Even though my autistic child has insurance, her disability still leads to extra healthcare expenses. However, earning too much for traditional Medicaid doesn't necessarily mean your child can't qualify for Medicaid coverage.
“In feedback sessions, parents often go from processing the diagnosis to worrying about costs within the same conversation. I always try to make sure they know that the cost of care shouldn’t be something they figure out alone. There are programs designed for exactly this situation.”
The Texas Medicaid Buy-In for Children program gives some families another option. It provides Medicaid coverage for children with disabilities under age 19 who meet the program's eligibility requirements. Some families may have to pay a monthly premium based on their income.
This coverage may matter most for families of autistic children. Texas Medicaid covers medically necessary autism services, including applied behavior analysis (ABA), for eligible children and young people. Knowing how the income rules and monthly payments work can help you decide whether to apply before you rule the program out.
Key Takeaways
- Coverage for children with disabilities: The Medicaid Buy-In for Children gives eligible Texas children with disabilities Medicaid coverage.
- Higher incomes can still qualify: Families may qualify even when their income is too high for regular Children's Medicaid.
- Some families pay each month: The monthly payment depends on family income, family size and whether a parent's job-based insurance covers the child.
- Help using the coverage for therapy: If your autistic child has the Buy-In or you're applying, you can start your intake with Alpaca Health.
Check if your child qualifies for Medicaid Buy-In and apply with every paper ready.
We also sent the link to your email.
What is the Texas Medicaid Buy-In for Children?
The Medicaid Buy-In for Children, also known as the MBIC, is a Texas Medicaid program for children with disabilities whose families make too much money to get regular Medicaid.
MBIC isn't like traditional children's Medicaid. It's designed to give higher-income families another way to access Medicaid benefits for an eligible child.
If approved, your child receives regular Medicaid benefits. They also receive a Medicaid ID card like other Medicaid members.
The program isn't free for every family. Your household income and whether your child has a parent's employer-sponsored health plan may determine whether you have to pay a monthly premium.
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Who qualifies for the Medicaid Buy-In for Children?
To qualify for MBIC, your child must meet the program's disability and other eligibility requirements.
Generally, the child must:
- Be age 18 or younger (coverage can last through the 19th-birthday month).
- Not be married.
- Have a qualifying disability.
- Live in Texas.
- Meet citizenship or immigration requirements.
- Meet the program's family income requirements.
Your child does not have to receive Supplemental Security Income (SSI), the monthly Social Security payment for people with disabilities and little income, to qualify for MBIC. But Texas does use the same disability standards Social Security uses for children. Those are based on how much a condition limits a child in their daily functioning, and a diagnosis on its own doesn't settle it.
“Parents ask me this all the time: ‘My child already has a diagnosis, so why isn’t that enough?’ It’s a fair question. The diagnosis tells us what’s going on, but disability programs mostly care about how much it affects a child’s day-to-day life. I see kids with the exact same autism or ADHD diagnosis who look completely different at home and at school.”
Another major difference from some Medicaid programs is that MBIC doesn't have a resource test. That means your family doesn't have to stay below a limit on savings or what you own.
The income calculation is also more complicated than comparing your paycheck with one number. Texas applies an MBIC income exclusion before determining financial eligibility, so your family's gross income isn't necessarily the amount used to decide whether your child qualifies.
Texas Medicaid Buy-In income limits by family size
MBIC can cover children in families with gross income up to 300% of the federal poverty level (FPL). The FPL is the income line the federal government sets for each family size. However, Texas doesn't determine eligibility by simply comparing your gross income to a number. Texas first applies the MBIC income exclusion ($85 plus half of the remaining income) and then compares the countable income that's left with 150% FPL.
