Can Undocumented Immigrants Get Health Insurance in Texas?

Health insurance for undocumented immigrants in Texas is limited by federal law, but it is not nonexistent. You cannot buy a plan through the Affordable Care Act Marketplace and you cannot enroll in standard Medicaid, regardless of income. What you can use: Emergency Medicaid for life-threatening situations, financial assistance programs run by county hospital districts for ongoing care, federally qualified health centers that charge on a sliding scale based on income, and CHIP Perinatal for prenatal care during pregnancy. None of these count against you under the current public charge rules.

What You Cannot Use

Federal law bars undocumented residents from buying coverage through the ACA Marketplace, even at full price with no subsidies.¹ The Personal Responsibility and Work Opportunity Reconciliation Act limits standard Medicaid to people who hold a qualifying immigration status such as lawful permanent resident, refugee, or asylee.² Routine checkups, preventive care, and ongoing treatment through those traditional channels are closed. Everything that follows operates outside them.

Emergency Medicaid

Emergency Medicaid is the one meaningful exception to the Medicaid ban. States can receive federal Medicaid reimbursement for emergency care given to someone without lawful status, as long as the condition meets the legal definition of a medical emergency: a situation where delaying treatment could seriously threaten health, cause serious harm to bodily functions, or involve labor and delivery.³ The same federal statute that otherwise blocks benefits carves out this exception explicitly.² Separately, any hospital with an emergency department must screen and stabilize anyone who arrives with an emergency condition, regardless of insurance, status, or ability to pay.⁴

The limit matters as much as the coverage: Emergency Medicaid pays only for the emergency itself. Once the immediate threat is over, so is the coverage. It will not pay for follow-up appointments, maintenance medications, or ongoing management of the underlying condition. That is where other Texas programs become essential.

County Hospital District Financial Assistance

If you live in a major Texas county, your local hospital district almost certainly runs a financial assistance program that functions like insurance in practice. Harris Health System in Houston extends assistance to households earning up to 150% of the federal poverty level, which comes to roughly $23,940 for an individual or $49,500 for a family of four in 2026.⁵⁶ Parkland in Dallas and University Health in San Antonio run comparable programs with their own thresholds.

Once you are approved, you receive a card or letter that lets you schedule primary care visits, see specialists, fill prescriptions, get lab work, and manage chronic conditions at reduced or no cost. These programs are the closest thing to continuous health coverage available to someone without legal status in Texas. They handle diabetes, hypertension, mental health care, and non-emergency surgeries — the kinds of care Emergency Medicaid will never touch.

The trade-off: each hospital district limits care to its own facilities and contracted providers. A Harris Health card does not work at a Parkland clinic. Where you live determines which system you can use, so start with the hospital district for your county.

Federally Qualified Health Centers

Federally qualified health centers are community clinics funded by federal grants under Section 330 of the Public Health Service Act. The law requires them to serve everyone in their service area regardless of ability to pay and to use a sliding fee schedule based on household income.⁷ The statute does not mention immigration status. Clinics ask where you live and what you earn, and that is the basis for your fee.

At the lowest income levels, a primary care visit can cost as little as $20. Services typically include primary care, prenatal visits, pediatric checkups, vaccinations, dental care, behavioral health, and chronic disease management. Texas has hundreds of these centers, concentrated in urban areas but reaching into rural communities as well.

These clinics do not collect or report immigration status. There is no immigration question on the intake form. For families worried about visibility, community health centers are generally considered the safest entry point into the system.

CHIP Perinatal for Pregnant Women

Pregnant women who cannot get Medicaid because of their immigration status may still qualify for prenatal coverage through CHIP Perinatal. Texas structures the program to cover the unborn child rather than the mother, which sidesteps the status requirement entirely. Eligibility runs up to 202% of the federal poverty level,⁸ which for 2026 means a family of four can earn up to about $66,660 and still qualify.⁶

CHIP Perinatal covers prenatal visits, lab work, ultrasounds, delivery, and a limited period of postpartum care. It is one of the broadest coverage options available to undocumented residents in Texas, and it is dramatically underused because many eligible women either do not know it exists or avoid applying for fear of immigration consequences. Those fears do not apply here: CHIP is excluded from public charge consideration, as explained below.

