Form H1113 2025

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Form H1113 is an application for prior Medicaid coverage, allowing individuals to seek Medicaid benefits for unpaid medical services received up to three months before their application date. The form requires proof of unpaid bills or services from the Texas Department of State Health Services and includes sections for listing household members, income, and unpaid medical bills. Applicants must sign the form and can submit it through various methods, including online, by mail, or in person.

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