TX HHS Form 8001. Medicaid Estate Recovery Program Receipt Acknowledgement

The TX HHS Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement, is a notice provided to individuals applying for long-term care services paid by Medicaid. This form serves as an acknowledgement of the state's obligation to inform applicants about Medicaid estate recovery.

This form is used when an individual applies for long-term care services covered by the Medicaid Estate Recovery Program (MERP). The program affects only long-term care services received after age 55, and only if the applicant first applied for these services after March 1, 2005. MERP does not apply to individuals who receive intermediate care facility services or certain Medicaid waiver programs.

The form highlights key information about MERP, including the state's right to ask for some money back from an individual's estate after they die, and the exceptions that may apply. These exceptions include having a spouse still alive, a child of any age who is blind or permanently and totally disabled, or a certain amount of Medicaid costs. The form also explains that the state will never ask for more money back than it paid for services.