To apply for the Harris Health Gold Card, gather proof of identity, Harris County residency, household income, and any dependents, then submit a completed Harris Health Financial Assistance Program application online through the Verity Source portal, by mail, or in person at a Harris Health eligibility center. A complete file is decided within 14 days, and approval gives you discounted care at Harris Health clinics and hospitals for one year. The Gold Card is a discount program, not insurance, so it only reduces your costs at Harris Health facilities.
Do You Qualify
Two things determine eligibility: you live in Harris County, and your gross household income sits at or below 150 percent of the Federal Poverty Level.1Harris Health System. Patient Eligibility Citizenship is not required, and household members without a Social Security number can still be included. Having limited Medicaid, Medicare, or other coverage does not knock you out either; the program can pick up services your other plan does not cover.2Harris Health System. Harris Health Financial Assistance Program Eligibility Frequently Asked Questions
2026 Income Limits
The 150-percent gross income ceilings for 2026 are:3U.S. Department of Health and Human Services. 2026 Poverty Guidelines
- 1 person: $23,940
- 2 people: $32,460
- 3 people: $40,980
- 4 people: $49,500
Add roughly $8,520 for each additional household member. Gross income is income before taxes or deductions and includes wages, Social Security, child support, unemployment, rental income, and self-employment earnings for every adult in the home.4Harris Health System. Harris Health System Financial Assistance Program Application
Documents to Gather Before You Start
Missing paperwork is the single most common reason applications stall. Harris Health asks for documents in four categories.4Harris Health System. Harris Health System Financial Assistance Program Application
Photo ID
One of: a state driver license or ID card, a U.S. or foreign passport, a foreign consulate ID (such as a Mexican Matrícula Consular), an INE photo ID, a current student ID, or a current employee badge. Without any photo ID, you can substitute two non-photo documents, such as a birth certificate paired with a Social Security card.
Proof of Harris County Residency
The preferred proof is a document dated within the last 60 days that shows your name and a Harris County address, such as a utility bill, check stub, credit card statement, or a Medicaid or Medicare letter. Older documents can work too within specific rules, and if nothing is in your name, ask for a Residence Verification Form so someone unrelated who does not live with you can vouch for your address.
Proof of Income
Provide gross income documentation for the past 30 days for yourself, your spouse, and any adult children ages 18 to 26 who live with you as full-time students. Pay stubs are simplest, but Social Security award letters, unemployment records, child support documents, self-employment tax returns (all pages of the IRS 1040), and retirement or VA benefit letters all count. If you have no income, complete a Harris Health Statement of Support Form naming whoever supports you. For cash or personal-check wages without pay stubs, use the Wage Verification Form.
Proof of Dependent Children
For each child in the household, bring a birth certificate, baptismal record, school enrollment proof (for students 18–26), or a Social Security award letter listing the child. Newborns under 90 days old can be documented with hospital records or a hospital wristband.
Getting the Application and Filling It Out
Two formats are available.
Online
The online application is at ola.veritysource.com/harris. You will need a Harris Health Medical Record Number to upload supporting documents. If you do not have one yet, either visit a Harris Health facility to get one or use the paper form instead.
Paper
You can download the paper form from the Harris Health website or pick it up at any eligibility center or health center. Instructions are printed in English and Spanish.4Harris Health System. Harris Health System Financial Assistance Program Application
Common Mistakes to Avoid
The form asks for names, birth dates, and Social Security numbers for each household member. Leave the SSN blank for anyone who does not have one; that alone will not disqualify you. Most rejections trace back to the income section. Whatever dollar amounts you write must match the pay stubs or other proof you attach. If the numbers do not line up, the file will stall or be denied. Mark clearly whether this is a new application or a renewal, because renewals require less documentation.
Where to Submit
By Mail
Send the completed application with copies (not originals) of all supporting documents to:2Harris Health System. Harris Health Financial Assistance Program Eligibility Frequently Asked Questions
Harris Health Eligibility
P.O. Box 300488
Houston, TX 77230
Use a mailing method with tracking so you can confirm the packet arrived.
In Person
You can drop off a completed application at any Harris Health eligibility or health center across the county, including sites in Houston, Baytown, Katy, Humble, and Pasadena.1Harris Health System. Patient Eligibility Four locations offer fast-track eligibility processing for urgent cases: Acres Home, El Franco Lee, Martin Luther King Jr., and Strawberry. Staff at drop-off desks do not review the file with you on the spot, so make sure it is complete before handing it over.
After You Apply
Processing Time
Harris Health decides a complete application within 14 days.2Harris Health System. Harris Health Financial Assistance Program Eligibility Frequently Asked Questions The clock starts when the file is complete. If something is missing, expect a letter requesting the item, and the timeline resets once you provide it. To check your status, call the Eligibility Call Center at 713-566-6509.
Approval and Enrollment
Approval comes by mail, and by text if you provided a phone number. Enrollment is generally valid for one year and lists an expiration date on the notice.1Harris Health System. Patient Eligibility
Renewal
Reminders go out by text and mail before expiration, and registration staff will flag it at check-in. If nothing has changed since last time (name, address, marital status, household size, insurance), the renewal is short: a new application form plus proof of income for the past 30 days. If you have Medicare, add a Medicare Assets form. Do not let your enrollment lapse. A gap means you lose the discount until a new application is processed.1Harris Health System. Patient Eligibility
What It Costs Once Approved
The program covers care at all participating Harris Health primary care clinics, same-day clinics, specialty offices, hospitals, and emergency departments.2Harris Health System. Harris Health Financial Assistance Program Eligibility Frequently Asked Questions Co-payments are requested but not required in order to receive services:5Harris Health System. Eligibility Calculator – Financial Assistance Program
- Clinic visit with a doctor: $3
- Clinic visit for lab or X-ray only: $3
- Prescription, 1–30 day supply: $8
- Prescription, 31–60 day supply: $16
- Prescription, 61–90 day supply: $24
The Gold Card only works at Harris Health locations. Care at a non-Harris Health hospital or clinic is not discounted.
If You Are Denied
A denial arrives in writing with the reason stated. You have 65 calendar days from the date on that notice to appeal. Download the Eligibility Determination Appeal Form from the Harris Health website, complete it, and mail it to:6Harris Health System. Eligibility Determination Appeal Form
Eligibility Appeals Committee
Harris Health
P.O. Box 300488
Houston, TX 77230
The committee will contact you by mail within 10 calendar days of receiving the form. Before you appeal, look at the denial reason. If it points to a missing document or an income mismatch you can fix, submitting a fresh application with the corrected paperwork is usually faster than the appeals track.