W-2400, Confidentiality

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Revision 21-3; Effective July 1, 2021

The Texas Health and Human Services Commission (HHSC) must accommodate reasonable requests to receive communications by alternative means or at alternate locations.

The person must specify in writing the alternate mailing address or means of contact. They must include a statement that using the home mailing address or normal means of contact could endanger them. Medicaid applications and renewal forms and the forms listed below allow women to provide a confidential mailing address and phone number for their Healthy Texas Women (HTW) Eligibility Determination Group (EDG):

  • Form H1871, HTW Client Turing 18 Years Old; and
  • Form H1872, HTW Opting Out and Reporting Confidential Address.

Do not provide any information regarding Healthy Texas Women (HTW) to anyone other than the certified household member, the authorized representative (AR) of an HTW certified woman, or the parent or legal guardian of an HTW minor.

Related Policy

Authorized Representatives (AR), A-170