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Harris county health system application form 2025

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The document provides detailed instructions on how to apply for the Harris Health Financial Assistance Program, which is free of charge. It outlines the application process, required documentation, and eligibility criteria for individuals and families seeking financial assistance for healthcare services. The document emphasizes that the program is not an insurance plan and includes information on additional support programs available through Harris Health.

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Click ‘Get Form’ to open the Harris County Health System Application for Financial Assistance in the editor.
Begin by entering your personal information, including your name, maiden name, home address, and contact details. Ensure accuracy as this information is crucial for processing your application.
Indicate your marital status and list all household members along with their details such as names, relationships, dates of birth, and social security numbers. This section helps establish eligibility based on family size.
Provide information regarding your household income. List each member's source of income and how often they receive it. This is essential for determining financial assistance eligibility.
Complete the health insurance section by indicating whether you or any household member has health coverage. If applicable, provide the insurance company name and member number.
Finally, ensure that you and all required signatories (spouse and children aged 18-26) sign and date the form before submission to validate the application.

Start filling out your Harris County Health System application form today using our platform for a seamless experience!

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (160 Votes)
2020	4.3 Satisfied (160 Votes)
2019	4.2 Satisfied (54 Votes)
2018	4.3 Satisfied (114 Votes)
2016	4.4 Satisfied (568 Votes)
2012	4.4 Satisfied (276 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is Harris Health System a Texas state agency?

Harris Health System was created by the State of Texas in 1966 to provide healthcare to the underserved residents of Harris County. Today, as the largest medical provider for Houstons uninsured, Harris Health is stretched beyond capacity 365 days a year.

Who is eligible for the Harris County Guaranteed Income Program?

Eligibility. Eligible applicants must: Be 18 or older. Have a household income at or below 200% of the federal poverty line (FPL).

Is Harris Health System part of Harris County?

Harris Health System is the public healthcare system providing primary, specialty and hospital care to the residents of Harris County, Texas, the third most populous county in the United States with a population of nearly four million people.

What is the Harris County low income program?

Uplift Harris will provide low-income families and households with direct, unconditional financial support to meet their households basic needs like rent, groceries, transportation, housing and utilities, and health care.

Who qualifies for the Harris County Relief Fund?

To qualify for the program, applicants had to meet the following eligibility requirements: Located within Harris County. Registered business operating in Harris County. Must have 30 or fewer employees (including part-time, contractors, full-time employees and owners)

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What is the $500 a month program in Harris County?

Program Overview In response, Harris County is investing $20.5 million from the American Rescue Plan Act (ARPA) to address economic inequity and reduce poverty. Uplift Harris, the countys first guaranteed income program, will distribute $500 per month for 18 months to eligible households.

What is considered low-income in Harris County?

Low-Income Determination Low-income households are those earning less than 80% of area median income.

How to check Harris County Gold Card application status?

Harris Health Financial Assistance Program or the status of my application, is there a phone number to call? For questions call 713-566-6509 (Monday Friday, 8am 4pm) to speak to the Eligibility Call Center team member for any questions regarding the Harris Health Financial Assistance Program.