Downloading a Form to Your Computer
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC application. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
If still having trouble viewing or downloading a form, click here.
- To notify former Medicaid for Breast and Cervical Cancer (MBCC) applicants or recipients certified on another Medicaid program that their benefits will be ending within two months so that they can reapply for MBCC if they still need treatment for breast or cervical cancer by going to a Breast and Cervical Cancer Services (BCCS) office.
- To notify former MBCC applicants or recipients how to locate a BCCS office near them.
When to Prepare
- The Texas Integrated Eligibility Redesign System (TIERS) generates Form H1833-L.
- TIERS pre-populates the following basic client information:
- address, and
- Eligibility Determination Group (EDG) number.
- The form is only generated by TIERS and is mailed to the clients.
- Staff may reprint the form if a household requests a copy from TIERS History Correspondence.
- TIERS will not allow staff to generate the form in Manual Correspondence.
TIERS maintains a copy of the form in History Correspondence.