Texas runs one of the most restrictive Medicaid programs in the country. As a non-expansion state, Texas Medicaid covers pregnant women, children, certain low-income parents, people with disabilities, and elderly adults in nursing care, but it does not cover most non-disabled adults without dependent children regardless of income. After the COVID-era continuous enrollment protection ended in April 2023, Texas HHSC redetermined eligibility for over 6 million enrollees and disenrolled approximately 2.5 million people, about 40% of the total caseload, making Texas the state with the largest absolute Medicaid enrollment reduction during the unwinding period. Annual redeterminations continue in 2026, and HHSC processes renewals on a rolling basis tied to each enrollee's anniversary date. If your 2026 renewal resulted in a termination notice, the first question to answer is whether the termination was correct or a mistake, and the second is what coverage you can access before your 90-day SEP window closes.
Two distinct paths exist after a Texas Medicaid termination in 2026. The reconsideration path lets you challenge the HHSC decision within 90 days if you believe your coverage was wrongly terminated, for example because HHSC sent the renewal notice to an outdated address, or your renewal was marked incomplete even though you submitted documents. The transition path accepts the termination and moves immediately to ACA Marketplace enrollment, CHIP for children, or, for those with income below 100% of the Federal Poverty Level in Texas, an acknowledgment of the coverage gap that expanded Medicaid would close. The Marketplace SEP for losing Medicaid or CHIP coverage is explicitly a 90-day window per CMS guidance, longer than the standard 60-day SEP for most other qualifying events. Both paths can be pursued simultaneously. Check healthcare.gov for Marketplace options and call 2-1-1 to ask about the reconsideration window at the same time.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes Texas residents make after losing Medicaid in 2026:
- Waiting more than 90 days to apply for a Marketplace plan. The Loss-of-Medicaid SEP window is exactly 90 days from the termination date. Miss it and you must wait until November 2026 Open Enrollment unless another qualifying event occurs.
- Assuming Texas expanded Medicaid. Texas remains a non-expansion state in 2026. Most non-disabled adults without dependent children cannot re-enroll in Texas Medicaid regardless of how low their income drops.
- Not filing a reconsideration when the renewal was closed for missing paperwork. Procedural terminations, the most common type during HHSC redeterminations, are reversible within 90 days. Filing a reconsideration costs nothing and can restore retroactive coverage.
- Using the wrong income figure when applying for Marketplace subsidies. The Marketplace uses projected 2026 MAGI, not last year's income. If your income dropped after losing your job or reducing hours, use your projected income for the rest of 2026, not your prior-year tax return figure.
- Failing to apply CHIP for children separately. Losing adult Medicaid does not automatically terminate children's CHIP eligibility. Children's CHIP enrollment is year-round and uses higher income limits than adult Medicaid. Apply at YourTexasBenefits.com even while your Marketplace application is pending.
- Selecting a Bronze plan without checking if your doctors are in network. Bronze plans carry a 2026 out-of-pocket maximum of $10,600 for individual coverage. Verify your current providers are in-network before enrolling. Silver plans with Cost-Sharing Reductions available below 250% FPL are often better value.
Why Texas Medicaid Renewal Denials Happen: Procedural vs Substantive Terminations
Texas HHSC issues two fundamentally different types of termination notices after a failed 2026 renewal. Procedural terminations happen when HHSC closes the renewal case because required documents were not received by the deadline, the household did not respond to renewal notices within 30 days, or HHSC had incorrect contact information on file. These terminations do not reflect an actual ineligibility determination. HHSC guidance allows a 90-day reconsideration period where the affected household can submit missing documents or complete the renewal, and HHSC must reinstate coverage retroactively if the household was actually eligible at the time of termination. Substantive terminations happen when HHSC reviewed income, household composition, or citizenship information and determined that the household no longer meets Texas Medicaid eligibility rules. Texas's eligibility rules are narrow: the program covers pregnant women through 60 days postpartum, children under 19, parents and caretakers of dependent children who meet very low income limits (often under $300 to $400 per month for a family of 4), and disabled or elderly adults in specific programs. Adults without dependents are not covered regardless of income in 2026.
Distinguishing between these two types of terminations is the first and most important step after a Texas Medicaid termination in 2026. Log in to YourTexasBenefits.com, navigate to your case history, and read the reason code on your Notice of Case Action. Reason codes indicating missed deadlines, no response, or unverified information point to a procedural termination, which is worth challenging. Codes indicating income over limits, household member no longer eligible, or loss of qualifying category point to a substantive termination, where the primary path is the ACA Marketplace rather than Medicaid reinstatement. For both types, the 90-day Marketplace SEP window begins running on the effective date of termination, so pursuing the reconsideration does not pause the Marketplace deadline.
