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

The TX HHS Form H5024-MBIC, Termination Notice (Medicaid Buy-In for Children), is used to notify individuals that their Medicaid Buy-In for Children benefits are ending. This form helps solve the problem of informing recipients of the termination of their benefits and provides a clear explanation of the reason for termination.

The key feature of this form is the notification of benefit termination, including the effective date and reason for termination. The form also provides information on how to file a complaint if the recipient believes they have been treated unfairly due to discrimination based on race, color, national origin, age, sex, disability, or religion.

This form should be used when an individual's Medicaid Buy-In for Children benefits are ending, and it is essential to provide timely notification of the termination. The form can be completed by Texas Health and Human Services (HHS) staff or other authorized personnel, and it serves as a formal record of the benefit termination.