School starts across Harris County this month. Cypress-Fairbanks, Katy, Houston ISD, Aldine, Pasadena, Klein, Alief — hundreds of thousands of kids are getting physicals, sports clearances, immunization records, and the paperwork that comes with all of it. It is also the moment a lot of Houston parents discover that the health coverage they assumed was handled is not.
Texas has the highest rate of uninsured children in the country. According to Georgetown University’s Center for Children and Families, working from Census Bureau American Community Survey data, 13.6% of Texas children were uninsured in 2024 — up from 11.9% the year before, and more than double the national rate of 6.0%. Roughly 1.1 million Texas children have no coverage at all, which means about one in four uninsured children in the United States lives in Texas. For children under six, the picture is worse: 10.8% of Texas kids under six were uninsured, the highest rate of any state, against a national figure of 5.3%.
Houston is at the center of that. Our metro area has a higher uninsured rate for children than any other major metropolitan area in the nation. And here is the part that matters most: a large share of those uninsured children are already eligible for coverage their families have not enrolled them in. The problem in Harris County is less often that no program fits, and more often that nobody walked the family through which one does.
This guide sorts out the three realistic paths for a Houston child — Children’s Medicaid, CHIP, and a Marketplace plan — and shows you which one your household lines up with.
- Three programs, one ladder. Children’s Medicaid covers the lowest income band, CHIP picks up above it, and a Marketplace plan with a premium tax credit covers families above the CHIP line.
- Texas children’s thresholds are far more generous than adult ones. A parent can be ineligible for Medicaid while their child qualifies comfortably. Never assume your kids are out because you are.
- Texas income levels: Medicaid reaches 198% of the federal poverty line for infants under 1, 144% for ages 1–5, and 133% for ages 6–18; separate CHIP covers children up to 201% FPL.
- CHIP enrollment fees are $50 or less per family, per year, and apply only to families above 151% FPL. Copays apply for some services.
- Coverage is locked in for 12 months. Since January 1, 2024, federal law requires states to give children under 19 twelve months of continuous eligibility in Medicaid and CHIP — a mid-year raise does not knock your child off.
- You can apply any time. Medicaid and CHIP have no open enrollment period. Marketplace coverage does, so if your children fall above the CHIP line, timing matters.
What This Guide Covers
- The three paths, and how they stack
- Where your family lands: the 2026 income numbers
- What CHIP actually costs and covers
- The 12-month rule that protects you mid-year
- When a Marketplace plan is the right answer
- Why eligible Harris County kids go uncovered
- How to apply, and what to have ready
- Frequently asked questions
The three paths, and how they stack
Think of children’s coverage in Texas as a ladder rather than a menu. Where your household income sits determines which rung you are on, and the programs are designed to hand off to each other without a gap.
| Path | Who it covers | What it costs the family | When you can apply |
|---|---|---|---|
| Children’s Medicaid (STAR) | Children in the lowest income band, by age bracket | No premium; minimal or no cost sharing | Any time of year |
| CHIP | Children whose family income is above the Medicaid line but at or below 201% FPL | Enrollment fee of $50 or less per family per year for families above 151% FPL, plus copays | Any time of year |
| Marketplace plan with premium tax credit | Children in households above the CHIP line | Monthly premium after the credit, plus deductible and copays | Open Enrollment, or a Special Enrollment Period |
The critical thing to understand about the first two rungs is that children’s eligibility in Texas is set much higher than adult eligibility. Texas did not expand Medicaid for adults, so the adult thresholds are extremely narrow. The children’s thresholds were never tied to that. This produces a situation we see constantly in Houston: a parent applies, is told they do not qualify, and walks away — without ever learning that their eight-year-old would have qualified for CHIP the same day.
Where your family lands: the 2026 income numbers
Texas sets children’s Medicaid eligibility by age bracket, then CHIP picks up above whichever Medicaid line applies. Here are the thresholds as a percentage of the federal poverty line:
| Child’s age | Children’s Medicaid up to | CHIP covers up to |
|---|---|---|
| Under 1 year | 198% FPL | 201% FPL |
| Ages 1 through 5 | 144% FPL | 201% FPL |
| Ages 6 through 18 | 133% FPL | 201% FPL |
Texas also applies a five-percentage-point income disregard when it tests eligibility, which effectively lifts each of these cutoffs slightly. That is one of several reasons not to disqualify yourself on arithmetic alone — the number the state actually uses may be a little higher than the number on the chart.
