This is an Official Government Record. Untrue or Incomplete information given on this form may result in Criminal Action being taken under Sections 31.04, 37.10 or other portions of the Texas Penal Code.
Nueces County Hospital District
APPLICATION FOR ASSISTANCE
The Nueces Aid Program helps people pay for needed medical care. Whether you can get this help depends on your income, what you own, where you live, other help you receive or could receive, and other items.
Assistance in completing this application will be provided to you if needed. Please call (361) 902-4855 for an appointment.
Try to answer as many questions as you can on this application.
Be sure to answer all questions in item 1, General Information, and sign and date the last page of the application.
Upload or mail back your application today, even if you cannot answer all the questions.
You may be asked to bring proof of what you write on your application or tell the person interviewing you. If you need help getting proof, the person interviewing you will help.
Examples of some of the things you may be asked to prove and the things you can use for proof are:
- WHERE YOU LIVE AND PLAN TO CONTINUE LIVING.
Possible Proof: mail that you received at your address, school records, voting records, property tax, rent or mortgage receipts, driver’s license, other official identification, automobile registration.
- YOUR INCOME.
Possible Proof: pay check stubs, pay checks, W-2 tax forms or income tax returns, sales records, statements from employers, award letters, legal documents, statements from persons giving you money.
- WHAT YOU OWN AND WHAT IT IS WORTH.
Possible Proof: property tax appraisals, estimates from car dealers, ads selling similar items, statements from real estate agents, bank statements.
- OTHER HEALTH CARE COVERAGE.
Possible Proof: award or claim letters, insurance policies, court documents, other legal papers.
Information on race and sex is voluntary. Information on Social Security numbers should be given if this information is available. This type of information will not change your eligibility.
You must give information about medical insurance and any other third party financially liable for medical services for yourself and members of your household.
You may be asked to apply for Medicaid, TANF (Temporary Assistance for Needy Families), or SSI (Supplemental Security Income) benefits. If you are asked to apply for one of these programs or have applied but are waiting for an answer, your Nueces Aid application may be held until you are determined ineligible for the other program(s). If you are not eligible for theses other programs, if you have answered all questions on the application, and if you have given all the proof asked for, your application is complete. The Nueces County Hospital District will determine if you are eligible within 14 days from the date you meet these requirements.
After turning in your application, you must report within 14 days any changes in your address, income, resources, people living with you, or application for or receipt of SSI, TANF or Medicaid.
Click here to download the Application for Assistance
Once you have completed the application please upload it here
How to complete the form:
- Download the form: Right-click the orange button:
- Chrome/ Firefox: "Save Link As…"
- Internet Explorer: "Save Target As…"
- Safari users: "Download Linked File as…"
- Chrome/ Firefox: "Save Link As…"
- Locate and open the file you've downloaded
- Click on the file to open it
- You may also right click the file to open it in the PDF editor of choice
- If you do not have a PDF editor you may download a free editor from Adobe by clicking here
- Complete the form
- Once the file is open you may type in the necessary boxes to fill it out
- Save the form
- Once you have finished, click File > Save As and put your name in the filename
- Choose location to save it, such as 'Desktop'
- Click save
- Visit the link above or click here to visit our submission form
Contact us below, or call (361) 902-4855 for assistance.