TX HHS Form 5006. Application for Hardship Waiver

The TX HHS Form 5006, Application for Hardship Waiver, is a crucial document that helps individuals navigate the Medicaid Estate Recovery Program (MERP) when faced with an undue hardship. This form is used in situations where the recovery of estate assets would cause significant financial strain or loss of primary income sources.

To qualify for a hardship waiver, applicants must meet specific criteria outlined in the Texas Administrative Code. These criteria include situations such as: the estate property being the site of a family business, farm, or ranch; heirs becoming eligible for public and/or medical assistance if the state were to recover the claim; or compelling reasons that demonstrate an undue hardship. The application requires supporting documents to be provided, and failure to do so will result in denial.

The applicant must complete the form and submit it with supporting documents within 60 calendar days from the date stated on the Notice of Intent to File a Claim Against the Estate. If denied, applicants have 60 calendar days to request a review of the decision. Key points to note include:

• A separate application must be submitted for each person requesting hardship consideration.
• Applications returned later than 60 days from the date stated on the Notice will not be reviewed.
• Contact Health Management Systems (HMS) Inc. at 1-800-641-9356 with questions about the claim or how to complete the form.