Form H1024 is a Self-Declaration Notice the Texas Health and Human Services Commission (HHSC) mails to Medicaid households during renewal when a child’s records show an overdue Texas Health Steps checkup or the case is flagged for not completing Health Care Orientation.1Texas Health and Human Services. Form H1024, Subject – Self-Declaration Notice You don’t request it; HHSC sends it to you with a return envelope. Check the box that fits your situation, add a brief explanation if the form asks for one, and mail it back quickly so your child’s Medicaid renewal isn’t held up.
Why HHSC Sent You This Form
The form is generated during the Medicaid renewal process for one or both of two reasons: HHSC’s records show a certified child has a Texas Health Steps (THSteps) checkup past its overdue date, or the case is flagged for noncompliance with Health Care Orientation.1Texas Health and Human Services. Form H1024, Subject – Self-Declaration Notice It only goes out when the issue couldn’t be cleared up by phone between the HHSC advisor and the household. If more than one of your children has an overdue checkup, you may receive a separate form for each child.
Health Care Orientation, sometimes called Introduction to Health Care, is a requirement for some Medicaid households to learn how to use their benefits. If the agency’s records don’t show you completed it, the form lets you confirm you did or explain why not.
The top of the form arrives pre-filled by the HHSC advisor: the date, the advisor’s name, and the local office’s address and phone number. Keep that contact information handy. In many cases a quick call to the advisor can resolve the flag faster than mailing the form, because the advisor can look directly at the THSteps tracking system.
Completing the Texas Health Steps Section
If this section is marked, HHSC’s records show the named child is not current on medical checkups. Pick the response that matches your situation:2Your Texas Benefits. Self-Declaration Notice – Texas Health Steps – Health Care Orientation
- The child had the checkup. Use this when the visit already happened but hasn’t posted to the state’s tracking yet. Provider claims can take weeks to appear.
- The child is scheduled for the checkup. HHSC treats a scheduled appointment as intent to comply.
- There is a good reason for not having the checkup. Write your reason on the blank line. A family emergency, transportation problems, or trouble finding a provider taking new Medicaid patients are examples that fit here.
- The child did not have the checkup and has no plans to have it. This is the noncompliance option, and selecting it confirms the child is overdue with no appointment planned.
If the visit already took place, consider calling the advisor listed at the top of the form before mailing it. The advisor can often clear the overdue flag directly once they confirm the visit in the system.
Completing the Health Care Orientation Section
If this section is marked, HHSC’s records don’t show you completed the orientation. The form notes that taking your child to a doctor or clinic visit after enrolling in Medicaid counts as credit for the orientation, so a routine doctor visit may already satisfy the requirement even if you never attended a formal session.2Your Texas Benefits. Self-Declaration Notice – Texas Health Steps – Health Care Orientation The choices are:
- I received the Introduction to Health Care (Health Care Orientation).
- I am scheduled for the Introduction to Health Care (Health Care Orientation).
- I took my child to a doctor or clinic visit.
- My child is scheduled for a doctor or clinic visit.
- There is a good reason for not having the orientation. Write the reason on the blank line.
- I didn’t have the orientation and my child has not been to a doctor or clinic. This confirms noncompliance.
Any of the first four options demonstrates compliance or intent to comply. Pick the one that best matches and move on.
How to Return the Form
HHSC includes a return envelope, so the simplest path is to check your boxes, fold the form, and drop it in the mail.1Texas Health and Human Services. Form H1024, Subject – Self-Declaration Notice Because the form is tied to your renewal, send it back promptly; delays can slow the redetermination.
HHSC generally accepts renewal documents through several channels. You can upload the form through your authenticated account at YourTexasBenefits.com, bring it in person to a local HHSC benefits office, or fax it.3Texas Health and Human Services. Texas Works Handbook – B-120, Redeterminations The local office phone number is printed at the top of the form if you want to confirm the fastest option for your area.
What Happens If You Don’t Send It Back
Not returning Form H1024 can lead to denial of your Medicaid renewal. The Texas Works Handbook references households “previously denied for failure to provide Form H1024.”4Texas Health and Human Services. Texas Works Handbook When that occurs, HHSC staff are instructed to schedule an appointment at the next application to deliver the Health Care Orientation or remind the household about the THSteps checkup, giving another chance to come into compliance.
The form isn’t asking for medical records or proof. It’s a self-declaration, which means your checked box and short written explanation are the response HHSC needs. Even selecting the “good cause” option and writing a brief reason counts as a valid reply. The worst move is ignoring the form, because that leaves HHSC with nothing to process. When you aren’t sure which box fits, call the advisor named at the top of the form before the return deadline.
If You Lose Your Copy
You usually won’t need a blank copy, since HHSC mails the form pre-filled with the advisor’s information and the child’s name. If your copy is lost or damaged, the current PDF is available from the HHSC forms page, with an effective date of June 2026, and a Spanish version (H1024-S) is posted on the same page.1Texas Health and Human Services. Form H1024, Subject – Self-Declaration Notice You can also request a replacement at a local HHSC office. A blank download won’t carry your advisor’s pre-filled information, so contact your local office for those details before submitting it.