Do I Qualify for Free or Lower-Cost Coverage?

Resources to help you figure out if you might be eligible for help paying for coverage, and what to do if you’ve been denied coverage. Includes information for individuals who aren’t eligible for help paying for health coverage because of the Coverage Gap, family glitch, or due to immigration status.
If I’ve been denied

Help with eligibility denials

HHSC Ombudsman for help with Medicaid or CHIP eligibility denial

HHSC's Ombudsman office can tell you what steps to take if your Medicaid or CHIP application was denied and you think it was an error, inclduing how to make a formal appeal
  • By Phone
Programs:
CHIP, Medicaid
Languages:
English, Spanish

Help with eligibility denials

Healthcare.gov information on how to appeal a Marketplace eligibility decision.

Healthcare.gov has detailed answers on how to appeal an eligbility decison if you think it is an error.
  • Online
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:
English

Help with eligibility denials

Spanish- Healthcare.gov information on how to appeal a Marketplace eligibility decision.

Cuidadodesalud.gov tiene respuestas sobre có mo presentar apelaciones al Mercado de Seguros
  • Online
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:
Spanish
Non US Citizens

Information for Immigrants

Health Reform Beyond the Basics report on Marketplace enrollment for families that include immigrants

Non-U.S. citizens in Texas who are lawfully present may enroll in marketplace coverage, and can qualify for premium subsidies and lower out-of-pocket costs from 0-400% of the federal poverty income guidelines.

Lawfully-present non-citizen children (under age 19) can participate in Texas Medicaid and CHIP on the same terms as U.S. citizen children. But, Texas is one of just 6 states that do not cover lawfully-present non-citizen adults in Medicaid.

  • Online
Programs:
Commercial Insurance, health insurance, Marketplace, Obamacare, Private Insurance
Languages:

Information for Immigrants

Immigrants without Legal Status

Non-U.S. citizens in Texas who are undocumented (do not have legal status) are excluded from Medicaid, CHIP, and the Marketplace. Their options for care are much more limited.

Most federally funded public health services and many (not all) city and county programs for the uninsured in Texas do allow undocumented residents to participate. See Getting Health Care Without Insurance for more information.

Programs:
Languages:
Obamacare Subsidy Calculators

These tools can show you whether you can get free or low-cost care based on your income, before you sign up.

Calculate your Subsidy

Healthcare.gov's Marketplace subsidy screener

Healthcare.gov has a tool to let you see if you qualify for savings, before you actually enroll in health coverage.

  • Online
Programs:
Commercial Insurance, health insurance, Marketplace, Obamacare, Private Insurance
Languages:
English, Spanish

Calculate your Subsidy

Kaiser Foundation's Marketplace subsidy screener

The Kaiser Family Foundation has a tool to let you see if you qualify for savings, before you actually enroll in health coverage.

  • Online
Programs:
Commercial Insurance, health insurance, Marketplace, Obamacare, Private Insurance
Languages:
English, Spanish

Calculate your Subsidy

Enroll America's Marketplace subsidy screener

Enroll America has a tool to let you see if you qualify for savings, before you actually enroll in health coverage.

  • Online
Programs:
Commercial Insurance, health insurance, Marketplace, Obamacare, Private Insurance
Languages:
English, Spanish
Who Can Get Medicaid or CHIP

Video: Medicaid and CHIP Income

Training for Medicaid and CHIP: How Income is Calculated - Part 4 of 4

Melissa McChesney, Outreach Coordinator for the the Center for Public Policy Priorities, explains eligibility and enrollment into income-based Medicaid programs and the Children’s Health Insurance Programs (CHIP) in a four-part series. Part 4 includes a description of Modified Adjusted Gross Income (MAGI) rules for Medicaid and CHIP and covers what income is included in the calculation of income.

  • Online
Programs:
CHIP, Medicaid
Languages:
English

Video: Medicaid and CHIP Family Size

Training for Medicaid and CHIP: How Family Size is Calculated - Part 3 of 4

Melissa McChesney, Outreach Coordinator for the the Center for Public Policy Priorities, explains eligibility and enrollment into income-based Medicaid programs and the Children’s Health Insurance Programs (CHIP) in a four-part series. Part 3 includes a description of Modified Adjusted Gross Income (MAGI) rules for Medicaid and CHIP and covers how family size is determined.

  • Online
Programs:
CHIP, Medicaid
Languages:
English

Video: Medicaid and CHIP General Eligibility

Training for Medicaid and CHIP: General Eligibility - Part 2 of 4

Melissa McChesney, Outreach Coordinator for the the Center for Public Policy Priorities, explains eligibility and enrollment into income-based Medicaid programs and the Children’s Health Insurance Programs (CHIP) in a four-part series. Part 2 covers the basic eligibility criteria for each eligibility group including age, residency, income limit, citizen/immigration status, and categorical eligibility requirements.

