What documentation is required to prove income and residency for Medicaid enrollment in Texas?
Executive summary
To enroll in Texas Medicaid applicants must generally provide proof of income and proof of Texas residency; Texas HHSC guidance and handbook chapters list acceptable evidence such as pay stubs, award letters, bank statements and documents showing a Texas address [1] [2]. Long‑term‑care (elderly/disabled) Medicaid has additional, program‑specific documentary requirements (assets, medical necessity, Medicare entitlement) and stricter income/resource rules such as a $2,000 resource limit for many programs and a 5‑year look‑back for asset transfers [3] [4] [1].
1. What Texas explicitly asks for: basic income and residency papers
Texas Health and Human Services requires applicants to furnish proof of income (examples: award letters, pay stubs, bank statements showing interest/dividends, rent receipts) and will accept a person’s attestation of Texas residency unless residency is questionable — in which case the agency asks for documents that show a Texas address [1] [2]. The HHSC handbooks list the kinds of income documentation it uses when making eligibility decisions and instruct staff to accept the applicant’s signed statement on the application about residency unless further evidence is needed [1] [2].
2. Practical examples of acceptable income documents
HHSC’s appendix and program guidance explicitly cite award letters, pay stubs, check stubs for pensions or mineral rights, bank statements listing interest/dividend payments and copies of checks as evidence the agency will use to verify income and income deductions [1]. Benefit‑oriented guides and application walkthroughs used by navigators mirror this list, recommending recent pay stubs, tax forms and bank statements to prove current income when applying [5] [6].
3. Residency: when a signed statement is enough — and when it isn’t
The MEPD (Medicaid Elderly & People with Disabilities) handbook instructs staff to accept the applicant’s statement on the application about Texas residency; additional proof is required only when residency is in question, at which point applicants must provide documents that indicate a Texas address [2]. That creates a pragmatic sequence: self‑attestation first, documentary proof only after staff flags a residency issue [2].
4. When documentation needs are heavier: elderly, disabled, long‑term care
Long‑term care Medicaid in Texas imposes more extensive documentary burdens: proof of assets and resources, medical necessity/level of care evidence, Medicare entitlement documents when applicable (Medicare card or SSA award letter), and strict income/resource thresholds (for example, a $2,000 countable asset limit for individuals in many long‑term care programs) [3] [1] [4]. HHSC also enforces a five‑year look‑back on asset transfers and may require documentation related to transfers, home equity, and allowable exemptions [4].
5. Income counting rules and why documentation matters
Most Texas Medicaid eligibility uses MAGI‑based income rules tied to the federal poverty level; HHSC converts FPL thresholds to monthly income amounts and compares applicant income using IRS and MAGI rules [7] [8]. Because eligibility hinges on these computations, HHSC specifically requests documents that substantiate income sources and deductions so staff can apply MAGI rules and monthly IRS thresholds accurately [1] [8].
6. Where sources disagree or leave gaps
Public guides and law‑firm writeups emphasize the practical checklist (proof of income, assets, identity, residency, medical necessity) but vary on exact dollar thresholds and program names; some third‑party sites cite higher or program‑specific income limits updated in 2025 without linking to HHSC tables [6] [9]. HHSC handbooks are the primary administrative source for what counts as evidence [2] [1]. Available sources do not mention a single, exhaustive “one‑page” list that covers every Medicaid pathway in Texas — instead, documentation depends on the coverage group [1] [3].
7. What applicants should do next (practical journalism)
If you’re applying, gather recent pay stubs or award letters, last year’s tax return if applicable, recent bank statements, photo ID, proof of Texas address (utility bill, lease, mail), and any Medicare/SSA letters or medical records needed for disability/long‑term care claims [1] [2] [3]. For nursing‑home or waiver applications expect additional asset documentation and transfer histories [4]. When in doubt, contact the Texas Medicaid Client Hotline or your local HHSC office and refer to HHSC handbooks for program‑specific lists [10] [2].
Limitations: this summary uses HHSC handbooks and public eligibility guides provided in the available sources; it does not replace HHSC’s application instructions and does not list every possible document for every Medicaid pathway [2] [1].