The Texas Coverage Gap: What It Means If Your Income Is Below 100% FPL in 2026
Texas is one of 10 states that have not expanded Medicaid under the ACA as of 2026. Medicaid expansion would extend coverage to adults earning up to 138% of the Federal Poverty Level, which in 2026 is $22,025 for a single adult or $45,540 for a family of 4. Because Texas has not expanded, non-disabled adults without dependents cannot qualify for Texas Medicaid at any income level. Adults who are parents or caretakers of dependent children may qualify, but the income limits are extremely low, often under $400 per month for a working family. The ACA Marketplace subsidy system assumes that adults with incomes below 100% FPL will be covered by Medicaid, so federal law does not offer Premium Tax Credits to that group. In practice, an adult in Texas earning $14,000 per year in 2026 earns too little to get Marketplace subsidies and does not qualify for Texas Medicaid. This is the coverage gap, and Texas accounts for approximately 42% of all coverage-gap adults in the United States.
Adults in the Texas coverage gap in 2026 have three practical options for accessing care. Federally Qualified Health Centers (FQHCs) operate on a sliding-scale fee schedule tied to income and serve patients regardless of insurance status. Texas has approximately 350 FQHC locations statewide. County indigent health programs, such as Harris Health System in Harris County or Parkland Health in Dallas County, provide subsidized care to county residents who meet local income limits. Hospital charity care programs, required under the ACA for nonprofit hospitals, provide free or discounted care based on income; most Texas hospital systems have charity care income thresholds at 200% to 300% FPL. Prescription drug costs for gap adults can be partially addressed through manufacturer patient assistance programs, GoodRx, and the 340B Drug Pricing Program which allows FQHCs to dispense medications at sharply reduced prices.
Medicaid Income Limits for Texas in 2026: Who Can Still Qualify
Texas Medicaid eligibility in 2026 depends heavily on which category you fall into, not just your income. Pregnant women in Texas can qualify for Medicaid with income up to 203% FPL, approximately $2,647 per month for a household of 1 in 2026. Children under age 1 qualify at the same 203% FPL threshold. Children ages 1 through 18 qualify at 133% FPL under CHIP-Medicaid rules, with CHIP covering children at incomes up to 200% FPL. Parents and caretaker relatives of dependent children face much stricter limits, often qualifying only at 17% to 20% of FPL for a working household, which is under $3,000 per year for a single parent with one child. Adults with disabilities who receive SSI automatically qualify for Texas Medicaid. Adults aged 65 and older are covered through specific Medicare Savings Programs and long-term care Medicaid programs. The core message for 2026 is that if you are a non-disabled adult without dependent children, Texas Medicaid has no coverage path for you regardless of income, and the ACA Marketplace becomes your primary option if your income is at or above 100% FPL.
Texas Medicaid Income Limits by Coverage Group, 2026| Coverage Group | Income Limit (% FPL, 2026) | Monthly Limit (Single/Household of 3) |
|---|
| Pregnant women | 203% FPL | ~$2,700/mo (hh-1) / ~$4,622/mo (hh-3) |
| Children under age 1 | 203% FPL | ~$2,700/mo (hh-1) |
| Children ages 1 to 18 (Medicaid) | 133% FPL | ~$1,769/mo (hh-1) |
| Children ages 1 to 18 (CHIP) | 200% FPL | ~$2,660/mo (hh-1) / ~$4,553/mo (hh-3) |
| Parents/caretaker relatives | 17 to 20% FPL (varies by family size) | ~$240 to $325/mo (working family of 3) |
| Adults with disabilities (SSI recipients) | SSI/Medicaid automatic link | SSI income limit applies (~$943/mo in 2026) |
| Non-disabled adults without dependents | NOT ELIGIBLE regardless of income | Texas has not expanded Medicaid under the ACA |
Texas income limits for parents/caretakers are set by the Texas legislature at extremely low levels, far below the ACA Medicaid expansion threshold of 138% FPL. Source: Texas HHSC 2026 Medicaid eligibility guidelines. FPL figures based on 2026 HHS ASPE poverty guidelines.
Source: Texas HHSC Medicaid Eligibility Handbook, HHS ASPE 2026 Poverty Guidelines
ACA Marketplace Income Eligibility After Losing Texas Medicaid in 2026
ACA Marketplace Premium Tax Credits in 2026 are available to adults with household income between 100% and 400% of the Federal Poverty Level. The 400% FPL cliff returned for 2026 after the enhanced Premium Tax Credits from the American Rescue Plan Act expired on January 1, 2026. Above 400% FPL, no Premium Tax Credit is available. Between 100% FPL and 400% FPL, the credit is calculated so that your premium contribution is capped at a sliding-scale percentage of your income, ranging from roughly 2% at 100% FPL to 9.6% at 400% FPL. Silver-level plans for those between 100% and 250% FPL also qualify for Cost-Sharing Reductions, which lower the deductible and out-of-pocket maximum well below the standard 2026 ACA out-of-pocket maximum of $10,600 for individual coverage. A Silver plan at 150% FPL in Texas can have a deductible under $500 and total out-of-pocket maximum under $1,500. Review the household-size income table below to find where your income falls.
Frequently Asked Questions
How long do I have to get health insurance after losing Texas Medicaid in 2026?
