TX HHS Form H1259. Correction of Applied Income

The TX HHS Form H1259, "Correction of Applied Income", is a crucial document for individuals who have paid co-payments to a nursing facility based on projected income and medical expenses. This form helps correct any discrepancies between the actual income received and medical expenses incurred, ensuring that the individual only pays what they owe.

The form requires specific information, including the case name, individual number, facility name, and complete mailing address. It also provides a table for calculating co-payment corrections, taking into account the actual income received and medical expenses incurred each month. The form is typically filled out by H Eligibility Specialists at the WIE Services ed Office.

If you have any questions or concerns about your co-payment corrections, please contact this office as explained on Page 2. Key points to note include:

• The form helps correct discrepancies between actual income and medical expenses.
• The form is used for individuals who have paid co-payments to a nursing facility.
• The form requires specific information, including case name, individual number, and facility name.