TX HHS Form 2800. Notice of Denial - Eligibility

The TX HHS Form 2800, Notice of Denial - Eligibility, is a crucial document that helps resolve issues related to the denial of Youth Empowerment Services (YES) Waiver program benefits for children or adolescents with severe emotional disturbance. This form is typically used in situations where an organization has reviewed eligibility and determined that YES Waiver services are not applicable.

The form requires specific information, including the child's name, date of birth, age, Medicaid number, and the reason for denial. The notice also outlines the reasons for denial, which are based on specific policies and pertinent language from relevant manuals. Key features of this form include the requirement to provide a written request for a fair hearing within 90 days of the letter if the decision is disputed.

If you disagree with the decision to deny YES Waiver services, you have the right to request a fair hearing. To exercise this right, submit a written request to the Texas Health and Human Services Commission no more than 90 days from the date of the letter. Failure to receive the request by this deadline may result in the loss of appeal rights.

• This form is used when an organization reviews eligibility for YES Waiver program benefits.
• The form requires specific information, including the child's name, date of birth, age, Medicaid number, and reason for denial.
• A written request for a fair hearing must be submitted within 90 days if the decision is disputed.