Translated into 2026 dollars, using the federal poverty guidelines HHS published for the 48 contiguous states, here is roughly where those lines fall:
| Household size | 133% FPL (ages 6–18 Medicaid) | 144% FPL (ages 1–5 Medicaid) | About 201% FPL (CHIP ceiling) |
|---|---|---|---|
| 2 people | $28,781 | $31,162 | $43,496 |
| 3 people | $36,336 | $39,341 | $54,913 |
| 4 people | $43,890 | $47,520 | $66,330 |
| 5 people | $51,444 | $55,699 | $77,747 |
| 6 people | $58,999 | $63,878 | $89,164 |
A note on how to read these. The percentages come from published state eligibility levels; the dollar conversions use the 2026 federal poverty guidelines and are approximate. Texas also uses modified adjusted gross income rules to decide what counts as income and who counts as part of the household, and those rules do not always match what you would guess. If your family is anywhere near a line, that is a reason to apply rather than a reason to assume.
What CHIP actually costs and covers
CHIP is the program most Houston families have heard of and fewest understand. It exists specifically for households that earn too much for Children’s Medicaid but for whom private coverage is a stretch — which describes an enormous share of working families in Harris County.
On cost, the headline numbers are modest. Families with income above 151% of the federal poverty line pay an enrollment fee of $50 or less per family, per year — note that it is per family, not per child, so a household with three kids pays the same as a household with one. Below that income level there is no enrollment fee. Most families also have copayments for doctor visits, prescriptions, and emergency care, set on a sliding scale.
On coverage, CHIP is comprehensive in the ways that matter for children: regular checkups and immunizations, doctor visits, prescriptions, dental and vision care, hospital care, lab work and X-rays, and access to specialists. Dental and vision are worth calling out, because those are exactly the benefits that get thinned out or dropped in bare-bones private coverage, and they are exactly the benefits school-age children use.
The 12-month rule that protects you mid-year
This provision is under-publicized and it removes the single biggest fear parents have about enrolling.
Effective January 1, 2024, states are required to provide 12 months of continuous eligibility for children under age 19 in both Medicaid and CHIP. The requirement came from Section 5112 of the Consolidated Appropriations Act, 2023. Before that, continuous eligibility was a state option; now it is mandatory nationwide.
In practice this means that once your child is enrolled, their coverage is locked in for the full twelve months even if your household income rises during that period. A raise in March does not end your child’s CHIP coverage in April. The exceptions are narrow: the child turns 19, the family moves out of state, the child dies, you request disenrollment, or the agency determines eligibility was granted in error. A child enrolled in separate CHIP can also move to Medicaid if they become eligible for it.
We hear the underlying worry constantly — “if I sign my kids up and then I get more hours, will they get dropped mid-year and lose their doctor?” Under the current rule, no. That stability is the entire point of the provision.
When a Marketplace plan is the right answer
If your household income puts your children above roughly 201% of the federal poverty line, CHIP is not available and the Marketplace becomes the path. There are a few things to know that are specific to covering children there.
First, children can be covered on a family Marketplace policy, and the premium tax credit is calculated on the whole household. Adding a child to the application raises your household size, which raises every federal poverty line threshold that applies to you — sometimes enough to change your credit meaningfully.
Second, plan structure matters more for kids than adults, because children’s care is high-frequency and low-severity: well visits, ear infections, sports physicals, the occasional urgent care trip for a broken wrist. That usage pattern rewards plans with low office-visit copays and good pediatric networks more than it rewards a low premium with a high deductible. If your income puts you in range, cost-sharing reductions on a silver plan can be substantially more valuable than the premium difference suggests — we explain that trade-off in why a silver plan can beat bronze for Houston families.
Third, network is the thing to check before anything else. If your children see a pediatrician at Texas Children’s, Kelsey-Seybold, Memorial Hermann, or a neighborhood practice you have used for years, confirm that group’s participation in the specific plan before you enroll. Our guide to HMO, EPO, and PPO networks in Houston walks through how the network types differ in practice.
Not sure which program your kids qualify for?
We help Harris County families sort out Children’s Medicaid, CHIP, and Marketplace coverage — including the very common case where the parents do not qualify but the children do. Independent, Texas-licensed, and happy to just answer the question.
Talk to a licensed Houston agent 832-400-6538Why eligible Harris County kids go uncovered
Given how far the children’s thresholds reach in Texas, the size of the uninsured population is not primarily an eligibility problem. These are the patterns we actually encounter.
