Texas Medicaid does not stop automatically at 18, but it usually changes. Instead of cutting you off on your birthday, the Texas Health and Human Services Commission (HHSC) reviews whether you qualify under adult Medicaid rules, which are much stricter than the children’s program. Because Texas has not expanded Medicaid, many 18-year-olds who were covered as children no longer fit any adult category and lose coverage after the review. Whether you keep Medicaid depends on your circumstances, and if you don’t, you have several fallback options worth acting on quickly.
What Happens on Your 18th Birthday
Children’s Medicaid in Texas covers kids through age 18, and children with disabilities can remain covered up to age 20 in some cases.1Texas Health and Human Services. Children’s Medicaid and CHIP As you approach 18, HHSC starts a redetermination, a formal review of whether you fit into an adult Medicaid category.2Texas Health and Human Services. B-120, Redeterminations
If you qualify under an adult category, coverage continues without a gap. If you don’t, HHSC sends a notice explaining that your coverage is ending and your right to appeal.
Which Adults Actually Qualify in Texas
Texas has no general Medicaid coverage for low-income adults. You have to fit a specific category:
- Parents or caretaker relatives caring for a dependent child who receives Medicaid. The income limit sits around 12% of the federal poverty level, roughly $273 per month for a family of three or $330 for a family of four in 2026. Those figures are among the lowest in the country.3Medicaid.gov. Medicaid, Children’s Health Insurance Program, and Basic Health Program Eligibility Levels4U.S. Department of Health and Human Services. 2026 Poverty Guidelines
- Pregnant individuals, with income up to 198% of the federal poverty level.3Medicaid.gov. Medicaid, Children’s Health Insurance Program, and Basic Health Program Eligibility Levels
- People with disabilities, either through Medicaid for the Elderly and People with Disabilities (MEPD) or Supplemental Security Income (SSI). Texans who receive SSI get Medicaid automatically, without a separate application.5Texas Health and Human Services. Medicaid for Children and Adults with Disabilities
- Adults 65 and older, through MEPD.
If you’re 18, not pregnant, without a dependent child, not disabled, and not 65, you fall into what’s often called the coverage gap. You earn too much for traditional Texas Medicaid and too little for Marketplace premium tax credits, which generally start at 100% of the federal poverty level.
Former Foster Youth Keep Coverage Until 26
If you were in foster care and receiving Medicaid when you aged out at 18 or older, you qualify for a separate Medicaid program that covers you until age 26 with no income test.6Texas Health and Human Services. Medicaid for Transitioning and Former Foster Care Youth This is a mandatory federal eligibility group.7Medicaid.gov. Implementation Guide: Former Foster Care Children
The rules broadened in 2023. If you turned 18 on or after January 1, 2023, you qualify even if you aged out of foster care in a different state, so long as you were on Medicaid at the time.8Texas Health and Human Services. E-110, Medicaid for Former Foster Care Children (FFCC) If you turned 18 before that date, you must have aged out in Texas. Either way, you need to be a Texas resident and meet citizenship or immigration requirements. Any former foster youth should check this pathway before assuming coverage is gone.
How to Handle Your Renewal
HHSC mails a renewal notice to your last known address in a yellow envelope marked “Action Required” in red. It arrives before your current certification period ends, and you have 30 days to respond.9Texas Health and Human Services. End of Continuous Medicaid Coverage Missing the deadline can end your coverage even if you otherwise qualify.
You can submit the renewal:
- Online through Your Texas Benefits
- By mail to Texas Health and Human Services, P.O. Box 149024, Austin, TX 78714-9024
- By fax to 877-447-2839
- By phone through 2-1-1, choosing Option 2 after selecting a language
- In person at a local HHSC office or community partner
You’ll provide updated information about income, household size, and any recent changes. HHSC verifies your Social Security number and checks federal and state databases against what you report. If you respond on time, coverage continues while HHSC reviews your case.9Texas Health and Human Services. End of Continuous Medicaid Coverage
The most common reason young adults lose Medicaid at 18 isn’t ineligibility. It’s a missed envelope or an outdated address. If you’ve moved, update your address through Your Texas Benefits or by calling 2-1-1 before your birthday.
What to Do If HHSC Says You No Longer Qualify
A denial arrives as a Notice of Case Action explaining the reason. You have 90 days from the notice date to request a fair hearing. For decisions made by a managed care organization, the window is 120 days.10Texas Health and Human Services. Fair and Fraud Hearings
You can appeal in writing, by calling 2-1-1, or at a local HHSC office. Timing matters: if you request a hearing before your coverage actually ends, HHSC generally cannot terminate your benefits until the hearing decision. Even if you file slightly late, benefits may be reinstated if you request a hearing within 10 days of the termination’s effective date.11eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries Once the termination takes effect and the appeal window closes, getting coverage restored becomes much harder.
Fallback Coverage If You Lose Medicaid
Staying on a Parent’s Plan
If a parent has employer-sponsored insurance or a Marketplace plan, the Affordable Care Act requires the plan to allow you to remain a dependent until age 26. That applies whether or not you live at home, are financially independent, or are married. For many 18-year-olds who lose Medicaid, this is the fastest option.
CHIP While You’re Still 18
The Children’s Health Insurance Program covers kids through age 18 in families who earn too much for Medicaid but can’t afford private coverage. Texas CHIP goes up to 201% of the federal poverty level.3Medicaid.gov. Medicaid, Children’s Health Insurance Program, and Basic Health Program Eligibility Levels Benefits include checkups, prescriptions, and hospital care at low cost.12HealthCare.gov. The Children’s Health Insurance Program (CHIP) Eligibility ends when you turn 19.
The Health Insurance Marketplace
Losing Medicaid triggers a special enrollment period. You generally have 60 days from the date coverage ends to sign up for a Marketplace plan.12HealthCare.gov. The Children’s Health Insurance Program (CHIP) Premium tax credits can reduce your monthly cost based on household income.
For 2026, credit eligibility may be tighter than in recent years. From 2021 through 2025, Congress temporarily removed the upper income cap on these credits. That expansion expired at the end of 2025, and as of early 2026, Congress had not enacted an extension. Without one, credits are available only to households between 100% and 400% of the federal poverty level, roughly $15,960 to $63,840 per year for a single person in 2026.4U.S. Department of Health and Human Services. 2026 Poverty Guidelines Check HealthCare.gov for current subsidy rules when you apply.
If You Keep Medicaid, Use It Fully Before 21
Even when your coverage continues past 18, the scope changes at 21. Children’s Medicaid includes Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), a federal benefit that requires the state to cover anything medically necessary for anyone under 21, including dental, vision, hearing aids, mental health treatment, and therapies.13Medicaid.gov. EPSDT Coverage Guide If you’re 18, 19, or 20 and still enrolled, you still get those benefits.
At 21, Texas adult Medicaid limits dental to emergency care with an annual cap of $5,000. Routine cleanings, fillings, and preventive dental care aren’t covered for adults.14Medicaid.gov. Dental Care Vision and other optional benefits also shrink. Core mandatory benefits, including hospital services, physician visits, lab work, and home health, stay in place regardless of age.15Medicaid.gov. Mandatory and Optional Medicaid Benefits Between now and 21, schedule the dental work, eye exams, and treatment you’ve been putting off. Those comprehensive benefits end on your 21st birthday.