Tomball - Magnolia Edition | September 2022

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Montgomery County Public Notice | Health Care Assistance Program (HCAP) All residents of Montgomery County who fall within the maximum income, resource, residency, citizenship, and household composition criteria established in the Montgomery County Indigent Care Program (MCICP) and Medical Assistance Program (MAP) Handbooks*, and who have no other equivalent public or private health care benefits, may be eligible for medically necessary health care benefits as mandated by the State of Texas pursuant to the programs and services offered by the Montgomery County Hospital District (MCHD).

Potentially eligible residents may include: • US Citizens or Legal Permanent Residents 18 years of age or older; • Those whose household composition makes them ineligible for Medicaid through the State of Texas; • Adult males, non-pregnant females without minor children; married couples of either gender or any age who reside in Montgomery County; • Those whose countable gross income minus work deductions does not exceed the maximum established Federal Poverty Income Level (FPIL) of 150% FPIL; and • Those whose resource standards approximate the State of Texas’ TANF standards. Eligibility determinations will be made within 14 (fourteen) days after the date a complete application and all the required documentation is received by MCHD’s HCAP office.

A complete application will include but may not be limited to the following types of verification: • Identification for each member of the applying household; • Proof of marital status; • Resources identification, to include automobile registration or title, property tax statement, savings account/CD statements, etc.; • Proof of income or lack of income to include verification of support by friends, family or other sources, pay stubs, Supplemental Nutrition Assistance Program (SNAP/food stamp) award printout, self-employment records, etc.; • Proof of County residency; and • Proof of registration with Texas Workforce Commission (some exemptions may apply).

Applicants must provide all requested information and documentation to receive an eligibility determination. Adverse decisions regarding eligibility can be appealed.

To request an application call (936) 523-5100 - Hablamos español Montgomery County Hospital District - Administration Building | Health Care Assistance Program (HCAP) 1400 South Loop 336 West (First Floor) | Conroe, TX 77304 HCAP Office Hours | Monday –Thursday: 7:30am – 4:30pm | Friday: 7:30am – 11:30am

Applications can be found on the MCHD website at www.mchd-tx.org by clicking on the HCAP tab at the top of the page. MCHD does not discriminate on the basis of age, race, or gender in administering HCAP Plans to eligible residents. *The most recent versions of the MCICP and MAP Handbooks are available online at www.mchd-tx.org

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