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English PDF: Form H1200; Spanish PDF: Form H1200-S; Instructions. English and Spanish forms can be found under the title "Form to apply for Medicaid for the Elderly and People with Disabilities or Medicare Savings Program" under section "Forms to apply for benefits".
Title Application for Assistance - Your Texas Benefits. Form H1200-A. Title Medical Assistance Only (MAO) Recertification. Form H1200-EZ. Title Application for Assistance - Aged and Disabled (Large Print) Form H1200-MBI. Title Application for Benefits - Medicaid Buy-In. Form H1200-MBIC.
Before you set up an account, we need to ask you some questions. This will help you know if you should apply for benefits on this site or for health insurance on HealthCare.gov.
You must apply for Medicare through a different agency - the Social Security Administration. To learn more, visit www.Medicare.gov or call 1-800-633-4227. Medicaid Buy-In Program. To ask for these forms, call 2-1-1 or 1-877-541-7905. Helps people who work and: (a) have a disability or (b) are age 65 or older.
A new tax credit that can immediately help pay your premiums for health coverage. Free or low-cost insurance from Medicaid or the Children’s Health Insurance Program (CHIP). Women's health and family planning services for women ages 15-44 (Healthy Texas Women).
To learn more about all your options, contact your local Aging and Disability Resource Center or call 2-1-1. To get MEPD, 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 to see if you qualify. Apply for MEPD.
Request to renew benefits for Medical Programs, SNAP and TANF. Screening document for staff to make necessary referrals to other agencies. The addendum to Form H1010 captures information needed to make an eligibility determination for Medicaid or the Children's Health Insurance Program (CHIP).
This form needs to be filled out, signed, and sent back with your application for benefits. Applying for or renewing Medicaid or CHIP? If yes, you must fill out this form. Each person listed in Section H of the Your Texas Benefits application needs to answer the questions below (Section 1).
Visit Your Texas Benefits website and choose “Apply for new benefits.” Call 2-1-1 (TTY 711) toll-free Monday through Friday from 8:00 a.m. to 6:00 p.m. Central Time. Print or request a paper form and submit it by mail.
Fill out and download the Form H1200 Application for Benefits - People Age 65 and Older, People With Disabilities in Texas. Easily apply for benefits online and save as a printable PDF.