TX HHS Form H0062-MBIC. Late Payment Notice

The TX HHS Form H0062-MBIC, Late Payment Notice, is used to notify Medicaid Buy-In for Children (MBIC) recipients of a late payment. This form helps solve the problem of missed payments, which can result in benefits being terminated.

This notice requires MBIC recipients to provide information about their payment status and any hardships they may be experiencing that could affect their ability to pay. The form includes sections for reporting lost income due to job loss, divorce or separation, or a parent's death. If an individual is experiencing hardship, they must fill out the "Hardship Form" (HOO65-MBIC) and return it by a specified date.

If no hardship is reported, MBIC recipients are required to pay the amount owed by a specific deadline. Failure to make timely payments can result in benefits being terminated. The form provides important information about payment deadlines and consequences for non-payment. For assistance with completing this form or understanding its requirements, individuals can call 2-1-1 or 1-877-541-7905.