All clients of Legal Hospice of Texas must meet certain requirements to qualify for services. Answering the questions on this survey will help you to know if you can qualify. You must answer every question truthfully. If and when you register as a client, written documentation of your answers will be required.
Section 1 – Health Condition/Diagnosis
▢ I am HIV+ or I have AIDS
▢ A doctor has told me that I have a terminal illness
▢ A doctor has told me that I have one of the following illnesses: Parkinson’s Disease; Alzheimer’s Disease; Lou Gerhig’s Disease
(ALS); Muscular Dystrophy; or, Multiple Sclerosis
▢ A doctor has told me that I am at “end stage” of a chronic illness
If you did not check at least one of the boxes above, you do not qualify for our services.
Section 2 – County of Residence
▢ I live in one of the following counties: Collin, Cooke, Dallas, Denton, Ellis, Fannin, Grayson, Henderson,
Hood, Hunt, Johnson, Kaufman, Navarro, Parker, Rockwall, Tarrant
If you did not check the box above, you do not qualify for our services.
Section 3 – Legal Issue
▢ Vocational issues
Have you been recently terminated from your job? Is your health status causing you problems at work? Do you know there may be protections to help you keep your job? Do you need job retraining?
▢ Insurance issues
Has your Health Insurance coverage unexpectedly stopped? Are you having problems understanding MEDICAID, COBRA, ACA or other insurance eligibility?
▢ Disability/Employment issues
Are you thinking about applying for Social Security? Have you been denied Social Security, Long Term/ Short Term Disability, or unemployment? Are you ready to try going back to work after being on Social Security?
▢ Housing issues
Have you been threatened with eviction or Foreclosure?
▢ Credit issues
Has your health status impacted your credit? Are you receiving harassing calls from collection agencies?
▢ Estate Planning issues
Are you interested in having Texas-specific legal documents to specify who you would like to act for you (or disqualify from acting for you) regarding health or financial decisions if you are unable to act for yourself?
If you did not check any of the boxes above, you do not qualify for our services.
Section 4 – Income and Assets
Income for ALL non-HIV+ clients and ALL clients from Hood, Johnson, Parker and Tarrant counties is capped at 125% of Federal Poverty Level.
Currently that cap is $13,538 for a single person; $18,213 for a family of 2; $22,888 for a family of 3; $27,563 for a family of 4. In addition to income restrictions, there is also an asset limit of $10,000 in easily accessible liquid assets.
▢ I am not HIV+ or I live in Hood, Johnson, Parker or Tarrant County AND my income is not more than listed above, and less than $10,000 in easily accessible liquid assets.
Income for HIV+ clients living in Collin, Cooke, Dallas, Denton, Ellis, Fannin, Grayson, Henderson, Hunt, Kaufman, Navarro, and Rockwall counties is capped at 300% of Federal Poverty Level. Currently that cap is $32,490 for a single person; $43,710 for a family of 2; $54,930 for a family of 3; $66,150 for a family of 4.
▢ I am HIV+ and I live in Collin, Cooke, Dallas, Denton, Ellis, Fannin, Grayson, Henderson, Hunt, Kaufman, Navarro or Rockwall County AND my income is not more than that listed above.