If You Have U.S.-Citizen Children

A child born in the United States is a U.S. citizen regardless of the parents’ status. That child is eligible for Medicaid and CHIP based on the child’s own citizenship and the family’s income. A parent without legal status can apply on the child’s behalf. The application asks about the child’s status for the purpose of determining the child’s eligibility, not the parent’s.

Mixed-status families that skip enrollment out of fear are leaving real coverage on the table. Under the 2022 public charge rule, applying for benefits for a family member, or living with someone who receives benefits, does not count against the parent. CHIP is entirely excluded from public charge consideration.⁹

Private and Employer-Sponsored Plans

The ACA Marketplace ban does not extend to private insurance outside the Marketplace. An undocumented person can technically buy a plan directly from a private insurer at full price with no tax credits. For most people this is prohibitively expensive, but it is not illegal.

Employer-sponsored group plans are murkier. Federal benefit-plan law does not explicitly exclude undocumented workers, but employers can require a valid Social Security number for enrollment, and many do. Some plan documents are drafted to exclude workers who are not authorized for employment. There is no settled case law and no formal Department of Labor guidance on whether these plans must cover undocumented employees. Access depends on the specific employer and plan.

The Public Charge Rule

Fear of the public charge rule keeps many undocumented residents from using programs they are legally entitled to. Under the current rule, the government looks at only two categories of benefits: cash assistance programs such as Supplemental Security Income and Temporary Assistance for Needy Families, and long-term institutionalization at government expense, such as a Medicaid-funded nursing home stay.¹⁰

The following are explicitly excluded from public charge consideration:

Applying for a benefit, being approved for one in the future, or living in a household where someone else receives benefits does not count. The rule looks only at whether the applicant personally received one of the narrow categories of cash benefits. Using Emergency Medicaid, enrolling a citizen child in CHIP, visiting a community health center, or receiving CHIP Perinatal does not put a future immigration case at risk under the current rules.

What You Need to Apply

County financial assistance programs and sliding-fee community health centers require three things: proof you live in the service area, proof of household income, and identification. None requires a Social Security number or proof of immigration status.

For residency, bring a current lease, a utility bill in your name, or a letter from your landlord. For income, bring recent pay stubs or a signed letter from an employer confirming your pay rate and frequency, including cash wages. For identification, most programs accept a foreign passport, a matricula consular, or other government-issued photo ID.¹¹ An Individual Taxpayer Identification Number from the IRS can simplify income verification; you apply using Form W-7.¹²

Contact the hospital district, county health department, or community health center that serves your area to schedule a financial screening. Processing often takes several weeks before you receive your approval and program card. Once approved, you can schedule medical appointments at the reduced rates set by that provider.

Finding a Program Near You

Dialing 2-1-1 from any phone in Texas connects you to a statewide helpline run by the Texas Health and Human Services Commission. Staff can identify community clinics, hospital district programs, prescription assistance, and dental resources near your address. The service is free and available in multiple languages. You can also search 211texas.org by category and ZIP code.

1
HealthCare.gov. Health Coverage for Immigrants
2
Office of the Law Revision Counsel. 8 USC 1611 – Aliens Who Are Not Qualified Aliens Ineligible for Federal Public Benefits
3
Office of the Law Revision Counsel. 42 USC 1396b – Payment to States
4
Office of the Law Revision Counsel. 42 USC 1395dd – Examination and Treatment for Emergency Medical Conditions and Women in Labor
5
Harris Health System. Patient Eligibility
6
U.S. Department of Health and Human Services. 2026 Poverty Guidelines
7
Office of the Law Revision Counsel. 42 USC 254b – Health Centers
8
Texas Health and Human Services. CHIP Perinatal FAQs
9
U.S. Citizenship and Immigration Services. Final Rule on Public Charge Ground of Inadmissibility
10
U.S. Citizenship and Immigration Services. Consideration of Current and/or Past Receipt of Public Cash Assistance for Income Maintenance or Long-term Institutionalization at Government Expense
11
Harris Health System. Harris Health Financial Assistance Application Instructions
12
Internal Revenue Service. About Form W-7, Application for IRS Individual Taxpayer Identification Number