H1113 form 2025

Show details

4.8 out of 5

76 votes

Form H1113 is an application for prior Medicaid coverage, allowing individuals to apply for Medicaid benefits for medical services received up to three months before their application date. To qualify, applicants must provide proof of unpaid medical bills or services from the Texas Department of State Health Services and demonstrate eligibility during the prior month. The form requires detailed information about household members, income, and unpaid medical expenses, and must be signed by the applicant or an authorized representative.

Here's how it works

01. Edit your h1113 form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send h1113 via email, link, or fax. You can also download it, export it or print it out.

The best way to modify H1113 form in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Handling paperwork with our extensive and intuitive PDF editor is easy. Adhere to the instructions below to fill out H1113 form online quickly and easily:

Sign in to your account. Log in with your credentials or create a free account to try the product prior to choosing the subscription.
Import a document. Drag and drop the file from your device or add it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit H1113 form. Quickly add and underline text, insert pictures, checkmarks, and signs, drop new fillable fields, and rearrange or delete pages from your document.
Get the H1113 form accomplished. Download your updated document, export it to the cloud, print it from the editor, or share it with other people through a Shareable link or as an email attachment.

Take advantage of DocHub, the most straightforward editor to rapidly manage your documentation online!

See more h1113 form versions

We've got more versions of the h1113 form form. Select the right h1113 form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (76 Votes)
2010	4.9 Satisfied (51 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does Texas Medicaid cover past medical bills?

An application for retroactive eligibility must be filed with the Health and Human Services Commission (HHSC); it is not granted automatically. The applicant must request the prior coverage from an HHSC representative and complete the section of the application about medical bills.

What is a proof of pregnancy form for Medicaid in Texas?

The Report of Pregnancy Form H3037 serves a critical purpose in determining the eligibility of low-income pregnant women for Medicaid and financial assistance. It collects necessary medical information to assess the applicants needs and streamline access to vital health services.

What documents do I need for pregnancy Medicaid?

Ho do I qualify for Medicaid? Proof of pregnancy. Proof of citizenship, if a legal US resident ( and identification documentation such as a birth certificate or social security card) Proof of non-citizenship if not a US resident. Proof of income.

What is the employment verification form for food stamps in Texas?

Use manual Form H1028 when TIERS is down and a person cannot furnish sufficient verification of income or mandatory deductions. Send the form to the person to take it to the employer for completion. Document in the households case record the date the form is given to the person.

What is the H1113 form for Texas benefits?

The purpose of the Texas Medicaid Coverage Application Form H1113 is to facilitate access to Medicaid benefits for individuals and families in Texas. This form allows applicants to retroactively apply for Medicaid coverage up to three months prior to the application date.

form h1113

Printable h1113 form H1113 form pdf H1113 form download How to fill out h1113 form H1113 form online Form h1113 spanish H1806 form Form 1049 your texas benefits

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

How do I apply for pregnancy Medicaid in Texas?

Apply and renew benefits online at YourTexasBenefits.com. Benefits can include pregnancy Medicaid, CHIP, SNAP, and support services like resources for caregivers and mental health programs. Call 211 or 877-541-7905 for help over the phone for applications.

What is the form H3038 from Texas Medicaid?

Complete Form H3038 to verify a nonimmigrant, an undocumented alien or a certain legal permanent resident, who does not meet citizenship or alien status requirements, was treated for an emergency medical condition.

H1113 form 2025

Here's how it works

The best way to modify H1113 form in PDF format online

See more h1113 form versions

Complete this form in 5 minutes or less

Got questions?

Does Texas Medicaid cover past medical bills?

What is a proof of pregnancy form for Medicaid in Texas?

What documents do I need for pregnancy Medicaid?

What is the employment verification form for food stamps in Texas?

What is the H1113 form for Texas benefits?

Complete this form in 5 minutes or less

People also ask

How do I apply for pregnancy Medicaid in Texas?

What is the form H3038 from Texas Medicaid?

medicaid texas

Try more PDF tools