The Value of Working Together to

Manage Indigent Healthcare Programs

There are over 254 Chapter 61 entities (counties, hospital districts and public hospitals) in the State of Texas. Each is required to provide indigent health care (IHC) within their service area. This unfunded mandate from the state government can create political, financial and operational issues at the local and regional level.

In recent years, the State has reduced administrative and financial support for IHC programs leaving each of them to, in effect, fend for themselves. The Texas Indigent Health Care Association has been formed to help

Chapter 61 entities effectively address many of the issues surrounding IHC administration. TIHCA’s intent is to meet and exceed the level of service formerly provided by the state.


What is the Texas Indigent Health Care Association (TIHCA)?

The Texas Indigent Health Care Association (TIHCA) was created in 2004 as a program of the Urban Counties, with the co-operation of the Texas Association of Counties when county indigent health care directors asked for organizational assistance in response to the State’s discontinuation of the Texas Department of Health Regional Coordinators the prior year.

What does TIHCA do?

The basic goal of TIHCA is to provide timely information on upcoming legislative issues and state level changes as well as staff training on program administration.

TIHCA can assist members in a number of ways including:

  • Keeping programs up to date with the latest news and information;
  • Strengthening inter-program dialogue and networking among programs;
  • Providing educational opportunities to programs;
  • Provide programs with technical support and peer review, and
  • Developing pooled-purchasing opportunities so programs can use the power of group negotiating and purchasing to gain price reductions on things like pharmacology, durable medical equipment and laboratory services.
What is the benefit of becoming a TIHCA member?

By working together, TIHCA members can assist each other with finding solutions to operational issues that, when coupled with cost savings arising from pooled-purchasing opportunities, can save your organization money. This means you may be able to provide the same level of services while reducing the burden on your taxpayers.

Who is eligible to join?

Membership is open to all programs with responsibilities under Chapter 61, Health And Safety Code, which defines the responsibilities of counties, hospital districts, and public hospitals in providing health care to eligible residents who are considered indigent.

How does an eligible entity join?

Interested counties, hospital districts and public hospitals may contact Windy Johnson at the Urban Counties offices for assistance in joining TIHCA. A potential member joins (or makes application) by adopting a minute order authorizing the county, HD, or PH to become a member of the association, authorizing the necessary expenditures for membership dues and appointing a representative to speak on behalf of the entity.

County Departments Affected by Indigent Healthcare


Sheriff's Department


Court Systems


Adult & Juvenile Probation


County Indigent Health Care Program (CIHCP)

Reasons Texans Remain Uninsured


Part-time, seasonal or contract


Unemployed or low income


Cost of employer sponsored insurance too high


Denied individual plans


Not enrolled due to process confusion & difficulty


Work for small employers


Recent immigrant


Willfully uninsured

TIHCA Members

  • Angelina County
  • Aransas County
  • Bastrop County
  • Bell County
  • Brazoria County
  • Brown County
  • Burnet County
  • Chambers County
  • Collin County
  • Comal County
  • Denton County
  • DeWitt County
  • Ellis County
  • Falls County
  • Fayette County
  • Fort Bend County
  • Galveston County
  • Grayson County
  • Guadalupe County
  • Hardin County
  • Harrison County
  • Hays County
  • Henderson County IHC
  • Hidalgo County
  • Hill County
  • Hockley County
  • Hood County
  • Howard County
  • Huntsville Memorial
  • Jasper County
  • Jefferson County
  • Jim Wells County
  • Kaufman County
  • Kerr County
  • Lamb County
  • Lee County
  • Liberty County
  • Limestone County
  • McLennan County
  • Rains County
  • Randall County
  • Red River County
  • Rockwall County
  • San Patricio County
  • Sterling County
  • Tom Green County
  • Van Zandt County
  • Webb County
  • Williamson County
  • Wood County
  • Big Bend Regional Medical Center
  • Brazos Valley Council of Governments
  • Brownfield Regional Medical Center
  • Garza County Health Care District
  • Liberty County Hospital District
  • Matagorda County Hospital District
  • Maverick County Hospital District
  • McCamey County Hospital District
  • Montgomery County Hospital District
  • Northwest Texas Hospital
  • Parker County Hospital District
  • University Medical Center
  • University of Texas Medical Branch

TIHCA Board of Directors


Chairman Elect


Board Member

Board Member

Board Member

Board Member

Board Member

Board Member

Board Member

Board Member

Isabel Rodriguez, Denton County

Lilly Moncivais, Brazos Valley Council of Governments

Lesa Gilbert, Northwest Texas Healthcare System

Victoria Lippman, Williamson County

Jennifer Gutierrez, Brazoria County

Martha Hernandez, Fort Bend County

Brandy Fannon, Garza County Hospital District

Lena Saenz, Guadalupe County

Dairen Sarmiento, Hidalgo County

Sandra Davis, University of Texas Medical Branch

Nancy Cadena, Webb County