Form H1200-MBIC: Texas Medicaid Buy-In Application for Children

Form H1200-MBIC PDF Details

This program helps families who make too much money to get traditional Medicaid. To get benefits, the family might have to pay a monthly amount.

Age: The child must be age 18 or younger.

Disability: The child must meet the same rules for a disability that are used to get Supplemental Security Income (SSI).

Insurance: If a parent's employer pays at least half of the annual cost of health insurance, the parent must sign up and keep that insurance.

Income: The family must meet income limits set by the program.

Fax: Fax: 1-877-447-2839. If your form is 2-sided, fax both sides.