  • Online
Programs:
CHIP, Medicaid
Languages:
English

Video: Medicaid and CHIP Eligibility Process

Training for Medicaid and CHIP: Eligibility Process - Part 1 of 4

Melissa McChesney, Outreach Coordinator for the the Center for Public Policy Priorities, explains eligibility and enrollment into income-based Medicaid programs and the Children’s Health Insurance Programs (CHIP) in a four-part series. Part 1 covers the eligibility process from application through eligibility determination and the benefit renewal process.

  • Online
Programs:
CHIP, Medicaid
Languages:
English

Texas Medicaid and CHIP eligibility basics

CPPP Medicaid Eligibility Chart

A summary picture of who gets Medicaid and CHIP in Texas from CPPP.

  • Online
Programs:
CHIP, Medicaid
Languages:

Texas Medicaid and CHIP eligibility basics

HHSC Medicaid Eligibility List with Links

This Texas HHSC page lists the kinds of people who can qualify for Medicaid and has links to more information.

  • Online
Programs:
CHIP, Medicaid
Languages:

Texas Medicaid and CHIP eligibility basics

HHSC Children's Medicaid and CHIP Eligibility Chart by Income and Family Size

This Texas HHSC chart shows which CHILDREN can qualify for Texas Medicaid and CHIP by income and family size.

  • Online
Programs:
CHIP, Medicaid
Languages:
English

Texas Medicaid and CHIP eligibility basics

Spanish- HHSC Children's Medicaid and CHIP Eligibility Chart by Income and Family Size

Tabla de ingresos para CHIP/Medicaid para Niños

  • Online
Programs:
CHIP, Medicaid
Languages:
Spanish
Who Is Left Out: Coverage Gap, Family Glitch

The Coverage Gap and the Family Glitch leave some Texans without access to affordable care. Texas' state governments can fix the Coverage Gap, and Congress can fix the Family Glitch.

Coverage Gap Resources

One-pager on the Texas Coverage Gap (CPPP).

Coverage Gap: States get to choose whether or not to provide Medicaid to adults at or near poverty. Most of the states do, but Texas and 18 other states have not.

Here is a 1-page explanation of why most Texas adults at or near poverty cannot get Medicaid, and information on the many ways Texas could benefit if Medicaid started covering them. From CPPP.

  • Online
Programs:
Medicaid
Languages:

Coverage Gap Resources

National information on the Coverage Gap (Kaiser Family Foundation).

The Kaiser Family Foundation's slide show of graphics of the Coverage Gap from a national perspective (June 2015).
  • Online
Programs:
Medicaid
Languages:

Coverage Gap Resources

Map of which states have Medicaid Expansion, and which have Coverage Gap (Kaiser Family Foundation).

Kaiser Family Foundation's map showing which states cover adults and which do not (updated regularly):
  • Online
Programs:
Medicaid
Languages:

Coverage Gap Resources

Blog report with the latest facts and figures on Medicaid Expansion and the Coverage Gap in Texas.

This blog post from the Texas Well and Healthy campaign rounds up all the latest on who is affected, dollars lost, who supports a solution, and more.
  • Online
Programs:
Medicaid
Languages:

Family Glitch Information

Consumers Union (the publishers of Consumer Reports) explains the Family Glitch, and a proposal to fix it.

Family Glitch: Due to a mistake in wording in the federal law, a spouse and/or children can be denied health coverage subsidies if one of the parents has a job-based health plan that covers that parent only, at a low cost. This is true even if the premium the family would pay (to add the spouse and kids) is a very high share of their family income. Congress can fix this, but they have not yet.

Consumers Union (the publishers of Consumer Reports) explains the Family Glitch, and a proposal to fix it.

  • Online
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:

Family Glitch Information

CPPP in Texas explains the Family Glitch.

CPPP in Texas explains the Family Glitch.
  • Online
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:

Family Glitch Information

The journal Health Affairs reports on the Family Glitch.

The journal Health Affairs reports on the Family Glitch.

  • Online
Programs:
Commercial Insurance, health insurance, Marketplace, Obamacare, Private Insurance
Languages:

Family Glitch Information

A news article in Huffington Post explains legislation filed to fix the Family Glitch.

A news article in Huffington Post explains legislation filed to fix the Family Glitch.
  • Online
Programs:
Obamacare, Commercial Insurance, Private Insurance, Marketplace, health insurance
Languages:

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