Form H0090-I Notice of Admission, Departure, Readmission or Death of an Applicant / Recipient of Supplemental Security Income and / or Medical Assistance Only in a State Institution - Texas

What Is Form H0090-I?

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 H0090-I?
A: Form H0090-I is a notice used in Texas to report the admission, departure, readmission, or death of an applicant or recipient of Supplemental Security Income (SSI) and/or Medical Assistance (MA) in a state institution.

Q: When is Form H0090-I used?
A: Form H0090-I is used when there is a change in the status of an individual receiving Supplemental Security Income (SSI) and/or Medical Assistance (MA) in a state institution in Texas. This includes admissions, departures, readmissions, and deaths.

Q: Who is required to complete Form H0090-I?
A: The facility or institution responsible for the care of the applicant or recipient of Supplemental Security Income (SSI) and/or Medical Assistance (MA) is responsible for completing Form H0090-I.

Q: What information is needed on Form H0090-I?
A: Form H0090-I requires information about the individual's name, Social Security number, date of admission, reason for departure or readmission, and date of death if applicable.

Q: Are there any time limits for submitting Form H0090-I?
A: Yes, Form H0090-I must be submitted within five working days of the admission, departure, readmission, or death of the applicant or recipient of Supplemental Security Income (SSI) and/or Medical Assistance (MA).

Q: Why is it important to submit Form H0090-I?
A: Submitting Form H0090-I is important as it ensures that the appropriate changes can be made to the individual's Supplemental Security Income (SSI) and/or Medical Assistance (MA) benefits and eligibility.