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

The Texas Health and Human Services (HHS) issues Form 2065-C, Notification of Ineligibility or Suspension of Waiver Services, to inform individuals that their waiver services are no longer eligible or have been suspended. This form serves as a notification of the last day an individual can receive these services.

This document is intended for individuals who are currently receiving waiver services and may be affected by changes in their eligibility status. The HHS uses this form to communicate its decision, which is based on the Medically Dependent Children Program Rule. The form provides important information about the reason for denial, termination, or suspension of services.

The notification includes a statement of the individual's rights and a provider authorization section, outlining the last day that authorized providers can deliver services. This form is an essential tool for individuals to understand their eligibility status and plan accordingly. By completing Form 2065-C, the HHS ensures that individuals are informed about any changes affecting their waiver services.