TX HHS Form H2053-B. Health Plan Selection

The Health Plan Selection Form H2053-B, issued by Texas Health and Human Services (HHS), is a crucial document for individuals seeking to begin the eligibility process for STAR+PLUS Home and Community Based Services (HCBS) program or Medically Dependent Children Program (MDCP). This form helps solve the problem of determining which health plan to coordinate healthcare benefits, ensuring that individuals receive the necessary care and support.

To initiate the eligibility process, individuals must select a health plan by checking one of the boxes below. The selected health plan will then be responsible for coordinating healthcare benefits. A nurse will schedule a visit with the individual to conduct a medical assessment to determine their need for program services. The form requires the signature of the individual or authorized representative to authenticate their health plan choice.

Key features of this form include selecting one of two health plans, [health plan name] or [health plan name], and providing a signature to confirm the chosen health plan. This form is typically used by individuals seeking to begin the eligibility process for STAR+PLUS HCBS program or MDCP. Here are some key points to keep in mind:

• This form is required for initiating the eligibility process for STAR+PLUS HCBS program or MDCP.
• A nurse will conduct a medical assessment to determine the individual's need for program services.
• The selected health plan will be responsible for coordinating healthcare benefits.