TX HHS Form 3082. Notice of Ineligibility

The TX HHS Form 3082, Notice of Ineligibility, is a crucial document for individuals who have applied for County Indigent Health Care Program (CIHCP) benefits but have been denied. This form serves as formal notification to the applicant, outlining the reasons for denial and providing information on the appeal process.

The form requires applicants to acknowledge the denial of their application and provides an opportunity to request a fair hearing within 90 days to appeal the decision. Key features include the specified reason(s) for ineligibility, the eligibility date beyond which benefits will not be available, and instructions on how to contact the issuing agency with questions or concerns.

If you believe this decision is incorrect, you may request a fair hearing within 90 days. To initiate an appeal, complete the information below and contact the office at the address or phone number listed at the top of the form. Key points to note:

• The denial of CIHCP benefits
• The reason(s) for ineligibility
• The eligibility date beyond which benefits will not be available
• The process for requesting a fair hearing and appealing the decision