The County Indigent Health Care Program (CIHCP) was established in 1985 by the Texas Legislature to provide health care to indigent Texans through county governments, including hospital and health services districts [1] and public hospitals. The Texas Administrative Code, Title 25, Part 1, Chapter 14 and Chapter 61 of the Health and Safety Code outline the program’s role and function: Counties not “fully” served by a public hospital must provide basic health care services to eligible residents, which are defined as physician services, annual physical examinations, immunizations, medical screening services, blood pressure, blood sugar and cholesterol screening, laboratory and x-ray services, family planning services, skilled nursing facility services, prescription drugs, rural health clinic services, inpatient hospital services, and outpatient hospital services. The CIHCP is not health insurance, but a discount program for medical care.


State assistance is available to offset CIHCP costs and is based on an annual allocation, subject to appropriation, once the county has exceeded 8 percent of its General Revenue Tax Levy (GRTL) on program expenditures. Eligible persons are county residents between 21 and 50 percent of the Federal Poverty Guideline (FPG). In 2017, this amounts to monthly income of $212 to $503 for an individual and $431 to $1,025 for a family of four. Other criteria include residents who are without another source of care (typically those who do not qualify for Medicaid, don’t have employer-sponsored insurance, and can’t afford health insurance in the individual market), who are not Supplemental Security Income (SSI) or Medicaid-eligible, and who do not possess assets exceeding $2,000 ($3,000 for elderly and disabled).

Annual maximum county liability for total health care services for each eligible resident, including hospital and skilled nursing facilities is $30,000 or the payment of 30 days of hospitalization or treatment in a skilled nursing facility, whichever occurs first, if the county provides hospital or skilled nursing facility services to the resident.

[1] Review encyclopedic entry “Texas Hospital and Health Service Districts”