Texas Health and Human Services

The “Statement of Intent to Return Home” (Form H1245) is used in Texas Medicaid cases to clarify whether a person temporarily living away from their residence still considers that property their primary home. This form often becomes important when an applicant enters a hospital, nursing facility, rehabilitation center, or moves in temporarily with family members. Because Medicaid rules treat certain property as a “countable resource,” this statement helps the Health and Human Services Commission (HHSC) determine whether the home should be excluded from the resource calculation.

Form H1238 is used by state assistance agencies to verify the details of an individual’s life insurance policies. When someone applies for public benefits, certain types of insurance may affect eligibility or benefit amounts. This form allows the caseworker to request verified policy information directly from an insurance company, ensuring that the agency receives accurate, up-to-date financial data.

Form H1280, titled "Statement of Residence Maintenance Needs," is a key document used in nursing facility admissions in Texas. It allows applicants to declare their intention to return to their residence after temporary placement in a nursing facility and to specify the expenses required to maintain that residence during their absence. This form ensures both transparency and proper financial planning for the applicant’s continued residence.

The TX HHS Form H1550, Out of State NBCCEDP Verification, is a crucial document that helps verify the eligibility of individuals participating in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) outside of Texas. This form is typically used by healthcare providers, medical facilities, or organizations involved in breast and cervical cancer detection and treatment.

The TX HHS Form H1350, Opportunity to Register to Vote, is a crucial document that helps individuals register to vote in the state of Texas. This form is typically filled out by individuals who are not currently registered to vote where they live.

The Declaration of Texas Residency Form H1300 helps individuals who have recently moved to Texas and are in need of Medicaid benefits. This form is typically used by Supplemental Security Income (SSI) clients who have relocated to the state and require assistance with healthcare costs.

The TX HHS Form H1297, Request for Information from Teacher Retirement System of Texas, is a crucial document that helps determine the eligibility of an individual applying for medical assistance. This form is typically used in situations where an individual's TRS (Teacher Retirement System) payee information needs to be verified or updated.

The Spousal Impoverishment Notification Form H1279 is a crucial document that helps individuals determine their Medicaid eligibility and manage their assets effectively. This form is typically used in situations where an individual's spouse has limited resources, making it essential to understand how these resources impact their own eligibility for Medicaid services.

The TX HHS Form H1278, Request for Patient Trust Fund Information, is a crucial document that helps individuals track their patient trust fund balances and interest earnings. This form is typically used by patients who have had a patient trust fund within the last six months and need to provide information about their account.

The TX HHS Form H1277, Notice of Opportunity to Designate Funds for Burial, is a crucial document that helps individuals who are ineligible for Medicaid due to exceeding the resource limit. This form provides an opportunity for them to designate separate liquid resources as burial funds, which can be excluded from their countable resources up to $1,500.