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Medicaid Members

I was denied Medicaid

If you received a notice saying you or someone in your family is no longer eligible for Medicaid, there may be other health coverage options available.

Free Local Help is Available

There is a lot of information on this page about your different options if you lose Medicaid. But you don’t have to navigate this alone. There are assisters in your community who can help you with every step of the process for free.

  • To find your closest Community Partner Program click here.
  • To find an Community Health Center outreach and enrollment assister, search here.

CHIP coverage for kids

CHIP is health insurance for children age 18 and younger whose families make too much to get Medicaid but cannot afford private health insurance. A child who is no longer eligible for Medicaid may be eligible for CHIP health insurance, especially if the family’s income increased since the last time you signed up your child for Medicaid.

  • If your child is denied Medicaid but the family’s monthly income makes them eligible for CHIP, the state will automatically enroll your child in CHIP. No extra application is needed and you will receive a notice.
  • Learn more about CHIP here.

If you think you are still eligible for Medicaid

If you are an adult age 19 and older, there are very few options to receive coverage through Texas Medicaid. Check out the No Longer Eligible section below for more options. But some adults might still be eligible for Medicaid coverage if you are a U.S. citizen (some Lawfully Present Immigrants), low income, and:

  1. Pregnant; or
  2. Blind or disabled; or
  3. Responsible for a child under 18 and have very low income, making less than $300 per month for a family of four.

If you think you are still eligible for Medicaid, call 2-1-1 or 1-877-541-7905 for assistance. After you pick a language, press 2. You can also reach out to community organizations for help. See I Received a Yellow Envelope page for information on Community Partner Programs and Case Assistance Affiliates.

If you are no longer eligible for Medicaid

If you are no longer eligible, there are still options for health coverage.

The Healthcare.gov Marketplace

  • For adults who are no longer eligible for Medicaid, the state will directly transfer your file to the federal Healthcare.gov Marketplace. You will not be automatically signed up for a health plan. Instead, you will receive a notice to complete the Healthcare.gov Marketplace application and pick a health plan that best fits your need. But, the state will only directly transfer your file to the Marketplace if the state officially determines you are no longer eligible for Medicaid (aka you are denied Medicaid). The transfer will not happen if your case is “closed” because you did not complete or return the required paperwork.
  • If a child is not on their parent’s health plan and the child is not eligible for CHIP health insurance, they may qualify for their own coverage through Healthcare.gov.

The state will be rechecking eligibility for all women who were enrolled in Medicaid for Pregnant Women during the COVID-19 pandemic. 

  • If the state has all the information needed to verify eligibility for the Healthy Texas Woman program, the state will auto enroll the woman in that program.
  • In the majority of cases, the state won’t have all the information or won’t have updated information. In this scenario, the woman’s case is paused while the state sends a letter asking for the additional or updated information. If the woman does not respond to the letter in the 30 day window set by the state, they will lose Medicaid and the state will send them a denial notice. This does not mean she is not eligible for Healthy Texas Women. It just means the state didn’t have the information it needed to determine eligibility in the rechecking timeframe.
  • She can call the state and ask them to reopen her case, or she can reapply for Healthy Texas Women.

Women’s Preventive Health and Family Planning Programs

  • Healthy Texas Women and Healthy Texas Women Plus programs offer annual visits, some medicines, and screenings.
  • The Family Planning Program provides limited services, such as STI treatment, annual check-ups, and contraception.
  • Title X program provides annual well-woman exams, contraception, STI treatment to any Texas resident.