TX HHS Form 1045. Request for Extension of Enrollment Offer Due Date

The TX HHS Form 1045, Request for Extension of Enrollment Offer Due Date, is a crucial document that helps individuals with intellectual and developmental disabilities (IDD) or related conditions request an extension on their enrollment offer due date. This form is typically used by the Local Intellectual and Developmental Disability Authority (LIDDA) to facilitate the enrollment process in Home and Community-based Services (HCS) and Texas Home Living (TxHmL). The form is usually completed by a representative of LIDDA or an individual with IDD.

The form requires specific information, including the LIDDA's name, program slot type, and contact details. It also asks about the person's current living situation, Medicaid status, and any mutually exclusive programs they may be participating in. The form has three sections: LIDDA Information, Person's Information, and Enrollment Activities. The latter section allows individuals to indicate whether specific enrollment activities have been completed, with space for detailed explanations if necessary.

Key features of this form include the request for an extension on the enrollment offer due date, the requirement for specific information about the individual's Medicaid status and current living situation, and the opportunity to provide a detailed explanation for any incomplete enrollment activities. By using this form, LIDDA can efficiently manage the enrollment process and ensure that individuals with IDD receive the necessary services and support.

• This form is used by the Local Intellectual and Developmental Disability Authority (LIDDA) to facilitate the enrollment process in Home and Community-based Services (HCS) and Texas Home Living (TxHmL).
• The form requires specific information about the individual's Medicaid status, current living situation, and mutually exclusive programs.
• The form has three sections: LIDDA Information, Person's Information, and Enrollment Activities.