TX HHS Form H1113. Application for Prior Medicaid Coverage

The TX HHS Form H1113, Application for Prior Medicaid Coverage, helps individuals who have unpaid medical bills from the past three months to apply for Medicaid coverage. This form is typically used by individuals who need assistance paying for past medical services received during a specific period.

To be eligible for prior Medicaid coverage, applicants must provide proof that their medical services were provided within the three-month period preceding their application. They must also demonstrate that they or a household member would have been eligible for Medicaid in the prior month. The form requires applicants to sign and date each sheet, as well as answer all questions truthfully.

The application process involves providing required information about the applicant's medical services, income, and tax filing status. Key features of this form include the need to list all household members based on their tax filing status, report any income received during the three-month period, and disclose any assets or purchases made during that time. By filling out this application, individuals can potentially receive Medicaid coverage for past medical bills.

• This form is used by individuals who need assistance paying for past medical services received within a specific three-month period.
• Applicants must provide proof of unpaid medical services and demonstrate eligibility for Medicaid in the prior month.
• The application requires sign-off and date-stamping each sheet, as well as truthful answers to all questions.