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, or their legally authorized representatives, make informed decisions about receiving Medicaid-funded services. This form should be used when an individual wants to enroll in the Youth Empowerment Services (YES) Waiver program and verify their freedom of choice.

This form requires important information, including participant name, date of birth, and legible authorized representative (LAR) name. It also includes sections for verifying the participant's understanding of their freedom of choice options, which include enrolling in the YES Waiver or an institutional program like a psychiatric facility. The form explicitly mentions that participants can choose to receive services through one of these programs but not both simultaneously.

The key feature of this form is its emphasis on the participant's right to choose their service provider from those available through the YES Waiver and the option to change providers when available. This form should be used by individuals who are considering enrolling in the YES Waiver program or need to verify their freedom of choice options.