The parent was denied, so they stopped. Covered above, and it is the single most common one. Texas adult Medicaid is narrow; Texas children’s Medicaid and CHIP are not. A denial for one says nothing about the other.
Income was estimated wrong. Families with variable income — construction, restaurant work, rideshare, contract labor, seasonal shifts — often report a good month as if it were the year. Eligibility runs on annual household income under specific counting rules, not on your strongest month.
The renewal packet got lost. Coverage runs in twelve-month blocks, and renewal paperwork arrives by mail. A move, a wrong address on file, or an envelope that looked like junk is enough to end coverage for a child who never stopped being eligible. If you have moved anywhere in the Houston metro, update your address with the state.
Immigration-status confusion. Eligibility rules for children depend on the child’s own status, and a child’s eligibility is evaluated on its own terms. Families frequently assume the whole household is ineligible when that is not what the rules say. This is worth getting a straight answer on rather than guessing.
Nobody explained CHIP existed. Plenty of Houston families in the band between Medicaid and Marketplace subsidies have simply never had the program described to them. They know they earn too much for Medicaid and assume the next stop is full-price private insurance.
How to apply, and what to have ready
Children’s Medicaid and CHIP use a single application through the state, and you can apply at any point in the year. A Marketplace application is separate, and if you apply through the Marketplace and your children appear eligible for Medicaid or CHIP, your information gets routed to the state program.
Have these ready before you start — gathering them first turns a frustrating process into a short one:
- Social Security numbers or document numbers for each household member applying
- Dates of birth for everyone in the household
- Recent pay stubs, or for self-employed income, records of what you have earned so far this year
- Your realistic estimate of total household income for the full calendar year
- Information on any employer coverage offered to anyone in the household
- Your current mailing address — and if you have moved, update it before you apply
That last one deserves emphasis. Renewal notices, requests for additional documents, and eligibility decisions all travel by mail. A stale address is one of the quietest ways a Houston family loses coverage that was working fine.
If your income changed recently
Income moves in both directions, and it changes which rung of the ladder your family is on. If your household income has dropped and your children are currently on a Marketplace plan, they may now qualify for CHIP or Medicaid — which would generally cost you considerably less. If your income has risen and you are on a Marketplace plan with a premium tax credit, that is a change you need to report promptly for a separate reason we cover in our guide to reporting income changes to the Marketplace.
And if your family recently lost Texas Medicaid, that loss opens a Special Enrollment Period for Marketplace coverage — the path is laid out in Lost Texas Medicaid? Your Special-Enrollment Path to a Marketplace Plan. For the wider picture of why so many Texans go without coverage and what the options are, see Why Texas Has the Highest Uninsured Rate in America.
You can also start from our overviews of ACA Marketplace plans and health insurance options, or come see us at either our North Houston or South Houston office.
Frequently asked questions
My kids might qualify for CHIP even though I was denied Medicaid — is that right?
What is the income limit for CHIP in Texas?
How much does CHIP cost?
If I get a raise, will my child lose CHIP coverage right away?
Is there an open enrollment period for CHIP or Children’s Medicaid?
Does CHIP cover dental and vision?
My children are above the CHIP limit. What are my options?
What documents do I need to apply?
Sources
- Georgetown University Center for Children and Families, analysis of U.S. Census Bureau American Community Survey data on children’s health coverage, 2024 — ccf.georgetown.edu
- MACPAC, “Exhibit 35: Medicaid and CHIP Income Eligibility Levels as a Percentage of the Federal Poverty Level for Children and Pregnant Women by State” — macpac.gov
- Texas Health and Human Services, “Children’s Medicaid and CHIP” — hhs.texas.gov
- Medicaid.gov, “Continuous Eligibility for Medicaid and CHIP Coverage” — medicaid.gov
- Centers for Medicare & Medicaid Services, “HHS Takes Action to Provide 12 Months of Mandatory Continuous Coverage for Children in Medicaid and CHIP” — cms.gov
- Medicaid.gov, “CHIP Eligibility & Enrollment” — medicaid.gov
- U.S. Department of Health and Human Services, ASPE, “2026 Poverty Guidelines: 48 Contiguous States” — aspe.hhs.gov
- HealthCare.gov, “The Children’s Health Insurance Program (CHIP)” — healthcare.gov
This article is for general educational purposes and reflects program rules and federal poverty guidelines published as of August 2026. Eligibility is determined by the State of Texas based on your specific household and income under modified adjusted gross income rules; dollar conversions shown here are approximate. Wise Insurance Agency is an independent, Texas-licensed insurance agency.