Delia Fuentes

Thursday mornings I sit at the front desk of a free clinic in San Antonio, and most of what I know about Texas health coverage I learned on that side of the window. People come in with a folder. Sometimes it holds three years of denial letters. Sometimes it holds one letter they have not opened. The question is almost always the same question, phrased as though it were a personal failing: what am I doing wrong. Usually nothing. They are in a category the state does not have a program for, and nobody has ever said that to them in a sentence they could act on.

I cleaned houses for fifteen years, two of us, our own small business. That meant no employer plan, and by the time my children were grown there was no dependent child in the household either, which in Texas closes the last adult Medicaid door there is. My income was low enough to be a problem in the opposite direction: too low to reach the bottom of the Marketplace subsidy range. Four years uninsured. In 2021 a gallstone attack put me in an emergency room and produced a bill with five figures on it. I found out that the hospital ran a charity care program about six weeks after the window I should have applied in, and I spent the next year working the balance down anyway. Then I moved my ordinary care to a community health center, where I pay on a sliding scale, and where I should have been the whole time.

This site is the version of that I wish somebody had handed me at the start, minus the parts I got wrong. Priscilla Alaniz writes the eligibility and program pages, because she is certified to read the rules and I am not. Dr. Warren Ashby clears the clinical content. I write the parts about what it is like to be the person holding the folder.

One rule matters more than any of the rest, and it is the reason I can stand behind the numbers here. Every dollar figure and every income limit on this site carries the date it was last checked and the source it came from. Texas program rules move, sometimes twice a year, and a confidently undated number is how people end up not applying for something they would have qualified for. When a figure lapses, we say so rather than leaving it there looking current.