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Revision 20-2; Effective June 1, 2020
Form H1200-MBIC and new forms have been created for this program. Most of the new forms are pre-populated by the system. These forms are also available in this handbook. If a form is completed manually from this handbook, follow the instructions for that particular form.
Even though a new application has been created for this program, also accept the Form H1200, Application for Assistance – Your Texas Benefits, as an application for the Medicaid Buy-In for Children (MBIC) program.
Use the current Form H1020, Request for Information or Action, for missing information. The H1020 instructions are updated to include MBIC program-specific information.
Appendix XLIX, Medicaid Buy-In for Children Forms Chart, outlines the:
- form name;
- purpose of each form;
- naming convention of each form in TIERS; and
- naming convention of each form in this handbook.
TIERS generates Form TF0001-MBIC for all eligibility notices. The MBIC program has seven notices that will use the TF0001 format in TIERS. Because the TF0001 is a TIERS-generated form, MBIC eligibility notices have a different number in this handbook. The form content is the same.