TX HHS Form H1139. Medical Expense Verification

The Medical Expense Verification Form H1139 is a crucial document that helps individuals verify their out-of-pocket medical expenses to determine their eligibility for services. This form is typically filled out by clients who incur medical expenses and need assistance from the Texas Health and Human Services Commission (HHSC) to evaluate their situation.

This form requires the client's information, including their name and contact details, as well as a description of their medical needs. The client must also provide authorization for HHSC to contact their doctors, medical facilities, or other healthcare providers to request copies of their health information. This authorization is essential to determine the client's eligibility for services.

The Medical Expense Verification Form H1139 is an important tool that helps clients navigate the process of verifying their medical expenses and determining their eligibility for services. Key features of this form include:

• Client information, including name and contact details
• Description of medical needs
• Authorization for HHSC to request health information from healthcare providers
• Expiration date for the authorization