TX HHS Form H5023-MBIC. Prior Months Eligibility (Medicaid Buy-In for Children)

The Prior Months Eligibility form (Form H5023-MBIC) helps individuals determine their eligibility for Medicaid Buy-In for Children benefits. This form is typically used by parents or guardians who need to apply for medical services coverage for children with disabilities or chronic illnesses.

This form provides key information about the eligibility process, including the requirement to pay for previous months' medical expenses. The form explains that individuals can choose to pay for all, some, or none of the months and outlines the consequences of not paying by the due date. Additionally, the form notes that payment coupons will be sent to eligible recipients.

Key points to keep in mind when using this form include:

• Prior Months Eligibility is used for Medicaid Buy-In for Children benefits
• Individuals must pay for previous months' medical expenses to receive benefits
• Payment coupons will be sent to eligible recipients
• Payments must be made by the due date to maintain eligibility