Fillable h1200 2026

The document is Form H1200-MBIC, an application for Medicaid Buy-In for Children (MBIC) benefits in Texas. It outlines the purpose of the form, procedures for completion and submission, and detailed instructions for providing necessary information about the child applying, their parents, siblings, health insurance coverage, medical bills, and other income. The form is used by staff for eligibility reviews and must be returned to the Document Processing Center or local office.

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Click ‘Get Form’ to open the fillable H1200 in the editor.
Begin with Section 1, where you will enter identifying information for each child applying for benefits. If there are more than two children, attach additional sheets as needed.
In Section 2, provide details about the parents living with the child. Include employment and health insurance information. If you want the employer to verify this information, check 'yes' and provide Form H1028-MBIC.
Proceed to Section 3 to list any brothers or sisters under 21 living in the same home. Complete their identifying information if applicable.
In Section 4, disclose any other health insurance covering the children applying for benefits, including those from non-custodial parents.
Section 5 requires details about medical bills incurred within three months prior to your application date.
Fill out Section 6 regarding any income not derived from a job, such as child support.
Complete Sections 7 through 12 as instructed, ensuring all necessary signatures are provided before submission.

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