Texas Medicaid and CHIP for a Grandchild in Kinship Care

Your Income Probably Does Not Count

The most important thing kinship caregivers need to know about getting a grandchild on Medicaid in Texas is that the income test usually ignores the caregiver entirely.

Texas uses Modified Adjusted Gross Income (MAGI) rules for children's healthcare eligibility. Under federal and state MAGI methodology, if the relative caregiver does not claim the child as a tax dependent, the child is evaluated as a separate single-person household. The grandparent's Social Security, pension, wages — all excluded from the child's eligibility determination.

A child with zero income in a single-person MAGI unit falls within the Children's Medicaid income thresholds if the child also meets the program's other eligibility requirements. Most grandchildren in kinship care have little or no income of their own, which means they fall well within the income thresholds.

Medicaid vs. CHIP: Which One Applies

Texas has a tiered structure for children's public health coverage:

Children's Medicaid covers children at the lowest income levels with zero premiums and zero co-pays:

• Infants under 1 year: up to 198% of the Federal Poverty Level
• Children ages 1–5: up to 133% FPL
• Children ages 6–18: up to 100% FPL

For a child evaluated as their own single-person MAGI household with no income, they qualify at every tier.

CHIP (Children's Health Insurance Program) covers children whose income exceeds Medicaid limits but falls under 201% FPL. CHIP has minor annual enrollment fees (up to $50) and low co-pays. For kinship children with zero income, Medicaid kicks in first, and CHIP is the safety net if something about the household calculation pushes income above the Medicaid threshold.

Medicaid Buy-In for Children (MBIC) serves children with qualifying disabilities up to 300% FPL, with a sliding-scale monthly premium. If a grandchild has a documented disability, MBIC can provide coverage even at higher income levels.

STAR Health for DFPS-Placed Children

Children in DFPS conservatorship — those removed from a parent's home by child protective services and placed with a relative — are enrolled in STAR Health, a managed care program specifically designed for foster and kinship youth. STAR Health covers medical, dental, vision, and behavioral health through a centralized managed care organization.

DFPS handles the Medicaid enrollment automatically for children in state conservatorship. You do not need to apply through HHSC separately. If the child transitions to Permanent Managing Conservatorship (PMC) with a PCA agreement, STAR Health coverage continues.

How to Apply for Children's Medicaid

For children not in DFPS conservatorship — those living with you under an informal arrangement, a Chapter 34 Authorization Agreement, or a private court order — you apply through HHSC:

1. Go to yourtexasbenefits.com or call 2-1-1
2. Complete the application (H1010 form) requesting healthcare coverage for the child
3. Report the child's income (typically zero or minimal)
4. Do not claim yourself as part of the child's healthcare household if you do not claim them as a tax dependent

HHSC will determine whether the child qualifies for Medicaid or CHIP based on the child's income and age.

If you are applying for TANF and SNAP at the same time, the healthcare application is bundled into the same process. A child approved for TANF automatically qualifies for Medicaid without a separate determination.

12 Months of Continuous Coverage

Once approved, children receive 12 months of continuous coverage. HHSC cannot disenroll the child mid-year because of minor family income fluctuations. This protects against the mid-year coverage gaps that can follow small changes in family income.

At the end of the 12-month period, HHSC sends a renewal notice. Complete it on time or coverage lapses. Mark the renewal date on a calendar the day you receive the approval letter — it is the single biggest cause of coverage loss for kinship children.

What Medicaid Covers

Texas Children's Medicaid covers:

• Doctor visits and hospital care
• Prescriptions
• Dental and vision care
• Immunizations
• Behavioral and mental health services
• Therapy (occupational, speech, physical)
• Medical equipment and supplies

There are no premiums and no co-pays for Children's Medicaid. CHIP has minor cost-sharing but covers the same services.

Getting Coverage Quickly

For a child who needs medical care right away — a prescription refill, an upcoming doctor's appointment, immunizations for school enrollment — standard Medicaid applications are processed within 30 calendar days, though some may complete sooner.

If the child needs emergency medical care before Medicaid is approved, Texas hospitals cannot refuse emergency treatment regardless of insurance status under federal EMTALA rules. But getting the Medicaid application filed immediately ensures coverage is in place for follow-up care.

Our Texas Kinship Financial Help Guide covers the full healthcare picture — Medicaid, CHIP, STAR Health, and MBIC — alongside the income calculations and application steps for each program.

See more Texas guides →