Charity Care and Indigent Care are initiatives designed to help low-income Texas residents access healthcare services. In both programs, the beneficiaries must not qualify for other state or federal healthcare programs.
These initiatives pertain to healthcare services provided to patients that aren’t expected to result in cash inflows. Under these programs, providers can be partially reimbursed by government entities.
Although similar, Charity Care and Indigent Care programs present significant differences. Here is a breakdown of their respective characteristics:
Charity Care
Each EMS provider formulates their respective Charity Care Policies. While these policies must adhere to HHSC guidelines, it is the provider’s sole responsibility to establish eligibility criteria. Through a Charity Care program, EMS providers have the authority to waive charges associated with caring for individuals who reasonably cannot pay EMS bills.
EMS providers must submit the policy to Texas Health and Human Services, which will review and approve it. With an approved policy, the Texas Ambulance Supplemental Payment Program (TASPP) can reconcile the cost of incidents that apply to the criteria. Providers must complete an annual Ambulance Cost Report before the end of the federal fiscal year (09/30) to facilitate reimbursement.
Indigent Care
The County Indigent Health Care Program (CIHCP) is an HHSC program with eligibility criteria set by the organization. To qualify for this program, individuals must:
1. Live in Texas.
2. Have an income level at or below 21% of federal poverty guidelines.
3. Have resources less than $2,000.
4. Not be eligible for Medicaid.
Local counties, hospital districts, and public hospitals assume responsibility for administering the program within their respective service area. Indigent Care programs must provide basic healthcare services stipulated by HHSC. Services included are:
- Physician services.
- Annual physical examinations.
- Immunizations.
- Medical screening services (Blood pressure, Blood sugar, and Cholesterol screening).
- Laboratory and X-ray services.
- Family planning services.
- Skilled nursing facility services.
- Prescription drugs.
- Rural health clinic services.
- Inpatient hospital services.
- Outpatient hospital services.
HHSC lists Emergency Medical Services as an optional healthcare service. Therefore, each department’s cost-effectiveness assessment determines whether to include EMS services in the program.
HHSC adheres to a standard reimbursement protocol, utilizing the Fee Schedule for Texas Medicaid Ambulance, accessible at www.tmhp.com.