What is Medicaid?

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What is Medicaid?

Medicaid is a state/federal partnership program that offers health care services to people who have limited income, are pregnant, and/or have disabilities. Medicaid is a large, complex program. Click here to find more detailed information.

Who Qualifies for Texas Medicaid?
To qualify for Medicaid, you or your children must:
• Be a Texas resident
• Be a U.S. Citizen or a legal resident
• Meet certain resource and income limits
• Fit into one of these groups:

• Families and children with low incomes
• Children
• Pregnant women
• Non-U.S. citizens needing emergency medical services, including labor and delivery
• Children or pregnant women who are medically needy due to high medical bills
• People who get Supplemental Security Income (SSI) from the Social Security Administration
• People who have low incomes and need long-term services and supports or help with daily activities

How Do You Apply for Medicaid?
• People with disabilities or who are over 65 with limited income receive Medicaid automatically when they receive SSI. You can apply for SSI at your local Social Security Administration office.

• Children under age 19 can apply for coverage by phone, fax, mail, or internet. You can follow the instructions for How to Apply on the “What is CHIP?” Page on this website. You can find the same information on www.chipmedicaid.org or by calling 1-877-543-7669 (1-877-KIDS-NOW).

• You can also apply in person at a local HHSC benefits office. Outstationed eligibility workers are also available in hospitals, and at many Community Health Center sites. Contact your local community health center to find out if there is an outstationed eligibility worker there that can assist you in applying for Medicaid.

What is the Eligibility Period?
Most people must renew their Medicaid every six months. For children, this is different from the CHIP program, which allows for twelve months continuous eligibility as of September 1, 2007.

What Benefits are Covered?
Covered services vary by eligibility category. For instance, children receive a comprehensive set of health benefits including preventive checkups, dental care, hospital services, and specialty services. Pregnant women receive full Medicaid benefits for the term of their pregnancy until two months after the baby is born. Medicaid clients in the Women’s Health Program receive only gynecological services, birth control, and limited health screenings. To see a comprehensive list of Medicaid benefits click here .

How do I use my Medicaid benefits?
Each month you will receive a Medicaid ID form to show each time you go to the doctor and/or get a prescription filled. Your identification form will list the services that will be covered by Medicaid and when regular checkups are scheduled. Payments are made directly to providers, such as doctors, pharmacist, or laboratories. The provider you use must accept Medicaid, or your visit will not be covered.

Who processes the application?
The Health and Human Services Commission (HHSC) is responsible for processing Medicaid applications. HHSC will contact you directly to schedule a personal interview only if eligibility cannot be determined through mail correspondence.

How will you know if you have been approved for Medicaid?
HHSC has up to 45 days to determine if you are eligible for Medicaid. Once a determination is made, you will be notified by mail if you have been approved or denied Medicaid benefits. If approved, you will receive 6 months continuous Medicaid coverage. In the last two months of your Medicaid coverage, you will receive notification in the mail requesting the need for you to recertify.

What is Medicaid Managed Care?
Medicaid clients in Texas urban areas will likely receive services through a Medicaid Health Maintenance Organization (HMO), often referred to as a health plan. Clients have a choice which health plan they use. Be sure to choose a health plan and primary care provider when you receive your enrollment packet. You can find more information about Medicaid managed care here .

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