Texas Medicaid Buy-In for Children with Disabilities: A Parent's Guide

If your family income is too high to qualify for regular Medicaid and you have an autistic child, you may not have heard about the Medicaid Buy-In for Children (MBIC) program. It's a separate Texas program that lets families with higher incomes keep full Medicaid coverage for their child with a disability by paying a small monthly premium instead of losing coverage altogether. For many Texas families pursuing ABA therapy and other autism services across Texas, this is the program that makes ongoing care financially possible.

Texas also runs a parallel program for working adults with disabilities: the Medicaid Buy-In (MBI). Both programs are run by the Texas Health and Human Services Commission (HHSC). Both give your child or family member the full Medicaid benefit package, not a stripped-down version.

What Is Texas Medicaid Buy-In?

Texas runs two Buy-In programs. They have different eligibility rules and serve different populations, but the idea is the same. If you earn too much for regular Medicaid, you pay a small monthly premium to keep coverage.

Medicaid Buy-In for Children (MBIC) covers children with a documented disability whose family income falls between the regular Medicaid limit and 300% of the federal poverty level (FPL). Coverage can last through the end of the month your child turns 19. Your child must meet Social Security's definition of disability, and if Social Security has never reviewed your child, HHSC makes that decision itself. Your child does not need to receive SSI payments to qualify.

Medicaid Buy-In (MBI) for Adults covers working Texans with a documented disability. It exists so adults with disabilities can take a job or pick up more hours without losing their health coverage. The income and asset rules are different from the children's program (see the comparison table below).

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MBI vs. MBIC: Side-by-Side Comparison

Double-check the current numbers in HHSC Bulletin 26-04 before you apply, since they shift with the federal poverty level each year. Income limits adjust annually with federal poverty level updates.

2026 Income and Asset Limits

MBIC Income Limits by Family Size

MBIC uses 300% of the federal poverty level as its upper income cutoff. New FPL numbers took effect in March 2026. The table below uses those updated figures, but always confirm with HHSC Bulletin 26-04 before applying:

Your premium depends on where your income lands and how many people are in your family. With no job-based insurance, it's $0 at or below 150% FPL, $90 or $115 a month between 151% and 200%, and $180 or $230 a month between 201% and 300%, with the higher amount for families of three or more. Families whose child is on a parent's job-based insurance pay less or nothing, per HHSC's premium chart.

Asset Limits

MBIC has no asset limit. Your savings, your house, and your car don't count against you. The adult MBI program does have an asset limit of approximately $5,000 in countable assets. Retirement accounts and your main car usually don't count, but the rules shift year to year. Confirm with HHSC before you apply.

How Medicaid Buy-In Connects to ABA Therapy

For Texas families with an autistic child, MBIC is the actual on-ramp to ABA therapy through Texas Medicaid. Most family guides cover the basics of who qualifies and stop there, which leaves out the part that matters most when you're trying to start therapy.

STAR Kids is the Medicaid managed care plan that kids with disabilities are enrolled in. It covers ABA therapy. A child enrolled in MBIC is enrolled in STAR Kids, which means their ABA therapy, speech therapy, occupational therapy, and other services are covered at Medicaid rates. For families where private insurance either doesn't cover ABA or caps it at low annual limits, MBIC can be the difference between accessing therapy and waiting on a grant that may or may not come through.

If your child already has an autism diagnosis and you're chasing Texas autism grants like the state's PDSES program or sitting on a Texas Medicaid waiver waitlist, apply for MBIC at the same time. Waivers can take 10 or more years to come through, while an MBIC decision comes within 45 to 90 days.

Alpaca Health works with Texas families whose kids get ABA through MBIC and STAR Kids every day. match with a Texas BCBA and we'll confirm your coverage before the first session.

Monthly Premiums and What They Actually Cost

The premium structure for MBIC is tiered by income and family size, based on HHSC's premium chart:

• $0/month for families at or below 150% FPL
• $90/month for families of one or two, or $115/month for three or more, between 151% and 200% FPL
• $180/month for families of one or two, or $230/month for three or more, between 201% and 300% FPL
• $0 to $70/month when a parent's job-based insurance covers your child and the state reimburses that premium through HIPP, and no MBIC premium when it doesn't

For context, ABA therapy through private pay runs $100 to $150 per hour. Even the $230 monthly MBIC premium is a fraction of what a single week of private-pay ABA costs for a child receiving 20 hours per week.