For 2026, these are the monthly FPL amounts Texas uses when calculating MBIC eligibility and premiums:
| Family Size | 150% FPL | 300% FPL |
|---|---|---|
| 1 | $1,995 | $3,990 |
| 2 | $2,705 | $5,410 |
| 3 | $3,415 | $6,830 |
| 4 | $4,125 | $8,250 |
| 5 | $4,835 | $9,670 |
| 6 | $5,545 | $11,090 |
| 7 | $6,255 | $12,510 |
| 8 | $6,965 | $13,930 |
Source: HHSC 2026 Budget Reference Chart
Because MBIC uses its own income calculation, don't assume your child is ineligible based only on your family's gross monthly income.
How the Buy-In compares with Children's Medicaid and CHIP
When you apply for children's health coverage, Texas first checks for Medicaid. If your child doesn't qualify, Texas then checks for the Children's Health Insurance Program (CHIP), which covers children in families that earn a bit more. MBIC is different because it's designed for children with disabilities.
| Program | Basic Income Rule | Disability Required? | ABA Coverage? |
|---|---|---|---|
| Children's Medicaid | Lower-income households; limit varies by age | No | Yes, when Medicaid criteria are met |
| CHIP | Above Children's Medicaid limit and up to 201% FPL | No | Ask the CHIP health plan |
| MBIC | Up to 300% FPL after MBIC budgeting rules | Yes | Yes, when Medicaid criteria are met |
If your child has a disability and your income is above the CHIP limit, MBIC is the route on this table that can still cover your child. It's one of several Texas autism resources, and it works differently from the Texas Medicaid waivers, which pay for long-term services at home and in the community.
How much does the Texas Medicaid Buy-In cost each month?
Some families pay nothing for MBIC. Others pay a monthly premium based on family income, household size and employer-sponsored insurance.
For 2026, families without employer-sponsored insurance generally pay:
| Family Income | Family of 1 or 2 | Family of 3+ |
|---|---|---|
| At or below 150% FPL | $0 | $0 |
| 151 to 200% FPL | $90 | $115 |
| 201 to 300% FPL | $180 | $230 |
Source: HHSC premium charts
Premiums are lower when a parent's job-based insurance covers your child. If the state's HIPP program pays you back for that insurance, the premium drops to between $25 and $70 a month. Without HIPP, there's no MBIC premium at all. Before you decide whether the premium is worth it, compare it with what ABA costs in Texas without coverage.
Check if your child qualifies for Medicaid Buy-In and apply with every paper ready.
We also sent the link to your email.
What the Buy-In covers when your child has autism
An MBIC-enrolled child receives regular Texas Medicaid benefits.
Covered services for an autistic child may include medically necessary ABA along with other Medicaid-covered healthcare services. ABA therapy must meet Texas Medicaid's medical necessity rules, which means a clinician has shown the therapy is needed to treat your child's condition. It also needs prior authorization, which is the plan's written OK before therapy starts. And an autism diagnosis alone doesn't automatically establish medical necessity for ABA.
“Insurance companies usually want more than a diagnosis. They’re looking at how a child’s symptoms show up in everyday life, like communication, safety, taking care of themselves, and behavior. So in my reports, I always make sure to spell out the severity level, explain why I landed there, and give specific recommendations with clear reasons behind them.”
ABA doesn't stop a child from getting other autism services, since Texas Medicaid covers many autism services. This can include speech therapy, occupational therapy, or other behavioral health services.
“Something I see a lot is a young child who’s barely talking, gets really upset when things change, and is either constantly seeking out sensory input or very sensitive to it. For a child like that, I might recommend ABA, speech, and OT all together. Parents often worry that’s too much, so I tell them to think of these therapists as a team. Speech works on communication, OT helps with regulation and sensory needs, and ABA helps the child use those skills during everyday routines. There’s a lot of overlap between them, so they work best when everyone’s on the same page.”
Turn these ideas into a plan built for your child.
Activities at home are a great start, and a Board Certified Behavior Analyst can shape them into a program around your child's real goals. Alpaca Health matches you with one, often within days.
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How to apply for the Medicaid Buy-In for Children
You can apply for MBIC through Texas Health and Human Services. Before you start, gather your documents to make the process easier.
