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If you need help confirming your identity, please try one of the following: Call 2-1-1 or 877-541-7905 (after you pick a language, press 2) Visit an HHSC benefits office and bring proof of identity such as a drivers license or other photo ID.
Proof of income from your job Last 3 pay stubs or paychecks, a statement from your employer, or self-employment records. Bank accounts The most current statement for all accounts. Medical costs Bills, receipts, or statements from health-care providers (doctors, hospitals, drug stores, etc.).
Phone. For help or questions with your HHSC benefits case or YourTexasBenefits.com, call 2-1-1 or 1-877-541-7905. After you pick a language, press 2.
Purpose. To serve as an application and recertification form for Medicare cost-sharing programs and Medicaid community-based programs, except waiver programs. (Form H1200-EZ is an optional alternative to Form H1200 and Form H1200-A for these programs.)
Send in this form by fax, mail, or in person: Fax: 1-877-447-2839. If the form is 2-sided fax both sides. In person: At a benefit office.
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