Form H1228-A, Medicaid for the Elderly and People with Disabilities -- Application Information

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Effective Date: 10/2018


Updated: 10/2007


To serve as a cover letter for medical assistance only (MAO) applications when application forms are given to outstation locations, such as nursing facilities and hospitals.

When to Prepare

Attach Form H1228-A to each Form H1200 provided to an outstation location. Include Form H0003.

Detailed Instructions

Local HHSC Address and Telephone Number — Self-explanatory.