Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form 5873 for the current year.

Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas

What Is Form 5873?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 5873?A: Form 5873 is the Medicaid and Chip Services Contract Application Packet Checklist for Waiver and Community-Based Programs and Services in Texas.

Q: What is Medicaid?A: Medicaid is a government program that provides health coverage to low-income individuals, including pregnant women, children, elderly adults, and people with disabilities.

Q: What is CHIP?A: CHIP (Children's Health Insurance Program) is a program that provides low-cost health coverage for children in families that earn too much money to qualify for Medicaid, but can't afford private insurance.

Q: What are Waiver and Community-Based Programs and Services?A: Waiver and Community-Based Programs and Services are programs in Texas that provide long-term care and support services to individuals with disabilities or chronic illnesses, allowing them to remain in their homes and communities instead of receiving care in institutional settings.

Q: Who can apply for these programs and services?A: Individuals with disabilities or chronic illnesses who meet the eligibility criteria can apply for Waiver and Community-Based Programs and Services.

Q: What is the purpose of Form 5873?A: Form 5873 serves as a checklist for the application packet for Waiver and Community-Based Programs and Services in Texas, ensuring that all required documents and forms are included.

Q: What documents are required for the application?A: The specific documents required may vary, but generally include proof of identity, proof of income, proof of residency, medical records, and any other relevant documentation.

Q: What happens after I submit the application?A: After submitting the application, it will be reviewed by the HHSC to determine eligibility. If approved, you will receive notification of your enrollment in the Waiver or Community-Based Program or Service.

ADVERTISEMENT

Form Details:

  • Released on March 1, 2023;
  • The latest edition provided by the Texas Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 5873 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.

Download Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas

4.5 of 5 (29 votes)
  • Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas

    1

  • Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas, Page 2

    2

  • Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas, Page 3

    3

  • Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas, Page 4

    4

  • Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas, Page 1
  • Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas, Page 2
  • Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas, Page 3
  • Form 5873 Medicaid and Chip Services Contract Application Packet Checklist - Waiver and Community-Based Programs and Services - Texas, Page 4
Prev 1 2 3 4 Next
ADVERTISEMENT