TX HHS Form 3045. Office of Primary and Specialty Health Presumptive Eligibility Notice

The TX HHS Form 3045, Presumptive Eligibility Notice, is a crucial document that helps address immediate medical or dental needs of clients who are unable to complete the eligibility determination process at the time of application. This form is typically used in situations where clients require temporary eligibility for primary health care services or Title V Maternal and Child Health Fee-for-Service programs.

The Form 3045 outlines key requirements, including the client's name, date of birth, and presumptive eligibility program name. It also specifies that the client has an immediate medical or dental need and understands that they must return with the requested documentation to complete their application within a 90-day period. The form emphasizes the importance of submitting required information to avoid expiration of presumptive eligibility.

Key features of this form include the provision of temporary eligibility for up to 90 days, the requirement to submit requested documentation to complete the application process, and the understanding that presumptive eligibility expires if the necessary information is not provided. The form also highlights the client's right to file a complaint with the HHSC Civil Rights Office in case of any issues or concerns related to the handling of their application.

• The Form 3045 is used for clients who require temporary eligibility for primary health care services or Title V Maternal and Child Health Fee-for-Service programs.
• It provides temporary eligibility for up to 90 days.
• The client must return with the requested documentation to complete their application within the specified period.