1000, Purpose, Contact Information, Program Administration

County Indigent Health Care Program Handbook

1000, Purpose, Contact Information, Program Administration

1100, Handbook Purpose and Contact Information

Revision 24-2; Effective Sept. 30, 2024

The County Indigent Health Care Program (CIHCP) Handbook serves as a guide for local program delivering Indigent Health Care Services in Texas. The policy manual provides local staff with the information needed to comply with program rules and regulations.

Contact Information

Mailing Address

County Indigent Health Care Program

North Austin Complex, Mail Code 0224

4601 W. Guadalupe Street, Suite 4.507

Austin, TX 78751-2920

Phone: 512-438-2350

Fax number: 512-776-7417

Email: CIHCP@hhs.texas.gov

Website: hhs.texas.gov/services/health/county-indigent-health-care-program

1110 Program Administration

Revision 25-1; Effective Jan. 30, 2025

Rules

The Texas Administrative Code (TAC) is the compilation of all state agency rules in Texas.

The County Indigent Health Care Program (CIHCP) rules are in TAC, Title 26, Health and Human Services, Part 1, Texas Health and Human Services Commission (HHSC), Chapter 363, CIHCP and the following Subchapters:

Program Administration
Determining Eligibility
Providing Services

Access the CIHCP rules at the Texas Administrative Code page.

Health and Safety Code

A law was passed by the First Called Special Session of the 69th Texas Legislature in 1985 that:

defines who is indigent;
assigns responsibilities for indigent health care;
identifies health care services eligible people can receive; and
establishes a state assistance fund to match expenditures for counties that exceed certain spending levels and meet state requirements.

Chapter 61, Health and Safety Code, helps ensure that needy Texas residents, who do not qualify for other state or federal health care assistance programs, receive health care services.

Access Chapter 61, Health and Safety Code at the Health and Safety Code statues page.

County Responsibility

A county not fully served by a public facility must:

administer a County Indigent Health Care Program;
provide basic health care services to eligible county residents who do not live in a county area served by a public facility;
follow either the policies and procedures described in this handbook or less restrictive policies and procedures;
establish procedures for administrative hearings that provide for appropriate due process, including procedures for appeals requested by households that are denied;
adopt reasonable procedures for:
- minimizing the opportunity for fraud;
- establishing and maintaining methods for detecting and identifying situations where a question of fraud exists; and
- administrative hearings to be conducted on disqualifying people where fraud appears to exist; and
maintain the records for an application until at least the end of the third complete state fiscal year after the application submission date.

Public Notice. By the beginning of the state fiscal year of Sept. 1, a county not covered by a public facility specifies the procedure it will use during that fiscal year to:

verify eligibility and the documentation required to support a request for assistance; and
make reasonable effort to notify the public of the application procedure.

Maintaining Program Information on 2-1-1

Programs must maintain current and correct program information on 211Texas.org for all locations providing services. Program coordinators or administrators will use the Add or Edit Your 2-1-1 Listing link found at the top of the webpage to make any changes to their program location information listing. The information that the program coordinator or administrator shall maintain in their 2-1-1 listing includes, but is not limited to, program phone number, location, hours and services provided.

Public Hospital and Hospital District

Public Notice. By the beginning of a public hospital’s or hospital district’s operating year, the hospital or district shall specify the procedure it will use during the operating year to:

determine eligibility and the documentation required to support a request for assistance; and
shall make a reasonable effort to notify the public of the procedure.

Public Hospital and Hospital District

Per the Health and Safety Code, Section 61.040, the department requires local county personnel responsible for tax information complete a survey to establish eligibility for state assistance for the relevant period:

1. The taxable value of property subject to county taxation and the county's applicable general revenue tax levy.

2. The amount of sales and use tax revenue received by the county.

The survey will be emailed in early October to all 254 counties. Designated personnel must fulfill the survey requirements by Nov. 15.

Options

A county not fully served by a public facility may file for Texas Medicaid reimbursement through the local provider or through HHSC for eligible Supplemental Security Income (SSI) appellant CIHCP recipients who become eligible for retroactive Medicaid. Request the CIHCP Medicaid Reimbursement Manual for instructions about the filing process through HHSC.

An entity that chooses to establish an optional work registration procedure may contact its local Texas Workforce Commission (TWC) office to determine how to establish the county’s procedure and to negotiate what type of information to provide. A county must also follow the guidelines below.

