TX HHS Form 2801. Youth Empowerment Services Waiver Fair Hearing Request

The TX HHS Form 2801, Youth Empowerment Services Waiver Fair Hearing Request, is a crucial document for individuals seeking to appeal decisions related to their child's YES Waiver benefits. This form helps solve the problem of contesting actions on YES Waiver benefits, such as denial, suspension, reduction, or discharge.

The form is typically used by parents or guardians who wish to request a fair hearing due to an adverse action taken on their child's YES Waiver services. Key features include required information such as the child's name, Medicaid ID number, and date of denial, as well as conditions for requesting a fair hearing, including within 10 calendar days of receiving notice of suspension or discharge. The form also outlines responsibilities, such as providing evidence and witnesses during the hearing process.

To request a fair hearing, individuals can submit this form by mail to Texas Health and Human Services Commission Behavioral Health Services Attn: Fair Hearing Request P.O. Box 13247, Mail Code: 2053 Austin, TX 78711. Key points to note include:

• Requesting a fair hearing within 10 calendar days of receiving notice of suspension or discharge
• Providing required information, such as the child's name and Medicaid ID number
• Having the option to bring witnesses and provide evidence during the hearing process