TX HHS Form 5842. TxHmL Financial Eligibility Information

The TxHmL Financial Eligibility Information Form (Form 5842) helps determine the financial eligibility status of applicants for the Texas Home Living (TxHmL) Program. This form is typically used by the Local Intellectual and Developmental Disability Authority (LIDDA) to assess an applicant's financial situation and make a determination about their eligibility for the program.

This form requires specific information, including the applicant's name, date of birth, Medicaid number (if applicable), and mailing address. It also asks for documentation, such as a copy of the SSI denial letter from the Social Security Administration or the Medicaid denial letter from the Health and Human Services Commission. The LIDDA contact is responsible for completing this form and ensuring its accuracy.

Key points to note when using Form 5842 include:

• The applicant must have been denied SSI or Medicaid to complete this form.
• A copy of the denial letter must be attached as proof.
• The LIDDA contact is responsible for ensuring the accuracy and completeness of the form.