TX HHS Form 3077. Notice of Eligibility

TX HHS Form 3077, Notice of Eligibility, is a crucial document that notifies individuals of their eligibility for health care services through the County Indigent Health Care Program (CIHCP). This form serves as confirmation that an applicant's application has been approved and outlines the terms of their benefits.

The notice highlights the individual's responsibilities, including the requirement to notify the program office within 14 days of any changes in their situation, such as address, household members, property, income, or receipt of Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF) or Medicaid. Failure to report changes may result in financial responsibility for health care services received after becoming ineligible and/or prosecution under the Texas Penal Code.

This form is essential for individuals seeking health care services through the CIHCP, providing them with a clear understanding of their eligibility and responsibilities. By using TX HHS Form 3077, Notice of Eligibility, program participants can ensure they are in compliance with program requirements and receive necessary health care services.