TX HHS Form 4801. State Fair Hearing Evidence Packet Cover Page

The TX HHS Form 4801, State Fair Hearing Evidence Packet Cover Page, is a crucial document that helps resolve eligibility disputes for individuals enrolled in the Medically Dependent Children Program (MDCP) or STAR+PLUS Home and Community Based Services (HCBS) program. This form is typically used when an individual's eligibility denial is being appealed through a state fair hearing.

The packet includes supporting documents, such as Form H2065-D, Notice of Managed Care Program Services Policy, which outlines the rules used to determine the eligibility decision being appealed. The fair hearings officer will consider this information during the state fair hearing. HHSC representatives may testify about these documents, and individuals have the right to ask questions and provide their own testimony.

Key points to note include:

• The packet includes copies of supporting documents sent to the Texas Health and Human Services Commission (HHSC) fair hearings officer.
• Individuals will receive a separate notification from the Fair and Fraud Hearings Department (FFHD) providing details on the hearing date, time, and dial-in information.
• The attached packet of information should be kept with you during the hearing.