Items you will need
- Income documentation
- Citizenship documents
- Utility bill
- Lease agreement
- Birth certificates
- Insurance cards
The Harris County Hospital District in Houston offers financial assistance for medical care to low income individuals and families. If eligible, applicants receive a discount gold card to cover medical services at county clinics and hospitals at minimal to no cost.
Print the two-page application from the Harris County Hospital District website. The first page is the application instruction form, which outlines all documentation needed to apply for a Gold Card.
Fill out each section on the second page of the application. You must provide information regarding income, legal status and health coverage for yourself, as well as all members of your household.
Mail the completed application and eligibility documents to : HCHD Financial Assistance Program c/o Patient Eligibility Services Administration P.O. Box 300488 Houston, TX 77230
If unable to print and complete the online application, call the Harris County Hospital District at 713-566-6509 to request help in applying for a Gold Card.
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