Does Texas Medicaid Stop When You Turn 18?

Texas Medicaid does not stop automatically when you turn 18, but it often ends anyway. Instead of simply cutting you off, the Texas Health and Human Services Commission (HHSC) reviews whether you qualify under adult rules, which are much stricter than the children’s program. Because Texas has not expanded Medicaid, adult eligibility is limited to a few narrow categories, so many young adults who had Children’s Medicaid will not keep it past 18 unless they fit one of those categories or qualify through a special pathway like former foster care.

What Happens at Your 18th Birthday

Children’s Medicaid in Texas covers kids who are 18 or younger, and children with disabilities can remain covered up to age 20 in some cases.1Texas Health and Human Services. Children’s Medicaid and CHIP As you approach 18, HHSC starts a redetermination: a formal review of whether you qualify under one of the adult categories.2Texas Health and Human Services. B-120, Redeterminations

If you qualify under an adult category, coverage continues without interruption. If you don’t, HHSC sends a notice explaining that your coverage is ending and your right to appeal. The income thresholds, categories, and in some cases the benefits all change at that point.

Who Still Qualifies as an Adult in Texas

Because Texas has not expanded Medicaid, there is no general program for low-income adults. You have to fit a specific category:

If you’re an 18-year-old who isn’t pregnant, doesn’t have a dependent child, and isn’t disabled, you likely fall into the coverage gap: too much income for traditional Medicaid, too little for Marketplace subsidies that generally start at 100% of the federal poverty level. That’s where the alternatives below become essential.

Former Foster Care Youth: Coverage Until 26

If you were in foster care in Texas and aged out at 18 or older while receiving Medicaid, a separate program with no income test covers you until age 26.6Texas Health and Human Services. Medicaid for Transitioning and Former Foster Care Youth This is a mandatory federal eligibility group, so Texas is required to offer it.7Medicaid.gov. Implementation Guide: Former Foster Care Children

The rules expanded in 2023. If you turned 18 on or after January 1, 2023, you qualify even if you aged out of foster care in a different state, as long as you were receiving Medicaid at the time.8Texas Health and Human Services. E-110, Medicaid for Former Foster Care Children (FFCC) If you turned 18 before that date, you must have aged out of foster care specifically in Texas. Either way, you need to be a Texas resident and meet citizenship or immigration requirements. There is no income or resource test. Former foster youth should always check this pathway before assuming coverage is lost.

How Your Benefits Change After 18

Even if you stay on Medicaid as an adult, the scope of coverage may shrink. Children’s Medicaid includes a federal benefit called Early and Periodic Screening, Diagnostic, and Treatment, or EPSDT, which requires the state to cover anything medically necessary for anyone under 21, including dental, vision, hearing aids, mental health treatment, and therapies.9Medicaid.gov. EPSDT Coverage Guide If you’re 18, 19, or 20 and still enrolled in Medicaid, you’re still entitled to EPSDT because the federal mandate covers everyone under 21.

At 21, the picture changes. Texas adult Medicaid limits dental coverage to emergency care only, with an annual cap of $5,000. Routine cleanings, fillings, and preventive care aren’t covered for adults. Vision and other optional benefits also shrink. Core mandatory benefits like hospital services, physician visits, lab work, and home health remain available at any age.10Medicaid.gov. Mandatory and Optional Medicaid Benefits If you’re still covered between 18 and 20, use EPSDT now. Get the dental work done, get your eyes checked, pursue any treatment you’ve been putting off. Those comprehensive benefits end on your 21st birthday.

Responding to the Renewal Notice

HHSC mails a renewal notice to your last known address in a yellow envelope marked “Action Required” in red. It arrives before your current certification period ends, and you have 30 days to respond.11Texas Health and Human Services. End of Continuous Medicaid Coverage Missing that deadline can end your coverage even if you would otherwise qualify.

You can submit the renewal online through Your Texas Benefits, by mail to the HHSC address in Austin, by fax at 877-447-2839, by phone through 2-1-1 (Option 2 after language selection), or in person at an HHSC office or community partner. You’ll report updated information about income, household size, and any changes since your last renewal. HHSC verifies the information against federal and state databases.12eCFR. 42 CFR Part 435 Subpart J – Redeterminations of Medicaid Eligibility If you respond on time, coverage continues while HHSC reviews.11Texas Health and Human Services. End of Continuous Medicaid Coverage

The most common reason people lose Medicaid at 18 isn’t ineligibility. It’s a missed notice. If you’ve moved recently, update your address through Your Texas Benefits or by calling 2-1-1 before your birthday arrives.

If You’re Denied

If HHSC decides you no longer qualify, you’ll get a Notice of Case Action with the reason. You have 90 days from the date of that notice to request a fair hearing. For decisions made by a managed care organization, the deadline is 120 days.13Texas Health and Human Services. Fair and Fraud Hearings

You can appeal in writing, by calling 2-1-1, or by going to a local HHSC office. If you request a hearing before your coverage actually ends, HHSC generally cannot terminate your benefits until a decision is issued. Even if you file slightly late, benefits may be reinstated if you request a hearing within 10 days of the effective date of the termination.14eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries Speed matters. Once the termination takes effect and the appeal window closes, restoring coverage gets much harder.

If You Lose Medicaid, What Else Is Available

CHIP While You’re Still 18

The Children’s Health Insurance Program covers children 18 and younger whose families earn too much for Medicaid but can’t afford private coverage. In Texas, CHIP income limits reach 201% of the federal poverty level.3Medicaid.gov. Medicaid, Children’s Health Insurance Program, and Basic Health Program Eligibility Levels If you’re still 18, CHIP can bridge the gap. Benefits are similar to Medicaid: checkups, prescriptions, and hospital care at low cost.15HealthCare.gov. The Children’s Health Insurance Program (CHIP) CHIP eligibility ends at 19.

A Parent’s Health Plan

If a parent has employer-sponsored insurance or a Marketplace plan, the Affordable Care Act requires those plans to let children stay on until age 26. This applies whether you live with your parents, are financially independent, or are married. For many 18-year-olds who lose Medicaid, this is the simplest fallback.

The Health Insurance Marketplace

Losing Medicaid is a qualifying life event that lets you enroll in a Marketplace plan outside open enrollment.15HealthCare.gov. The Children’s Health Insurance Program (CHIP) You generally have 60 days from the date of coverage loss to sign up. Premium tax credits can reduce your monthly cost based on household income.

For 2026, premium tax credit eligibility may be more limited than in recent years. From 2021 through 2025, Congress temporarily eliminated the upper income cap, allowing people at any income to qualify. That expansion expired at the end of 2025, and as of early 2026 Congress had not enacted an extension. Without it, credits are available only to households between 100% and 400% of the federal poverty level, which for a single person in 2026 is roughly $15,960 to $63,840 per year.4U.S. Department of Health and Human Services. 2026 Poverty Guidelines Check HealthCare.gov for current subsidy rules when you apply.