Texas Form H1836-A: Medical Release, Physician’s Statement, and TANF Submission

Texas Form H1836-A is the Medical Release and Physician’s Statement that the Texas Health and Human Services Commission (HHSC) uses to verify whether you have a disability that limits your ability to work. HHSC relies on the completed form to decide if you qualify for an exemption from work requirements attached to SNAP or TANF benefits. Your caseworker, called a Texas Works advisor, starts the form with your case details; you sign an authorization; a qualified medical provider fills in the medical sections; and the finished form goes back to HHSC.¹

When You Would Receive This Form

You don’t request Form H1836-A on your own. Your Texas Works advisor prepares it when your case calls for medical verification of a disability. That happens in a few specific situations: when a SNAP recipient appears able to work but reports a disability, when a TANF recipient reports a temporary or permanent disability affecting their ability to work or support their children, when a TANF recipient asks for a severe personal hardship exemption during the five-year freeze-out period, or when a TANF recipient asks for an extended TANF personal disability hardship exemption at or after their 60th month of assistance.¹

Your advisor fills in Section I with your identifying information first, your name, date of birth, Social Security number, case name, and case number, before giving or mailing the form to you.¹ A blank version is posted on the HHSC website, but the standard route is the pre-filled copy from your advisor.²

Who Can Fill In the Medical Sections

Not just any clinician qualifies. The provider who completes Section II must be one of the following:

A licensed physician (M.D.)
A licensed osteopath (D.O.)
A physician’s assistant working under a physician’s orders
An advanced practice nurse
A certified psychologist, for mental health conditions affecting your ability to work

Pick someone who is actively treating you or who has your records, since they’ll need to describe your specific limitations in detail.¹

What You Sign and What the Provider Completes

Section I: Your Authorization

Section I holds the case information your advisor entered and an authorization that you sign. Your signature lets HHSC obtain medical information from your provider. Signing is voluntary; the form states you don’t have to sign to remain eligible for TANF, SNAP, or Medicaid. But you do have to sign if you want an exemption from work requirements.² Before you sign, confirm your name, date of birth, Social Security number, and case number are entered correctly. Errors in those fields can delay processing or send the form to the wrong case.

Section II: The Physician’s Statement

Once you’ve signed, take the form to your provider. Section II has three parts.

Part A asks the provider to check one of three boxes describing the extent of your work limitation:³

Option 1: You can work or participate in work-preparation activities without restrictions, full time (40 hours per week) or part time at a stated number of hours.
Option 2: You can work or participate with restrictions, full time or part time. This option requires the provider to also complete Parts B and C.
Option 3: You cannot work or participate in any work-preparation activities. The provider then indicates whether the disability is permanent, expected to last more than six months, or expected to last six months or less, and completes Part C.

Part B applies only when the provider selects Option 2. It’s a grid where the provider marks how many hours per workday you can sit, stand, walk, climb stairs, kneel, bend, push or pull, use a keyboard, and lift or carry. The provider also notes a maximum lifting weight and whether you could do light seated tasks such as answering phones or filing.2 Most exemption decisions turn on the answers here, and vague entries are a common reason forms come back for clarification.

Part C is the diagnosis section. The provider writes your primary disabling diagnosis, any secondary diagnosis, and additional comments. Part C is required whenever the provider chose Option 2 or Option 3.

At the bottom of Section II, the provider prints their name, signs, dates the form, and enters their license number, office address, and phone number.² Before you leave the appointment, look over every field. A missing license number or an unsigned form will be returned.

How to Submit the Completed Form

The completed form can reach HHSC in a few ways. The provider can hand it back to you, mail it directly to HHSC at the address printed in Section I, or fax it to the number on the form.¹ If the provider gives it back to you, you can upload it through your Your Texas Benefits account, drop it off in person at your local HHSC benefits office, or mail or fax it yourself.⁴

If you fax the form, keep the confirmation page. If you upload through Your Texas Benefits, save the receipt the system generates. The sooner the form reaches your advisor, the sooner the exemption can be processed.

The Six-Month Rule for Extended TANF

If you’re applying for extended TANF beyond the 60-month lifetime limit based on a personal disability hardship, your Form H1836-A must be dated no more than six months before the month you apply, and it must show that your disability is expected to last more than 180 days.⁵ A form on which the provider marked the disability as lasting six months or less will not meet this requirement. The 180-day threshold applies specifically to extended TANF hardship; for a regular SNAP or TANF exemption, a shorter expected duration can still qualify.

What Happens After Submission

Texas processes SNAP applications and redeterminations within 30 days.⁶ Households eligible for expedited service must receive benefits within seven days.⁷ Your medical exemption request is decided as part of your overall case, so it falls inside the same window.

You’ll get a written notice, or an update in Your Texas Benefits, telling you whether the medical statement was accepted or whether HHSC needs more information. Respond quickly to any request for more documents. A late response can push your case past the processing deadline and produce a denial you’d then have to appeal.

Appealing a Denial

If HHSC denies the exemption, the denial notice (Form 2065-A) will state the reason and your appeal rights. You have 90 calendar days from the date of the action to request a fair hearing.⁸ You can request it by returning Form 2065-A with the appropriate box checked or by making a verbal or written request to HHSC.

To keep receiving current benefits while the appeal is pending, you have to request the hearing before the effective date shown on the denial notice. If you miss that earlier deadline but file within 90 days, your appeal will still be heard; you may just have a gap in benefits while it is decided.⁸ Requests filed after 90 days aren’t automatically rejected either; a hearings officer decides whether you had good cause for the delay.

Accuracy Matters

A fraudulent medical claim on Form H1836-A can trigger an intentional program violation finding. Under federal SNAP rules, a first violation costs 12 months of SNAP benefits, a second costs 24 months, and a third brings permanent disqualification. An IPV is administrative, but Texas can pursue criminal fraud charges separately.⁹ An honest mistake is not an intentional violation, but make sure what your provider documents on the form matches your actual condition.

1
Texas Health and Human Services. Form H1836-A, Medical Release and Physician’s Statement
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Health and Human Services Commission. Form H1836-A – Medical Release/Physician’s Statement
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Health and Human Services Commission. Form H1836-A – Medical Release/Physician’s Statementa>
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Texas Health and Human Services. Benefits Application Next Steps
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Texas Health and Human Services. A-1930, Extended TANF and Hardship Exemptions
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Texas Health and Human Services. B-160, SNAP Timeliness Charts for Applications and All Redeterminations
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Food and Nutrition Service. SNAP Application Processing Timeliness
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Texas Health and Human Services. 2900, Appeals and Fair Hearings
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eCFR. 7 CFR 273.16 – Disqualification for Intentional Program Violation