TX HHS Form H4808. Notice of Change in Applied Income/Notice of Denial of Medical Assistance

The TX HHS Form H4808, Notice of Change in Applied Income/Notice of Denial of Medical Assistance, is a crucial document for individuals who receive medical assistance. This form helps to notify the recipient of changes in their applied income or co-pay, ensuring that they are aware of any adjustments made to their monthly payments.

This notice is typically used when an individual's regular monthly income has changed, resulting in a revised projected amount taking into account their actual income and medical expenses. The form outlines the reasons for the change, including changes in income, allowable medical expenses, and home maintenance deductions. Key features of this form include the required information on the individual's name, address, and case number, as well as the details of the change in applied income or co-pay.

The Notice of Denial of Medical Assistance section of the form explains why an individual will no longer be eligible for certain medical assistance programs. This may occur due to changes in their income or medical expenses, which affect their eligibility for benefits such as Medicaid, Medicare Savings Programs, and Qualified Medicare Beneficiary (QMB) Benefits. The form also provides information on the right to apply for the Medicare prescription drug program and the right to a hearing.

• This form is used when an individual's applied income or co-pay changes due to changes in their regular monthly income, allowable medical expenses, or home maintenance deductions.
• The notice outlines the reasons for the change and provides information on the revised projected amount.
• The Notice of Denial of Medical Assistance section explains why an individual will no longer be eligible for certain medical assistance programs.