Eligibility Rules for Medicaid for Adults in Texas

Eligibility Rules for Medicaid for Adults in Texas. Medicaid is a comprehensive health insurance program for seniors, the disabled, pregnant women, children, the blind and the medically needy. In Texas, there are several Medicaid programs available, and eligibility criteria varies for each. In general, you have to be a U.S. citizen or legal resident alien an meet income and asset (savings) guidelines, which are based on your situation and the size of your household.

SSI and Medicaid

Supplemental Security Income, or SSI, provides a monthly benefit to those age 65 and older, disabled and blind who qualify based on income and assets. Your countable income (not all the income you receive each month counts toward qualifying) has to be less than the current SSI benefit amount. As of 2011, the individual monthly benefit is $674 for an individual and $1,011 for a couple. The asset limit for SSI is $2,000 for an individual and $3,000 for a married couple. If you qualify for SSI in Texas, you automatically qualify for Medicaid.

Medicaid and Facility Care

In Texas, if you've been in a nursing facility for 30 consecutive days or more, you may be eligible for Medicaid if you meet the income and asset requirements. To qualify for Medicaid based on nursing home care, the maximum income for an individual is $2,022 or $4,044 for a couple. Your assets must be under $2,000 as an individual or $3,000 as a couple. Your home, one vehicle and up to $1,500 in life insurance are not counted as assets.

Medicaid Buy-In

Disabled Texans, and those age 65 and older, who are working may be eligible to buy-in to Medicaid by paying a monthly premium. To qualify, you can't be institutionalized, you have to qualify for SSI or Social Security Disability Insurance, you have to pay state and federal taxes and have earned at least $1,000 in the three months before you apply. You can personally make up to $2,269 per month and have up to $5,000 in assets and buy into Medicaid.

Medicaid Women's Programs

Texas women also have access to Medicaid, based on their situation, income and assets. Low-income pregnant women may be eligible throughout their pregnancy and up to two months afterward. Texas' Women's Health program provides partial Medicaid benefits to women ages 18 to 44. Women diagnosed with breast and cervical cancer and who are under age 65 can qualify for full Medicaid benefits through the Breast and Cervical Cancer Services program. To qualify for Medicaid for pregnant women and the Women's Health program, as of 2011, your monthly income must be $1,679 or less for a household of one, or $2,268 for a household of two. To qualify for the Breast and Cervical Cancer Services program, as of 2011, your income must be $1,815 or less for a one-person household or $2,452 for a two-person household. The income threshold for all programs increases based on your household size.


  • Benefits.gov: Texas Medicaid
  • Social Security Online: Understanding Supplemental Security Income SSI Eligibility Requirements
  • Social Security Online: SSI Federal Payment Amounts for 2011
  • Texas Health and Human Services: Medicaid Eligibility for the Elderly and People with Disabilities Handbook: Appendix XII