Application

An application packet is available from 8am until 5pm, Monday thru Friday at the Public Health Clinic in Bay City and at Palacios Community Medical Center in Palacios or by clicking on the application tab. Assistance in completing the application will be provided as needed.

Applicant must provide all information and documentation which is requested and the application must be completely filled out, signed and dated. Verification of income, residence, household composition and resources are required.

We will process your application within 14 days of when all the required information is received. We will determine your eligibility for one of the programs and notify you either in person or by mail. Applicants have the right to appeal denials.

Matagorda County Hospital District
Medical Assistance Program (MAP)

To the Applicant:
To apply or renew for medical assistance, please use the attached Instructions for Applicants.

Please make sure that you complete the entire application and that you submit all of the necessary documents with the application to the MAP office located at The Public Health Clinic at 1100 Avenue G, Bay City.

Palacios residents contact Palacios Community Medical Center at 361-972-2511

Thank you,
Lydia Dominguez
MAP Coordinator

If you have questions or need more information Please call (979) 244-8136

MAP
ANY FALSIFICATION or OMISSION of PERSONAL or FINANCIAL INFORMATION or RECORDS WILL RESULT IN LOSS OF MAP BENEFITS. YOU WILL BE HELD RESPONSIBLE for REPAYMENT OF THOSE BENEFITS TO MATAGORDA COUNTY HOSPITAL DISTRICT.

Instructions for Applicants

1. Read carefully and complete the entire application.
2. Sign and date the application. (page 3)
3. You must submit copies of all the following documents with your application: YOU WILL BE NOTIFIED BY MAIL. CHECK BOXES TO HELP ENSURE THAT YOU SUBMIT ALL THE ITEMS THAT APPLY TO YOU:
   • Driver’s license/State Identification AND Birth Certificate
   • Social Security Cards for all household members AND Birth Certificates (if SS# not available)
   • Social Security Disability Insurance (SSDI) and or (SSI)
   • If you are disabled, you must apply for Disability Benefits (bring any paperwork)
   • Workers compensation statement; payment from Pension Plan
   • Last month’s paycheck stubs or letter from employer stating your gross pay
   • Last years Income tax return – if Self Employed include Schedule C (deductions)
   • Current and previous bank statement
   • Child support income Documentation
   • Utility bill with name and address of the household member or person you are living with.
   • Vehicle insurance card (make and model of vehicle)
   • Medicaid Award letter (approval-denial) for children; Any Health Insurance Cards coverage
   • Food Stamp status-approval or denial letter (is REQUIRED)
   • If you are unemployed, you must show registration with The Work Source (PRINT OUT); Unemployment checks stubs or award letter
   • Written statement from whomever is providing or assisting you with name, address amp; phone (Please Specify i.e.: pay bills, money, gifts, providing a place to stay.)

   ** More information may be requested in order to process your application.

   NOTE: Failure to provide ALL of these items WILL DELAY your application and could cause you to be DISQUALIFIED.

4. When all the information is received, we will process your application. You will receive a notice by mail or you may call to schedule appointment at 979-244-8136.

The Medical Assistance Program is offered as a service of Matagorda County Hospital District for qualified citizens who reside in Matagorda County, and is based on criteria established by the District. This program is subject to change at the sole discretion of Matagorda County Hospital District.