Medicaid

Medicaid and CHIP are public insurance programs created under federal law, and operated as federal-state partnerships.  Medicaid was created by Congress in 1965, and the Children’s Health Insurance Program (CHIP) was added in 1997.  States have minimum federal standards their Medicaid programs must meet, but also have a lot of options they can take or leave.  Texas Medicaid is run by the Texas Health and Human Services Commission (HHSC), and you can learn more about our state’s program in their biennial report, the Texas Medicaid and CHIP Reference Guide.

a mom and child at the doctors office

Equity in Focus

Texas leaders’ choice to refuse federal funds for Medicaid Expansion–estimated at $10 billion per year–has a disproportionate effect on uninsured Hispanic adults in Texas. Of the 1.5 million uninsured Texas adults who could enroll under a Medicaid Expansion, 57% are Hispanic, compared to just 39% of adult Texans 19-64 (13% are African-Americans, on par with their share of adult Texans).  Studies have found Medicaid Expansion linked to reduced disparities by income or race/ethnicity in measures of affordability or financial security, including: significantly reduced medical debt and collections, better credit scores, lower over-limit credit card spending, and reduced evictions, bankruptcies, and wage garnishments. 

Background

In 2019, about 4 million Texans were covered by Medicaid on any given day, about 3 million of them children.  Texas has the lowest income limit for parents to get Medicaid in the U.S., so only a handful of the children on Medicaid have parents who qualify themselves.

texans with medicaid and chip health coverage infographic

Not everyone who is an uninsured U.S. citizen in poverty can get Medicaid in Texas, and coverage of non-U.S. citizens is limited, even for legal permanent residents.  

  • Very few parents can access Texas Medicaid; left out of Texas Medicaid are parents with incomes between 18% and 100% of the federal poverty income. 
  • Adults with serious, chronic, or mental illness.  Disability-related Medicaid only becomes available when a person is no longer able to work at all, or is considered to be within 12 months of death.  As a result, uninsured Texans with serious diagnoses struggle to continue working without adequate treatment.  
  • Uninsured Adults in Poverty.  Texas Medicaid does not cover adults in poverty without dependent children, unless they have a serious or permanent disability, are elders in poverty, or get  temporary maternity coverage that ends 2 months after the birth. The Affordable Care Act (ACA, or Obamacare) directed that all 50 states would offer Medicaid to US citizen adults, but a 2012 Supreme Court Decision ruled that states that did not provide that coverage could not be penalized with loss of federal Medicaid funds.  As of May 2020, Texas was one of only 14 states not providing Medicaid to adults in poverty.  

Many Texans are not aware that under federal law, ACA insurance subsidies are only available for U.S. citizens who are above the federal poverty income.  This leaves most working-poor Texas adults uninsured, because our state’s Medicaid program is closed to them, and they cannot get sliding-scale ACA coverage either.  

Texas qualifies for 90% federal funding for Medicaid expansion. A number of conservative states have coverage programs with co-pays, private insurance plans, and other market-based components.

A solution would benefit those Texans in the Coverage Gap and their families by ensuring they have access to cancer treatment, mental health care, preventive care that saves lives and money, and other care that is not available in the ER or in the patchwork of other services for the uninsured. It would also provide significant economic benefits, with the potential to create up to 230,000 jobs over three years, according to an estimate by former Deputy Texas Comptroller Billy Hamilton.

Meet Our Staff

Anne Dunkelberg

Associate Director, Program Director - Health and Wellness Team