Texas has three separate ways to get a hospital bill reduced or erased, and they use completely different income rules. The County Indigent Health Care Program (CIHCP) covers residents with monthly net income at or below 21% of the federal poverty level, roughly $279 a month for one person in 2026. County hospital district programs, including Harris Health, Parkland, JPS Connection, CareLink, and Central Health MAP, cover residents up to 150% to 250% FPL. And individual hospital charity care policies at systems like Baylor Scott & White and Houston Methodist erase bills entirely at or below 200% FPL, with sliding discounts up to 500% FPL. Which one applies to you depends on the county you live in and the hospital that treated you.
This matters more in Texas than in almost any other state. Texas has not expanded Medicaid, so a childless adult under 65 has essentially no Medicaid pathway regardless of income, and parents qualify only at around 12% to 15% FPL. Texas has the highest uninsured rate in the country, roughly 16.7% overall, and an estimated 617,000 adults sit in the coverage gap: earning too much for Texas Medicaid, too little to have qualified for marketplace subsidies. The enhanced premium tax credits that had lowered marketplace premiums expired at the end of 2025, pushing more Texans back into the self-pay category. Charity care and county indigent programs are what is left underneath.
The Three Systems, Side by Side
| County Indigent Health Care Program (CIHCP) | Hospital district program | Hospital charity care (FAP) |
|---|
| Who runs it | Your county government, under Health and Safety Code Chapter 61 | A taxing hospital district (Harris Health, Parkland, JPS, University Health, Central Health) | The individual hospital or hospital system |
| Where it exists | 143 Texas counties without a hospital district or public hospital | 142 hospital districts plus 18 public hospitals | Statewide, at nearly every nonprofit hospital |
| Typical income limit | 21% FPL net income (counties may set higher, up to 50% FPL with state match) | 150% to 250% FPL | Free care at or below 200% FPL, discounts to 400% or 500% FPL |
| Resource limit | $2,000, or $3,000 if an aged or disabled member qualifies | Varies; several districts have no asset test for basic eligibility | Rarely, though some policies count assets |
| Covers | Basic services: physician, hospital, lab, x-ray, 3 prescriptions per month, skilled nursing | Care delivered inside that district's system | Bills from that hospital only |
| Applies to future or past care | Future care after certification, plus limited retroactive coverage | Future care after enrollment | Bills you already received, including some already in collections |
Most Texans in financial trouble over a hospital bill should apply to more than one of these. They are not mutually exclusive, and the applications ask for the same documents.
County Indigent Health Care Program: the 21% Rule
CIHCP is the state-mandated floor. Chapter 61 of the Texas Health and Safety Code requires every county that is not fully served by a hospital district or public hospital to run a program for its indigent residents. That is 143 of the 254 counties.
The mandated income standard is very low. A household qualifies if monthly net income does not exceed 21% of the federal poverty guidelines.
| Household size | 2026 monthly income limit (21% FPL) | Annual equivalent |
|---|
| 1 | approximately $279 | approximately $3,352 |
| 2 | approximately $379 | approximately $4,544 |
| 3 | approximately $478 | approximately $5,737 |
| 4 | approximately $578 | approximately $6,930 |
| 5 | approximately $677 | approximately $8,123 |
| 6 | approximately $776 | approximately $9,316 |
Counties are allowed to be more generous. A county may raise its threshold anywhere from 21% up to 50% FPL and still receive state matching funds, and it may go higher than 50% using its own money. Some counties do. Never assume you are over the limit without asking your specific county, because the published state minimum is the floor, not the ceiling.
Other CIHCP rules that decide applications:
Resources. Countable household resources must stay at or below $2,000, or $3,000 for households that include a person who is aged or disabled and meets the relationship requirement. Your homestead and typically one vehicle are excluded.
Medicaid comes first. A person who receives Medicaid, or who is categorically eligible for it, is disqualified from CIHCP. Counties will usually require you to apply at YourTexasBenefits.com and show the denial notice.
Residency. You must live in the county and intend to remain there.
Covered basic services. Primary and preventive care, immunizations, medical screening, an annual physical, inpatient and outpatient hospital services, rural health clinic services, laboratory and x-ray, family planning, physician services, skilled nursing facility care, and payment for up to three prescriptions per month. Counties may add optional services such as dental care and diabetic supplies, usually with prior authorization.
County liability cap. For each state fiscal year, a county's maximum liability for one eligible resident is 30 days of hospitalization or skilled nursing care, or $30,000, whichever comes first. Past that point, the county is not obligated to keep paying.
The 8% shutoff. A county may close its program for the rest of the fiscal year if it has spent 8% of its general revenue tax levy on eligible services and no state matching funds are available. This is why an application can be denied in September and approved in October, after the new fiscal year starts.
