Facts HHSC Has About Me
HHSC uses facts about people applying for
benefits to decide: (1) who can get benefits,
and (2) the amount of benefits. HHSC checks
facts with the federal Income and Eligibility
Verification System. If any facts don’t match,
HHSC will check other sources (banks,
employers, etc.). If anyone applying for
benefits has an immigration registration
number, HHSC must check with the U.S.
Citizenship and Immigration
Services’ (USCIS) system. HHSC will not
give anyone’s facts to USCIS.
In most cases, I can see and get facts HHSC
has about me. This includes facts I give
HHSC and facts HHSC gets from other
sources (medical records, employment
records, etc.). I might have to pay to get a
copy of these facts. I can ask HHSC to fix
anything that is wrong. I do not have to pay to
fix a mistake. To ask for a copy or to fix a
mistake, I can call 2-1-1 or my local HHSC
Medicaid health care providers (doctors,
drug stores, hospitals, etc.) might give out
facts about me to HHSC. This will allow
the providers to be paid by Medicaid.
Giving Out Facts About Me
If I choose not to tell the truth, I might:
If I Give False Information
• Be charged with a crime.
• Have to repay benefits.
The same is true if I let someone else use
my medical card or Medicaid ID.
If I get Medicaid, HHSC will keep medical
service payments I can get from other
sources, such as:
I must tell HHSC about these sources. If I
don’t, I am breaking the law.
• My health insurance.
• Money I got because of injuries.
HHSC will only keep the amount of
medical support and service payments
allowed by law. I will work with HHSC to
get these funds.
I agree to let HHSC know, within 10 days,
about any changes to my case. This
includes changes in facts I give on this
form such as money I get, things I own or
are paying for, where I live, or insurance I
have (including health insurance
HHSC can share facts about me
• When needed for me to get state health
• With phone and utility companies. They
will find out if my bill amount can be
lowered. HHSC will give them my name,
address, and phone number.
Asset Verification Consent
I know that my signature below and/or on the
application lets the HHSC get facts about
things I own (including money) from banks,
credit unions, or other financial institutions so
HHSC can decide if I can get Medicaid.
HHSC can keep checking these facts until:
• HHSC denies my application for Medicaid;
• I can't get Medicaid anymore; or
• I tell HHSC in writing that I do not want
HHSC to check these facts any more.
If I do not let HHSC get facts about me from
financial institutions, or I tell HHSC I do not
want it to check these facts anymore, I know
that HHSC may deny or stop my Medicaid.
HHSC will keep my facts private if they
• By HHSC staff or contracted provider
• To find out if I can get state benefits.
Keeping My Facts Private
Application for Benefits
Texas Health and Human Services Commission