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Medicaid
What Is Medicaid?
Medicaid provides medical assistance to families and persons with low income and in need of medical services.
Who is eligible?
There are three groups of individuals that are eligible for Medicaid:
- Categorically needy:
- Children under age 6 whose family has low income
- Newborns, if mother is receiving Medicaid at the time of childbirth, until the first birthday as long as the child lives with the mother
- Pregnant women with low income and in need of services related to pregnancy, delivery, and postpartum care (after birth).
- Adopted and Foster children until adoption or 18 yrs. of age
- Recipients of Supplemental Security Income (SSI)
- Caretakers of adopted children or children in foster care
- Categorically related:
- Babies up to 1 yr. old and pregnant women who do not fit the "categorically needy" group, but with low income.
- Persons who are in a mental institution and with low income or persons who would be in a mental institution but are receiving care at home.
- Certain working-and-disabled persons with low family income
- Medically needy:
- Persons (not aged or disabled) who would be eligible under "categorically needy", except that their income is above the eligibility level.
- Persons (not aged or disabled) who may be eligible for TANF but have chosen not to participate.
What services does Medicaid offer?
- A program of regular medical and dental checkups for minors and treatment of any conditions identified by the Texas Health Steps (EPSDT) program or a medical provider.
- Ambulance
- Family planning/genetics
- Federally qualified health centers
- Home health care
- Inpatient and outpatient hospital
- Renal Dialysis
- Lab and X-ray
- Medical transportation (non-emergency) to Medicaid-covered health services
- Nursing facility care
- Rural Health Clinics
- Physicians
- ICF/MR dental
- Dentists (when providing physician services)
- Certified Nurse / Midwife
- Certified Family Nurse Practitioner
- Certified Pediatric Nurse Practitioner
Optional services
- Birthing center (limited)
- Case Management for people with chronic mental illness, women with high-risk pregnancies and infants, persons with mental retardation and related conditions and blind or visually impaired adolescents
- Certified registered nurse anesthetists
- Chiropractic (limited)
- Christian Science Sanitarium
- Day activity and health services
- Dental care (under 21)
- Durable medical equipment (under 21)
- Emergency medical
- Licensed Professional Counselor
- Licensed Masters of Social Work
- Licensed marriage and family therapists
- Hearing instruments and related audiology
- Hospice care
- Intermediate Care Facilities for people with mental retardation
- Institutions for Mental Disease(under 21, over 65)
- Maternity care clinics
- Medically necessary surgery and dentistry
- Optometry and eyeglasses
- Personal care services in the home
- Physical therapy
- Podiatry
- Prescription drugs
- Psychology
- Private Duty Nursing (under 21)
- Rehabilitation: limited to chronic illness, chronic mental conditions, day activity and health services
- In-home respiratory care
- In-home tube feeding (enteral)
- Total parental hyperalimentation
Limits On Services Provided
- 30 days maximum stay in a hospital per illness
- more than one 30 day hospital stay can be paid for if stays are separated by 60 or more consecutive days.
- 3 prescriptions per month only for patients not hospitalized or in nursing homes.
These limits do not apply to children whenever they have medical necessity.
How to apply?
If you live in Texas and need services (Medicaid, food stamps, TANF, WIC, medicare, etc.) follow these instructions to apply:
- Print these two forms and fill them out
- Contact your Texas Department of Human Services office
- Make an appointment
- Take a picture I.D., your Social Security Card, and proof of pregnancy (if applicable), and filled out forms
To find your local office:
Go to http://www.txstars.net/ and type your zip-code in the box that looks like this:
Once you get the name of an office, click on the address and you will find a map with directions to get there.
If you live in the San Antonio area you can also call 871-6434 / TDD 871-6443
If you live in another state click here to get a telephone number, address, and internet address.
For more information on Medicaid
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