Many ask, "Why not just get insurance?" This page explains the systemic barriers low-income families face in Texas, drawing from our personal experience.
As a single mother typically working full-time, my annual income was about $26,000 when employed. This placed us in the "coverage gap"—above Medicaid eligibility but below the threshold for Affordable Care Act (ACA) subsidies on Healthcare.gov.
As of October 2025, I am unemployed following a wage theft issue in June 2025. I now rely on virtual assistant work but without steady income, we have no health insurance.
Texas has not expanded Medicaid under the ACA, limiting adult coverage to specific groups with very low income thresholds. Eligibility requires meeting one of these categories:
Key Limitation: Children under 19 can qualify for Medicaid at higher income levels (up to 206% FPL, or ~$5,520/month for a family of four), but adults without dependent minors or disabilities generally cannot, even if working full-time.
Once Isabelle turned 18, she lost her coverage, as Texas does not offer Medicaid to adults without children. Texas is one of only 10 states that has not expanded Medicaid under the Affordable Care Act, leaving most low-income adults with no coverage options.
The ACA aims to make insurance affordable, but for those in the coverage gap, it falls short. Premium tax credits (subsidies) are available only if household income is at least 100% FPL—$32,150 for a family of four in 2025—and up to 400% FPL ($128,600), with enhanced credits through 2025 making zero-premium plans possible for incomes up to 150% FPL (~$48,225).
Our family of four includes me, my twin daughters Isabelle and Rosie (both 25), and my son Mark (who qualifies for Medicaid as a minor).
To access subsidies, I had to estimate earning $32,150 or more. However, falling short triggers IRS repayment penalties. After losing my job, I canceled coverage in August 2025 to avoid this.
Even though Mark has Medicaid, he counts in household calculations. As adults, my daughters' eligibility ties to mine if claimed as dependents, preventing separate applications without subsidies.
Without credits, plans cost $300—$500/person/month—unaffordable at $26,000/year.
I've applied for SSI for Isabelle multiple times due to her severe depression, ADHD, suicide attempt at 15, social isolation, and AVM-related limitations. Despite these, approvals are rare—initial denial rates exceed 60%, often requiring appeals and lawyers. Processing in Texas can take over a year per stage.
SSI would grant automatic Medicaid, but repeated denials leave us without options. Mental health claims like depression and ADHD qualify only if they severely impair daily functioning, which is hard to prove without extensive documentation.
From 2020—2025, we had subsidized ACA coverage, but it proved ineffective for Isabelle's rare AVM condition. Marketplace plans use narrow networks to control costs, excluding many specialists. Despite switching plans and contacting providers in Houston, Dallas, Austin, and San Antonio, referrals were denied, and out-of-network care was unaffordable.
This is common for rare conditions: Insurers require pre-authorization, and if no in-network specialist exists, patients face gaps in care. In Texas, limited provider networks exacerbate this, leaving families like ours unable to access necessary treatment even with insurance.
These barriers illustrate how the system punishes low-income workers, particularly single parents, for circumstances beyond their control.
Single mothers like me face compounded challenges:
Even earning $32,150 wouldn't fully resolve Isabelle's access to specialists, as ACA plans often exclude them, highlighting the need for broader reforms.
The Broader Impact: Millions in non-expansion states like Texas fall into this gap, working hard yet unable to afford care. This leads to delayed treatments, worsened health, and financial ruin.
After exhausting all avenues, direct donations are our only path forward. Every contribution goes to Isabelle's medical needs, with full transparency on usage.