Notify all eligible residents and those with pending applications of the program requirements at least 30 days before the program begins.
Allow an exemption from work registration if applicants or eligible residents meet one of the following criteria:
- receive SNAP benefits;
- receive unemployment insurance benefits or have applied but not yet been notified of eligibility;
- physically or mentally unfit for employment;
- distance prohibits walking or transportation is not available;
- commuting time, not including taking a child to and from a child care facility, is more than two hours a day;
- 15 or younger;
- 16 or 17 and not the head of household;
- 16, 17 or 18 and attending school, including home school, or on an employment training program on at least a half-time basis;
- 60 or older;
- parent or other household member who personally provides care for a child under 6, or a disabled person of any age living with the household;
- employed or self-employed at least 30 hours per week;
- receive earnings equal to 30 hours per week multiplied by the federal minimum wage;
- migrant in the mainstream;
- a regular participant or outpatient in a drug addiction or alcoholic treatment and rehabilitation program; or
- three to nine months pregnant.
If a nonexempt applicant or CIHCP eligible resident fails without good cause to comply with work registration requirements, disqualify them from CIHCP benefits as follows:
- for one month or until they agree to comply, whichever is later, for the first noncompliance;
- for three consecutive months or until they agree to comply, whichever is later, for the second noncompliance; or
- for six consecutive months or until they agree to comply, whichever is later, for the third or subsequent noncompliance.

1200, Definitions

Revision 24-2; Effective Sept. 30, 2024

The following words and terms, when used in this manual, have the following meanings:

Accessible Resources – Resources legally available to the household.

Adult – A person at least 18 or a younger person who is or was married or had the disabilities of minority removed for general purposes.

Aged Person – Someone 60 or older as of the last day of the month that benefits are being requested.

Alien Sponsor – A person who signed an affidavit of support (namely, INS Form I-864 or I-864-A) on or after Dec. 19, 1997, agreeing to support an alien as a condition of the alien’s entry into the United States.

Application Completion Date — The date Form 3064 and all information necessary to make an eligibility determination is received.

Approval Date – The date Form 3077, Notice of Eligibility, is issued to the household.

Assets – All items of monetary value owned by a person.

Budgeting – The method used to determine eligibility. It’s done by calculating income and deductions using the best estimate of the household’s current and future circumstances and income.

Claim – CMS-1500, UB-04 or pharmacy statement.

Claim Pay Date – The date the county writes a check to pay a claim.

Client—A person who was screened and determined to be eligible for the program. The term client and patient may be used interchangeably in other sources.

Common Law Marriage – A relationship where the parties 18 or older are free to marry, live together and hold out to the public that they are spouses. A minor child in Texas is not legally allowed to enter a common law marriage unless the claim of common law marriage began before Sept. 1, 1997.

Complete Application – Includes Form 3064, Application for Health Care Assistance, and:

applicant’s full name and address;
applicant’s county of residence;
names of everyone who lives in the house with the applicant and their relationship to the applicant;
type and value of the CIHCP household’s resources;
CIHCP household’s monthly gross income;
information about any health care assistance the household members may receive;
applicant’s Social Security number, if available;
applicant’s and spouse’s signatures with the date Form 3064 is signed; and
all needed information, such as verifications.

Confidentiality—The state of keeping information private and not sharing it without permission.

County – A county not fully served by a public facility, namely a public hospital or hospital district, or a county that provides indigent health care services to its eligible residents through a hospital established by a board of managers jointly approved by a county and a municipality.

Days – All calendar days, except as specifically identified as workdays.

Denial Date – The date Form 3082, Notice of Ineligibility, is issued to the household.

Disqualified Member – A person receiving, or categorically eligible to receive, Medicaid.

Earned Income – Income a person receives for a certain degree of activity or work. Earned income relates to employment and, therefore, entitles the person to work-related deductions not allowed for unearned income.

Eligibility Date—Date the program administrator determines a person becomes eligible for the program.

Emancipated Minor – A person under 18 who has been married. The marriage must not have been annulled.

Equity – The amount of money that would be available to the owner after the sale of a resource. Determine this amount by subtracting from the fair market value any money owed on the item and the costs normally associated with the sale and transfer of the item.

Expenditure – Funds spent on basic or department-established optional health care services.

Expenditure Tracking – A county should track monthly basic and department-established optional health care expenditures.

Fair Market Value – The amount a resource would bring if sold on the current local market.

Family Planning Services – Educational or comprehensive medical activities that enable clients to freely determine the number and spacing of their children and select how this may be achieved.

Federal Poverty Level (FPL) – The set minimum amount of income that a family needs for food, clothing, transportation, shelter and other necessities. In the United States, the Department of Health and Human Services determines this level. FPL varies per family size. The number is adjusted for inflation and reported annually in the Federal Poverty Guidelines. Public assistance programs, such as Medicaid, define eligibility income limits in terms of a percentage of FPL.

Fiscal Year – The state fiscal year is from Sept. 1 through Aug. 31.

