When did you last check whether your children qualify for government health coverage — not you, just your children, evaluated on their own terms?
I had spent the morning interviewing a benefits navigator at a clinic in downtown El Paso last November, and I stopped at a nearby Walgreens on my way back to the car. That’s where I first saw Ruben Ramos — a compact man in his early fifties, still wearing his Uber driver lanyard, speaking quietly across the pharmacy counter. He was asking the pharmacist whether the store participated in any prescription discount programs. The pharmacist slid a GoodRx card across the counter. Ruben stared at it for a moment, then folded it carefully into his shirt pocket like it was something fragile.
I introduced myself. He was cautious at first — most people are when a stranger mentions the word journalist. But when I said I covered government assistance programs, something shifted. “Maybe you can explain something to me,” he said. “Because I’ve been driving twelve hours a day and I still can’t figure out how to get my son covered.”
We found a bench outside. He talked for nearly two hours. I took notes the entire time.
A Budget Built on Hours That Disappeared
Ruben Ramos has driven for Uber in El Paso since 2019. For most of that stretch, the arrangement held together — not comfortably, but it held. His wife, Claudia, stays home full-time to care for their nine-year-old son, Marco, who has a developmental disability that requires constant supervision and a daily medication regimen. Ruben had been pulling 55 to 60 hours a week, and the airport surge windows on weekend mornings had become the financial backbone of the entire household.
Then, in early 2025, Uber restructured its El Paso airport queue system, effectively eliminating the premium surge window Ruben had built his schedule around. His monthly take-home dropped from roughly $2,850 to approximately $2,100. That $750 monthly gap, he told me, was the precise difference between a managed household and a quiet, grinding crisis.
Marco’s medications — a combination of anticonvulsants and behavioral support prescriptions — cost approximately $340 a month without coverage. As an independent contractor, Ruben had no employer-sponsored insurance to fall back on. The family had been paying out of pocket for over two years.
Why Texas Made the Medicaid Question So Complicated
Ruben had heard the word Medicaid but assumed it was reserved for people with no income at all — no job, no car, nothing. What he didn’t know was that his son Marco almost certainly qualified for coverage regardless of Ruben’s earnings, through Texas’s Children’s Medicaid and CHIP programs, which evaluate children under a completely separate eligibility framework.
Texas has not expanded Medicaid under the Affordable Care Act, making adult coverage thresholds among the most restrictive in the country. But children are a different story. For a family of three in Texas, CHIP income limits extend to approximately 201% of the federal poverty level — which in 2025 translated to roughly $4,700 a month in gross household income. Ruben’s income fell well below that number.
Beyond standard CHIP, children with significant disabilities may also qualify for Medicaid-funded services through Section 1115 waiver programs, which allow states to test approaches to care that differ from standard federal Medicaid requirements. According to the KFF Medicaid Waiver Tracker, Texas operates several approved waivers specifically designed for individuals with intellectual and developmental disabilities. Marco’s documented diagnosis may have opened a level of coverage Ruben had never thought to ask about.
The programs existed. The problem was that no one had ever told Ruben they were there.
The Application: What Ruben Actually Went Through
After we spoke outside the Walgreens that November afternoon, Ruben agreed to keep me updated as he navigated the process. He submitted Marco’s application through Texas’s Your Texas Benefits portal in December 2025 — a process he said took about 45 minutes to fill out. The waiting, and the documentation requests that followed, were considerably harder.
The documentation requirements hit differently when you’re a gig worker. Ruben has no employer, no HR department, and no W-2. To satisfy income verification, he had to compile three months of Uber earnings statements, a letter from his bank showing consistent direct deposits, and a signed self-employment income declaration. He told me he nearly abandoned the application twice — once when a caseworker told him he had submitted the wrong income form, and again when he couldn’t locate his annual tax summary inside the Uber driver app.
He called the 2-1-1 helpline twice during the process. One of those calls connected him to a local Medicaid application navigator — a resource he hadn’t known existed — who helped him understand the difference between the standard CHIP pathway and a supplemental route available for children with documented disabilities. That distinction, he said, was never made clear anywhere in the written application materials.
Families in similar situations can search for local benefit navigators and assistance programs through Benefits.gov or by calling 2-1-1 and asking specifically for Medicaid application assistance.
The Outcome — and What It Still Doesn’t Cover
Marco was approved for Texas Children’s Medicaid in February 2026. His prescriptions are now fully covered under the program, eliminating the $340 monthly out-of-pocket cost that had been quietly draining the household budget for two years. Ruben called it the best Valentine’s Day present when the first covered prescription printed a $0.00 receipt on February 14th.
But Ruben himself remains uninsured. Texas’s decision not to expand Medicaid under the ACA means adults in his income bracket — above the state’s restrictive adult eligibility threshold but below what makes ACA marketplace plans affordable after subsidies — fall into what policy researchers call the coverage gap. When I asked what a marketplace plan would cost him, he said he had looked it up: a bronze-level plan was running approximately $190 to $220 a month after any subsidy calculation. He said he can’t absorb that right now.
When I asked Ruben how he manages his own health, he went quiet for a moment. “I don’t go to the doctor,” he said. “I’m 52 and I don’t go to the doctor. That’s the honest answer.” He knows it’s a problem. He’s hoping the financial math shifts. Right now, he told me, Marco comes first — and that’s not a complaint, it’s just the order of things.
What Ruben’s Story Reveals About Gig Workers and Coverage
Ruben’s situation isn’t exceptional — it reflects a structural reality for millions of gig economy workers across the country. Many are unaware that their children may qualify for Medicaid or CHIP even when the adults do not, and the application process for workers without traditional employment records is objectively more burdensome than it is for salaried workers.
A few specific realities Ruben’s experience surfaces:
- Children’s eligibility is evaluated separately from adult eligibility. A parent who earns too much for adult Medicaid in a non-expansion state may still have a child who qualifies for CHIP or Children’s Medicaid under a higher income threshold.
- Documented disabilities may open additional pathways. Section 1115 Medicaid waivers in many states fund supplemental services for children with intellectual or developmental disabilities that go beyond standard CHIP coverage.
- Gig workers can typically use a 3-month income average rather than the prior year’s tax return when income is variable — a critical detail many applicants don’t know to ask about.
- The 2-1-1 helpline connects callers to local Medicaid navigators at no cost. In Ruben’s case, one call made the difference between a failed application and an approved one.
- The SSA disability benefits system may be a separate avenue worth exploring for children with significant developmental disabilities. More information is available through SSA.gov Disability Benefits.
For Ruben, the win was real and it was meaningful — and it was partial. His son is covered. He is not. He still drives the same twelve-hour shifts, still wears the lanyard, and keeps that $0.00 pharmacy receipt in his camera roll as evidence that the system, at least once, bent in his direction.
When I left him that afternoon in El Paso, Ruben was already back in his car, the Uber app open, waiting for the next ping. The relief on his face when he talked about Marco’s coverage was genuine. So was the worry underneath it. Some problems get solved. Others get smaller — small enough to carry, for now.
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