How to Get Free Health Insurance in Texas: Medicaid, CHIP, and More

Free or nearly free health insurance in Texas comes from a short list of programs: Medicaid, the Children’s Health Insurance Program (CHIP), the Healthy Texas Women program, zero-premium Marketplace plans with federal tax credits, and the County Indigent Health Care Program. Because Texas has not expanded Medicaid under the Affordable Care Act, state-funded coverage is limited to children, pregnant women, seniors, and people with disabilities. If you are a working-age adult without a disability or dependent children, your path to no-cost coverage usually runs through the federal Marketplace instead.

Texas Medicaid

Texas Medicaid covers low-income children, pregnant women, adults 65 and older, and people with qualifying disabilities.1USAGov. How to Apply for Medicaid and CHIP Most adults under 65 who don’t have a disability and aren’t pregnant or caring for a dependent child cannot get Medicaid in Texas at any income level.

Income limits for the groups that do qualify are tied to the Federal Poverty Level (FPL) and calculated using Modified Adjusted Gross Income (MAGI), which is your adjusted gross income plus any untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest.2HealthCare.gov. Modified Adjusted Gross Income (MAGI) Supplemental Security Income doesn’t count.

  • Infants under one year: household income up to roughly 203% FPL.
  • Children ages one through five: about 149% FPL.
  • Children ages six through eighteen: about 138% FPL.
  • Pregnant women: up to 198% FPL.

Seniors and applicants with disabilities also face an asset test. Countable resources are generally capped at $2,000 for an individual or $3,000 for a couple, but your primary home and one vehicle are excluded.1USAGov. How to Apply for Medicaid and CHIP

Every applicant must be a Texas resident and a U.S. citizen or qualifying immigrant. Most lawful permanent residents wait five years from the date they received their status before they can enroll.3HealthCare.gov. Health Coverage for Lawfully Present Immigrants Refugees, asylees, and certain other humanitarian categories skip that wait, and Texas has waived the five-year rule for lawfully residing pregnant women and children.4Medicaid.gov. Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women

CHIP for Children Who Don’t Qualify for Medicaid

Families who earn slightly too much for children’s Medicaid may still qualify for CHIP, which covers uninsured children up to age 19 in households earning up to 201% FPL.1USAGov. How to Apply for Medicaid and CHIP CHIP is not entirely free. Annual enrollment fees are $50 or less per family, and co-payments run from $3 to $5 for lower-income families and $20 to $35 for higher-income families.5Texas Health and Human Services. CHIP Coverage includes checkups, immunizations, hospital care, and dental visits. One application screens your household for both Medicaid and CHIP.

Healthy Texas Women

Women ages 15 through 44 without other health coverage may qualify for the Healthy Texas Women (HTW) program, which pays for preventive and family planning services at no cost. Household income must be at or below 204.2% FPL, and you can’t be currently pregnant or enrolled in Medicaid, Medicare, or CHIP.6Texas Health and Human Services. W-110, Healthy Texas Women (HTW) Applicants 15 through 17 need a parent or legal guardian to apply for them. Services include birth control, annual wellness exams, and screenings for blood pressure and diabetes. The same state application that covers Medicaid and CHIP also screens you for HTW.

Zero-Premium Marketplace Plans

If no Texas state program fits, private coverage through HealthCare.gov may still cost you nothing each month. Premium tax credits reduce your monthly bill based on income, and for many Texans those credits cover the full premium.7Internal Revenue Service. Eligibility for the Premium Tax Credit The credit goes directly to the insurer each month, so you never front the money.

To qualify, household income generally must be at least 100% FPL. For 2026, that’s roughly $15,960 for an individual or $33,000 for a family of four.8U.S. Department of Health and Human Services. 2026 Poverty Guidelines – 48 Contiguous States

Extra Savings on Silver Plans

If your income is below 250% FPL, picking a Silver-level plan also unlocks cost-sharing reductions that lower your deductibles, co-pays, and out-of-pocket maximums. The savings are largest at the lowest incomes:

  • Up to 150% FPL: Silver plan covers about 94% of costs.
  • 151% to 200% FPL: about 87% of costs.
  • 201% to 250% FPL: about 73% of costs.

Cost-sharing reductions apply only to Silver plans. A Bronze plan with a lower sticker premium can end up costing far more once co-pays and the deductible kick in.

