Effective Date: 
4/2019

Documents

 

Instructions

Updated: 4/2019

 

Purpose

  • To notify Texas Women's Health Program (TWHP) recipients of the expiration of their 12-month continuous eligibility period.
  • To remind TWHP recipients to file a renewal application to ensure continuous TWHP coverage.

Procedure

When to Prepare

Staff prepare Form H1830-W to send with a renewal application packet if it is determined that the TWHP recipient is not adjunctively eligible.

This form is attached and sent with Form H1867-R, Texas Women's Health Program Application.

Number of Copies

The Texas Integrated Eligibility Redesign System (TIERS) mails Form H1830-W along with Form H1867-R to the TWHP recipient in the 10th month of the 12-month certification period. If the advisor needs to give a form to the individual, the advisor must issue a manual form.

Transmittal

Staff give or mail the original form to the individual with Form H1867-R. The individual may apply online, by phone by calling 2-1-1, or may fax or mail the renewal application to the Document Processing Center (DPC). Include the fax number and a return stamped envelope with the renewal packet.

Texas Health and Human Services Commission
P.O. Box 149024
Austin, TX 78714-9024
Fax Number: 1-877-447-2839

Form Retention

See the Texas Works Managers Guide.

Detailed Instructions

Enter the individual's name and address. Also enter the eligibility determination group (EDG) number at the top of the form. Enter the DPC's mailing address and fax number.

  1. Enter the year, month and day of the last certification month of the continuous eligibility period.
  2. and 3. Enter the year, month and the first day of the last certification month of the continuous eligibility period by which the individual has to return the form.

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