Gathering your documents
You may need:
- Proof of income.
- Proof of your child's age and identity.
- Citizenship or immigration documents.
- Information about your child's disability.
- Medical records or provider information.
- Information about job-based health insurance.
Submitting the application
You can apply online through Your Texas Benefits or complete the paper application, Form H1200-MBIC, and submit it to Texas HHS.
Provide as much information as possible about your child's disability and healthcare providers. Texas may ask for additional medical information to determine whether your child meets disability requirements.
Waiting for a decision
HHSC has 45 days to decide, or 90 days when its own disability team has to review your child. Watch for a request from Texas HHS after you apply. If the state needs additional documents or information, responding by the deadline can help prevent delays.
How the Buy-In works with your job-based health insurance
Your child can have private health insurance and Medicaid at the same time. Private insurance will typically pay first, because Medicaid is the payer of last resort.
Sometimes a parent who lives with your child can get job-based insurance for the child. If the employer pays at least half of the yearly cost, MBIC requires the parent to enroll. Texas then sends the plan to HIPP, the Health Insurance Premium Payment program. HIPP can pay back your share of the premium when that costs Medicaid less than covering your child alone.
Let's look at an example. Consider a family of four with income between 201% and 300% FPL. Without employer-sponsored insurance, the MBIC premium would be $230 a month. If the child is on a parent's job-based plan and HIPP pays that family back, the premium drops to $70 a month. On the same plan without HIPP, the family owes no MBIC premium.
What to do if your Buy-In application is denied
Read the notice carefully. It should explain why Texas HHS made that decision and what you can do if you disagree.
You can appeal by requesting a fair hearing, and you have 90 days from the notice date to ask. Pay close attention to the deadline listed on your notice.
If the denial involves missing information, find out whether you can provide the requested documents before starting a new application.
Renewing the Buy-In and reporting income changes
MBIC eligibility must be renewed, and HHSC usually writes once a year when it's time. Texas may ask for updated information about your household, income, insurance, or your child's eligibility, and the letter gives the deadline.
You should also report changes that could affect eligibility or your premium within 10 days instead of waiting for renewal. Follow instructions from Texas HHS or Your Texas Benefits to report changes.
How Alpaca Health helps Texas families get ABA through the Buy-In
Alpaca Health accepts Texas Medicaid and connects families across Texas with independent board certified behavior analysts (BCBAs). These are the clinicians who assess your child and write the therapy plan. If your child has MBIC, the team can help you understand your ABA coverage and the next steps for accessing ABA benefits.
Only HHSC decides whether your child qualifies for MBIC, so keep your application moving with the state. If you're ready to use your child's Medicaid for ABA, talk with Alpaca Health about your child's coverage.
Check if your child qualifies for Medicaid Buy-In and apply with every paper ready.
We also sent the link to your email.
Frequently Asked Questions About Texas Medicaid Buy-In for Children
What is the maximum income a family can have to qualify for Medicaid in Texas?
Texas doesn't have one income limit for every Medicaid program. For MBIC, Texas uses special income calculations and family size to determine eligibility. The program can serve eligible children with disabilities in families with income up to 300% FPL, which is $8,250 a month for a family of four in 2026.
Does Medicaid Buy-In cover ABA therapy in Texas?
Yes. Children enrolled through MBIC receive Texas Medicaid benefits, which include medically necessary ABA for eligible autistic children age 20 and younger. ABA services must meet Medicaid coverage and prior authorization requirements, and you can begin your intake while that's sorted out.
Can my child get the Medicaid Buy-In without SSI?
Your child doesn't have to receive SSI to qualify for MBIC. If Social Security hasn't reviewed your child's disability, HHSC's disability team decides using your child's medical records.
What happens to Buy-In coverage when my child turns 19?
MBIC coverage can last through the month of your child's 19th birthday. After that, they may need to qualify for another Medicaid eligibility program to continue Medicaid coverage.
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