X-2050, Notice of Renewal

Revision 15-4; Effective October 1, 2015

The Texas Integrated Eligibility Redesign System (TIERS) generates a renewal packet to a recipient two months before the periodic review due date.

The renewal packet includes:

• Form H1830, Application/Review/Expiration/Appointment Notice;
• Form H2340, Medicaid for Breast and Cervical Cancer Renewal;
• Form H1551, Treatment Verification, to verify if the recipient is currently receiving treatment for breast or cervical cancer; and
• a self-addressed stamped envelope.