TX HHS Form H1113. Application for Prior Medicaid Coverage

The TX HHS Form H1113, Application for Prior Medicaid Coverage, is a crucial document that helps individuals demonstrate their eligibility for Medicaid coverage by showing prior unpaid medical services. This form should be used when an individual needs to prove that they had medical services rendered during the three months preceding their application month.

To complete this application, applicants must provide proof of unpaid medical services or services provided by the Texas Department of State Health Services. They must also answer all questions and sign and date each sheet, as well as include information about household members who need to be included in the application. The form requires details such as name, date of birth, relationship to the applicant, and income received during the relevant months.

This application is particularly useful for individuals who have outstanding medical bills from previous months and are seeking Medicaid coverage. By completing this form, applicants can demonstrate their prior eligibility for Medicaid and potentially receive retroactive coverage for their medical expenses. The TX HHS Form H1113, Application for Prior Medicaid Coverage, is a vital tool in the process of applying for Medicaid benefits.