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Effective Date: 


Note: This form is computer generated. A sample is provided.



Updated: 8/2001


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.

Form Retention

HHSC does not keep a copy of this form.

Detailed Instructions

Not applicable.