Health-care coverage is a very important piece of getting our children the care they need. For many families, Medicaid and its related programs offer a much-needed source of free or low cost health care coverage and benefits.
Most Medicaid programs require that families have a very low income to be approved. However, Medicaid Buy-In programs use higher income requirements to help children and adults with disabilities or special health care needs get Medicaid health care coverage and benefits.
There are 2 Medicaid Buy-In programs:
To get Medicaid Buy-In for Children, a child must:
To take part in Medicaid Buy-In, an adult must:
In addition, if an adult gets home and community-based services through a waiver program, and they begin to earn more than the waiver’s limit, they might be able to keep getting waiver services through Medicaid Buy-In.
For either Medicaid Buy-In program, once you or your young adult has turned in an application and has been accepted into the program, your child will be able to use Medicaid services. To learn more about Medicaid services, see our Medicaid page.
There is a monthly premium (fee) and cost share for these services through the Buy-In program. The amount will be based on how much money your child and family are getting from work, SSI benefits, or other sources. To find out what your premium costs would be, you can call 2-1-1 or 1-877-541-7905. When you call, pick a language and then press 2. Follow the “Medicaid” choices.
Medicaid Buy-In for Children helps working parents get health care coverage for their children with disabilities or special health care needs.
The monthly premium is based on the amount of money that your family makes (you, your spouse, and your children who live with you), the number of people in your family, if you get insurance through work, and if you are in the Medicaid Health Insurance Premium Payment (HIPP) program.
The cost share means that you will be expected to pay part of the cost of your child’s doctor's visits, hospital stays, medications, therapies, and other health care services. Once you reach your yearly limit, you might not have to pay your monthly premium or co-payments until after you renew your benefits the next plan year.
There are 2 ways that you can use Medicaid Buy-In for Children:
In Texas, Medicaid programs are managed by the Health and Human Services Commission (HHSC). You or your child can apply for any HHSC program by visiting your local office. You can find that office by calling 2-1-1 or visiting 2-1-1 Texas online. If you and your child don’t want to go apply in person, there are other choices listed below. You can also get free help applying for Medicaid services from a community partner organization. To apply, get the application form and fill it out.
When you apply, you will need to show or send:
Once you have filled out the application and gathered your other proof, you can:
Health and Human Services Commission P.O. Box 149024 Austin, TX 78714-9024
You should expect to hear back within 45 days, on average, and HHSC might need to find out more about your child’s disability or your family’s situation. You will get a letter that will tell you if you are approved for the program, how much you’ll have to pay monthly, and when your coverage will begin.