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Purpose. To serve as an application and recertification form for Medicare cost-sharing programs and Medicaid community-based programs, except waiver programs. (Form H1200-EZ is an optional alternative to Form H1200 and Form H1200-A for these programs.)
Effective Date: 1/2022. Availability. English PDF: Form H1200. Spanish PDF: Form H1200-S. Instructions. English and Spanish forms can be found under the title "Form to apply for Medicaid for the Elderly and People with Disabilities or Medicare Savings Program" under section "Forms to apply for benefits".
To learn more about all your options, contact your local Aging and Disability Resource Center or call 2-1-1. To get MEPD, you must be a Texas resident and a U.S. citizen or qualified non-citizen. When you apply, we'll ask about your income, your age, and your disability to see if you qualify. Apply for MEPD.
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