TX HHS Form H4857. Notice of Decision. Administrative Disqualification Hearing

The TX HHS Form H4857, Notice of Decision: Administrative Disqualification Hearing, is a crucial document that helps resolve disputes related to the Texas Temporary Assistance for Needy Families (TANF) program. This form is typically used in situations where an individual or household has been accused of committing intentional program violations and may face disqualification from receiving TANF benefits.

The Notice of Decision outlines the outcome of an administrative hearing, stating whether the individual or household will be disqualified from receiving TANF benefits. The form details the specific duration of the disqualification period, ranging from six months to permanent disqualification. Additionally, it informs the affected party that they may stop receiving TANF-related Medicaid benefits and provides information on how to apply for other types of Medicaid coverage.

The key features of this form include the required information about the case number, client name and address, and OIG case number. The document also outlines the conditions under which an individual or household will be disqualified from receiving TANF benefits, including the specific duration of the disqualification period. Furthermore, it highlights the responsibilities of the affected party to notify their local eligibility determination office about potential changes in their Medicaid coverage.

• This form is used in situations where an individual or household has been accused of committing intentional program violations and may face disqualification from receiving TANF benefits.
• The Notice of Decision outlines the outcome of an administrative hearing, stating whether the individual or household will be disqualified from receiving TANF benefits.
• The form provides information on how to apply for other types of Medicaid coverage if the affected party is disqualified from receiving TANF benefits.