County Indigent Health Care in Texas: Chapter 61, County by County

Every Texas county runs an indigent health care program under Health and Safety Code chapter 61, the state sets a floor rather than a uniform rule, and the answer to almost every question about it is county by county. The statutory minimum eligibility standard “must incorporate a net income eligibility level equal to 21 percent of the federal poverty level”, and a county may adopt a more generous standard but never a more restrictive one¹ (checked 30 July 2026).

I work as a Certified Application Counselor, which means most of my week sits inside HHSC’s systems, and the county program is the one thing I have to relearn every time I cross a county line. The first county application I ever helped somebody through, I arrived with the folder an HHSC case needs: pay stubs, a lease, birth certificates. The clerk went through it, slid it back across the counter and said, “this is all fine, but we need a utility bill in your name and we count the month before the month you apply.” None of that was on a website anywhere. It was on a photocopied checklist taped to the inside of the window, and it decided the case.

Nothing on this page is an eligibility determination, and this page less than most: your county sets its own standard inside the statutory floor, and only that county’s program office can apply it to your household. What follows is what the statute requires of every county, with the section numbers and the date each figure was checked, so you walk in knowing what a county cannot refuse to do.

What is the county indigent health care program?

It is a county payment program for residents who meet a local eligibility standard, not an insurance card and not a Medicaid category. Approval means the county pays for a defined list of services, usually through providers it has arranged with, for an eligibility period the county sets. There is no card to hand a receptionist anywhere in the state, and nothing about it travels with you if you move.

That distinction matters because of the hole it partly fills. Texas has the highest uninsured rate in the country, 16.7% against a national 8.2% in 2024² (2024 data, checked 30 July 2026), and a large share of those people are in categories Texas Medicaid does not operate at all. Chapter 61, the Indigent Health Care and Treatment Act, is the one health program in Texas whose front door is an address rather than an age, a pregnancy, or a diagnosis. HHSC publishes a state level overview of it³, and the county administers it.

For how it sits against everything else, see Texas health programs and health coverage in Texas.

What does the state minimum eligibility standard require?

The floor is a net income eligibility level equal to 21 percent of the federal poverty level, set by section 61.006(b), and counties may go above it. Two words in that sentence do the work. “Minimum” means 21 percent is the least a county may do. “Net” means the county is not measuring your gross pay.

Against the 2026 federal poverty guidelines, 21 percent works out at roughly $3,350 a year for a household of one and roughly $5,740 for a household of three⁴ (2026 guidelines, checked 30 July 2026). Treat those as an illustration of scale, not as your line: the guidelines are reissued every January, the county is working from net income, and the county may set a standard well above the floor.

There is a second number in the statute that tells you counties are expected to sit above the floor rather than on it. Section 61.023(b) lets a county credit toward state assistance the services it provides to residents under a standard that incorporates a net income eligibility level below 50% of the federal poverty level¹ (checked 30 July 2026). So the practical range a Texan meets in real life runs from the 21 percent floor upward, and the only way to learn where your county sits is to ask it. How income is counted is its own subject, worked through in what counts as income in Texas.

Which services must a county program cover?

Section 61.028 lists the basic services a county program must provide, and it is a broader list than most people expect. In the statute’s own order¹ (checked 30 July 2026):

• primary and preventative services designed to meet the needs of the community, including immunizations, medical screening services, and annual physical examinations
• inpatient and outpatient hospital services
• rural health clinics
• laboratory and X-ray services
• family planning services
• physician services
• payment for not more than three prescription drugs a month
• skilled nursing facility services, regardless of the patient’s age

Read that list as the floor, not the menu. A county may cover more, and many arrange care through specific hospitals and clinics rather than letting you choose, so the second question after “am I eligible” is always “where do I go with it”.

Three prescription drugs a month: the most useful line in chapter 61

Payment for not more than three prescription drugs a month is a mandatory service under section 61.028, and for somebody on a long term medication it is the single most useful thing in the chapter¹ (checked 30 July 2026). It is also the line county staff are most used to being asked about, which makes it a good opening question.

Three practical points, because the number by itself decides nothing.

• It is a monthly count and a statutory floor. A county may pay for more; the statute requires at least this.
• How a county counts is a county question. Ask whether a 90 day supply counts once or three times, whether refills of the same drug count again, and which pharmacies the county uses.
• Bring the actual list. Names, doses, and how often, copied from the bottles or from the pharmacy printout. Which of your medications the county pays for is a decision somebody makes about a list, and turning up without one costs a visit.

If you take more than three regular prescriptions, the county program is one layer of several. Prescriptions without insurance covers cash pricing and pharmacy discounts, and patient assistance programs covers manufacturer help, which is the layer people miss most often. Nothing on this site tells you what to take or what to stop; that is a conversation with your prescriber.

What is the most a county has to pay?

Section 61.035 caps county liability for one eligible resident at “the payment of 30 days of hospitalization or treatment in a skilled nursing facility, or both, or $30,000, whichever occurs first”, per state fiscal year¹ (checked 30 July 2026).

Two readings of that sentence, and only one is right. It is a limit on what the county is obliged to pay, which is why it exists in a statute about county duties. It is not a $30,000 credit sitting in your name, and it is not a warning that a bill above $30,000 becomes yours by operation of law. What happens to care beyond the cap depends on the county, the hospital, and the hospital’s own financial assistance policy, which is a separate route with its own rules.

