Accessing quality medical care is crucial for everyone, and Harris Health System offers various programs to support residents in need. To successfully apply for these vital medical care programs and potentially receive your Medical Care Program Card, it’s essential to understand and prepare the necessary documentation. This guide outlines the documents required for your application, ensuring a smoother and more efficient process.
Essential Identification Documents for Your Application
Providing proper identification is the first step in your Harris Health application. This section details the identification documents needed for you and your spouse, if applicable.
Identification for You and Your Spouse
If you are married, you will need to provide proof of your marital status. Acceptable documents include:
- Marriage License/IRS 1040: If formally married, a marriage license or your most recent IRS 1040 form (if filed jointly) can serve as proof.
- Declaration and Registration of Informal Marriage: For common law marriages, a Declaration and Registration of Informal Marriage is required.
- Other Proof of Marriage: Alternative forms of marriage proof may be considered; please check with Harris Health for specifics.
For those declaring common law marriage:
- DSHS Form VS-180.1: If you possess the DSHS Form VS-180.1, this will be accepted as marriage verification.
- THHSC Form H1057: If you do not have the DSHS Form VS-180.1, download and print THHSC Form H1057. Both partners must date and sign this form.
Picture Identification Requirements
You must also provide a copy of one photo identification document. Acceptable forms include:
- State-issued Driver’s License
- State-issued ID Card
- Current Student ID
- Current Employee Job Badge
- Passport with Picture
- U.S. Immigration Documents
- Foreign Consulate ID Card
- Agency Letter (from a recognized agency)
- Current Enhanced Public Library Photo ID Card
- National Electoral Institute (INE) Photo ID Card
Non-Picture Identification Options
If you lack photo identification, you can submit copies of two of the following documents:
- Birth Certificate (Married women can use their maiden name birth certificate with a marriage license or child’s birth certificate showing their maiden name)
- Marriage License or Declaration and Registration of Informal Marriage
- Social Security Card
- Other Federal Document showing your name and Harris County address
- Hospital or Birth Records
- Adoption Papers or Records
- Current Harris County Voter Card
- Current Check Stub
- Medicare Card or Medicaid Card
Proof of Address: Confirming Your Harris County Residency
To be eligible for Harris Health programs, you must demonstrate residency in Harris County. You will need to provide proof of address dated within a specific timeframe.
Address Verification Documents (Dated Within 60 Days)
Submit a copy of one of the following documents dated within the last 60 days:
- Utility Bill (gas, water, electricity, etc.)
- Check Stub
- School Record for children under 18 years old
- Mortgage Coupon
- Credit Card Statement
- Certification Documents or Benefit Checks from Social Security Administration
- Certification Documents or Benefit Checks from Texas Workforce Commission
- Certification Documents from Supplemental Nutrition Assistance Program (SNAP), or SNAP Form TF0001
- Letter from Agency or Harris Health System Agency Letter
- Medicaid or Medicare Letter
- Letter from Recognized Social Services Agency
- Business Mail (official business correspondence)
- Statement from a Licensed Child Care Provider
- Harris Health System Residence Verification Form (English, Spanish, Vietnamese) completed by a non-related person not living in your household.
Address Verification Documents (Dated Within One Year)
Alternatively, you can submit a copy of one of these documents dated within the last year:
- Lease Agreement
- Department of Motor Vehicles Record
- Property Tax Document
- Automobile Insurance Documents
- Automobile Registration
- Harris County Voter Card
- Printout from IRS of most current year’s tax filing
Verifying Gross Income for Eligibility Assessment
Income verification is a critical component of the application process for Harris Health’s medical care programs. You need to provide documentation of gross income for yourself, your spouse, and any children over 18 living with you. Important: Every household member over 18 must sign and date the application to authorize Harris Health to verify TWC (Texas Workforce Commission) information.
Acceptable documents for income verification include:
- Cash Income, Dividends, and Royalties Documentation
- Rental Property Income Documentation
- Alimony Records
- Workmen’s Compensation Records
- Military Pay and Allowances Statements
- Current Check Stubs
- Child Support Documents
- Current IRS 1040/1040A Tax Return (all pages) if self-employed
- Harris Health System Statement of Self Employment Income Form (English, Spanish, Vietnamese) if no tax return is filed.
- Harris Health System Wage Verification Form (English, Spanish, Vietnamese) (for cash and personal check wages only)
- Social Security Award Letter
- Retirement Award Letter
- Veteran Affairs Letter or Check
- Agency Letter (confirming income details)
- Income information on SNAP form TF0001
- Unemployment Benefit Records
- Harris Health System Statement of Support Form (English, Spanish, Vietnamese) if you have no income.
Proof of Relationship to Dependent Children
If you are applying for medical care programs and have dependent children living with you, you must provide documentation verifying your relationship to them. Acceptable documents include:
- Birth Certificate
- Baptismal Record
- Proof of Full-Time School Enrollment for students aged 18 to 26
- Social Security Award Letter with dependents’ names
- School Documents or Insurance Documents showing names of both parent and child
- U.S. Immigration Applications with dependents’ names
- Divorce Decree or Child Support Documents
- Baby’s Popras Form
- Birth Fact Record or Hospital Armband for infants less than 90 days old
- Death Certificate for previous household members (if applicable, to explain household composition)
- U.S. Department of Health and Human Services – Office of Refugee Resettlement-Verification of Release Form (ORR UAC/R-1) for Unaccompanied Alien Child (if applicable).
Immigration Status Documentation
Providing documentation of immigration status is required for yourself, your spouse, and all dependent children. You must present current or expired documents from the U.S. Citizenship and Immigration Services (USCIS).
Health Care Coverage Verification
You must provide proof of any existing health care coverage for yourself, your spouse, and all dependent children. Acceptable proof includes current documentation for:
- Medicaid
- CHIP (Children’s Health Insurance Program)
- CHIP Perinatal
- Medicare
- Private Health Insurance
Medicare Asset Form Requirement
If you are a Medicare beneficiary and are potentially eligible for Harris Health System Financial Assistance Program, you must complete a Medicare Asset Form. You will also need to provide documentation of your current resources and liabilities, including:
- All pages of Bank Statements
- Credit Card Bills
- Loan Documents
- etc.
Relevant Medicare Asset Forms:
Program Application Paperwork
As part of the Harris Health application process, you may be required to complete paperwork for other programs for which you might be eligible. These programs can include:
- CHIP
- CHIP Perinatal
- Medicaid
- Health Insurance Marketplace programs
- TANF (Temporary Assistance for Needy Families)
- SSI (Supplemental Security Income)
- Title V programs
- Healthy Texas Women Program (HTWP)
By carefully preparing these documents, you can streamline your application for Harris Health medical care programs and take a significant step towards obtaining your medical care program card, ensuring access to the healthcare services you need. Remember to gather all necessary documents and double-check the Harris Health website or contact them directly for the most up-to-date requirements and any specific questions related to your application.
