Your Texas Benefits: Getting Started
Texas Women for minors age 15-17. • Proof of income from your job – One pay stub or paycheck from the last 60 days, a statement from your employer, or self-employment records. • Medicaid and CHIP only - Medical costs – Bills or statements from health-care providers (doctors, drug stores, etc.) from the past 3 months. We only need
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Items we might need from anyone on your case
www.yourtexasbenefits.comMore items we might need from you If you need help getting these items, let us know. It’s our duty to help you. Don’t send this form back to us.
Application for Prior Medicaid Coverage - Your …
www.yourtexasbenefits.comForm H1113 December 2016 Application for Prior Medicaid Coverage You might be eligible for Medicaid for three months before the month you applied for Medicaid.
Your Texas Benefits
www.yourtexasbenefits.comMedicaid Buy-In for Children is a different program. It is for families who have a child with a disability, but make too much money to get traditional Medicaid. To get the form for that program, call 2-1-1 or 1-877-541-7905 and ask for Form H1200-MBIC. Medicare Savings Programs Helps people who already get Medicare. Helps people pay Medicare costs.
Your Texas Benefits: Getting Started
www.yourtexasbenefits.comQuestions about this form or about benefits • Go to YourTexasBenefits.com. or • Call 2-1-1 (if you can’t connect, call 1-877-541-7905). After you pick a …
Texas Department of Human Services - Your Texas Benefits
www.yourtexasbenefits.comTexas Health and Human Services Commission Medical Release/Physician’s Statement Form H1836-A January 2006 Section I — To Be Completed By Staff Name of Patient Date of Birth Social Security No. - - Case Name (caregiver) Case No. Patient’s Usual Job
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