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BY MAIL

PO Box 17848,
Austin, TX 78760

PHYSICAL ADDRESS

6800 Burleson Road,
Building 310,
Suite 165
Austin, TX 78760

TEL: (512) 916-6062
TOLL FREE:
888-622-9111
FAX:
(512) 916-6042
EMail: aaacap@capcog.org

TRAVIS COUNTY MEDICAL ASSISTANCE PROGRAM
header

GUIDE TO SERVICES

Community Health Centers

The Community Health Center system is the family doctor for over 45,000 children and adults in Austin and Travis County. The Community Health Centers (CHCs) provide outpatient primary healthcare, dental, behavioral health, and HIV/AIDS treatment services.

Fourteen CHC locations serve Travis County residents whose low incomes and lack of private health insurance qualify them for enrollment. More than 92 percent of CHC patients have incomes below the federal poverty level of $18,400 per year for a family of four.

What is an FQHC?

Federally Qualified Health Centers (FQHCs) such as Austin’s Community Health Centers represent a vital safety net in the nation’s health delivery system. A growing nationwide network of 1,000 FQHCs serves twelve million people. FQHCs are the family doctor to one of every nine uninsured persons and one of every five low-income children. Congress created the FQHC program to support primary healthcare providers who serve disproportionate numbers of uninsured residents and operate in medically underserved neighborhoods or communities. To be certified as an FQHC, a provider must meet strict requirements regarding the scope of services offered, access provided to low-income patients, and community governance.

Responding to Increased Healthcare Demand

Travis County has an estimated 200,000 uninsured residents or almost 25 percent of its population. Research indicates that many of these residents have great difficulty in accessing basic primary and preventive healthcare. For example, a 2002 study found that local safety net primary care providers, including the CHCs, consistently operate at more than 100 percent of their capacity. It also found that some private non-profit providers must turn away large numbers of patients every month due to overwhelming demand.

The CHC system plays a leading role in our community’s healthcare safety net. It is the medical home to about one-half of local safety net primary care patients. By way of comparison, the system serves more than twice the number of patients served by private non-profit providers such as People’s Community Clinic or SETON’s primary care clinic system. As the largest volume provider, the CHCs have worked diligently to respond to increasing community-wide demand. By increasing efficiency, they increased total medical visits by 14 percent with only a four percent increase in the number of physicians and nurse practitioners in 2002. So far in 2003, the system has applied for over $1.4 million in federal grants to hire additional medical and support staff. Federal grant dollars would substantially increase the number of patients who can be served at existing CHC locations.

CHC Eligibility

The Community Health Centers (CHCs) serve Austin and Travis County. An individual must be a resident of Travis County to be enrolled as a patient.

Services are provided regardless of the patient’s ability to pay. We serve patients who are enrolled in the following health benefits programs: Medicaid, Medicare, CHIP, and Austin/Travis County Medical Assistance Program (MAP). We also serve patients who do not qualify for any of these programs and pay for services according to a sliding discount, based on their income.

To enroll as a CHC patient, an individual must undergo screening to determine whether he or she is eligible for any of the health benefits programs listed above. This screening is performed at Austin/Travis County Eligibility offices. For information on accessing MAP eligibility screening services and income guidelines, please consult the MAP webpage.

If the eligibility screening determines that an individual’s income is too high for these programs, the agent will determine if the individual is eligible for the CHC sliding discount.

CHC Services

The CHC system is comprised of 13 healthcare delivery sites. The system provides eligible patients with comprehensive primary care and dental services. Medical care is available at 11 of these sites and dental care at three. For more information, please consult individual CHC locations or call Central Scheduling at 972-4278.

  • Gynecology
  • Confidential HIV testing
  • Pap smears
  • Pregnancy testing
  • Ultrasound examinations
  • Prenatal care
  • Diagnostic studies
  • Immunizations
  • Newborn/infant care
  • Growth/development screening
  • Lead levels/anemia screening
  • Vision and hearing screening
  • Care for chronic/acute illnesses
  • Treatment for illness/injury
  • Laboratory/x-ray services
  • Physical examinations
  • Specialty care referral
  • Behavioral health counseling
  • Routine and emergency dental exams
  • Teeth cleaning
  • Dental fillings
  • Dental extractions
  • Limited root canal treatments
  • Dentures
  • Dental sealants
  • Extended hours based on need
  • Prescription Refill Service
  • Patient Satisfaction Line
  • Appointment Reminder Service
  • Radiology
  • After-hours telephone assistance
  • Nutrition counseling
  • Reach Out and Read pediatric literacy program
  • And more

CHC Appointments

New patients: Please call Central Scheduling and Triage at 972-4278.

