Free application help

Texas Medicaid application form

Name: Community Health Access Hub Texas
Address: 711 Mudd Street, Coldspring, TX, 77331, US
Telephone: +1-678-789-6953
Price range: Free

Fill in one page and we'll email your details to a community navigator — plus give you a printable worksheet to take with you when you apply.

Free and confidential. Please leave out Social Security numbers and medical records — your navigator will collect anything else that's needed. Texas Health Help is a community nonprofit, so this is a request for help and a printable worksheet, not an official state application.

Let's check if you likely qualify

Estimated due date

Weeks pregnant

Household size *

Count yourself, your baby, and anyone you file taxes with.

Income before taxes

How often

County *

Health coverage right now

Citizenship / immigration status

We ask so we can point you to the right program. You never have to answer.

How we reach you

Full name *

Date of birth

Email *

Phone

Street address

City

ZIP code

Employer (if any)

Preferred language

Best time to reach you

Documents you'll need

Check off what you already have. Don't upload anything here — just tick the boxes so your navigator knows what's still missing.

Photo IDProof of pregnancy with a due dateProof of Texas residency (lease, utility bill, mail)Last 30 days of pay stubs or an employer letterTax return or profit-and-loss (if self-employed)Immigration or citizenship documents (if they apply)

Still to gather: Photo ID, Proof of pregnancy with a due date, Proof of Texas residency (lease, utility bill, mail), Last 30 days of pay stubs or an employer letter, Tax return or profit-and-loss (if self-employed), Immigration or citizenship documents (if they apply). You can start your application without them and send them later.

Anything else we should know?

Check and send

Name: —
Email: —
Phone: —
County: —
City / ZIP: —
Due date: —
Household size: —
Income: —
Coverage now: —
Documents ready: None yet

Please don't include Social Security numbers or medical records here. Texas Health Help is a nonprofit, not a government agency — this form requests free help and creates a printable worksheet. It is not an official Medicaid application.

Would you rather go step by step?

The pregnancy Medicaid guide has the same form as a short four-step walkthrough with an income check.

Need help now? Call 832-937-9655 or dial 2-1-1 (option 2).