Who needs a Form H-1010-R?
Any person whose household (family members) is participating in Texas Benefits program should use Form H-1010-R, Texas Benefits: Renewal Form to apply for another program different from the one in which a person is already involved.
What is Form H-1010-R for?
The Program allows a person to apply for the following types of benefits:
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SNAP food benefits. This program helps a person to buy food for good health.
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Healthcare. This is a Medicaid and Children’s Health Insurance, which provides help with paying hospital’s and doctor’s bills.
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Cash support for families (TANK). General help for paying applicant’s food, clothing, and housing.
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Medicare Saving Programs. It helps to manage the current Medicare insurance and cover some costs of extra payments the Medicare needs.
Each time the participant wants to switch on another program from the list or to add participation in one more part of the program, the Texas Benefits: Renewal Form must be filed.
Is Form H-1010-R accompanied by other forms?
A submitter must send pay stubs or statement of all money their household spent for the last 60 days before the form submission. If a submitter works for himself, proof of income and expenses must be attached as well.
How do I fill out Form H-1010-R?
Provide the following information to complete the form:
- Personal information and address of the submitter;
- Information on people renewing their benefits (indicating their relations to the submitter and their birthdate);
- List of anyone who lives with the submitter, but isn’t listed in the previous block.
- Information about the money coming into the submitter’s home;
- Information on housing costs, costs on people who depend on the submitter, medical costs, etc.
Where do I send Form H-1010-R?
When you complete and sign the form, direct it to the following address: HHSC, P.O. Box 14700, Midland, TX 79711-9907.
