D-1420, Reporting Requirements

Revision 15-4; Effective October 1, 2015

CHIP, CHIP Perinatal

Households must report the following changes to:

  • address;
  • intent to reside in Texas;
  • the individuals living in the home;
  • income, including sources of income, regular hours worked, and pay rate;  
  • Modified Adjusted Gross Income (MAGI) expenses;
  • pregnancy termination;
  • a child being institutionalized or dying; and
  • medical insurance coverage.

Exceptions: A child is disenrolled if the child reapplies and becomes eligible for Medicaid or at the end of the month of the child’s 19th birthday.

Process all other changes, including agency-generated changes, at the time of report.

D—1421 How to Report

Revision 15-4; Effective October 1, 2015

CHIP, CHIP Perinatal

Persons with case authority may report changes by one of the following means:

  • online through YourTexasBenefits.com;
  • in person at a Texas Health and Human Services Commission Benefits Office;
  • telephone;
  • mail;
  • fax;
  • Form H1019, Report of Change, and;
  • signed Form H1028, Employment Verification.

A person with case authority is an individual who has the authority to apply on the child’s behalf, as explained in A-121, Receipt of Application, for Medical Programs. 

D—1422 Receipts for Reported Changes

Revision 13-4; Effective October 1, 2013

CHIP, CHIP Perinatal

Households may request a receipt to acknowledge the change report. The receipt includes the type of change(s) and the date reported. If an individual requests a receipt, issue Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change.