Form H1010, Texas Works Application for Assistance — Your Texas Benefits

Form H1010 integrates Texas Works programs into one single application.

The addendum to Form H1010 — Form H1010-M, Applying for or Renewing Medicaid or CHIP? — captures the information needed to make an eligibility determination for Medicaid or the Children's Health Insurance Program (CHIP).

Form H1010 can be used to apply for the following benefits:

SNAP food benefits;

TANF cash help for families; and

health care for: children; adults caring for a child; adults not caring for a child; pregnant women; people under age 26 who were in foster care in Texas and receiving federally funded Medicaid at age 18 or older; and people under age 21 who were in foster care in Texas or had an ICPC agreement at age 18 or older.