TX HHS Form H1228. Application Letter

The TX HHS Form H1228, Application Letter, helps individuals apply for Medicaid benefits in specific situations. This form is typically used by those who reside in long-term care facilities, have received both Social Security and Supplemental Security Income (SSI) benefits prior to denial of their SSI, or are enrolled in Part A Medicare and desire assistance in paying premiums, deductibles, and co-insurance on Medicare-covered services.

The application form requires the applicant's personal information, including name and address, as well as proof of income and assets. The applicant must also provide information about their spouse, if applicable, and answer questions about their current living situation and medical needs. It is essential to complete all sections of the form accurately and thoroughly, as incomplete or inaccurate applications may be rejected.

After submitting the application, it will be reviewed to determine eligibility for Medicaid benefits. The applicant will be notified of the decision, and if approved, they can begin receiving benefits. If questions arise during the application process, applicants are encouraged to contact the office at the address shown above. Additionally, individuals who believe they have been discriminated against may file a complaint with HHSC Civil Rights Office or the U.S. Department of Health and Human Services.

• Reside in a long-term care facility (nursing facility, state supported living center, or private ICF-IID facility)
• Received both Social Security and Supplemental Security Income (SSI) benefits prior to denial of SSI
• Enrolled in Part A Medicare and desire assistance in paying premiums, deductibles, and co-insurance on Medicare-covered services