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Click ‘Get Form’ to open it in the editor.
Begin by entering the Date at the top of the form. This is essential for tracking your application.
Fill in the Advisor Name, Office Address, and Telephone Number. This information helps ensure that you can be contacted regarding your application.
Next, provide your Client Name and Address along with your Case/Application Number. Accurate details here are crucial for processing your renewal.
Indicate the Program for which you are renewing benefits. Make sure this matches your current enrollment.
Complete all required sections of the form thoroughly. Missing information can delay processing.
Sign and date the form at the designated area to validate your submission.
Staple this letter to your completed form and prepare it for mailing or faxing using the pre-paid envelope provided.

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How do I renew my Texas Medicaid benefits?

California Enrollment. ☎ Call the Medi-Cal Helpline: 800-541-5555, or 916-636-1980. To contact your county for a renewal, find the phone number here.

How do you submit documents to your Texas benefits?

Form H1830-R is sent with Form H1010-R during the month before the last month of certification. The notice tells the household the date HHSC must receive the application to be timely.

What is the H1028 form for Texas benefits?

To submit proof of facts, upload your documents to a Your Texas Benefits account, deliver them to a local benefits office , or send them by mail or fax. Below is the information we may need from you based on the program youve applied for.

What is the form to renew Medicaid in Texas?

For individuals residing in Texas, Form H1028 - Employment Verification is used to secure confirmation of income and other employee earnings via an employer when the information provided by an employee is not sufficient.

How do I get my Medicaid renewed?

All Medicaid Members Must Renew Their Coverage This included automatic renewal of benefits for Medicaid members. The PHE is ended in May 2023 which means that automatic renewal has also ended. All Medicaid members must submit a renewal application to continue receiving benefits.

hhsc form 3713

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