TX HHS Form H1834. Your Medicaid Benefits Have Ended - Cover Letter

The TX HHS Form H1834, "Your Medicaid Benefits Have Ended - Cover Letter", helps individuals who have had their Medicaid benefits terminated to apply for the Medicaid for Breast and Cervical Cancer program. This form is used in situations where an individual's Medicaid benefits have ended due to a diagnosis of breast or cervical cancer.

The key feature of this form is its requirement for applicants to provide specific information, including proof of diagnosis or treatment verification from their doctor. The form also outlines the responsibilities of the applicant, such as filling out and signing the renewal form (H2340) and submitting supporting documentation, if applicable. Additionally, the form provides instructions on how to apply by mail or fax.

If you are eligible for the Medicaid for Breast and Cervical Cancer program, follow these steps:

• Fill out and sign the Medicaid for Breast and Cervical Cancer Renewal form (H2340)
• Ask your doctor to fill out the “Treatment Verification Form” (H1551)
• If you have other health insurance, send a copy of the card or policy
• Send all items back to HHSC using the pre-paid envelope or mail/fax instructions provided