W-1910, Notice to Applicants

Revision 22-4; Effective Oct. 1, 2022

At the end of the interview or during the processing of the woman’s application, give her one or more of the following notices as appropriate. If the case is:

  • pended;
  • certified;
  • sustained; or
  • denied.

Form H1020, Request for Information or Action, to inform the woman of the:

  • reason the case is pending;
  • action she or HHSC staff must take;
  • date by which she or HHSC staff must take action; and
  • date staff must deny the application or case if she does not take action, if applicable; or

Form TF0001, Notice of Case Action, to inform the woman of the:

  • date benefits begin;
  • date of denial;
  • right to appeal; and
  • address and phone number of free legal services available in the area.

Note: Form TF0001 for HTW only includes information about HTW benefits and is sent separately from the TF0001 for other benefits.

Women who transition to Healthy Texas Women (HTW) from another Medicaid program or the Children’s Health Insurance Program (CHIP) receive Form H1872, HTW Opting Out and Reporting Confidential Address, along with Form TF0001. The Form H1872 informs the woman of the:

  • options to voluntary withdraw from HTW; and
  • process to report a confidential address.

HTW recipients turning 18 years old receive Form H1871, HTW Client Turning 18 Years Old, ten days before their 18th birthday. The Form H1871 informs the woman of:

  • the process to report a confidential address; and
  • their responsibility to manage their HTW benefits.

Note: For women who only speak Spanish, ensure that all comments provided are in Spanish.