TX HHS Form H1245. Statement of Intent to Return to Home

The Statement of Intent to Return to Home (Form H1245) is a crucial document for individuals who are temporarily absent from their primary residence. This form helps resolve the issue of determining Medicaid eligibility when an individual's home is not currently occupied. The form is typically used in situations where an applicant or recipient needs to declare their intention to return to their home, which may affect their Medicaid benefits.

The key feature of this form is the declaration of intent to return to one's home. The applicant/recipient must provide their name, address, and client/application number, as well as a statement explaining their temporary absence from their home. The form also outlines conditions under which HHSC may exclude the home from consideration as an available resource for Medicaid benefits. Additionally, it highlights responsibilities and follow-up actions, such as reporting any changes to the property's status or ownership.

Some key points to note include:

• The applicant/recipient must declare their intention to return to their home in the future.
• The form requires information about the property's current status, including whether it is rented, leased, producing income, or vacant.
• The applicant/recipient understands that HHSC may consider the equity value of the property a resource available to meet their needs if they no longer intend to return to their home.