TX HHS Form 8571. Request to Change Interest List Information for Home and Community-based Services (HCS) or Texas Home Living (TxHmL)

Form 8571 is an official Texas Health and Human Services Commission (HHSC) document used by Local Intellectual and Developmental Disability Authorities (LIDDAs) to request corrections or changes to a person’s interest list information for Home and Community-based Services (HCS) or Texas Home Living (TxHmL) waiver programs. This form plays a critical role in ensuring that interest list dates accurately reflect a person’s eligibility history and conversations about services.

Purpose of Form 8571

The main purpose of Form 8571 is to formally request an adjustment to a person’s interest list date or related data when an error, discrepancy, or special circumstance is discovered. Because interest list dates can affect service priority and future enrollment opportunities, HHSC requires documented justification before any change is approved.

This form is not used to place someone on an interest list for the first time. The individual must already have an interest list status of Interested before a change can be requested.

Who Uses This Form

Form 8571 is completed and submitted exclusively by a LIDDA. Individuals, families, or providers cannot submit this form directly to HHSC.

• LIDDA service coordinators
• LIDDA quality assurance staff
• LIDDA IDD directors (review and certification)

When This Form Is Required

A request using Form 8571 is typically required when:

• An incorrect interest list date is discovered
• A duplicate interest list record is identified
• A prior conversation about HCS or TxHmL was not properly documented
• A parent, guardian, or legally authorized representative (LAR) requests a review
• An internal LIDDA review identifies a discrepancy
• HHSC Contract Accountability and Oversight (CAO) requests clarification

Legal and Program Background

Interest list management for HCS and TxHmL is governed by HHSC administrative rules and waiver program requirements. Because these waivers are funded through Medicaid and state general revenue, HHSC must ensure that changes to interest list data are justified, documented, and applied consistently across the state.

Form 8571 provides a standardized process for documenting why a change is necessary and allows HHSC to review supporting evidence before approving or denying the request.

Section-by-Section Explanation

Section I – Information on Person and Request

This section identifies the individual whose interest list information is being reviewed. It includes personal identifiers such as name, Medicaid number, date of birth, CARE ID, and CSIL ID. Accuracy here is essential, as HHSC uses these identifiers to verify records across multiple systems.

The section also specifies whether the request relates to HCS, TxHmL, or both, along with the current and requested interest list dates.

Required Documentation

LIDDAs must attach documentation supporting the requested change. Commonly required documents include:

• Form 8648, Identification of Preferences
• Form 8591, Community Services Interest List (CSIL) Data Entry
• LIDDA contact notes showing discussion dates
• CSIL and/or CARE screenshots showing current interest list dates
• Proof of active military service, if applicable

Additional supporting materials may be submitted if relevant. If any required document is missing, the LIDDA must clearly explain why it is unavailable.

Interest List Discrepancy Explanation

This narrative portion is one of the most important parts of the form. The LIDDA must provide a clear, chronological explanation of how the discrepancy was discovered and what events led to the request. Vague or incomplete explanations are a common reason for denial.

Section II – LIDDA Contact Representative

This section identifies the LIDDA staff member responsible for the request and provides contact information in case HHSC needs clarification.

Section III – LIDDA IDD Director Certification

The IDD Director confirms that the request has been reviewed and that the information provided is accurate to the best of their knowledge. This certification adds accountability and oversight to the process.

Section IV – HHSC Determination

This section is completed by HHSC staff. HHSC reviews the documentation and determines whether it supports the requested change. The decision, comments, and notification date are recorded here.

Practical Tips for Completing Form 8571

• Ensure the person’s interest list status is “Interested” before submitting the request
• Attach clear screenshots with visible dates and identifiers
• Write a detailed explanation using plain language and specific dates
• Double-check all IDs and numbers for consistency across documents
• Submit the form using encrypted email as required by HHSC

Common Mistakes to Avoid

• Missing required attachments without explanation
• Providing a vague or overly brief discrepancy explanation
• Requesting changes without supporting contact notes
• Incorrect CARE, CSIL, or Medicaid numbers
• Submitting the form without IDD Director review

Real-Life Examples of When This Form Is Used

• A family discovers that an early conversation about TxHmL was never recorded, resulting in an incorrect interest list date.
• A LIDDA quality assurance review identifies two records for the same individual with conflicting dates.
• An individual’s military service qualifies them for an adjusted interest list date once documentation is provided.

Frequently Asked Questions

Can families submit Form 8571 directly?

No. The form must be completed and submitted by the LIDDA.

Does submitting this form guarantee approval?

No. HHSC approves requests only when documentation supports the change.

Can this form be used to add someone to an interest list?

No. It is used only to change existing interest list information.

Is military service always required?

No. Proof of military service is required only if it supports the request.

How is the form submitted?

It must be sent to HHSC IDD Services by encrypted email.

Micro-FAQ

• Purpose: Request correction of HCS or TxHmL interest list data.
• Who files: LIDDA staff only.
• Programs: HCS, TxHmL, or both.
• Attachments: Required forms, notes, and system screenshots.
• Submitted to: HHSC IDD Services by encrypted email.

Related Forms and Resources

• Form 8591 – Community Services Interest List Data Entry
• Form 8648 – Identification of Preferences
• Form 8577 – Questionnaire for LTSS Waiver Program Interest Lists
• Form 8601 – Verification of Freedom of Choice
• Form W21 – Interest List Services

Form Details

• Form Name: Request to Change Interest List Information for HCS or TxHmL
• Form Number: 8571
• Issued By: Texas Health and Human Services Commission
• Applies To: Texas
• Revision Date: September 2024