TX HHS Form H1242. Verification of Mineral Rights

The TX HHS Form H1242, Verification of Mineral Rights, helps solve the problem of ensuring accurate income information for medical assistance eligibility. This form is typically used in situations where mineral rights are involved, such as oil or gas production. The client or representative fills out this form to provide fair market value and income information about the mineral rights.

The form requires the following information: fair market value of the mineral rights, gross production tax, and other income paid to the client in the past 12 months. The department cannot grant or continue eligibility for medical assistance without this information. The undersigned client has given permission for the department to receive this information, and the department is not liable for any action resulting from its receipt.

This form must be returned to the Health and Human Services (HHS) office with a signature from both the client or representative and the HHSC worker. Key points to note include:

• The form is used to verify mineral rights income information for medical assistance eligibility.
• The department requires fair market value and income information about the mineral rights.
• The client or representative must provide this information to ensure continued eligibility for medical assistance.