Health insurance for undocumented immigrants in Texas is limited but not nonexistent. You cannot buy a plan through the ACA Marketplace or enroll in standard Medicaid, but four options remain open regardless of immigration status: Emergency Medicaid for life-threatening situations, county hospital district financial assistance for ongoing care, federally qualified health centers that charge on a sliding scale, and the CHIP Perinatal program for prenatal care. None of these count against you in a future immigration case under the current public charge rules.
What You Cannot Get
Federal law bars undocumented residents from buying coverage through the Affordable Care Act Marketplace, even at full price and without subsidies.1HealthCare.gov. Health Coverage for Immigrants Standard Medicaid is also off the table, because federal public benefits are restricted to people with a qualifying immigration status such as lawful permanent residents, refugees, or asylees.2Office of the Law Revision Counsel. 8 USC 1611 – Aliens Who Are Not Qualified Aliens Ineligible for Federal Public Benefits
The practical result is that the routine preventive care and long-term treatment options available to citizens through government-funded insurance do not exist for someone without status. What follows are the programs that operate outside those systems.
Emergency Medicaid
Federal law lets states use Medicaid to pay for emergency care given to people who are not lawfully admitted, as long as the condition meets the legal definition of a medical emergency. That covers situations where delay could seriously threaten health, cause serious harm to bodily function, or involve labor and delivery.3Office of the Law Revision Counsel. 42 USC 1396b – Payment to States The same statute that blocks other federal benefits explicitly carves out this exception.2Office of the Law Revision Counsel. 8 USC 1611 – Aliens Who Are Not Qualified Aliens Ineligible for Federal Public Benefits
Separately, the Emergency Medical Treatment and Labor Act requires any hospital with an emergency department to screen and stabilize anyone who arrives with an emergency, regardless of insurance, status, or ability to pay.4Office of the Law Revision Counsel. 42 USC 1395dd – Examination and Treatment for Emergency Medical Conditions and Women in Labor EMTALA creates the duty to treat; Emergency Medicaid creates a way to pay for it.
The limit matters. Emergency Medicaid covers the emergency itself and stops once the immediate threat is resolved. It will not pay for follow-up visits, ongoing medication, or long-term management of the underlying condition.
County Hospital District Financial Assistance
Texas law requires counties without a public hospital or hospital district to provide basic health services to eligible low-income residents. The statutory floor is 21% of the federal poverty level.5State of Texas. Texas Health and Safety Code 61.006 – Standards That threshold is very low, which is why the hospital districts in most large Texas cities set their own limits well above it.
Harris Health System in Houston extends financial assistance to households earning up to 150% of the federal poverty level, which is about $23,940 for an individual or $49,500 for a family of four in 2026.6Harris Health System. Patient Eligibility7U.S. Department of Health and Human Services. 2026 Poverty Guidelines Parkland in Dallas and University Health in San Antonio run similar programs with their own income thresholds. Once approved, you receive a card or letter that lets you schedule appointments, see specialists, fill prescriptions, and get lab work at reduced or no cost within that district’s network.
This is the closest thing to ongoing health coverage available to undocumented residents in Texas. These programs handle chronic conditions like diabetes and hypertension, non-emergency surgery, and mental health care that Emergency Medicaid never touches. Each system limits care to its own facilities and contracted providers, so where you live decides which one you use. A Harris Health card does not work at a Parkland clinic.
Federally Qualified Health Centers
Federally qualified health centers are community clinics funded under Section 330 of the Public Health Service Act. The law requires them to serve everyone in their service area regardless of ability to pay and to charge on a sliding scale based on household income.8Office of the Law Revision Counsel. 42 USC 254b – Health Centers The statute does not mention immigration status.
For someone at the lowest income tier, a primary care visit can cost a nominal amount, sometimes as little as $20. Services typically include primary care, prenatal visits, pediatric checkups, vaccinations, dental care, behavioral health, and chronic disease management. Texas has hundreds of these clinics, concentrated in urban areas but present in many rural communities too.
These clinics do not collect or report immigration status. The intake process focuses on health history and income verification. For families worried about visibility, they are generally considered the safest entry point into the health care system.
CHIP Perinatal for Pregnancy
Pregnant women in Texas who cannot get Medicaid because of immigration status may still qualify for prenatal coverage through CHIP Perinatal. Texas structures the program to cover the unborn child rather than the mother, which sidesteps the status requirement. Eligibility runs up to 202% of the federal poverty level.9Texas Health and Human Services. CHIP Perinatal FAQs For 2026, a family of four could earn up to about $66,660 and still qualify.7U.S. Department of Health and Human Services. 2026 Poverty Guidelines
Coverage includes prenatal visits, lab work, ultrasounds, delivery, and a limited period of postpartum care. This is one of the broadest options available to undocumented residents in Texas, and it is dramatically underused. Many eligible women either do not know it exists or avoid applying out of fear of immigration consequences that, as explained below, do not apply.
