TX HHS Form H1028-MBIC. Employment Verification (Medicaid Buy-In for Children)

The Texas Health and Human Services Commission's Form H1028-MBIC, Employment Verification (Medicaid Buy-In for Children), is a crucial document that helps determine the eligibility of households applying for assistance. This form is used in situations where an individual's employment status affects their application or another household member's application.

The form requires employers to provide information about their employees, including employee name and social security number, as well as details about the job type, rate of pay, and health insurance offered by the employer. Employers are responsible for ensuring that all provided information is complete and accurate, as it affects someone's eligibility and benefits.

The form must be completed and returned to HHSC P.O. Box 149027 Austin, TX 78714-9917 by mail or fax (877-447-2839). Employers may also choose to fax the completed form to the listed number. The attached Authorization to Furnish Information (Form H0003) is required for employers to provide the necessary information.

• The form is used to verify all earnings and group health insurance for households applying for assistance from the Texas Health and Human Services Commission.
• Employers must ensure that all provided information is complete, accurate, and correct.
• The form can be returned by mail or fax to HHSC P.O. Box 149027 Austin, TX 78714-9917 or 877-447-2839.