TX HHS Form 1068. Withdrawal of Offer for Home and Community-based Services (HCS) Program

The Texas Health and Human Services (HHS) has issued Form 1068, Withdrawal of Offer for Home and Community-based Services (HCS) Program, to notify individuals of the withdrawal of their offer to enroll in the HCS program. This form is used by the Local Intellectual and Developmental Disability Authority (LIDDA) to inform individuals that their offer has been withdrawn due to a lack of response or incomplete enrollment process.

The purpose of this form is to provide notice to individuals who have received an offer to enroll in the HCS program, but have failed to respond or complete the necessary steps to finalize their enrollment. The form outlines the reasons for withdrawal and provides instructions on how to reinstate their interest list status. This process ensures that only eligible individuals are enrolled in the HCS program, which is designed to provide home and community-based services to individuals with intellectual and developmental disabilities.

This form is intended for individuals who have received an offer to enroll in the HCS program and need to be notified of the withdrawal of their offer. The issuing agency, Texas Health and Human Services (HHS), has developed this form to ensure that individuals are properly informed of the status of their enrollment application. By using Form 1068, LIDDA can efficiently manage the HCS program and provide services to eligible individuals in a timely manner.