Coverage for U.S.-Born Children
A child born in the United States is a U.S. citizen regardless of the parents’ status. That child qualifies for Medicaid and CHIP based on their own citizenship and the family’s income. A parent without status can apply on behalf of a citizen child; the application asks about the child’s status, not the parent’s.
Families that skip enrollment for a citizen child out of fear about a parent’s status leave real coverage on the table. Under the 2022 public charge rule, applying for benefits or having a family member who receives them does not count against someone seeking a future immigration status change, and CHIP is fully excluded from public charge consideration.10U.S. Citizenship and Immigration Services. Final Rule on Public Charge Ground of Inadmissibility
Private and Employer-Sponsored Plans
The Marketplace ban does not reach the entire private market. An undocumented person can buy a plan directly from a private insurer outside the Marketplace, though without any subsidies or tax credits the full premium puts this out of reach for most people. It is not legally prohibited.
Employer-sponsored group plans are murkier. Federal law governing employer benefit plans does not explicitly exclude undocumented workers, but employers can require a valid Social Security number for enrollment, and many do. Some plan documents exclude workers who are not authorized for employment. There is no settled case law and no formal Department of Labor guidance on the question. In practice, access depends on the specific employer’s plan and enrollment rules.
Will Using These Programs Affect Immigration Status
Fear of the public charge rule keeps many undocumented residents from care they are entitled to use. Under the current rule, the government considers only two categories of benefits: cash assistance programs like Supplemental Security Income and Temporary Assistance for Needy Families, and long-term institutionalization at government expense, such as a nursing home stay funded by Medicaid.11U.S. Citizenship and Immigration Services. Consideration of Current and/or Past Receipt of Public Cash Assistance for Income Maintenance or Long-term Institutionalization at Government Expense
Excluded from public charge consideration:
- Emergency Medicaid treatment for emergency conditions.10U.S. Citizenship and Immigration Services. Final Rule on Public Charge Ground of Inadmissibility
- CHIP, including CHIP Perinatal.10U.S. Citizenship and Immigration Services. Final Rule on Public Charge Ground of Inadmissibility
- Non-cash medical services at community health centers.11U.S. Citizenship and Immigration Services. Consideration of Current and/or Past Receipt of Public Cash Assistance for Income Maintenance or Long-term Institutionalization at Government Expense
- Disaster relief, school lunch programs, and similar non-cash benefits.10U.S. Citizenship and Immigration Services. Final Rule on Public Charge Ground of Inadmissibility
Applying for a benefit, being approved for one in the future, or living in a household where someone else receives benefits also does not count. The rule looks only at whether the applicant personally received one of the narrow cash categories. Using Emergency Medicaid, enrolling a citizen child in CHIP, visiting a community health center, or receiving prenatal care through CHIP Perinatal does not put a future immigration case at risk under these rules.
How to Apply
Applying for county financial assistance or a sliding-fee program at a health center requires proof of three things: that you live in the service area, what your household earns, and who you are. None of these programs require a Social Security number or proof of immigration status.
For residency, a current lease, a utility bill in your name, or a letter from your landlord usually works. For income, recent pay stubs or a signed letter from an employer confirming your pay rate and frequency, including for cash wages. For identification, most programs accept a foreign passport, a matricula consular, or another government-issued photo ID.12Harris Health System. Harris Health Financial Assistance Application Instructions
An Individual Taxpayer Identification Number can also help. The IRS issues ITINs to people who need a tax identification number but are not eligible for a Social Security number, using Form W-7.13Internal Revenue Service. About Form W-7, Application for IRS Individual Taxpayer Identification Number It is primarily a tax number, but it simplifies income verification and serves as another form of identification at some programs.
Once your documents are ready, contact the hospital district, county health department, or community health center that serves your area to schedule a financial screening. You will submit paperwork and answer questions about household size and monthly expenses. Processing times vary, but expect several weeks before receiving your approval and program card.
Finding a Program Near You
Dialing 2-1-1 from any phone in Texas connects you to a statewide helpline operated by the Texas Health and Human Services Commission. Staff can point you to community clinics, hospital district programs, prescription assistance, and dental resources near your location. The service is free and available in multiple languages. You can also search at 211texas.org by category and ZIP code.