A few miles can change the kind of help a family receives. In North Texas, county lines decide which office takes a medical assistance application. They also decide which hospital system offers financial help and which transit agency provides a ride.
Seagoville shows how this works. The city sits mostly in Dallas County, but a small portion extends into Kaufman County. Two neighbors on the same street could face different rules.
How Texas Sets the Floor
Texas law makes counties responsible for basic health care for low income residents who have no other options. That duty applies to counties not fully served by a public hospital or hospital district. The state sets minimum standards, and counties may be less restrictive than those standards but not more restrictive.
Under the state program, a person generally must have income at or below 21 percent of federal poverty guidelines. Countable resources must fall under $2,000, and the person cannot be eligible for Medicaid. The county serves as the payor of last resort, which means other coverage comes first.
To apply, residents contact the program in their own county. Dialing 2-1-1 can help locate the right office.
Kaufman County’s Program
The Kaufman County Indigent Health Care Program serves residents who do not qualify for other state or federal programs. Applicants must live in Kaufman County and intend to stay. Monthly net income cannot exceed 21 percent of federal poverty guidelines.
Resources cannot exceed $2,000 for most households. The limit rises to $3,000 when an aged or disabled person who meets the relationship requirements lives in the home. Applicants must also show a medical necessity for the services they seek.
Covered basic care includes physician services, annual physical examinations and immunizations. It also includes medical screenings, inpatient and outpatient hospital services, rural health clinics, laboratory and x-ray work, and prescriptions. Diabetic supplies and equipment are listed as an optional service.
For residents of Crandall, Combine and other Kaufman County communities, this county program is the local pathway.
What Neighboring Counties Offer
Rockwall County runs its own program under the same state law. The county says it pays for medically necessary care for people who meet income, resource, residency and household rules. Applicants must also be ineligible for Texas Medicaid. They must live in Rockwall County and intend to remain there.
Ellis County uses nearly the same criteria as Kaufman County. Its income limit is 21 percent of federal poverty guidelines, and resources cannot exceed $2,000. That limit rises to $3,000 for a household with an aged or disabled member. The county’s page points clients to Hope Clinic for basic medical attention.
County officials have also described a contract with Hope Health. They say it allows clients to receive basic health care, dental services, women’s health care and behavioral health services. The Ellis County program is administered in house.
Henderson County operates an indigent health office in Athens. The county describes the program as basic medical services for residents who cannot get coverage elsewhere. Eligibility depends on income and resources. Residents are asked to call or email for an appointment, and the office number is 903-677-6372.
Dallas County Takes a Different Route
Dallas County residents are served through Parkland Health’s financial assistance program. Parkland describes it as help paying for medical services at a Parkland location. The program is not health insurance.
The income door is much wider than in Kaufman County. People with income below 250 percent of the federal poverty level may apply. Applicants must provide proof that they live in Dallas County and proof of income.
Parkland financial counselors work at clinics throughout the county. Before enrolling someone, they first look for grants or other state and federal programs that may fit. Renewals can be handled through Parkland’s MyChart portal or by mail.
The program covers care at Parkland facilities, including hospitals, clinics and ambulatory surgery centers. Services include hospital care, emergency room visits, preventive care and medically necessary outpatient services. A resident of Kaufman County who needs the same help must go through the county program instead.
Transportation Depends on the Map Too
Transportation also follows the county line. STAR Transit has served Kaufman County as a rural transit district since 1988. Its service area includes Kaufman County and Rockwall County. It also includes Mesquite, Balch Springs, Seagoville, Hutchins, DeSoto, Cedar Hill and Duncanville.
STAR Transit says anyone living in its service area may ride. It added Seagoville in 2013. Its on demand STARNow service operates in Terrell, Kaufman, Mesquite, Cedar Hill, Duncanville, Balch Springs, DeSoto, Seagoville and Forney.
The agency also provides human service transportation under contracts with local programs. That work reaches Dallas County as well as its home territory.
Dallas Area Rapid Transit follows federal Americans with Disabilities Act standards for paratransit eligibility. Applicants complete an in person assessment with an eligibility specialist. DART does not offer same day paratransit service.
DART offers reduced fares to riders age 65 and older and to riders with a disability. Paratransit eligible riders with a valid ID ride free on GoLink. The DART certification office can be reached at 214-828-6717.
Where the County Line Does Not Matter
Medicaid transportation is the exception. The Medical Transportation Program is run statewide by the Texas Health and Human Services Commission. It provides rides to the doctor, dentist, hospital and drugstore for Medicaid enrollees who have no other means of transportation.
Riders must request routine trips at least two working days ahead. Long distance trips and nonemergency ambulance transport require five working days. The program can also pay mileage to a relative, friend or neighbor who enrolls as an individual transportation participant.
A separate state program covers transportation for indigent cancer patients. Eligibility for that program is determined by the state, not by the county.
What Residents Should Do First
Residents should start by confirming which county they live in. That is not always obvious in cities that cross a county line. The answer decides which office to call and which paperwork to bring.
Applicants should gather proof of residency, income and household size before calling. Anyone already on Medicaid should ask about Medicaid transportation first. Rules and income thresholds can change, so residents should confirm details with the county office or program before applying.
The same need can lead to a different door depending on the address. Knowing which door to knock on can save weeks of delay.
