Medicaid Buy-In for Children

Medicaid Buy-In for Children can help pay medical bills for children with disabilities. This program helps families who need health insurance, but make too much money to get traditional Medicaid. Families “buy in” to Medicaid by making a monthly payment (premium).

To be in this program a child must:

• Be age 18 or younger.
• Meet the same rules for a disability that are used to get Supplemental Security Income (SSI).
• Live in Texas.
• Be a U.S. citizen or legal resident.
• Not be married.

Medicaid health-care services for children

This program pays for many health-care services for children. Here are some examples:

• Doctor and clinic visits.
• Hospital visits.
• Emergency care.
• Medicine.
• Glasses.
• Dentist visits.
• Mental health care.
• Care in the home.
• Care in a nursing home or other place of care.
• Speech therapy (how to speak again or speak better).
• Occupational therapy (how to do everyday activities like getting around your home, getting in a car, and getting dressed).
• Physical therapy (how to move around better or become stronger).
• Regular checkups and help with Medicaid services (case management).

If you have other health insurance

If you have health insurance from your work, Medicaid might pay for services your insurance doesn’t cover. Medicaid will pay only for services you get from a Medicaid doctor.

If your work offers health insurance and your employer pays half or more of the annual cost:  You must sign up and keep that insurance. If you don’t, your child can’t be in the Medicaid Buy-In for Children program.

Medicaid Health Insurance Premium Payment Program (HIPP):  If your work offers health insurance, we will check to see if the HIPP program can pay your insurance premium. To learn more about HIPP, call 1-800-440-0493 or visit www.GetHIPPTexas.org.

Monthly payments (premium)

Most families make monthly payments to be in the Medicaid Buy-In for Children program.

The monthly payment is based on:

• The amount of money your family gets from jobs and other sources (income).
• The number of people in your family.
• If you get insurance through work.
• If you are in the HIPP program.

Cost-share

Some families have to pay part of the cost for their child’s doctor visits, hospital stays, medicine, therapy, and other health services. These costs are usually for the monthly buy-in payments, co-pays, and deductibles.

There is a limit to the amount of costs a family has to pay every 12 months. This is called the cost-share limit. When the family meets this limit, they might not have to make monthly payments until their next benefit period.

How to apply:

• Fill out an application: [English] [Español]
• Call 2-1-1 and ask to have a Medicaid Buy-In for Children application mailed to you.
• Go to an HHSC benefits office. Call 2-1-1 to find one near you.

To learn more:

• See program flyer: [English] [Español]
• Call 2-1-1 or 1-877-541-7905. You can call 8 a.m. to 8 p.m. Central Time. When you call, pick a language, and then pick option 2. You will need to pick “Medicaid” options.

  If you are deaf, hard of hearing, or speech impaired, you can call any number by calling 7-1-1 or 1-800-735-2989.

  2-1-1 can:

• Answer questions about this program.
• Help you apply for this program.
• Tell you what health care services your child can get.
• Help you renew benefits.
• Answer questions about your monthly payments.
• Answer questions about your cost-share limit.
• Make changes to your records when you have a change in your case.
• Tell you how to file a complaint or appeal.

Presentation material:

You can use these things to tell others about the Medicaid Buy-In for Children program:

• Program flyer: [English] [Spanish]
• Slide show: [English] [Spanish]
• Slide show handouts: [English] [Spanish]