TX HHS Form H5024-MBIC. Termination Notice (Medicaid Buy-In for Children)

The Termination Notice (Medicaid Buy-In for Children) Form H5024-MBIC is a crucial document that helps resolve the issue of Medicaid benefits ending. This form is typically used in situations where an individual's Medicaid Buy-In for Children benefits are being terminated, and it provides a formal notice of this change. The form is usually filled out by the Texas Health and Human Services (HHS) or other authorized agencies.

The Termination Notice Form H5024-MBIC requires specific information to be provided, including the reason for termination, the effective date of termination, and any necessary follow-up actions. It also outlines the individual's responsibilities in regards to their terminated benefits, such as notifying the agency if they disagree with the termination decision. Additionally, the form provides contact information for the HHSC Office of Civil Rights and the U.S. Department of Health and Human Services' Office for Civil Rights, which individuals can use to file a complaint or seek further assistance.

Key points to note when using Form H5024-MBIC include:

• The form is used to notify an individual that their Medicaid Buy-In for Children benefits are being terminated.
• The reason for termination must be provided, along with the effective date of termination.
• Individuals have the right to file a complaint if they disagree with the termination decision.
• Contact information is provided for the HHSC Office of Civil Rights and the U.S. Department of Health and Human Services' Office for Civil Rights.