TX HHS Form H0064. State Kids Insurance Program (SKIP) Referral

The State Kids Insurance Program (SKIP) Referral form (Form H0064) helps solve the problem of determining eligibility for SKIP subsidy for children of state agency or UGIP-participating institution employees. This form is used in situations where an employee's child(ren) are not eligible for Medicaid but may be eligible for a SKIP subsidy.

This referral letter, processed by the Texas Health and Human Services Commission (HHSC), provides proof of eligibility for the employee's child(ren). The form requires information such as employee name, social security number, child(ren)'s name(s) and date of birth, and their social security numbers. It also highlights conditions that affect Medicaid eligibility, including income and resource limits.

If you have any questions about this referral letter or the SKIP subsidy process, please contact HHSC at the provided number. This form serves as a valuable tool for employees seeking to determine their child(ren)'s eligibility for a SKIP subsidy and for institutions participating in UGIP programs.

• This form is used when an employee's child(ren) are not eligible for Medicaid but may be eligible for a State Kids Insurance Program (SKIP) subsidy.
• The form requires information such as employee name, social security number, child(ren)'s name(s), date of birth, and their social security numbers.