The state fiscal year matters too. The cap resets annually rather than following your treatment, so the timing of a hospital admission can change what the county is on the hook for. Ask the county which fiscal year your case sits in.

Does the county stop helping once it has spent eight percent?

No. The eight percent figure in section 61.037 is a county to state reimbursement trigger, and it works in the resident’s favor rather than against it. The state begins reimbursing a county for eligible health care services once that county has spent “at least eight percent of the county general revenue levy for that year”, and there is an earlier tripwire: the county must notify the department within seven days of reaching “at least six percent” of the applicable levy¹ (checked 30 July 2026).

This is a transfer between two levels of government, not an eligibility rule and not a cap on any individual. Written carelessly, and it frequently is written carelessly, it reads as “the county stops helping at 8%”, which is the opposite of what the section does. If somebody at a county office tells you the county has run out of money for the year, the eight percent provision is the thing to ask about by name, because reaching it is the point at which state assistance starts.

How do you find out what your county actually does?

Call the county and ask for the indigent health care program by name, and if that leads nowhere, dial 2-1-1. 2-1-1 Texas answers from anywhere in the state, or on (877) 541-7905⁵ (checked 30 July 2026), and it is the routing service for exactly this kind of local question. The office is not in the same department from one county to the next, so ask who runs it locally before you ask anything else.

Then ask these, in this order, and write down the answers with the date and the name of the person who gave them:

1. What is the county’s current eligibility standard, as a percent of the federal poverty level, and does it use net or gross income.
2. Which month of income does the application look at, and what proof does it accept.
3. What else do I have to bring: identity, proof of county residence, household composition, resources.
4. How long does the eligibility period run, and when do I have to reapply.
5. Which providers can I use, and where do I take a prescription.
6. How do I contest a decision, and to whom.

That last one is worth asking before you need it. A county decision is not an HHSC decision, so the HHSC fair hearing route does not automatically apply to it; appealing a denial in Texas covers the HHSC process and where the two part company.

What exists alongside the county program?

Three things are available regardless of what the county says, and they are worth lining up in parallel rather than after a refusal.

• A community health center’s sliding fee discount schedule. Every health center funded under the federal Health Center Program must run one, with a full discount at or below 100% of the poverty guidelines unless the center elects a nominal charge, partial discounts in at least three pay classes between 100% and 200%, and no discount above 200%. The operative line is that a center “must operate in a manner such that no patient shall be denied service due to an individual’s inability to pay”⁶ (HRSA page last reviewed November 2025, checked 30 July 2026). The discount applies to the center’s own charges, so labs, imaging, referrals, and prescriptions can be priced separately. Texas had 71 reporting health center organizations serving 1,859,052 patients in 2024, of whom 624,629 (33.60%) were uninsured⁷ (2024 data, checked 30 July 2026). See community health centers in Texas and how the sliding scale works.
• Free and charitable clinics. More than 1,400 operate nationally, and the National Association of Free and Charitable Clinics says patients are “typically within 100% to 300% of the Federal Poverty Level” and that “no one is turned away for an inability to pay”⁸ (checked 30 July 2026). That 300% ceiling is higher than a health center’s 200% cut off, which is why a free clinic is the next call after a health center says no: free and charitable clinics.
• The emergency room, on EMTALA’s terms. A Medicare-participating hospital that offers emergency services must provide a medical screening examination and stabilizing treatment “regardless of an individual’s ability to pay”⁹ (CMS page last modified 10 March 2026, checked 30 July 2026). All three limits belong in the same breath: it is not free care and a bill follows, it reaches Medicare-participating hospitals with emergency departments rather than clinics or urgent care, and it covers screening and stabilization rather than the ongoing treatment an emergency reveals you need. Go anyway if it is an emergency, and read EMTALA and the emergency room.

And apply to HHSC in parallel. One application at YourTexasBenefits¹⁰ is screened against Medicaid, CHIP, and Healthy Texas Women together, and children in a household often qualify when the adults do not: children aged 6 to 18 reach 133% of the federal poverty level and CHIP 201% on HHSC’s chart effective 1 April 2026¹¹ (checked 30 July 2026). Start at applying through YourTexasBenefits, and if the adults come back denied, the Texas coverage gap explains why reapplying next year with the same income changes nothing.

Why this page cannot tell you what your county does

Because chapter 61 sets a floor and every county sets the rest, and an averaged answer would be wrong almost everywhere. The 21 percent net income floor in section 61.006(b), the three drugs a month in section 61.028, and the 30 day or $30,000 cap in section 61.035 are statutory minimums read from the Health and Safety Code and stamped 30 July 2026¹. None of them is your county’s standard, and this site publishes no county by county table, because a table that is out of date in one county sends somebody to be turned away and a table that is wrong in the strict direction stops somebody applying for help they would have received.

The dollar illustrations here move every January, when the federal poverty guidelines are reissued and every percentage on this site is recalculated against them. The section numbers move only when the Legislature moves them. When you call your county, the answer you get is the current one, and it is the only one that decides your case.

Texas Care Map is an independent publisher. We are not part of the State of Texas, the Texas Health and Human Services Commission, the Texas Department of Insurance, or the Centers for Medicare and Medicaid Services, we do not administer any county’s program, and we cannot approve anyone for anything.