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Form HHSC-Medical-MEF Rev 09/01/2013 EB-SPENR-M ENG - Page 1 Medical Enrollment Form Name: hohName E Need help filling out this form? Call toll-free 1-800-964-2777. If you have a speech or hearing.

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Purpose. To provide TANF, food stamp, and Medicaid clients with a list of acceptable sources of verification required to determine eligibility.

Purpose. To provide TANF, food stamp, and Medicaid clients with a list of acceptable sources of verification required to determine eligibility.

When a notice is posted to your account, we will let you know by sending a text message or an email, depending on what you picked. To view the notices, log in to YourTexasBenefits.com and go to "Letters and Forms." Not all notices will be on YourTexasBenefits.com. You may still get some in the mail.

Form 1024 is used to document the waiver benefits that result in an Individual Service Plan (ISP) or Individual Plan of Care (IPC) exceeding the assigned cost ceiling and to establish the medical need and rationale for these items or services.

To go back to getting all your notices in the mail, you can: Go to an HHSC benefits office: Offices are open Monday to Friday, 8 a.m. to 5 p.m. To find an office, you can either: (a) go to YourTexasBenefits.com and click on "Find an office," or (b) call 2-1-1 or 1-877-541-7905 (after you pick a language, press 1).

Proof of income from your job – Last 3 pay stubs or paychecks, a statement from your employer, or self-employment records. Bank accounts – The most current statement for all accounts. Medical costs – Bills, receipts, or statements from health-care providers (doctors, hospitals, drug stores, etc.).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232