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Revision 26-2; Effective Sept. 1, 2026
The following words and terms, when used in this manual, have the following meanings:
Adjusted Gross Household Income – The gross household income before taxes, minus any allowable deductions. The adjusted gross household income is used to calculate the Federal Poverty Level (FPL) percentage.
Alternate Eligibility Screening Tool (AEST) – An HHSC-approved eligibility screening form substitute, such as in-house form or electronic form, that contains the required information for determining eligibility.
Applicant – A person who applies to receive PHC services.
Barrier to Care – A factor that hinders a person from receiving health care. For example, proximity or distance, lack of transportation, documentation requirements and co-payment amount can impact access to services.
Client – A person who has been screened and determined to be eligible for the program.
Confidentiality – The state of keeping information private and not sharing it without permission.
Consultation – A service provided by a health care provider with expertise in a medical or surgical specialty.
Contraception – The means of pregnancy prevention, including permanent and temporary methods.
Co-payment or Co-pay – Money collected directly from clients for services.
Dental Services – Diagnostic, preventive and therapeutic dental services provided to an eligible client in a dental office, clinic or by teledentistry. Dental services are optional in the PHC program and are not included in the six required priority health services.
Department of State Health Services (DSHS) – The agency responsible for public health in the state of Texas.
Dependent Care Deduction – The expense of providing care for a dependent. This expense must be both necessary for employment and incurred by an employed person. Allowable deductions are actual expenses, up to $200 per month for each child younger than 2 years old and $175 per month for each child 2 years or older.
Diagnosis – The recognition of disease status determined by evaluating the client’s history, the disease process, and the signs and symptoms present. Determining a diagnosis may require some or all the following:
- microscopic – culture
- chemical – blood tests
- radiological examinations – X-rays
Diagnostic Services – Activities related to the diagnosis made by a physician or other health professional.
Diagnostic Studies or Diagnostic Tests – Tests ordered by a health care practitioner to evaluate a client's health status for diagnostic purposes.
Eligibility Date – Date the grantee or program administrator determines a person becomes eligible for the program.
Emergency Services – Urgent care services provided for an unexpected health condition that requires immediate attention. Clinical emergency situations include:
- anaphylaxis
- syncope
- cardiac arrest
- shock
- hemorrhage
- respiratory difficulties in response to environmental emergencies, which include natural and man-made disaster situations
Family Composition or Household – A person living alone or a group of two or more people related by birth, marriage including common law, or adoption. They live together and are legally responsible for the support of the other person.
Family Planning Services – Educational or comprehensive medical activities that enable clients to freely determine the number and spacing of their children and select how this may be achieved.
Federal Poverty Level (FPL) – The set minimum amount of income that a family needs for food, clothing, transportation, shelter and other necessities. In the United States, this level is determined by the Department of Health and Human Services. FPL varies per family size. The number is adjusted for inflation and reported annually in the Federal Poverty Guidelines. Public assistance programs, such as Medicaid, define eligibility income limits in terms of a percentage of FPL.
Fiscal Year – The state fiscal year is Sept. 1 through Aug. 31. The federal fiscal year is Oct. 1 through Sept. 30.
Grantee – A non-state entity that receives an award directly from the state awarding agency to carry out an activity under a state program. The term does not include subgrantees or subrecipients.
Gross Household Income – The total countable income of the household before taxes. For descriptions of countable income refer to Appendix I, Definition of Income.
Health and Human Services Commission (HHSC) – The Texas administrative agency established under Chapter 531, Texas Government Code, or its designee. HHSC manages programs that help families with food, health care, safety and disaster services.
Health Care Provider or Provider – A physician, physician assistant, nurse practitioner, clinical nurse specialist, certified nurse midwife, group of clinicians, federally qualified health center, family planning agency, health clinic, ambulatory surgical center, hospital ambulatory surgical center, laboratory or rural health center that provide health care services.
Health Education – The process of educating or teaching people about lifestyles and daily activities that promote physical, mental and social well-being. This process may be provided to a person or to a group of people.
Health Screening – Providing tests, such as blood glucose, serum cholesterol and fecal occult blood, to determine the need for intervention and maybe a more comprehensive evaluation.
Laboratory or Informally, Lab – A facility that measures or examines materials derived from the human body to provide information on diagnosis, for monitoring prevention or treatment of disease.
Laboratory, X-ray or other Appropriate Diagnostic Services – Studies or tests ordered by the client’s health care practitioner(s). Physicians, dentists and mid-level providers can provide these services to evaluate a client’s health status for diagnostic purposes.
Managing Conservator – A person designated by a court to have daily legal responsibility for a child.
Medicaid – The Texas Medical Assistance Program, a joint federal and state program provided in Texas Human Resources Code Chapter 32 and subject to Title XIX of the Social Security Act, 42 USC Section 1396. The program reimburses for health care services delivered to low-income clients who meet eligibility guidelines.
Minor – Per the Texas Family Code, a person younger than 18 years who is not and has not been married or who has not had the disabilities of minority removed for general purposes, such as emancipated. In this policy manual, minor and child may be used interchangeably.
Payor Source – Programs, benefits or insurance that pays for the service provided.
Preventive Health Care – Services include, but are not limited to the following: immunizations, risk assessments, health histories and baseline physicals for early detection of disease and restoration to a previous state of health, and prevention of further deterioration or disability.
Program Income – Money collected directly by the grantee, subrecipient or provider for services provided under the grant award such as third-party reimbursements, Title XIX, private insurance and client co-pay fees and donations.
Referral – The process of directing or redirecting a medical case or person to an appropriate specialist or agency for information, help or treatment.
Service Member – A member or former member of the state military forces or a component of the U.S. Armed Forces, including a reserve component. This includes active duty, reserve and veterans of the U.S. Armed Forces and active and former members of the Texas National Guard and the Texas State Guard.
Subgrantee or Subrecipient – A non-state entity that receives a subaward from a pass-through entity to carry out part of a state program. It does not include a person who is a beneficiary of such a program. A subgrantee or subrecipient may also be a grantee of other state awards directly from a state awarding agency. Refer to the Texas Grant Management Standards.
Teledentistry – A health service delivered by a dentist, or a health professional acting under the delegation and supervision of a dentist. The providers act within the scope of the dentist's or health professional's license or certification to provide dental care to a patient at a different physical location using telecommunications or information technology.
Telehealth Service – A health service, other than a telemedicine medical service, delivered by a health professional licensed, certified or otherwise entitled to practice in this state and acting within the scope of the health professional’s license, certification or entitlement to a client at a different physical location than the health professional using telecommunications or information technology.
Telemedicine Medical Service – A health care service delivered to a client at a different physical location than the physician or health professional using telecommunications or information technology. Service is done by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state. and acting within the scope of the physician’s or health professional’s license.
Texas Resident – A person who lives within the geographic boundaries of Texas.
Treatment – Any specific procedure used to cure or improve a disease or pathological condition.
Unduplicated Client – A client who is counted only one time during the program’s fiscal year, regardless of the number of visits, encounters or services they receive. Example: One client seen four times during the year is counted as one unduplicated client.
Vision Care or Vision Services – Basic visual screening, management and treatment of minor eye issues provided by a primary health care practitioner. In the context of the Primary Health Care program, vision services are optional and are not included in the six required priority health services.