TX HHS Form H1200-PFS. Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial Statement

The TX HHS Form H1200-PFS, Medicaid Application for Assistance (for Residents of State Facilities) Property and Financial Statement, is a crucial document that helps facilitate the application process for Medicaid assistance to residents of state facilities. This form is typically used in situations where individuals residing in state facilities require financial support to cover their living expenses.

The form requires applicants to provide essential information about themselves, including their name, date of birth, race, place of birth, and Social Security number. Additionally, the form asks questions about the applicant's marital status, Medicare coverage, and guardianship or power of attorney arrangements. Key features of this form include the need for a legal guardian or duly appointed power of attorney to complete the application process.

To ensure a smooth application process, applicants are advised to provide accurate and complete information. The form also emphasizes the importance of enclosing supporting documentation, such as letters of guardianship or power of attorney documents. By completing this form, residents of state facilities can take the first step towards securing necessary financial assistance through Medicaid.

• The form is used for residents of state facilities seeking Medicaid assistance.
• Applicants must provide essential information about themselves and their guardianship or power of attorney arrangements.
• The form requires supporting documentation, such as letters of guardianship or power of attorney documents.