The adult MBI premium is calculated individually based on income, typically in the $20 to $40 range per month, with a maximum annual cap. For help before you apply, call 2-1-1 (877-541-7905), the state's health and human services help line.

How to Apply for Texas Medicaid Buy-In

Step 1: Gather your documents

Before opening an application, collect the following. Missing documents are the most common reason applications stall:

• Proof of Texas residency (utility bill, lease, or government ID with your address)
• Your child's Social Security number and disability determination letter
• Proof of household income for all working adults (pay stubs, tax returns)
• Your child's current diagnosis documentation
• Insurance information if you have private coverage

Step 2: Submit your application

You have three ways to submit:

• Online: yourtexasbenefits.com is the fastest method and lets you track your application status.
• Phone: Call 2-1-1 to apply by phone or get help from a benefits navigator at no cost.
• In person: Visit your local HHSC benefits office. Find locations at hhs.texas.gov.

Step 3: The processing window

HHSC has 45 days to decide, or 90 days when it has to make the disability decision because Social Security hasn't already reviewed your child. During that time, HHSC may ask for more documents with a final due date, and it can deny the application if they don't arrive by then. Respond quickly and keep copies of everything you submit.

Step 4: If you're denied

Denials are common and frequently overturned on appeal. If HHSC denies the application, you have 90 days to request a fair hearing. Disability Rights Texas provides free legal help for families navigating appeals and can represent you at the hearing if needed. Texas Parent to Parent also offers peer support from families who have been through the process.

Renewals and What Happens When Your Income Changes

Both MBIC and MBI renew once a year. HHSC mails a renewal notice when it's time, and a lot of families lose coverage simply because the notice went to an old address. If you move, update your address with HHSC right away so the paperwork actually reaches you.

If your income goes up past the 300% FPL cutoff mid-year, let HHSC know. Coverage usually continues to the end of the current benefit period instead of cutting off the day you report the change. If your income drops, your premium tier adjusts at the next renewal.

The adult MBI program includes specific work incentive provisions tied to Social Security rules. If your hours or earnings increase while on MBI, contact HHSC before assuming you're no longer eligible. The program is designed to support people who work, not penalize them for earning more.

How Alpaca Health Helps Texas Families

Working out whether your child qualifies for MBIC, finding ABA providers inside STAR Kids, and getting a therapy authorization moving is a lot to handle at once. Alpaca Health connects Texas families with local, independent BCBAs and handles the insurance verification and prior authorization process. If you're ready to start ABA therapy while your MBIC application is in progress, find a Texas BCBA today.

You don't have to figure this out alone.

Alpaca Health matches your family with a vetted, in-network BCBA, often within days and with no waitlist. We handle the insurance paperwork so you can focus on your child.

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Frequently Asked Questions About Texas Medicaid Buy-In

We earn too much for regular Medicaid. Can we still get MBIC?

Yes, if your income is under 300% of the federal poverty level and your child has a documented disability. MBIC is built for families who sit above the regular Medicaid income line but still need coverage for a child with a disability. The program's upper cutoff for a family of four in 2026 is approximately $7,875 to $8,250 per month — verify the exact figure against HHSC Appendix L before applying.

Does Medicaid Buy-In cover ABA therapy in Texas?

Yes. Children enrolled in MBIC receive coverage through STAR Kids, which includes ABA therapy as a covered benefit. The amount of therapy authorized depends on your child's assessment and the recommendation from their Board Certified Behavior Analyst (BCBA).

How is MBIC different from a Texas Medicaid waiver?

MBIC is an insurance program with a 45-day application window. The four Texas Medicaid waivers (CLASS, MDCP, HCS, and TxHmL) fund long-term home and community-based services but have waitlists that commonly run 10 or more years. Apply for both at the same time since they serve different purposes and have very different timelines.

My child doesn't receive SSI. Can they still qualify for MBIC?

Yes. MBIC requires a disability determination from Social Security, but not active SSI payments. If your child has received an SSI denial based on income rather than disability, that determination letter may still satisfy the disability documentation requirement. Confirm with HHSC.

What if our application is denied?

Request a fair hearing within 90 days of the denial notice. Disability Rights Texas provides free legal representation for families in the appeals process. Many initial denials are based on missing documentation or income calculation errors and are overturned on appeal.

Can adults with autism apply for MBI?

Yes. The adult MBI program covers working Texans with a documented disability, including autism. Employment is required. The program is designed to let adults with disabilities work without losing Medicaid coverage.

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