TX HHS Form 3082. Notice of Ineligibility

The TX HHS Form 3082, Notice of Ineligibility, is used to inform individuals that their application for County Indigent Health Care Program (CIHCP) benefits has been denied. This form outlines the reasons for denial and provides information on how to appeal the decision.

This notice is typically issued when an individual's application does not meet the eligibility criteria or when they are no longer eligible for CIHCP benefits after a certain date. The form requires the applicant to complete specific information if they have questions about the denial, including their case record number and contact details.

The key feature of this form is the provision of an appeal process, allowing individuals to request a fair hearing within 90 days to challenge the decision. This form should be used when an individual's application for CIHCP benefits has been denied, and they wish to understand the reasons for denial or seek reconsideration.