TX HHS Form 1069. Withdrawal of Offer of Texas Home Living Program

The Texas Home Living Program (TxHmL) withdrawal notice, Form 1069, is issued by the Texas Health and Human Services (HHS), Local Intellectual and Developmental Disability Authority (LIDDA). This document informs individuals that their offer to enroll in the TxHmL program has been withdrawn due to non-response or incomplete enrollment activities.

The withdrawal notice outlines the reasons for the cancellation, including failure to respond within 30 calendar days after receiving the initial letter and forms, such as Form 8592, Deadline Notification. Additionally, the notice highlights the importance of completing necessary activities, like Form 1049, Initial Documentation of Provider Choice, and Form 8601, Verification of Freedom of Choice, to complete the enrollment process.

This notice also reinstates the individual's name on the TxHmL interest list, allowing them to re-register within a specified timeframe. The document provides instructions for reinstatement and contact information for LIDDA staff, should individuals have any questions or concerns about the withdrawal notice.