Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Texas program

Medicaid when family income is higher (MBIC)

Full Medicaid for children with a disability whose family income is too high for ordinary Medicaid.

What it is

Full Medicaid for children with a disability whose family income is too high for ordinary Medicaid.

Medicaid Buy-In for Children checks family income and disability. Active leukemia treatment supports the disability review; HHSC still decides. The premium depends on income and work insurance.

Eligibility rules
  • The child must be under 19 and meet the Social Security disability standard. HHSC accepts an existing SSA finding or uses its Disability Determination Unit.
  • The March 2026 gross family-income screen is 300% of poverty, or $8,250 a month for four. HHSC decides which relatives and income count and applies the MBIC exclusions and budget calculation; it is not simply everyone’s income added together. MBIC does not test savings.
What you get
  • Full Medicaid with a monthly premium of $0 to $230.
  • Covered cancer care, medicines and access to Medicaid home services.
  • Coverage that can pay after a work plan.
What the help covers
  • The premium rises with income: nothing at the lowest incomes, up to $230 a month at the top of the range. Keeping work insurance brings it down to $70 at most.
  • Annual premium caps are 5% of income through 200% of poverty and 7.5% at 200–300%.
If you decide to apply
  1. Ask your hospital social worker to help with the buy-in application form and send it to the buy-in program.
  2. Have every family member’s income and the employer insurance information ready. Ask the clinic for the disability records.
  3. Ask the counselor to compare STAR Kids plans with your cancer team before you choose.

Use the MBIC application or call 877-541-7905, option 2. · Official page ↗

After you apply
  • The clinic supplies the diagnosis date, pathology and treatment plan for the disability review. The first premium notice sets the payment deadline.
  • MBIC members enroll in STAR Kids. A change requested by the 15th starts on the first of the next month; a later request starts the following month.
  • The decision standard is 45 days, or 90 days when HHSC’s Disability Determination Unit must decide. SSA’s Compassionate Allowances process is separate from HHSC’s clock.
Good to know

If your employer pays at least half of your child's premium, MBIC expects you to keep your child on that plan.

Other details
  • Disability can continue after therapy because of lasting effects or the leukemia listing period. A review around month 24 needs current medical records.
  • A plan directory does not settle every campus, clinician, pharmacy or service. The hospital can check the exact treatment team.
Official sources
Ask your social worker

“Could the buy-in cover our child, what premium would we pay with our work insurance, and could you help with the disability packet?”

Why I’m asking: I want to know whether this separate Medicaid route could reduce treatment bills without losing our doctors.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File the agency form, give every family member's income, return the agency form from the employer, and pay the first premium notice on time.

Your social worker

Confirms the case is routed to MBIC and not only regular Medicaid, tracks the disability packet, and files HIPP after approval.

The care team

Sends the diagnosis, date, pathology and treatment plan to the Disability Determination Unit when asked.

Who decides
HHSC decides the budget and enrollment. SSA or HHSC's Disability Determination Unit supplies the disability finding
Ask your social worker
“Who sends the MBIC disability packet and checks the diagnosis date? Can you confirm HHSC is reviewing MBIC as well as regular Medicaid?”

How to apply

First step: Apply for MBIC this week or call 877-541-7905, option 2. Ask the clinic to send the diagnosis note, date and marrow result.

  1. File the agency form this week with the diagnosis note.
  2. Return the agency form from the employer.
  3. After approval, ask the STAR Kids plan for a service coordinator and file HIPP.

Official application / program page ↗

Where it starts: Use the MBIC application or call 877-541-7905, option 2.

What to gather

  • Form H1200-MBIC and the medical release
  • The clinic's initial consult note with the diagnosis date and marrow result (an SSA award letter if you have one)
  • Pay stubs or income proof for both parents and any step-parent at home
  • Form H1028-MBIC from the employer: dependent premium and the employer's share

How long: 45 days by rule. 90 days when HHSC's Disability Determination Unit must decide. SSA runs Compassionate Allowances for acute leukemia. HHSC's timing is separate.

What a yes looks like

A notice with Medicaid dates and a premium tier. The child is enrolled in a STAR Kids plan; pick one the oncology center lists, and ask for the service coordinator that week.

What a no looks like, and the next move

Check whether HHSC denied income, disability or missing documents. Ask HHSC to correct any wrongly counted family income, missing employer form or premium payment.

Watch out

  • HHSC counts wages and other income from everyone in the family. The limit for four is $8,250 a month; other sizes have different limits.
  • MBIC premiums depend on income, family size and HIPP. Employer insurance without HIPP has a $0 MBIC premium; employer insurance with HIPP has a $0–$70 schedule. The employer-half contribution rule determines required available coverage, not the premium column.
  • The disability finding can end after therapy if no lasting effects remain. Expect a review around month 24. Ask the clinic to document current needs and line up coverage before Medicaid ends.
  • After approval you pick a STAR Kids plan. Ask the clinic which plans list it: Texas Children's posts BCBSTX, Community First, Superior, Texas Children's Health Plan and UnitedHealthcare for STAR Kids. You can switch any month; call by the 15th and the change starts the 1st of the next month.

Dates that change this

2026-03-01: MBIC income references effective March 1, 2026.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 8, 2026.

What it is worth

Full Medicaid with no savings test for a child with a disability. Family gross income up to 300% of poverty ($8,250 a month for four). Premium $0–$230.

  • $300 — Gross income ceiling
  • $8,250/month — Family of four gross monthly ceiling
  • $0–$230/month — Monthly premium without employer insurance ($0 / $90–$115 / $180–$230 by income range)
  • $0–$70/month — Monthly premium with employer insurance and HIPP ($0 / $25–$35 / $50–$70)
  • $0/month — Monthly premium with employer insurance and no HIPP
  • undefined% of income — Annual cap on premiums as a share of income (5% to 200% FPL. 7.5% at 200–300%)

Covers: Full Texas Medicaid through a STAR Kids plan · Home nursing, personal care and equipment as regular benefits · Rides, meals and lodging · Pays second behind an employer plan

What it costs the family: MBIC premiums depend on income, family size and HIPP. Employer insurance without HIPP has a $0 MBIC premium; employer insurance with HIPP has a $0–$70 schedule. The employer-half contribution rule determines required available coverage, not the premium column.

The eligibility facts, as published

Age max exclusive
19
Disability
SSA standard; existing SSA finding accepted, otherwise HHSC Disability Determination Unit
Gross income percent fpl max
300
Resource test
none
Esi rule
must enroll in an employer plan that pays 50% or more of the dependent premium
Managed care
must enroll in STAR Kids; the family picks a STAR Kids plan for its service area (Texas Children's Health Plan: Harris, Jefferson, Northeast; Superior: Bexar, El Paso, Hidalgo, Lubbock, MRSA West, Nueces, Travis; full statewide table not read) and can change plans any month (by the 15th for the 1st of the next month)

The trap: 300% gross is the ceiling: HHSC counts earned and unearned income of everyone in the family unit. No formula lets a family above $8,250 (four) in.

Where I read this

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