Texas Medicaid is a state and federally-funded program that provides health coverage to eligible low-income residents, including children, pregnant women, parents and caretakers, elderly individuals, and people with disabilities. The program offers many services, such as doctor visits, hospital care, prescription drugs, and long-term care services. Texas Medicaid operates through managed care and fee-for-service models, ensuring access to necessary medical care while promoting cost-effective treatment options. Residents can apply for Medicaid online, by phone, or in person at local offices and must renew their benefits periodically to maintain coverage.

In Texas, Medicaid and CHIP provide various services, broadly categorized into acute care services, behavioral health services, long-term services and supports (LTSS), and other specific services.

Acute Care Services

• Includes doctor or clinic visits, vaccines, prescription drugs, emergency services, hospital care, prenatal care, childbirth, and vision and hearing care
• Dental services for children and youth
• COVID-19 testing, vaccines, and treatment

Behavioral Health Services

• Covers treatment for mental health conditions and substance use disorders (SUD)
• Services include screenings, interventions, psychological testing, outpatient and residential withdrawal management, targeted case management, rehabilitation services, psychiatric evaluations, and various therapies

Long-Term Services and Supports (LTSS)

• For adults 65 and older and individuals with physical, intellectual, or developmental disabilities
• Delivered through managed care, fee-for-service (FFS), or both
• Includes nursing care and assistance with daily living tasks
• Provided in long-term care facilities, community settings, or at home.

Long-Term Care Facilities

• Nursing facilities offer room, board, nursing, medical supplies, social services, and more
• Intermediate Care Facilities for Individuals with an Intellectual Disability (ICFs/IID) provide health or rehabilitative services.
• Texas Medicaid Waiver Programs like CLASS, DBMD, HCS, MDCP, and others offer additional support.

Home and Community-Based Services

• Personal Assistance Services (PAS), Community Attendant Services (CAS), and others
• Include assistance with activities of daily living, cooking, cleaning, and nursing care

Prescription Drugs

• Covered under the Vendor Drug Program (VDP)
• Drugs may be listed as "preferred" or "non-preferred" on the Texas Formulary and Preferred Drug List (PDL)

Medical Transportation Services

• Nonemergency medical transportation (NEMT) to healthcare providers, pharmacies, etc.
• Includes demand response transportation, mass transit tickets, mileage reimbursement, and more

Telehealth and Telemedicine

• Expansion during COVID-19 for services like behavioral health, therapy, rural health clinic services, etc.

Services for Children and Youth

• Comprehensive medical, dental, and case management services through Texas Health Steps
• Behavioral health care, including Health and Behavior Assessment and Intervention (HBAI)
• Dental benefits provided by dental maintenance organizations or STAR Health MCO.

Women's Health Services

• Reproductive health care, prenatal care, labor and delivery, breast and cervical cancer screening
• Programs like Healthy Texas Women and CHIP Perinatal offer additional services

Services for Adults and People with Disabilities

• Various programs like STAR Kids, Medicaid for the Elderly and People with Disabilities (MEPD), and Medicaid Buy-In programs
• Medicaid 1915(c) waiver programs for intellectual and developmental disabilities (IDD)

Medicaid for Breast and Cervical Cancer

• Offers chemotherapy, radiation, surgery, and other cancer treatments.

Special Initiatives

• Initiatives like the Maternal Opioid Misuse Model, Postpartum Depression strategy, and Long-acting Reversible Contraception (LARC) to improve birth outcomes.

Programs for the Elderly

• Includes Medicare-Medicaid Plans (MMP), Medicaid Hospice Services, and Program of All-inclusive Care for the Elderly (PACE).

The eligibility requirements for Medicaid and the Children's Health Insurance Program (CHIP) in Texas are quite comprehensive. Here is a summary:

Medicaid Eligibility

Residency and Citizenship

• Must live and intend to remain in Texas
• Need a Social Security number or apply for one
• U.S. citizens, nationals, or qualified aliens (some categories have limited eligibility or waiting periods)

Financial Eligibility

• Based on household income relative to the federal poverty level (FPL)
• Uses Modified Adjusted Gross Income (MAGI) methodologies
• Exclusions: Individuals 65 and older, with disabilities, or receiving SSI

Groups Covered

Children and their families, pregnant women, former foster care youth, individuals with disabilities, and people 65 and older.

Special Categories

• Emergency Medicaid for certain noncitizens, including undocumented aliens (covers only emergency conditions)
• Limited eligibility for certain aliens, such as asylees and refugees, up to seven years
• Lawful Permanent Residents are sometimes subject to a five-year waiting period

Medicaid for the Elderly and People with Disabilities

Covers adults with disabilities and people 65 and older based on income and resource limits.

Medicaid Buy-In Programs

For children and adults with disabilities who work

CHIP Eligibility

1. For children up to 18 years old
2. Uninsured and not eligible for Medicaid
3. Household income at or below specific thresholds

Specific Programs for Various Groups

Programs cater to pregnant women, former foster care youth, incarcerated youth, women (including breast and cervical cancer screening services), parents and caretaker relatives, medically needy with spend-down program, and those eligible for Medicare and Medicaid.

This is a broad overview, and for detailed information, including specific income limits and more nuanced rules, it's advisable to refer to the official Texas Medicaid and CHIP guidelines.

To apply for Medicaid in Texas, you can choose from several methods:

Online Application

Visit YourTexasBenefits.com to apply for Medicaid and other state benefits. You can also check your application status, renew your benefits, and manage your account.

Local Eligibility Offices and Community Partners

You can apply in person at any local Texas Health and Human Services Commission (HHSC) office. To find the nearest office, you can use the HHSC Office Locator at https://hhs.texas.gov/about-hhs/find-us.

Phone Service

Call 2-1-1 toll-free. Choose your preferred language and then select Option 2 to discuss Medicaid and other benefits. For the hearing impaired, the TTY number is 711.

Mail or Fax

Fill out a paper application and mail or fax it to HHSC. The form can be downloaded from the Your Texas Benefits website at https://yourtexasbenefits.com. The mailing address and fax number will be provided on the form.

Renewing Medicaid in Texas is a critical process to ensure continuous healthcare coverage. Texas Health and Human Services (HHS) sends you a renewal notice about 60 days before your coverage expires, including instructions on how to renew your benefits.

Online Renewal

The easiest way to renew Medicaid benefits is online through the YourTexasBenefits.com website. Log in to your account to complete and submit the renewal form.

Mail or Fax

You can renew your Medicaid by filling out the paper renewal form included in the notice and mailing or faxing it back to HHS. The mailing address and fax number will be provided in the renewal package.

Local HHS Office

You can also renew your Medicaid at your local HHS office. Find the nearest office using the HHS Office Locator: https://hhs.texas.gov/about-hhs/find-us

By Phone

Call 2-1-1 to renew over the phone. Choose your preferred language and then select the option for renewing benefits.

Be sure to respond to the renewal notice promptly to avoid any lapse in coverage. If you don’t receive a renewal notice and your coverage end date is approaching, contact HHS or log in to your account on YourTexasBenefits.com to check your renewal status.

If you need help with the renewal process, trained community partners across Texas can assist you. Find them through the Office Locator or by calling 2-1-1.