General Revenue Tax Levy (GRTL) – Used by the county to determine eligibility for state assistance funds. Contact HHSC County Indigent Health Care Program for information reporting the GRTL.

Governmental Entity – A county, municipality or other political subdivision of the state, excluding a hospital authority.

Gross Income – Income before deductions.

Health and Human Services Commission – The Texas administrative agency established under Chapter 531, Texas Government Code, or its designee. HHSC manages programs that help families with food, health care, safety and disaster services.

Hospital Authority – Created under Article 4437E, Section 3, City Created Hospital Authorities or Article 4494R, Section 3, County Created Hospital Authorities, a hospital authority has no obligation under Chapter 61, Health and Safety Code, to provide indigent health care assistance.

Hospital District – Created under the authority of the Texas Constitution, Article IX, Sections 4 – 11.

Identifiable Application – An application is identifiable if it includes the applicant’s name, applicant’s address, applicant’s signature and the date the applicant signed the application.

Inaccessible Resources – Resources not legally available to the household. Examples include, but are not limited to irrevocable trust funds, property in probate, security deposits on rental property and utilities.

Managing Conservator – A person designated by a court to have daily responsibility for a child.

Mandated Provider – A health care provider, selected by the county, who agrees to provide health care services to eligible residents.

Married Minor – A person, 14-17 years, who is married. These people must have parental consent or court permission. A person under 18 years may not be a party to an informal (common law) marriage.

Medicaid – The Texas Medical Assistance Program, a joint federal and state program provided in Texas Human Resources Code Chapter 32 subject to Title XIX of the Social Security Act, 42 U.S.C. Section 1396, reimburses for health care services delivered to low-income clients who meet eligibility guidelines.

Minor– Per the Texas Family Code, a person under 18 years old who is not and has not been married or who has not had the disabilities of minority removed for general purposes and is not emancipated. In this policy manual, minor and child may be used interchangeably.

Minor Child – A person under 18 who is not, or has not been, married and has not had the disabilities of minority removed for general purposes.

Net Income – Gross income minus allowable deductions.

Optional Services – Department-established optional health care services that a county may choose to provide.

Person with Disabilities – Someone who is physically or mentally unfit for employment.

Personal Possessions – Appliances, clothing, farm equipment, furniture, jewelry, livestock, and other items if the household uses them to meet personal needs essential for daily living.

Public Facility – A public hospital or a hospital owned, operated, or leased by a hospital district.

Public Hospital – A hospital owned, operated or leased by a county, city, town or other political subdivision of the state, excluding a hospital district and a hospital authority. Refer to Chapter 61, Health and Safety Code, Subchapter C for more information.

Real Property – Land and any improvements on it.

Reimbursement – Repayment for a specific item or service.

Referral – The process of directing or redirecting, a medical case or a person, to an appropriate specialist or agency for information, help or treatment.

Reimbursement Expenditure – A health care expenditure that may be applied to state assistance funds eligibility or reimbursement and is for a service provided to a person eligible under a monthly net income standard that is at least 21% of the Federal Poverty Level (FPL) or up to 50% of the FPL. Refer to Section 5, State Assistance Funds, for additional information.

Relative – A person who has one of the following relationships biologically or by adoption:

mother or father;
child, grandchild or stepchild;
grandmother or grandfather;
sister or brother;
aunt or uncle;
niece or nephew;
first cousin;
first cousin once removed; and
stepmother or stepfather.

Relationship also extends to:

the spouse of the relatives listed above, even after the marriage is terminated by death or divorce;
the degree of great-great aunt or uncle, and niece or nephew; and
the degree of great-great-great grandmother or grandfather.

Resident – A person who lives within the geographic boundaries of the state of Texas.

Resources – Both liquid and non-liquid assets a person can convert to meet their needs. Examples include, but are not limited to:

bank accounts;
boats;
bonds;
campers;
cash;
certificates of deposit;
gas rights;
livestock unless the livestock is used to meet personal needs essential for daily living;
mineral rights;
notes;
oil rights;
real estate,
including buildings and land, other than a homestead; and
stocks and vehicles.

Service Area – The geographic region that a governmental entity, public hospital or hospital district has a legal obligation to provide health care services.

Sponsored Alien – A person who has been lawfully admitted to the United States for permanent residence under the Immigration and Nationality Act (8 U.S.C. Section 1101 et seq.) and who, as a condition of admission, was sponsored by a person who executed an affidavit of support for the person.

Tip Income – Income earned in addition to wages that is paid by patrons to people employed in service-related occupations, such as beauticians, waiters, valets, pizza delivery staff, etc.

Unearned Income – Payments received without performing work-related activities.