Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
Note: This form is computer generated. A sample is provided.
To notify certified Supplemental Security Income (SSI) clients of their potential eligibility for prior medical coverage.
When to Prepare
Management Information Systems (MIS) produces Form H1298 on newly certified SSI clients who have indicated they have unpaid medical bills. Form H1298 is a computer-generated form. It contains the individual's name, address, Social Security number, HHSC client number, and the two months preceding the Medicaid Start Date.
Number of Copies
MIS produces one copy of Form H1298.
MIS sends Form H1298 to the SSI client. The SSI client is advised via Form H1298 to contact the local department office if he wishes to apply for prior medical coverage.
HHSC does not keep a copy of this form.