Form H1200

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What is Form H1200?

The form H1200 is also called Application for Benefits Medicaid Buy-In for Children. It was created by the Texas Health and Human Services Commission for the Medicaid program. Since Medicaid offers to pay the bills on behalf of children with disabilities in specific cases, you can use this form to become a part of the program.

You have to follow strict rules to join the program and receive benefits. Your employer must pay at least half the yearly cost for your health insurance program. As a parent, you must sign up for the Medicaid Buy-In proposal and keep the insurance active. The income limits that are mentioned in the program have to be met by the family. Apart from that, the family that has a child with a disability might need to pay the fee every month.

The H1200 Medicaid form is just a part of the program that helps children with disabilities to receive the medical help they need and their parents pay the bills. Consider it as a first step. Medicaid representatives must check all the information you provide before sending you the answer to your Texas benefits form H1200.

Form H1200 on PDFLiner

What I need the Form H1200 for?

  • You need to use the Texas application for benefits form H1200 if you have a child with disabilities under 16 years old that require medical treatment and you or your employer pays the insurance that allows taking part in the Medicaid program;
  • An employer who has an employee with children with disabilities needs to ask for the Medicaid application Texas PDF from the employee. This program may help to pay costs for the medical treatment of the child;
  • The family of a child with a disability can use the benefits provided by this Medicaid program to receive help while still paying the monthly fee.

How to Fill Out Form H1200?

The Medicaid buy in for children form is available on the Medicaid official website. You can read and download it there. If you want to ease your task, you may fill it out online using a PDF editor like PDFLiner. This service offers you to enter the document and complete empty sections using the tools you see in front of you.

You may even create your electronic signature and sign the form. Once you fill it out, download the copy on your computer, and send the other copy to Medicaid. You can always print the form and hand it in manually or send it by regular mail. Here is what you need to include inside:

  1. Provide information about the child, including name, social security number, home address, phone number, birth date, and nationality;
  2. Provide information on the second child that applies for benefits if you want;
  3. Add more pages with the same information about children if there are more than two children who apply for medical help;
  4. Provide information about parents, including the name, social security number, birth date, and whether the parent lives with the child;
  5. Provide information about the employer, including name, address, and payment for the insurance;
  6. Provide information on the second parent and employer using the same scheme;
  7. Provide information on the sisters and brothers who live with the child, if there are any;
  8. Share details of your financial situation and the money you get not from the job, if you have any;
  9. Write down information on the authorized representative of the person;
  10. Sign the document and ask witnesses to sign it.

Organizations that work with Form H1200

  • Texas Health and Human Services Commission.

Fillable online Form H1200
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