2100, Program Authorization and Services

Revision 23-2; Effective Sept. 15, 2023

Primary Health Care Services Program Background

In the early 1980s, economic recession and cost containment measures on the part of employers and government agencies led to a decrease in the availability and accessibility of health care services for many Texans. A legislative task force identified the provision of primary health care to the medically indigent as a major priority. The task force recommended the following:

  • A range of primary health care services shall be made available to the medically indigent residing in Texas.
  • The Texas Health and Human Services Commission (HHSC) shall provide or contract to provide primary health care services to the medically indigent.
  • These services should complement existing services or should be provided where there is a scarcity of services.
  • Health education should be an integral component of all primary care services delivered to the medically indigent population.
  • Preventive services should be marketed and made accessible to reduce the use of more expensive emergency room services.

Statute

These recommendations become the basis of the indigent health care legislative package enacted by the 69th Texas Legislature in 1985. The Primary Health Care Services Act, House Bill 1844, was part of this legislation and is the statutory authority for Primary Health Care (PHC) Services Program administered by HHSC. The Act delineates the specific target population, eligibility, reporting and coordination requirements for PHC.

Rules

The state rules for PHC services in Texas can be found in the Texas Administrative Code (TAC), Title 26, Part 1, Chapter 364, Subchapter A. PHC program rules require that, at a minimum, a grantee must provide the following six priority PHC services:

  1. Diagnosis and treatment
  2. Emergency medical services
  3. Family planning services
  4. Preventive health services
  5. Health education
  6. Laboratory, x-ray, nuclear medicine or other appropriate diagnostic services

PHC provides services through contracted providers (grantees) for individuals who are at or below 200% of the Federal Poverty Level (FPL) and are unable to access the same care through other funding sources or programs. Grantees must assure that services provided to clients are accessible in terms of cost, scheduling and distance, and are provided in a way that is sensitive to the individual’s culture.

Funding Sources

PHC program services are funded by state general revenue. HHSC PHC funds are allocated through a competitive application process, after which selected applicants negotiate contracts with HHSC to provide services. A variety of types of organizations provide PHC program services, such as local health departments, medical schools, hospitals, private nonprofit agencies, community-based clinics, federally qualified health centers (FQHCs) and rural health clinics. Providers must enroll with the Texas Medicaid & Healthcare Partnership (TMHP) to provide the HHSC PHC program services. State and federal law prohibits the use of contracted funds awarded by HHSC to pay the direct or indirect costs (including overhead, rent, phones and utilities) of abortion procedures.