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 document used to request a fair hearing for denied, suspended, reduced, or discharged Youth Empowerment Services (YES) Waiver benefits. This form helps applicants and participants contest actions taken on their YES Waiver benefits.

This form should be used when an individual wishes to appeal a decision made by the Texas Health and Human Services Commission regarding their child's YES Waiver services. The form requires information such as the applicant's organization, child or youth's name, Medicaid ID number, and date of denial of eligibility letter. The applicant must also specify the reason for requesting a fair hearing.

The key features of this form include Section 1, which requests a fair hearing due to denied, suspended, reduced, or discharged YES Waiver services, and Section 2, which outlines the parent or guardian's rights during the fair hearing process. The form also specifies that applicants are entitled to representation at their own expense and may provide their own evidence and witnesses.