TX HHS Form 2809. Youth Empowerment Services Waiver Verification of Freedom of Choice

The TX HHS Form 2809, Youth Empowerment Services Waiver Verification of Freedom of Choice, is a crucial document that helps individuals make informed decisions about their healthcare services. This form is typically used by participants in the Medicaid-funded Youth Empowerment Services (YES) Waiver program to verify their freedom of choice in selecting a service provider.

The form requires participants to provide essential information, including their name, date of birth, and legally authorized representative's name. It also outlines key conditions and responsibilities, such as understanding that they have the right to choose their service provider from those available through the YES Waiver program. Additionally, participants must acknowledge that they are not eligible to participate in or receive services through another 1915(c) Home and Community-based Services waiver or 1915(i) program while enrolled in the YES Waiver program.

The form is an important tool for ensuring that individuals have a clear understanding of their options and responsibilities within the YES Waiver program. By completing this form, participants can verify their freedom of choice and make informed decisions about their healthcare services. Key points to note include:

• Participants must understand that they have the right to choose their service provider from those available through the YES Waiver program.
• Participants are not eligible to participate in or receive services through another 1915(c) Home and Community-based Services waiver or 1915(i) program while enrolled in the YES Waiver program.
• Participants must acknowledge that they have received information about the types of institutional services available to them, as well as their questions being answered by the Wraparound Provider Organization (WPO).