Transitional Medicaid in Texas covers the same health services as the state’s regular STAR managed care program: doctor visits, hospital care, prescription drugs, dental and vision care, hearing services, mental health and substance use treatment, lab work, and free rides to medical appointments. The parent or caretaker relative and every eligible child in the household keep this coverage for up to 12 months after a raise or new job knocks the family off regular Parents and Caretaker Relatives Medicaid (TP 08). The formal name of the program is Earnings Transitional Medicaid, or TP 07.
The Full STAR Benefit Package
Once a family moves to transitional Medicaid, each member is enrolled in a STAR managed care health plan, the same system that serves low-income children, pregnant women, and families across Texas.1Texas Health and Human Services. STAR Medicaid Managed Care Program The benefits are identical to what any other STAR member receives.
Preventive and primary care runs through the member’s chosen primary care provider. Regular checkups, immunizations, and screenings are included, as are both inpatient hospital stays and outpatient procedures. Lab tests, X-rays, and other diagnostics are covered when ordered through the plan.
Dental coverage is split by age. Children under 21 receive dental exams and treatment.2Driscoll Health Plan. STAR Program Adults enrolled under the Parents and Caretaker Relatives benefit package qualify for regular dental checkups.3Texas Health and Human Services. Medicaid for Parents and Caretakers
Vision benefits include eye exams and prescription glasses. Adults get a covered exam and glasses once every 24 months; children get an annual eye exam.4Wellpoint. Texas Medicaid STAR Hearing evaluations and hearing aids are covered for members of any age when medically necessary.5Texas Medicaid and Healthcare Partnership. Vision and Hearing Services
Behavioral health is covered broadly. The plans pay for both inpatient and outpatient mental health and substance use disorder treatment, including individual and group counseling, psychiatric evaluation and medication management, detoxification, residential treatment, and intensive outpatient programs. You can go directly to a behavioral health provider in your plan’s network without a referral from your primary care doctor.6Aetna Better Health. Behavioral Health7Molina Healthcare. Behavioral Health Services
Transportation is often overlooked but worth knowing about. The non-emergency medical transportation benefit provides free rides to doctor, dentist, hospital, and pharmacy appointments for members who have no other way to get there. Each STAR health plan contracts with its own transportation vendor, and rides should be requested at least two business days in advance.8Texas Health and Human Services. Nonemergency Medical Transportation Program
Individual STAR plans also offer “value-added services” above the standard package. These extras differ by plan and service area, and can include additional vision allowances, wellness programs, or expanded dental benefits.1Texas Health and Human Services. STAR Medicaid Managed Care Program When you’re choosing between plans, these are the main thing that distinguishes one from another.
Prescription Drug Coverage
Prescriptions are covered at no cost to the member. Texas maintains a statewide Preferred Drug List (PDL), and drugs on the list generally do not require prior authorization. Non-preferred medications can still be obtained, but your prescriber will need to go through a prior approval process.9Texas Health and Human Services. Texas Prescription Drug Benefits
If you need a medication urgently and prior authorization is holding things up, a 72-hour emergency override process is available at the pharmacy. That gives the pharmacist authority to dispense a short supply while the paperwork is sorted out.10Texas Vendor Drug Program. Preferred Drugs
What It Costs the Family
Texas does not charge premiums for transitional Medicaid. Federal rules allow states to impose a modest premium (capped at three percent of income) on families above the federal poverty level during the second half of the transitional period, but Texas has not adopted a premium.11Social Security Administration. Section 1925 of the Social Security Act Prescriptions are free. Standard STAR cost-sharing rules apply to any covered service.
Which Family Members Are Covered
Both the parent or caretaker relative and the children stay covered. When a parent moves from TP 08 to TP 07, each child is certified on their own transitional Medicaid case with the same 12-month coverage window as the parent.12Texas Health and Human Services. Transitional Medicaid Coverage Children born or adopted into the family during the transitional period can also be added if they meet citizenship, residency, and age requirements.
How Long the Coverage Lasts
Transitional Medicaid runs for 12 months from the loss of regular TP 08 eligibility.13Texas Health and Human Services. Transitional Medicaid Coverage During that period, the family must stay in Texas and continue to include at least one eligible child in the household. Unearned income like child support or investment returns is not counted when the state checks ongoing eligibility.
Coverage can be shortened in a few situations. If the household’s average gross monthly earnings exceed 185 percent of the federal poverty level, benefits are cut off. For a family of three, that threshold sits at $4,109 per month; for a family of four, it is $4,957.14Texas Health and Human Services. Medical Programs Income Limits Coverage can also end after the sixth month if the parent or caretaker has zero earned income for an entire month without good cause (involuntary job loss, illness, or an active job search can qualify). Moving out of Texas, or no longer having an eligible child in the home, ends coverage for the whole family.
If your coverage is terminated early and the original 12-month window has not yet closed, you can ask for reinstatement for the remaining months without filing a new application, as long as you meet the eligibility rules at the time of the request.13Texas Health and Human Services. Transitional Medicaid Coverage
To keep coverage going, the household has to return a short Medicaid Report (Form H1146) at the end of the third, sixth, and ninth months, listing gross earnings, child care expenses, and any changes in household or address.15Texas Health and Human Services. Form H1146 Medicaid Report No pay stubs are required with the report; a signature is enough.16Texas Health and Human Services. Form H1146-M Medicaid Report Manual
Picking Your STAR Health Plan
You don’t apply separately for transitional Medicaid. When the state’s eligibility system processes a TP 08 denial driven by increased earnings, it automatically evaluates the family for TP 07 and opens the new case if the rules are met. Then you get a notice (Form TF0001) telling you regular Medicaid has ended, transitional coverage has started, and when it will expire.13Texas Health and Human Services. Transitional Medicaid Coverage
You then choose a STAR managed care plan. If you don’t pick one, Texas Health and Human Services will assign a plan for you. If you had Medicaid in the previous six months and are re-approved, you’ll be put back into your previous health plan automatically.17Texas Health and Human Services. Choosing a Health Plan Because the core STAR benefits are set by the state and are the same across plans, the practical differences come down to the provider network and the value-added services each plan offers.
If Alimony or Spousal Support Caused the Loss of Medicaid
A separate program, TP 20, covers families who lose TP 08 specifically because of new or increased alimony or spousal support. The covered services are the same STAR benefits described above, but the duration is only four months rather than 12.18Texas Health and Human Services. TP 20 Alimony/Spousal Support Transitional Medicaid Coverage One note on who the program reaches: alimony received under a divorce or separation agreement executed or last modified after December 31, 2018, isn’t counted in the household’s budget at all, so TP 20 in practice applies mostly to families with older divorce agreements.