TX HHS Form 3065. Worksheet

The TX HHS Form 3065, Worksheet is a tool used to determine eligibility for health care assistance through the Texas Health and Human Services (HHS) County Indigent Health Care Program (CIHCP). This form helps program administrators assess an individual's or family's need for financial assistance in receiving medical care.

The worksheet requires specific information, including the applicant's name and case record number, as well as details about their household composition. It also includes sections to document the applicant's eligibility status, including whether they have a signed and dated application, and if any household members receive Medicaid or are potentially eligible for it. The form provides instructions on how to verify household information and use the Medicaid screening tool at www.yourtexasbenefits.com.

This form should be used by program administrators when processing applications for health care assistance through the CIHCP. It is an essential tool in determining eligibility and ensuring that applicants receive the necessary support. The TX HHS Form 3065, Worksheet is a crucial document in the application process, helping to streamline the determination of financial assistance for those in need.