TX HHS Form H5021-MBIC. Initial Certification (Medicaid Buy-In for Children)

The TX HHS Form H5021-MBIC, Initial Certification, helps individuals certify their children for the Medicaid Buy-In for Children program. This form is typically filled out by parents or guardians who want to access healthcare benefits for their children. The program provides financial assistance for medical expenses, and this certification process ensures that eligible children receive the necessary support.

The form outlines the key features of the program, including the requirement to pay a monthly premium starting from a certain date. Beneficiaries will receive a letter with a payment coupon and prepaid envelope each month, and they must pay the full amount by the due date to continue receiving benefits. Additionally, some individuals may need to track their medical bills, which can affect their monthly payments.

Key points to note include:

• The program provides financial assistance for medical expenses starting from a certain date.
• Beneficiaries must pay a monthly premium starting from that date.
• A letter with a payment coupon and prepaid envelope will be sent each month, and payments must be made by the due date to continue receiving benefits.