The Coverage Gap

Adults who earn below 100% FPL but don’t fit a traditional Medicaid category fall into what’s known as the coverage gap. They earn too little for Marketplace premium tax credits and too much (or in the wrong category) for Texas Medicaid. If that’s you, the County Indigent Health Care Program below or a local community health center may be the only affordable option.

County Indigent Health Care Program

The Texas Indigent Health Care and Treatment Act requires counties, public hospitals, or hospital districts to provide basic medical services to the most financially vulnerable residents.9State of Texas. Texas Health and Safety Code Chapter 61 – Indigent Health Care and Treatment Act The default income cutoff is 21% FPL, and no other source of coverage, including Medicaid, can be available to you.10Texas Health and Human Services. County Indigent Health Care Program Counties can raise that threshold up to 50% FPL. Your homestead and personal belongings such as furniture, clothing, and appliances are excluded from the asset count.11Cornell Law School – Legal Information Institute. 26 Texas Administrative Code 363.59 – Resources

Required basic services include:12Texas Health and Human Services. 4200, Basic Health Care Services

  • Physician and hospital care, inpatient and outpatient.
  • Up to three prescriptions per month.
  • Lab and X-ray services ordered by a physician outside a hospital setting.
  • Annual physicals and screenings for blood pressure, blood sugar, and cholesterol.
  • Immunizations and family planning.
  • Skilled nursing facility services when medically necessary.

Each county runs its own program, so applications and any extra services vary. Contact your county health services office to apply.

How to Apply

Medicaid, CHIP, and Healthy Texas Women use a single state form, H1205, the Texas Streamlined Application, which also screens you for Marketplace subsidies.13Texas Health and Human Services. Form H1205, Texas Streamlined Application Applications are accepted year-round. Before you start, gather:

  • Social Security numbers for everyone seeking coverage.
  • Proof of Texas residency, such as a utility bill, lease, or bank statement.
  • Recent pay stubs, pension statements, self-employment records, or last year’s tax return.
  • Each working household member’s employer name, address, and phone number.
  • Immigration documents if they apply to you.

You can submit the state application four ways:

Federal rules give the state 45 days to decide most Medicaid applications, or 90 days if the decision hinges on a disability.16eCFR. 42 CFR 435.912 – Timely Determination and Redetermination of Eligibility A caseworker may call to verify income or household details; answer quickly to avoid delays.

Marketplace plans are applied for separately at HealthCare.gov. Open Enrollment runs November 1 through January 15 each year.17HealthCare.gov. When Can You Get Health Insurance? Outside that window you need a qualifying life event, such as losing other coverage, getting married, having a baby, moving, or being denied Medicaid or CHIP after the window closed, to open a Special Enrollment Period.18HealthCare.gov. Special Enrollment Periods for Complex Health Care Issues Most Special Enrollment Periods give you 60 days from the event to pick a plan.

Keeping Your Coverage

Once you’re enrolled in a state program, report any change in income, household size, or address within 10 days of learning about it.19Texas Health and Human Services. B-620, Reporting Requirements Medicaid and CHIP are reviewed once a year through a redetermination. The state first checks electronic records to see whether you still qualify, then sends a renewal letter.20Texas Health and Human Services. B-120, Redeterminations If the letter says additional information is needed, you have 30 days to return a signed renewal form and any requested documents. Miss that deadline and coverage ends.

If you take a Marketplace plan with premium tax credits, you have to file a federal tax return for that year even if your income would otherwise be too low to require one. The Marketplace sends you Form 1095-A, which you use to reconcile the credits you received against what you actually qualified for. Skipping this can make you ineligible for advance credits in future years.21Internal Revenue Service. Premium Tax Credit – Claiming the Credit and Reconciling Advance Credit Payments

If You’re Denied

You have 90 days from the effective date of a Medicaid, CHIP, or other state program denial (or a reduction or termination of benefits) to request a fair hearing.22Texas Health and Human Services. B-1020, Time Period for Requesting Fair Hearing Requests can be made by phone or in writing, and a hearings officer can accept a late appeal if you had a good reason for missing the window. Marketplace disputes, like a denied Special Enrollment Period or a wrong subsidy amount, are appealed through HealthCare.gov, and a favorable outcome can itself open a Special Enrollment Period so you can pick or change a plan.18HealthCare.gov. Special Enrollment Periods for Complex Health Care Issues