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  • Tx H3034 2017

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1-877-447-2839 Please answer each question. This will help us process your case faster. Case Identification A. Applicant Name (last, first, middle initial) Social Security No. Sex Date of Birth Case No. Name of Spouse M N/A F City/Town of Residence B. Eligibility Specialist Name Mail Code Region Telephone (include area code) Extension For Agency Use Only C. Program Prior Medical MDCP D. Emergency Medical Benefits CLASS HCS MBI MBIC SSI-Related MAO - Special Income Limit Wai.

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Forms FormTitleForm H1200-PFSTitle Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial StatementForm H1201Title MAO WorksheetForm H1201-ATitle Client Declaration or Streamline Review WorksheetForm H1201-EZTitle Medicaid Eligibility Client Declaration Worksheet145 more rows

To get Medicaid, you must be a Texas resident and a U.S. citizen or qualified non-citizen. When you apply, we'll ask about your income, your age, and your disability status to see if you qualify.

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.).

A person can prove residency by providing document(s) that indicate a Texas address. For example, sources of evidence could be from the following: Property, income or other tax forms or receipts. Utility bills, leases or rent payment records.

In Texas, there are 5 different types of Medicaid: Traditional Medicaid. STAR. STAR Kids. STAR Health. STAR+PLUS.

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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