TX HHS Form 2800. Notice of Denial - Eligibility

The TX HHS Form 2800, Notice of Denial - Eligibility, is a crucial document used to inform legally authorized representatives (LARs) of the denial of their child or youth's eligibility for the Youth Empowerment Services (YES) Waiver program. This form helps solve the problem of communicating the outcome of an eligibility review and outlines the reasons behind the decision.

The key features of this form include the required information such as the LAR's name, address, and contact details, as well as the child or youth's name, date of birth, age, Medicaid number, and reason for denial. The important sections to note are the review outcome, which indicates whether the YES Waiver services have been denied, suspended, reduced, or terminated, and the reasons supporting this decision.

This form is typically used when an organization reviews a child or youth's eligibility for the YES Waiver program and determines that they do not meet the criteria. The conditions explicitly mentioned in the text include the requirement to request a fair hearing to appeal the decision within 90 days from the date of the letter, failing which the right to appeal may be lost.