Low income in Texas: why there’s no Medicaid or subsidy, and what to do about it

I earn little, so I’ll get help, right?

Picture an adult in Texas with a small income. They work part-time, have just started their own business, recently moved, or are temporarily without a steady job. Their reasoning seems logical: since I earn so little, the government will help — either through Medicaid or through a large subsidy for a health plan.

They apply and are turned down on both sides. They don’t qualify for Medicaid, and their income turns out to be too low for a subsidy. The first thought is a mistake on the application. But most often there is no mistake. It’s a feature of Texas that few people hear about in advance.

Where the coverage gap comes from

The Affordable Care Act was built on a simple idea: people with the lowest incomes would be covered by Medicaid, and those who earn a little more would get a subsidy for a private plan. That’s why subsidies start only at 100% of the federal poverty level. For 2027 coverage, that’s $15,960 a year for one person.

Most states expanded Medicaid to cover adults with incomes below that line. Texas did not. So adults without children and without a disability whose income is below the poverty level often qualify for neither Medicaid nor a subsidy here. That gap is what’s called the coverage gap.

Who can get Medicaid in Texas

Medicaid in Texas is based on categories, not just on income. It is usually available to children, who also have the CHIP program, pregnant women, people with disabilities and SSI recipients, low-income seniors, and parents with very low incomes.

Adults without children are generally not on this list, even if their income is close to zero. They are the ones who most often end up in the gap.

For immigrants the rules are even stricter. Since October 1, 2026, federal Medicaid has been limited to green card holders, Cuban and Haitian entrants, and COFA migrants, and most green card holders wait five years to become eligible for Medicaid. At the same time, Texas covers lawfully residing children without the five-year wait, so children in the family should always be checked separately.

Emergency care is not a substitute for coverage

Once in the gap, many people simply go without coverage. The reasoning goes: if something serious happens, the hospital will take me anyway. That’s true — an emergency room won’t turn you away. But you’ll get the care and then the full bill, and a single episode like that can easily cost thousands of dollars.

The second trap is an inaccurate income estimate. The 100% line is strict: a difference of a few hundred dollars in annual income decides whether a person gets a subsidy or not. If next year’s actual income turns out to be above the line, but the application shows the old, lower figure, a person may lose out on help for nothing.

If your household income is close to the poverty level, every hundred dollars in your estimate matters. Calculate it especially carefully and realistically.

What you can do

First, honestly recalculate your income for 2027. If you expect side work, a new job or business growth, and a realistic estimate is above the line, you qualify for a subsidy. The key word is realistic: you can’t inflate your income to get a subsidy — it will come out when you file your taxes anyway.

Second, a catastrophic plan. People who don’t qualify for a subsidy because their income is below the poverty level are allowed to enroll in one with a hardship exemption. It’s real coverage with a high deductible: it does little for everyday visits, but it protects you from the worst-case scenario.

Third, check children and pregnant family members separately. They may qualify for Medicaid or CHIP even if the adults in the family don’t.

Fourth, local programs. Many Texas counties have assistance programs for low-income residents, and nonprofit hospitals have free or discounted care programs. There are also health centers where the price depends on your income. It isn’t insurance, but it’s a real way to get basic care for less.

There’s no perfect solution here. But doing nothing is the worst option of all.

How we can help

Averon Insurance is a licensed insurance broker. We enroll you in plans through the official system and only with your consent. You keep a personal account where you can see the status of your policy, and you get notifications if anything changes.

Based on your income, household and status, we’ll determine where you stand relative to the line, who in your family can get Medicaid or CHIP, and which coverage option is available to everyone else. If the best option for you isn’t a policy but a local assistance program, we’ll tell you so.

Our help is free for clients. We are paid by the insurance company, and the price of the plan is the same for you as if you enrolled on your own.

Two scenarios, and both are better than nothing

If your realistic 2027 income is above the line, we’ll enroll you in a plan with a subsidy by December 15, and you’ll be covered from January 1.

If your income is below the line, we’ll find the best available option: Medicaid or CHIP for those who qualify, a catastrophic plan for everyone else. And we’ll agree to review your situation as soon as your income changes.

Legal information

This article is for informational purposes only and is not legal, immigration, tax or financial advice. The deadlines are given for states that use the federal exchange; states with their own exchanges may have different dates. Subsidy eligibility, the premium amount and available plans depend on your income, state of residence and immigration status. ACA Marketplace rules changed several times in 2026–2027. The date of the last update is shown at the top of the page. For questions about your immigration status, please consult an immigration attorney.

Averon Insurance (Sergei Nesterov, LLC) is a licensed insurance broker. Texas resident license, NPN: 22255483. Full list of licenses.