Established patients should contact their clinic home to schedule an appointment.

Medical Assistance Program--MAP

Administrative Offices
1111 E. Cesar Chavez
Phone: 972-5210

What is the Medical Assistance Program (MAP)?
The Medical Assistance Program (MAP) provides access to health care through networks of established providers for those City of Austin and Travis County residents who meet eligibility criteria. Some services require a co-payment.

Who may qualify for MAP?

  • City of Austin residents with family incomes at or below 100% of the Federal Poverty Index Guidelines, (FPIG) and who meet asset guidelines. (If they have Medicaid, they will not qualify for MAP.) City of Austin residents who reside outside of Travis County do not qualify for MAP. Williamson County residents must contact: Williamson County and Cities Health District at 248-3252. The Contact person is Bride Roberts.

  • Travis County residents with family incomes at or below 100% of the Federal Poverty Index Guidelines, and who meet asset guidelines. (If they have Medicaid, they may qualify for limited MAP benefits.)

  • Disabled or elderly individuals, if their income is at or below 200% of the Federal Poverty Index Guidelines, and if they meet asset guidelines. (If they live in the City of Austin and have Medicaid, they will not qualify for MAP. If they live outside the City of Austin and in Travis County, they may qualify for limited MAP benefits).

  • Residents who receive Medicare and meet the income and asset guidelines. (They may qualify for limited MAP benefits.)

What if I don't qualify for MAP?
Austin/Travis County residents who do not qualify for MAP and do not have other funding may be placed on the Austin/Travis County Community Health Center (CHC) sliding-fee scale. They can receive medical and prescription services at the Austin/Travis County Community Health Centers, on a sliding-fee basis. (City of Austin residents also can receive emergency dental services at a City dental clinic, on a sliding-fee basis.) These services require a co-payment, based on where on the sliding-fee scale the client's household income falls.

The reduced-fee scale, like the MAP income guidelines, is based on the FPIG. A resident's income may fall within the following percent pay range:

  • 0% (small co-payment required),
  • 25% (required co-payment of 25% of the total fees),
  • 50% (required co-payment of 50% of the total fees),
  • 75% (required co-payment of 75% of the total fees), or
  • 100% (resident is required to pay the total bill).

What if I am interested in family planning or maternity services?

Title V benefits are those maternity services delivered at the Austin/Travis County Community Health Centers. Those eligible for Title V services are female Travis County residents whose income is at or below 185 percent FPIG and who are not eligible for Medicaid. Title V services are free at the Community Health Centers, as long as Title V funding is available. If no funding is available, a co-payment is required.

Title XX benefits are those family planning services (including pregnancy testing, birth control, gynecological exams and miscellaneous gynecological procedures) delivered at the Community Health Centers. Those eligible for Title XX services are female Austin/Travis County residents whose income is at or below 150% FPIG. Title XX services are free at the Community Health Centers, as long as Title XX funding is available. If no funding is available, a co-payment is required.

How do I apply for medical assistance?

City of Austin residents should contact a city eligibility office listed below for an eligibility appointment. All sites are closed on the third Thursday of each month from 8 a.m. until 1 p.m., and the fifth Friday of each month until 9:30 a.m.

Cesar Chavez, 972-5300
1111 E. Cesar Chavez (Located at E. Cesar Chavez and Waller Streets)
Capital Metro Routes: #17 Johnston, #21 Exposition, #22 Chicon

Northeast Austin Health Center, 972-5300

South Austin Neighborhood Center, 972-5300

Travis County residents should contact a Travis County eligibility office listed below. All sites are closed on the third Thursday of each month from 8 a.m. until 1 p.m. Please call each office for hours of operation.

Del Valle Community Health Center, 247-4407

Manor Community Health Center, 272-5561

Oak Hill Community Health Center, 854-2130

Pflugerville Community Health Center, 251-4168

Jonestown Community Health Center, 267-3245

For women's health and family planning services, no income or residency documentation is required. For MAP or CHC sliding-fee scale certification, bring the following documents to your interview (the Eligibility Offices above can advise acceptable alternate documents to determine eligibility, if you do not have the listed documents):

  • Birth certificate or U.S. passport
  • Texas driver's license/photo ID
  • Current utility bill (except homeless)
  • Proof of income for past four weeks
  • Medicare, Medicaid or other insurance card/letter (if applicable)
  • Social Security card
  • Lease agreement/rent receipt
  • Bank statement (if applicable)
  • Tax receipt or property appraisal (if applicable)
  • Proof of alien sponsor's income (if applicable)

