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Medicare and Medicaid in Texas

Texas ended its Dual Demonstration in 2025 and moved to integrated D-SNPs paired with STAR+PLUS in five counties. Here is what that means and what HHSC has said about 2027.

Last updated October 23, 2026 · 7 min read

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By Alexander James, Licensed Independent Insurance Agent · NPN 19291077

Part of our guide to Medicare and Medicaid together. For general Medicare help in Texas, see Medicare in Texas.

Texas at a glance

  • Medicaid is run by

    Texas Health and Human Services Commission (HHSC)

  • Current state programs

    STAR+PLUS

  • Published Medicaid figures

    4 figures below, each with the date it applies

  • Federal change, January 1, 2027

    One D-SNP per area for full-benefit duals, generally, where a company also offers a Medicaid plan

Sources: the Texas Health and Human Services Commission (HHSC) (linked below) and 42 CFR 422.514.

Texas's Medicaid program for people with Medicare

Medicaid in Texas is run by the Texas Health and Human Services Commission (HHSC). The state decides who qualifies for Medicaid; a Medicare plan or an agent cannot.

STAR+PLUS
Texas Medicaid managed care for adults with disabilities and people 65 and older, including home- and community-based services.
Dual Demonstration (ended)
The Medicare-Medicaid Plan demonstration, which HHSC ended on December 31, 2025 as required by federal rules.

Integrated D-SNPs since January 1, 2026

HHSC replaced the Dual Demonstration with integrated D-SNPs that are exclusively aligned with STAR+PLUS. They began January 1, 2026 in Bexar, Dallas, El Paso, Harris and Hidalgo counties, for full-benefit dual adults.

In those counties, HHSC says an organization running an integrated D-SNP may not also run coordination-only D-SNPs for full-benefit duals, though existing members could stay in their coordination-only D-SNP during 2026. Integrated D-SNP members get integrated member materials and a combined appeals process.

In the rest of Texas, people with Medicare and Medicaid use Original Medicare, Medicare Advantage or other D-SNPs.

What HHSC has said about 2027

In a November 2025 presentation, HHSC listed January 1, 2027 as the date when parent companies of the remaining STAR+PLUS plans begin operating the integrated D-SNP model in those counties. HHSC's current public page does not list a 2027 date, so check with HHSC for the latest. The federal one-D-SNP-per-area rule that starts January 1, 2027 also applies.

If you have QMB, SLMB or QI only

HHSC describes the integrated D-SNP option as being for full-benefit dual eligible adults in the five counties. People who qualify only for a Medicare Savings Program should ask which Medicare plan types are open to them.

Texas Medicaid figures, as the state publishes them

These are the figures Texas HHSC publishes in its Medicaid handbook.

Texas: published Medicaid figures, with the date each applies

  • Medicaid for the elderly, SSI-level income (monthly)

    Amount
    $994 individual, $1,491 couple
    As of
    effective January 1, 2026

  • Special income limit for nursing-home and waiver care (300%)

    Amount
    $2,982 individual, $5,964 couple (monthly)
    As of
    2026

  • Resource limit for nursing-home and waiver Medicaid

    Amount
    $2,000 individual
    As of
    2026

  • QMB monthly income (before the $20 disregard)

    Amount
    $1,330 individual, $1,804 couple
    As of
    effective March 1, 2026

Your own eligibility depends on your full situation and is decided by the state. Federal figures that apply in every state are in our guides to the Medicare Savings Programs, Extra Help and Medicaid long-term care.

What works the same in every state

Some rules are federal. Medicare pays first and Medicaid pays last. Since 2025, people with Medicaid or Extra Help have a once-a-month option to change drug coverage, and full-benefit duals have a once-a-month option to join an integrated plan that matches their Medicaid plan. Starting January 1, 2027, federal rules generally limit companies to one D-SNP per area for full-benefit duals where they also offer a Medicaid plan. Our guide to integrated D-SNPs explains each step, and Will I lose my Medicaid if I join a D-SNP? covers what changes when you join one.

Who pays first when you have Medicare and full Medicaid

  1. Step 1

    You get a Medicare-covered service

    A doctor visit, a hospital stay or a prescription that Medicare covers.

  2. Step 2

    Medicare pays first

    Through Original Medicare or your Medicare plan. Your prescription drugs are covered by a Medicare drug plan, not by Medicaid.

  3. Step 3

    Medicaid pays last

    After Medicare and any other health insurance you have. Medicaid can also cover some services Medicare does not, depending on your state.

Source: Medicare.gov, “Medicaid” (people who have both Medicare and full-benefit Medicaid).

Before you change anything

FAQ

Medicare and Medicaid questions from Texas

Sources

Each page was read on October 23, 2026.

Guides for other states

Continue learning

Related reading

Questions about Medicare and Medicaid in Texas?

A licensed agent can explain how the plans they offer in your area work with your Medicaid and check your doctors first. No pressure, and no obligation to enroll.

Talk with a licensed agent Schedule a consultation

Or call (954) 601-3544.

Educational content. Insurance products are subject to underwriting; rates and availability vary by health, age, state, and carrier. Licensed Insurance Advisor | NPN: 19291077 | Licensed in 25+ states.