The Title V Maternal and Child Health Fee for Service Program is available to low-income women, children and adolescents who aren’t eligible for Medicaid, CHIP, CHIP Perinatal or another source that covers the same service.
Eligibility Determination Forms
- Form 3029, Office of Primary and Specialty Health Application for Program Benefits (English and Spanish)
- Form 3045, Office of Primary and Specialty Health Presumptive Eligibility Notice (English and Spanish)
- Form 3046, Office of Primary and Specialty Health Statement of Applicant's Rights and Responsibilities (English and Spanish)
- Form 3047, Office of Primary and Specialty Health Notice of Ineligibility (English and Spanish)
- Form 3048, Office of Primary and Specialty Health Notice of Eligibility (English and Spanish)
- Form 3049, Office of Primary and Specialty Health (OPSH) Employment Verification (English and Spanish)
- Form 3051, Office of Primary and Specialty Health Statement of Self-Employment Income (English and Spanish)
- Form 3056, Office of Primary and Specialty Health Request for Information (English and Spanish)
How to Become a Provider
See contracting opportunities and learn how to become a provider by visiting the Vendor and Contractor Information page.
Policy Manual
Title V Maternal and Child Heath Fee-for-Service Program Provider Manual
Resources
Contact Us
Phone
800-222-3986 Ext. 4382574
8 a.m.-5 p.m. Central Time
Monday through Friday
Austin Area Phone
512-438-2574
Email Address
titlevffs@hhs.texas.gov
Mailing Address
Title V MCH Fee-For-Service
MC 1938
P.O. Box 149030
Austin, TX 78714-9947