Blog / Health and ACA

What is the Texas coverage gap?

Texas did not expand Medicaid, so some adults earn too little for Marketplace subsidies and too much for Medicaid. Here is what to do if that is you.

Updated August 17, 2026 · 3 min read

Marketplace subsidies were designed to begin where Medicaid expansion was supposed to end. Texas did not expand Medicaid. The result is a gap where some adults qualify for neither program.

If a Marketplace application told you your income was too low for help, this is what happened. It is not an error and you did not fill anything in wrong.

Who falls into it

Generally adults under 65 who are:

• Earning below the level where Marketplace subsidies begin
• Not disabled
• Not pregnant
• Not the parent of a dependent child, or a parent earning above Texas's very low parent limit

Texas Medicaid for adults is narrow. Children, pregnant women, people with disabilities and seniors have paths. A working age adult without children generally does not, no matter how low the income.

Before you accept that answer, check these

A surprising number of people are told they are in the gap and are not. Work through this list.

1. Recheck the income estimate. It is for the coming year, not last year. If you expect to earn more than you did, say so. Self employed income should be net of expenses, and people often report gross by mistake.
2. Count the household correctly. Household size moves the threshold. Include everyone on your tax return.
3. Check immigration status. Lawfully present immigrants in the five year Medicaid waiting period can qualify for Marketplace subsidies even below the usual floor. See immigration status and eligibility.
4. Check for a dependent child, a pregnancy, or a disability determination. Any of those opens a Medicaid path.
5. If you are close to 65, check the Medicare timeline instead.

If you genuinely are in the gap

There is no subsidy available, but you are not without options.

• Federally qualified health centers across South Texas use sliding scale fees based on income. For primary care this is often the practical answer.
• Hospital financial assistance. Every non profit hospital is required to have a charity care policy. Ask for it by name before treatment when you can.
• Prescription assistance programs from manufacturers, and pharmacy discount programs.
• An unsubsidized Marketplace plan, if you can afford it. You can still buy one, you simply pay full price.
• Recheck at every income change. Rising above the floor makes you eligible, and an income change is a qualifying event.

Do not simply go without and forget it

Set a reminder to check again at open enrollment, and any time your work or household changes. The thresholds move every year with the federal poverty level, and so does your income. People sit in the gap for years without rechecking.

If you want a second opinion on a gap determination, bring the paperwork. It costs nothing and we see determinations reversed by a corrected income estimate more often than you would think. See how income limits work.