Other Helpful Phone Numbers
Patient Services, 972-5272
MAP Medical/Claims Management, 972-5210
Hearing Impaired/Relay Texas Voice, 1-800/735-2988
TDD, 1-800/735-2989

Download CHC/MAP Guide to Services

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AUSTIN/TRAVIS COUNTY HEALTH and HUMAN SERVICES DEPARTMENT
MANAGED SERVICES DIVISION, MEMBER SERVICES UNIT

Conducts Eligibility Screening and Certification for:


Sample Copy of "WELCOME TO THE MEDICAL ASSISTANCE PROGRAM" Letter

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MEDICAL ASSISTANCE PROGRAM (MAP)

Benefits MAP may provide

  • Physician Services
  • Hospital Care
  • Outpatient services, including Specialty care
  • X-rays and laboratory services
  • Emergency care
  • Home health care
  • Durable medical equipment
  • Prescription drugs
  • Dental services
  • Emergency Transportation

Who is MAP eligible

  • Austin/Travis County Residents
  • Gross Monthly Income at a percentage of the Federal Poverty Level
  • Based on Family Size, Assets Level ranges from $5000 to $10000

MAP Eligibility Criteria

  • Residency
  • Income
  • Resource/Assets

Residency

  • Applicants must have the intent to reside in Austin/Travis County

Income

  • Verification of earned and unearned income is required for the 4 weeks prior to the interview.
  • Applicants qualify at or below 100% of the FPIG
  • Applicants who are disabled and/or elderly (67 yrs. or older) qualify at or below 200% FPIG

Assets/Resources

  • Household assets must be at or less than the allowable limit
Family sizeAsset Limit
01$5,000
02$6,000
03$7,000
04$8,000
05$9,000
06+$10,000

Length of Issuance

  • Varies from 1 month to 2 years, is based on household composition, source of income, and potential eligibility for a 3rd party payor source (e.g.Medicaid, Medicare)

MAP is administered by the Community Care Services Department (CCSD) ofthe City of Austin. www.ci.austin.tx.us/health/healthcare_portal

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COMMUNITY HEALTH CENTER (CHC) SLIDING-FEE SCALE

What is "CHC Self-Pay?"

  • "CHC Self-Pay" allows access to services in the City/County CHC's on a sliding-fee scale basis. The fee is determined by income and family size. The scale ranges from 0% to 100% pay for medical, pharmacy, and emergency dental services.
Percent (%) Pay Payment
0% $8.00 co-pay
25%25% of bill
50%50% of bill
75%75% of bill
100%100% of bill
  • Note: Individuals at 0% Pay are charged a $5.00 co-pay for their prescriptions.

Who is eligible for Self-Pay Categories?

  • Austin/Travis County Residents
  • Persons who do not qualify for MAP (except those with active Visa's classes A-M)
  • Persons who are referred to Medicaid, but do not have Medicaid

CHC Self-Pay applies to:

  • Medical services at Community Health Centers
  • Prescriptions filled at a Community Health Center Pharmacy (limited to prescriptions written by a CHC physician)
  • Emergency Dental Care at a Community Health Center Dental Clinic (City residents only)

CHC Financial Eligibility Criteria:

  • Residency - Must reside in Austin/Travis County
  • Income - Last 4 weeks of income
  • Resources/Assets are NOT used to determine slifing fee scale

Length of Issuance:

  • Varies from five (5) days to six (6) months

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WOMEN'S HEALTH SERVICES' GRANTS TITLE V and TITLE XX

What is Title V?

  • Title V is a grant that reimburses the Community Health Centers for maternity services.

What type of services does Title V cover?

  • Prenatal
    • Ultrasound
    • Stress Test

What is Title XX?

  • Title XX is a grant that reimburses the Community Health Centers for family planning services.

What type of services does Title V cover?

  • Pregnancy Test
  • Birth Control
  • Annual Gynecology Exam
  • Miscellaneous Gynecological Procedures

Title V and XX Grant Criteria:

  • Residency - Must reside in Texas
  • Income - Last 4 weeks of income
  • Not Medicaid eligible (Title V only)
  • Assets/Resources are NOT used to determine Title V/XX elgibility

Note: Verbal declaration is acceptable for all Grant services.

Length of Issuance

  • One year of coverage is given to clients who qualify for Title V or Title XX.

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Medical Assistance Program (MAP) (espanol)

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med asst. program, espanol


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Questions/comments concerning this page,
EMail: austexal@austin.rr.com