Texas Works Medical Programs Hierarchy

Step Eligible Persons With Income Type Program Code Type Program 1 People ages 18 through 25 who have aged out of foster care in Texas and were enrolled in Medicaid on their 18th birthday Not Applicable TP 82 MA Former Foster Care Children (FFCC) 2 People ages 18 through 20 who have aged out of foster care and: are not eligible for FFCC (were not receiving federally funded Medicaid when they aged out of foster care); or who aged out of foster care at age 18 or older, currently reside in Texas, and have had an Interstate Compact on the Placement of Children (ICPC) agreement At or below program FPL TP 70 MA Medicaid for Transitioning Foster Care Youth (MTFCY) 3 Pregnant Women At or below program FPL TP 40 MA Pregnant Women 4 Pregnant women who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible At or below TP 40 FPL TP 36 MA Pregnant Women - Emergency 5 Newborn children of Medicaid-eligible mothers up to age 1, including mothers receiving TP 36 for the delivery Not Applicable TP 45 MA Newborn Children (Deemed) 6 Children under age 1 At or below program FPL TP 43 MA Children Under Age One 7 Children ages 1 through 5 At or below program FPL TP 48 MA Children 1–5 8 Children ages 6 through 18 At or below program FPL TP 44 MA Children 6–18 9 Children ages 1 through 5 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible At or below TP 48 FPL TP 33 MA Children 1–5 - Emergency 10 Children ages 6 through 18 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible At or below TP 44 FPL TP 34 MA Children 6–18 - Emergency 11 Children under age 1 who are nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible At or below TP 43 FPL TP 35 MA Children Under Age One - Emergency 12 A parent or caretaker relative caring for a dependent child under age 18 or who meets school attendance requirements who receives Medicaid At or below program FPL TP 08 MA Parents and Caretaker Relatives Medicaid 13 Nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible as a parent or caretaker relative of a Medicaid-eligible child At or below TP 08 FPL TA 31 MA Parents and Caretaker Relatives - Emergency 14 Parents, caretaker relatives and children receiving Medicaid who receive denial due to new or increase in earnings Above the limits for TP 08 TP 07 MA Earnings Transitional 15 Parents, caretaker relatives and children receiving Medicaid who receive denial due to new or increase in spousal support income Above the limits for TP 08 TP 20 MA Child Support Transitional 16 Uninsured women ages 18 through 64 diagnosed with breast or cervical cancer and presumed eligible for Medicaid for Breast and Cervical Cancer (MBCC) Not Applicable TA 66 MA MBCC Presumptive 17 Uninsured women ages 18 through 64 diagnosed with breast or cervical cancer Not Applicable TA 67 MA MBCC 18 Children under age 19 and pregnant women Above the limits for TPs 40, 43, 44, and 48 FPL TP 56 MA Medically Needy with Spend Down 19 Nonimmigrants, undocumented aliens and certain legal permanent residents who have emergency medical conditions and who, except for alien status, would be Medicaid-eligible as a pregnant woman or child under age 19 Above the limits for TPs 40, 44, or 48 FPL and at or below program limit TP 32 MA Medically Needy with Spend Down - Emergency 20 Children under age 19 ineligible for Medicaid due to income Above the limits for TPs 43, 48, or 44 FPL, and at or below program limit TA 84 CI CHIP 21 Unborn children whose mother is ineligible for Medicaid or CHIP due to income or immigration status Above the limits for TPs 40 and 36, and at or below program limit TA 85 CI CHIP - Perinatal 22 Former foster care youth ages 21 through 22 attending school of higher education who: are not eligible for FFCC; or who aged out of foster care at age 18 or older, currently reside in Texas, and have had an ICPC agreement. At or below program FPL TA 77 Health Care Benefits Health Care - FFCHE 23 Children under age 1 presumed to be eligible for Medicaid as determined by a Qualified Hospital (QH) At or below TP 43 FPL TA 74 MA Children Under Age One - Presumptive 24 Children ages 1 through 5 presumed to be eligible for Medicaid as determined by a QH At or below TP 44 FPL TA 75 MA Children 1–5 - Presumptive 25 Children ages 6 through 18 presumed to be eligible for Medicaid as determined by a QH At or below TP 48 FPL TA 76 MA Children 6–18 - Presumptive 26 Parents and caretaker relatives presumed to be eligible for TP 08 by a QH At or below TP 08 FPL TA 86 MA Parents and Caretaker Relatives - Presumptive 27 Former Foster Care Children presumed to be eligible for Medicaid by a QH Not Applicable TA 83 MA FFCC - Presumptive 28 Healthy Texas Women At or below program FPL TA 41 MA Healthy Texas Women 29 Pregnant women presumed to be eligible for TP 40 by a QH or Qualified Entity (QE) At or below TP 40 FPL TP 42 Pregnant Women - Presumptive

Notes :

If the pregnant woman or child under age 19 indicates unpaid medical expenses for any of the three months prior to application month or for the application month, determine eligibility under the following programs: TP 56, Medically Needy with Spend Down, for pregnant women and children under age 19 who are ineligible for Medicaid because of income. TP 32 Medically Needy with Spend Down - Emergency, for pregnant women and children under age 19 who are ineligible for Medicaid because of income and alien status.

Children ages 0 thru 18 who are ineligible for medical programs because of income are tested for CHIP.