Skip to main content

Texas flag An official State of Texas website.

Here's how you know.

  • Apply for Benefits
  • Connect
  • Español
  • Subscribe

Dot gov

The .gov means it’s official.
State and federal government websites often end in .gov. Before sharing sensitive information, make sure you’re on an official government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Texas Health and Human Services Home Texas Health and Human Services
  • Home
    • Services
    • Aging
    • Disability
    • Disaster Assistance
    • Family and Safety Resources
    • Financial
    • Food
    • Health
    • Mental Health & Substance Use
    • Questions About Your Benefits
    • Your Rights
    • Providers
    • Assistive Services Providers
    • Behavioral Health Services Providers and Programs
    • Child Care Regulation
    • County Jail Reporting
    • Health Care Facilities Regulation
    • Health Services Providers
    • Long-term Care Providers
    • Medicaid Business Resources
    • Provider Training
    • WIC Providers
    • Business
    • Contracting with HHS
    • Electronic Benefit Transfer Program
    • Grants
    • Licensing, Credentialing & Regulation
    • Open Enrollment Opportunities
    • Regulations
    • Forms
    • Handbooks
    • Legal Information
    • Policies and Rules
    • Reports and Presentations
    • About
    • About Us
    • Advisory Committees
    • Community Engagement
    • Financial Information
    • Jobs at HHS
    • Live and Archived Meetings
    • Meetings and Events
    • Process Improvement
    • Records and Statistics
    • Strategic Plans
  • Newsroom
    • Contact
    • HHS Locations
    • Office Closures
    • Open Records Policy and Procedures
    • Social Media
    • Where Can I Find Services?

Breadcrumb

  1. Home
  2. Search Providers
  3. Health Services Providers
  4. County Indigent Health Care Program Providers
  5. CIHCP Handbook and Forms

CIHCP Handbook and Forms

CIHCP Handbook

Download the complete CIHCP Handbook or select a section below.

  • Section 1000 - Program Administration
  • Section 2000 - Eligibility Criteria
  • Section 3000 - Case Processing
  • Section 4000 - Service Delivery
  • Section 5000 - State Assistance Fund
  • Section 6000 – Supplemental Security Income Reimbursement

Forms and Instructions

  • 3064 - Application for Health Care Assistance
  • 3065 - Worksheet
  • 3066 - Report of Changes
  • 3067 - Appointment Notice
  • 3068 - Request for Information
  • 3069 - Health Care Services Record
  • 3072 - CIHCP Monthly Financial Report
  • 3073 - Eligibility Dispute Resolution Request
  • 3076 - Case Record Information Release
  • 3077 - Notice of Eligibility
  • 3078 - Claim Processing Notification
  • 3079 - Facility Payment Rate Request
  • 3080 – SSI Appellant Notification
  • 3081 - Appellant – Provider Assignment
  • 3082 - Notice of Ineligibility
  • 3083 - Optional Health Care Services Notification
  • 3084 - Employment Verification
  • 3085 - Statement of Self-Employment Income
  • 3086 - End of Year Report
  • 3087 - TMHP Confidentiality Agreement
  • 3088 - Request for State Assistance Funds (90 percent)
  • 211 Texas
  • Apply for Benefits
  • Compact with Texans
  • Department of State Health Services
  • Email Encryption
  • File Viewing
  • Jobs at HHS
  • Notice of Privacy Practices
  • Report Fraud, Waste or Abuse
  • Statewide Search
  • Texas.gov
  • Texas Homeland Security
  • Texas Veterans Portal
  • Website Policy
  • Website Help
  • Website Survey

© Copyright 2016-2025. Texas Health & Human Services Commission. All rights reserved.

Facebook Instagram LinkedIn Twitter YouTube