Eligibility for Health Care Assistance

Please fill out the DSHS Family & Community Health Services Division household eligibility form and bring the following documentation to your interview. Para español, haga clic aquí.

Income Verification – All that apply to you

  • Three consecutive current paycheck stubs, earnings printout, or Employment Verification Form.
  • Letter of Support signed and dated.  
  • Award printout from Unemployment, Social Security, SSI, Workers Compensation, retirement, VA benefits, TANF payments and educational benefits (grants, scholarships).
  • Self-Employment Income: Current IRS Return including all Schedules-C, D, E, etc; or
  • Current Self-Employment Statements - income and expenses. Receipts, invoices, etc.
  • Any other income: from property sales/rental, dividends, interest, royalties, etc.
  • Documentation of legally obligated Child Support payments made, or payments received
  • Receipts for Childcare payments made (or received).

Proof of Residency – Physical Address - One of the Following listed below dated within the past 30 days.

  • Current mail addressed to the applicant
  • Utility bill or rent receipt, dated with the physical address
  • Valid Texas Driver’s License
  • Current Auto Insurance listing physical address

Other Needed Documentation

  • Picture ID (Driver’s License, ID, Residence Card or Passport)
  • Birth Certificates for children and adults with no current ID
  • Court Documents showing Guardianship, CPS placement documents
  • Current voter registration
  • Social Security card
  • Medicaid, Medicare, HTW and CHIP cards
  • Other Private or Group Insurance: VA, Tri-Care, BC/BS, Aetna, etc.
  • Disability Documentation indicating the current status of your SS/SSI claim.
  • Print out or letter showing the date of Medicare eligibility
  • Documentation of Work-Related Injury or Motor Vehicle Accident, if applicable.
    ***These are the basic requirements. Other documents may be requested.

Please have your spouse sign a Statement of Applicants Rights and Responsibilities form and bring everything that applies to your situation.

 

Contact ACCHD
503 Hill Street
Lufkin, TX
(936) 632-1139

HOURS
Monday - Friday
7:30 am - 4:30 pm

Please arrive 45 minutes before closing to ensure time for processing for needed services.
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