TX HHS Form 2065-C. Notification of Ineligibility or Suspension of Waiver Services

The TX HHS Form 2065-C, Notification of Ineligibility or Suspension of Waiver Services, is a crucial document that helps resolve situations where an individual's waiver services are terminated or suspended. This form is typically used by HHSC Case Managers to notify clients of the change in their eligibility status and provide information on the last day they will receive services.

The form provides key details about the reason for denial, termination, or suspension, including the medically dependent children program rule that applies. It also includes a section for comments, where additional information can be provided to explain the decision. The document requires the signature of the HHSC Case Manager and includes a statement of rights on page 2.

This form is essential for ensuring that individuals receive timely notification of changes to their waiver services. By filling out this form, case managers can provide clear communication to clients about their eligibility status and any follow-up actions required. Key points to note include:

• The last day an individual will receive services
• The reason for denial, termination, or suspension of waiver services
• The medically dependent children program rule that applies