TX HHS Form H1201-EZ. Medicaid Eligibility Client Declaration Worksheet

The TX HHS Form H1201-EZ, Medicaid Eligibility Client Declaration Worksheet, is a crucial document that helps determine an individual's eligibility for Medicaid benefits. This form is typically used in situations where individuals are applying for or reviewing their Medicaid status, and it serves as a declaration of their financial situation and resources.

The form requires the client to provide essential information about their financial management, including bank accounts, prepaid burial spaces, and other countable assets. It also asks about the date of onset of any disability or blindness, as well as the alien registration number if applicable. The form emphasizes the importance of proper documentation for verified resources and notes that a client statement may be accepted without verification in certain cases.

The TX HHS Form H1201-EZ is an essential tool for determining Medicaid eligibility, and its completion is crucial for ensuring accurate assessments. Key features include:

• Required information about financial management and resources
• Verification of disability or blindness
• Alien registration number (if applicable)
• Proper documentation for verified resources
• Acknowledgement that a client statement may be accepted without verification in certain cases