Timelines and appeals. Counties have 14 days to determine eligibility once all requested documentation is received, and must formally review eligible recipients at least every six months. If you are denied or terminated, you can request a fair hearing, orally or in writing.
To find your county's program, call the state CIHCP line at 1-800-222-3986, extension 6467, email CIHCP@hhsc.state.tx.us, or dial 2-1-1.
Hospital District Programs in the Big Counties
If you live in one of the large urban counties, ignore CIHCP. Your county funds a hospital district instead, and the district program is far more generous.
| County | Program | Income limit | How to apply |
|---|
| Harris (Houston) | Harris Health Financial Assistance, the Gold Card | At or below 150% FPL gross income | Online at ola.veritysource.com/harris, or call 713-566-6509 |
| Dallas | Parkland Financial Assistance (PFA) | Below 250% FPL, with free care generally at the lower tiers and sliding discounts above | Apply through Parkland's applicant portal, or call 214-590-8831 |
| Bexar (San Antonio) | University Health CareLink | At or below 250% FPL | Call CareLink Member Services at 210-358-3350 to schedule an enrollment appointment |
| Tarrant (Fort Worth) | JPS Connection | Up to 250% FPL, uninsured only | Apply at jpshealthnet.org or at any JPS eligibility center or registration desk |
| Travis (Austin) | Central Health Medical Access Program (MAP and MAP Basic) | At or below 200% FPL | Call 512-978-8130, option 1 |
Details that trip people up:
- These are not insurance. They pay for care delivered inside that system. A Harris Health Gold Card does not cover a bill from a private Houston hospital.
- Residency proof is strict. CareLink asks new applicants for proof of 12 months of Bexar County residency. Harris Health drops you if you move out of Harris County.
- Terms expire. Harris Health enrollment usually runs one year and must be renewed. Parkland lets you use the renewal path if your coverage expired less than six months ago; past six months you reapply as a new applicant.
- Income tests differ from Medicaid's. Central Health bases MAP eligibility on income received in the last 30 days and updates its FPL figures each March 1.
2026 Federal Poverty Level Figures Texas Programs Use
Every threshold above is written as a percentage of the federal poverty level. HHS published the 2026 guidelines in January 2026.
| Household size | 100% FPL | 150% FPL | 200% FPL | 250% FPL | 400% FPL |
|---|
| 1 | $15,960 | $23,940 | $31,920 | $39,900 | $63,840 |
| 2 | $21,640 | $32,460 | $43,280 | $54,100 | $86,560 |
| 3 | $27,320 | $40,980 | $54,640 | $68,300 | $109,280 |
| 4 | $33,000 | $49,500 | $66,000 | $82,500 | $132,000 |
| 5 | $38,680 | $58,020 | $77,360 | $96,700 | $154,720 |
| 6 | $44,360 | $66,540 | $88,720 | $110,900 | $177,440 |
Add roughly $5,680 per person for households larger than eight at 100% FPL.
Charity Care Policies at Major Texas Hospital Systems
Separate from any county program, nearly every nonprofit hospital in Texas has a written financial assistance policy. Federal law, Section 501(r) of the Internal Revenue Code, requires nonprofit hospitals to publish that policy and the application, offer plain-language summaries in the emergency department and registration areas, cap what approved patients are charged at the amounts generally billed to insured patients, and make reasonable efforts to check eligibility before sending a bill to collections.
Texas adds its own layer. Health and Safety Code Section 311.045 lets a nonprofit hospital satisfy its charity care obligation by providing charity care and community benefits equal to at least 5% of net patient revenue, with charity care and government-sponsored indigent health care at a minimum of 4% of net patient revenue, or by meeting one of the alternative standards in the statute.
| System | Free care threshold | Discounted care | Contact |
|---|
| Baylor Scott & White | At or below 200% of federal poverty guidelines, 100% discount | 200% to 500% FPG, "medically indigent," patient owes the lesser of the balance or 10% of gross charges when bills exceed 5% of household income | 1-833-968-5862 |
| Houston Methodist | At or below 200% FPL, free services | Above 200% up to 500% FPL, discounted and capped near what insurers pay; some assistance possible above 500% | 877-493-3228 |
| Texas Health Resources | Assistance generally available at or below 250% of federal poverty guidelines | Policy may allow help above 250% FPG based on income, assets, and bill size | Apply online through texashealth.org |
| Memorial Hermann | Eligibility set by a published gross income table tied to federal poverty guidelines | Partial discounts above the free-care tier | 713-338-5502 or 1-800-526-2121, option 5 |
Two things to note. First, Baylor Scott & White accepts applications from the date service is scheduled through the 365th day after the first billing statement, which is more generous than the 240-day minimum federal rule. Second, for-profit chains such as HCA Healthcare hospitals are not bound by Section 501(r), but most publish a financial assistance policy anyway. Ask for it in writing.
