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Declaration of Domicile Health and Human Services Division Indigent Health Care Client Name:Client DOB:I hereby declare that I reside in and maintain a permanent residence and domicile at:Street and
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Visit the website www.hhstexas.gov/services/health/county-indigent-health-care
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Who needs wwwhhstexasgovserviceshealthcounty indigent health care?

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Low-income individuals and families who cannot afford health insurance
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Uninsured residents of a specific county in Texas who meet the eligibility requirements
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County indigent health care programs provide basic health care services such as doctor visits, medications, hospital care, and other services to qualifying residents of the county.
Residents of the county who are in need of indigent health care services and meet the eligibility criteria are required to file for county indigent health care programs.
To apply for indigent health care services, individuals need to complete an application form provided by the county health department and submit necessary documentation to prove eligibility.
The purpose of county indigent health care programs is to ensure that low-income residents have access to essential health care services that they may not be able to afford otherwise.
Individuals applying for indigent health care services must report their income, assets, household size, and any other relevant information to determine their eligibility for the program.
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