Texas Kidney Health Care Program — Drug Help for Medicare Beneficiaries with ESRD

Texas doesn't have a general state pharmacy assistance program for seniors. But for Medicare beneficiaries diagnosed with End-Stage Renal Disease (ESRD), the state runs one targeted program: the Kidney Health Care (KHC) Program, administered by HHSC under Texas Health and Safety Code Chapter 42.

What KHC Covers

KHC provides two categories of prescription help for ESRD patients:

• Up to four ESRD-related prescriptions per month from a specific formulary maintained by the program
• Up to $35 per month toward Part D plan premiums — this stacks with Extra Help if the beneficiary also qualifies for the federal Low-Income Subsidy

CMS classifies KHC as a State Pharmaceutical Assistance Program (SPAP) specifically for ESRD. That classification matters because it means KHC payments count toward the Part D TrOOP (True Out-of-Pocket) threshold, helping ESRD patients reach catastrophic coverage faster.

KHC acts as a payer of last resort. It coordinates with Medicare Part D as a secondary payer — Part D pays first, and KHC covers remaining costs within its formulary scope.

Eligibility Requirements

• Texas residency
• Certified medical diagnosis of End-Stage Renal Disease from a licensed physician
• Annual income under $60,000
• Not eligible for full Medicaid prescription drug benefits (Medicaid beneficiaries already have drug coverage)

There is no age minimum or maximum. ESRD patients under 65 who qualify for Medicare through the ESRD exception are eligible alongside older beneficiaries.

How to Apply

Application requires Form 3035 and one of two physician-signed medical forms, typically submitted through a dialysis facility's renal social worker:

1. Form 3035 — Kidney Health Care Application
2. Form 3057 or CMS-2728 — the Kidney Health Care Program Physician Assessment or the ESRD Medical Evidence Report; either is completed and signed by the physician

KHC applications are handled by HHSC's Kidney Health Care unit, not the standard MEPD benefits offices. Dialysis facilities and transplant centers usually have social workers who manage the paperwork.

How KHC Relates to Medicare Savings Programs

KHC and the Medicare Savings Programs (QMB, SLMB, QI) serve different purposes and can work together:

• MSP covers Medicare premiums and cost sharing — your Part B premium, deductibles, and coinsurance
• KHC covers ESRD-specific prescriptions and Part D premium contributions

A Texas ESRD patient approved for QMB gets Medicare cost-sharing coverage through QMB, automatic Extra Help (Part D subsidy) through the deemed eligibility that comes with any MSP, and additional ESRD drug coverage through KHC. The three benefits layer without conflicting.

If your parent has ESRD and a low income, applying for both an MSP and KHC covers the broadest range of costs.

The Texas Medicare Savings Programs & Extra Help Guide explains how MSP enrollment triggers automatic Extra Help and how to coordinate that with any disease-specific state programs.

See more Texas guides →