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Forms and documents
TX HHS Form H5018-MBIC. Denial Notice (Medicaid Buy-In for Children)
TX HHS Form H5019-MBIC. Hardship Waiver Approved (Medicaid Buy-In for Children)
TX HHS Form H5020-MBIC. Hardship Waiver Denied (Medicaid Buy-In for Children)
TX HHS Form H5021-MBIC. Initial Certification (Medicaid Buy-In for Children)
TX HHS Form H5022-MBIC. Notice of Change in Monthly Payment or Cost Share Limit (Medicaid Buy-In for Children)
TX HHS Form H5023-MBIC. Prior Months Eligibility (Medicaid Buy-In for Children)
TX HHS Form H5024-MBIC. Termination Notice (Medicaid Buy-In for Children)
TX HHS Form H6516. Community First Choice Assessment
TX HHS Form HRG-83. SSN Maintenance Memorandum
TX HHS Form LSC. Lone Star Card
TX HHS Form LSC. Lone Star Card
TX HHS Form LSCS. Lone Star Card Sleeve
TX HHS Medical Power of Attorney Designation of Health Care Agent (MPOA)
TX HHS Form H2065-A. Notification of Community Care Services
TX HHS Form H4701. HHSC Out Card
TX HHS Form H2064. Gap in Enrollment for Medicaid Managed Care Members
TX HHS Form H2062. STAR+PLUS Waiver Activity Record
TX HHS Form H4800. Fair Hearing Request Summary
TX HHS Form H4800-A. Fair Hearing Request Summary (Addendum)
TX HHS Form H2060-B. Needs Assessment Addendum
TX HHS Form H2065-D. Notification of Managed Care Program Services
TX HHS Form H4800-ADH. Request for Administrative Disqualification Hearing
TX HHS Form H2067. Case Information
TX HHS Form H4803. Notice of Hearing
TX HHS Form H2067-MC. Managed Care Programs Communication
TX HHS Form H3033. Report of Physical or Mental Examination
TX HHS Form H4806. Request for Another Appointment Request to Withdraw
TX HHS Form H2776. Job Search Worksheet for TANF Employment Hardship Exemption
TX HHS Form H4807. Action Taken on Hearing Decision
TX HHS Form H3675. Application Acknowledgement
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