How to Apply, Step by Step
- Apply for Medicaid first, even if you expect a denial. Go to YourTexasBenefits.com or call 1-800-252-8263. County programs and many hospital policies require the denial notice as proof you exhausted other coverage. Pregnant women, children, and people with disabilities often do qualify in Texas.
- Identify which program covers you. If you live in Harris, Dallas, Bexar, Tarrant, Travis, El Paso, or another hospital district county, start with the district program. Otherwise call 2-1-1 and ask for your county indigent health care office.
- Ask the hospital for its financial assistance application at the same time. Every nonprofit hospital must give you one free. Ask specifically for the "financial assistance policy plain language summary" and the application form.
- Gather documents once and copy them. Photo ID for household members, proof of residence such as a lease or utility bill, income for the last 30 days including pay stubs, Social Security or benefit award letters, recent tax returns, proof of relationship for dependent children, bank statements, and any insurance denial or Medicaid denial letter.
- Submit before the deadline. Federal rules give you at least 240 days from the first billing statement. Several Texas systems allow longer. If your bill is already with a collection agency, apply anyway; hospitals routinely pull accounts back.
- Get a written decision. Approval letters state the discount percentage and the period covered. If denied, ask for the reason in writing. CIHCP denials carry fair hearing rights, and hospital denials can usually be appealed with corrected income documentation.
- Reapply on schedule. Most county and district programs run 6 or 12 months. A lapsed card means self-pay prices at your next visit.
Billing Protections Texans Can Use While Waiting
Texas Senate Bill 490, effective September 1, 2023, requires health care facilities to give patients an itemized bill with a plain-language description of each service, the billing codes, amounts billed to and paid by any third-party payer, and the amount you owe. A provider may not pursue debt collection against you unless it has met that itemized billing requirement. You can request an updated itemized bill at any time.
That is a real lever. If a Texas hospital sends you to collections without an itemized bill, say so in writing and ask for the bill. Reviewing the itemization also catches duplicate charges and services never delivered, which is common on long emergency department bills.
Under 501(r), an approved charity care patient cannot be charged more than the "amounts generally billed" to insured patients, which is usually far below the sticker price on an uninsured bill.
For more Texas program details and income limits across Medicaid, CHIP, SNAP, and other assistance, see our Texas benefits guide.
Frequently Asked Questions
What is the income limit for the County Indigent Health Care Program in Texas in 2026?
The state minimum standard is monthly net income at or below 21% of the federal poverty level, approximately $279 a month for one person and $578 for a household of four in 2026. Countable resources must stay at or below $2,000, or $3,000 for households with an aged or disabled member. Counties may set higher income thresholds, and many do, so confirm with your county rather than assuming.
Which Texas counties have CIHCP and which have hospital districts?
143 counties run a County Indigent Health Care Program for residents not served by a public hospital or hospital district. 142 hospital districts and 18 public hospitals cover the rest, including the largest urban counties: Harris, Dallas, Bexar, Tarrant, and Travis. Call 2-1-1 to find out which entity serves your address.
Can I get charity care if I already paid part of the hospital bill?
Often yes. Many Texas hospital policies apply the discount to the full account and refund payments made on the forgiven portion, though refund practices vary by system. Apply and ask directly whether payments already made will be refunded or credited.
Does charity care cover a bill already in collections?
Usually. Federal 501(r) rules require nonprofit hospitals to make reasonable efforts to determine financial assistance eligibility before extraordinary collection actions, and hospitals commonly recall accounts from collection agencies when an application is approved. Apply even if the account has been sold, and send a copy of the application to the collection agency in writing.
Can undocumented immigrants get help with Texas hospital bills?
Emergency care is provided regardless of immigration status under federal EMTALA rules, and Emergency Medicaid may cover emergency treatment for people who meet income rules but not immigration rules. CIHCP and most hospital district programs impose citizenship or lawful presence requirements. Individual hospital charity care policies vary, and some do not require immigration status documentation at all. Read the specific hospital policy.
How long does a charity care or county program decision take?
Counties have 14 days to determine CIHCP eligibility once all requested documents are received. Hospital financial assistance decisions commonly take 30 to 60 days. Hospital district programs like Harris Health and CareLink typically require an appointment or interview first, which can add weeks. Keep making small good-faith payments only if the hospital requires it, and ask for the account to be flagged as "pending financial assistance" so collections pause.
What if my income is too high for every program?
Ask about a self-pay or prompt-pay discount, which most Texas hospitals offer separately from charity care, and request an interest-free payment plan. Several large systems extend partial discounts to 400% or 500% FPL when medical bills exceed a percentage of household income, so submit the application even if you assume you earn too much. A denial costs nothing but time.
