Medicaid Income Limits in Texas: Traditional, STAR, STAR+PLUS 2024

5 The Different Types of Medicaid in Texas

In Texas, Medicaid, the federal-state health insurance program, is not a one-size-fits-all system. Rather, it has several different versions tailored to serve different populations with unique health needs. According to Texas Health and Human Services (1), these include Traditional Medicaid, STAR, STAR+PLUS, STAR Kids, and STAR Health.

1. Traditional Medicaid: This program is generally best for low-income individuals and families who need comprehensive health coverage. Traditional Medicaid offers comprehensive health coverage to low-income individuals and families across Texas. Traditional Medicaid is administered by the Texas Health and Human Services Commission (HHSC).
2. STAR: This program is similar to traditional Medicaid but is being managed by private insurance companies. STAR is becoming more popular due to its variety of perks and additional benefits like gym membership. One thing to be careful about STAR is their narrower network compared to Traditional Medicaid and reported higher denial rate of care.
3. STAR+PLUS: STAR+PLUS is a Texas Medicaid-managed care program specifically designed for adults with disabilities or those aged 65 or older. It provides acute medical care and long-term services and support for individuals who need help performing daily activities due to age, chronic illness, or disability. STAR+PLUS aims to help people stay in their homes or communities for as long as possible (Texas Health and Human Services, 2021).
4. STAR Kids: This program is a comprehensive Medicaid plan that provides benefits to children and adults 20 years old and younger who have disabilities. Like the other STAR programs, it operates on a managed care model.
5. STAR Health: STAR Health is a specialized program for children in Texas' foster care system. The program also offers a variety of value-added services such as 24-hour nurse help lines and case management services for children with special health needs.

Traditional Medicaid vs. STAR: What's the difference?

Historically, States are responsible for managing and funding Medicaid programs. In the last decades, States like Texas increasingly contracted out the management of Medicaid to private insurance companies. These plans are often called “Managed Medicaid” or managed care. In theory, as a beneficiary, your coverage should be identical. However, in practice, many have reported higher denial rates as well as out-of-network bills due to a network of managed Medicaid being much narrower than traditional Medicaid in selected areas. 

How To Be Eligible For Medicaid in Texas?

General Eligibility Requirements

According to Texas Health and Human Services (1), to qualify for Medicaid, an individual must be:

1. A resident of Texas, a U.S. national, citizen, permanent resident, or legal alien,
2. Meet the income threshold guidelines

Unfortunately, if you don't have legal status, you aren't qualified for Medicaid in TX. However, you can try other programs like Mira. 

You can also qualify for special Medicaid programs such as STAR+PLUS if:

• Pregnant, or
• Be responsible for a child 18 years of age or younger, or
• Blind, or
• Have a disability or a family member in your household with a disability.
• Be 65 years of age or older.