automatically renewed?
When COVID-19 started, the government said Medicaid would be automatically renewed without doing anything.
A law was passed, because of the declared public health emergency (PHE), that allowed you to keep your Medicaid coverage automatically.
But now, the law has changed. And as we’ve covered in this article, if you are eligible, you need to renew your benefits to keep getting Medicaid.
At what age does Medicaid end in Texas?
When children become adults, at the age of 18, their Medicaid coverage will end.
If they have STAR Kids coverage, they are able to stay covered with that program until they are 20 years old. Then, when they turn 21, they can transition into STAR+PLUS.
How do I renew my Texas Medicaid benefits?
Here are the overall steps you should take to stay covered:
Confirm if you are eligible to continue Medicaid by reapplying.
Submit paperwork (if you are eligible).
We can help you renew your Texas Medicaid benefits.
If you are not eligible, we can assist you in getting a healthcare plan from the marketplace that is similar to Medicaid. Four out of five people can obtain a plan for under $10 a month.
Call our office for assistance at (361) 852-8005
Don’t forget to share this post with someone you know who might
be at risk of losing Medicaid.
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NOTE: This content is not intended to be taken as legal, benefits, or HR advice. Since regulations change over time and can vary by location and employer size, consult a licensed broker or HR certified expert for specific guidance.