Most Texas Adults with Serious and Chronic Illnesses Do Not Quality for Medicaid

Texas Medicaid rules strictly limit which adults can get health coverage. As a result, there are more than 3.5 children enrolled for every one adult we cover.

These are the adults Texas Medicaid covers today:

  • Low-income pregnant women (coverage ends 2 months after birth).
  • Low-income women with Breast or Cervical Cancer (covered during treatment).
  • Extremely low-income parents caring for children (example: parents in family with 2 children must earn less than $386 per month to get Medicaid coverage).
  • Former Foster Care Children (coverage from age 19, ends at age 26)
  • People age 65 and over, and people with disabilities, who are below or near poverty.
    • This group is mostly made up of Texans receiving Supplemental Security Income (SSI). These Texans either have a serious disability or are over 65, and must have income below the SSI upper limit of $733 a month (which is below the poverty income line). A smaller number can have higher income if they need medical care to avoid an institution like a nursing facility.

Little-Known Facts about Adults and Texas Medicaid:

  • Most parents whose children get Medicaid cannot get Medicaid themselves (3 million Texas children but fewer than 150,000 parents covered in November 2015).
  • Many Texas adults with serious illnesses and complex chronic conditions (e.g., cancer, MS) do not qualify for Medicaid. Only those who get federal SSI disability benefits can get Medicaid.

Most Adults who Can Work, Can’t get Texas Medicaid. Why?

To get SSI disability benefits, an adult must be so incapacitated by health conditions that even the simplest forms of employment are impossible. As long as a person can work even at a very reduced capacity, they will not get SSI disability payments, and in Texas that also means they will not get Medicaid. So, even if before your illness you taught physics, and now you can only do much simpler, lower-paying work, you still can be denied SSI because you are capable of employment.

This strict limit may be the right choice for determining who gets cash disability benefits. However, it is a disastrous choice for letting adults who want to work be as productive as they possibly can be, and empowering them to be the best parents they possibly can be.