You have 90 days from your Texas Medicaid termination date to select and enroll in an ACA Marketplace plan on healthcare.gov. This 90-day Loss-of-Medicaid Special Enrollment Period is longer than the standard 60-day SEP for most other qualifying events. For example, if HHSC terminates your coverage effective June 1, 2026, your Marketplace SEP window runs through August 30, 2026. Select your plan before that window closes, and coverage starts the first of the month after you choose. Children in your household can also apply for Texas CHIP year-round with no SEP deadline.
Can I get Texas Medicaid back after losing it in a 2026 renewal?
Possibly, depending on why coverage ended. If HHSC terminated your Medicaid because renewal paperwork was incomplete or you missed a deadline (a procedural termination), you have a 90-day reconsideration window to submit the missing information by calling 2-1-1 Option 2, faxing documents to 877-447-2839, or mailing to Texas HHSC PO Box 149024 Austin TX 78714-9024. If reinstated, coverage is typically restored retroactively. If HHSC terminated coverage because your income or household composition no longer meets Texas eligibility rules (a substantive termination), reapplying will not succeed unless your situation has changed. Texas has not expanded Medicaid, so non-disabled adults without dependent children cannot qualify regardless of income.
Does Texas have Medicaid expansion in 2026?
No. Texas is one of 10 states that have not expanded Medicaid under the ACA as of 2026. Expansion would allow adults earning up to 138% of the Federal Poverty Level to qualify, which for a single adult in 2026 is $22,025 per year. Without expansion, most non-disabled Texas adults without dependent children cannot get Medicaid regardless of income. The Texas legislature has rejected expansion proposals multiple times. This means losing Texas Medicaid typically means moving to the ACA Marketplace rather than re-enrolling in Medicaid, and adults earning below 100% FPL fall into the coverage gap with no Marketplace subsidies available.
How do I document my Texas Medicaid loss for the ACA Marketplace SEP?
When you apply on healthcare.gov and select the loss-of-Medicaid qualifying event, enter the effective date of your HHSC termination. Healthcare.gov may send a post-enrollment verification request within 30 days asking you to upload proof. Acceptable documents include the Texas HHSC Notice of Case Action (the letter or notice from HHSC stating your Medicaid is ending), a printout of your case status from YourTexasBenefits.com showing the termination, or a written statement from HHSC. Keep your Medicaid termination notice. If you receive it electronically through YourTexasBenefits.com, download and save a PDF copy immediately.
What if my income is below 100% FPL and I just lost Texas Medicaid?
Adults earning below 100% of the Federal Poverty Level, which in 2026 is $15,960 for a single adult, fall into the Texas coverage gap if they do not meet a specific Texas Medicaid eligibility category. No ACA Marketplace subsidies are available below 100% FPL because federal law assumes Medicaid covers this group, which is true in expansion states but not in Texas. Your practical options include Federally Qualified Health Centers (FQHCs), which operate on a sliding-scale fee schedule and serve uninsured patients, county health systems such as Harris Health or Parkland in major metro areas, and hospital charity care programs. CHIP remains year-round and subsidized for children in your household.
Can my children stay on Texas Medicaid or CHIP even if I lost Medicaid?
Yes. Losing your adult Medicaid does not automatically terminate your children's Medicaid or CHIP coverage. Children have separate eligibility rules with higher income limits: children qualify for Texas Medicaid at up to 133% FPL and for CHIP at up to 200% FPL. Both programs enroll children year-round with no SEP deadline. Apply or check your children's coverage status at YourTexasBenefits.com or call 2-1-1. Even if you are moving to a Marketplace plan for yourself, your children may be better served by staying on CHIP or Medicaid if they still qualify.
What does a Texas Medicaid Fair Hearing do, and should I request one?
A Texas HHSC Fair Hearing is a formal appeal where you present evidence that the Medicaid termination decision was wrong. You must request a Fair Hearing within 90 days of the Notice of Case Action date. Filing a Fair Hearing request can allow you to continue receiving Medicaid benefits while the appeal is pending if you request it within 10 days of the notice, though this rule applies specifically to continuing benefits rather than reinstating already-terminated coverage. Fair Hearings are most useful when you believe HHSC made an error in applying eligibility rules, used incorrect income information, or denied coverage based on incomplete documentation. Request a Fair Hearing by calling 2-1-1, writing to HHSC, or visiting a local HHSC office.
How do I apply for an ACA Marketplace plan after losing Texas Medicaid?
Go to healthcare.gov and click Get Coverage. Create an account or log in to an existing account. Select the qualifying event type as loss of Medicaid or CHIP coverage and enter your HHSC termination date. The application will calculate your Premium Tax Credit based on your projected 2026 household income. Select and enroll in a Marketplace plan within your 90-day Loss-of-Medicaid SEP window. Coverage starts the first of the month after you select a plan and pay your first premium. If your income is between 100% and 250% FPL, choose a Silver plan to access Cost-Sharing Reductions that lower your deductible and out-of-pocket costs. If you need help, call the Marketplace call center at 1-800-318-2596 or find a local Navigator or certified enrollment assister through localhelp.healthcare.gov.
