Form 2800, Youth Empowerment Services (YES) Waiver Notice of Denial

Instructions

Updated: 2/2026

Detailed Instructions

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1. Fill out all the form fields.
   • Reasoning options to copy and paste into The YES Waiver field:
     • Enrollment is denied because your child or youth does not meet the demographic eligibility criteria required to participate in the program per the YES Waiver Policy Manual, Section 2100 and 26 TAC 307.5.
     • Enrollment is denied because your child or youth does not meet the clinical eligibility criteria required to participate in the program per the YES Waiver Policy Manual, Section 2200 and 26 TAC Section 307.5.
     • Services are ending because your child or youth made sufficient progress toward adequately meeting the identified needs in the Wraparound plan and no longer requires a YES level of care.
     • Adaptive aid request is denied due to not meeting the criteria in the YES Waiver Policy Manual, Section 7000.1.
     • Minor home modification request is denied due to not meeting the criteria in the YES Waiver Policy Manual, Section 7000.5.
     • Transitional service request is denied due to not meeting the criteria in the YES Waiver Policy Manual, Section 7000.14.
     • Discharge is based on your decision, or your child or youth's decision to withdraw from the YES Waiver program per YES Waiver Policy Manual, Section 5500.
     • Discharge is based on the lack of participation in YES Waiver services for 60 consecutive calendar days or longer per YES Waiver Policy Manual, Section 5500.
     • Discharge is because your child or youth's permanent residence is no longer in the state of Texas per YES Waiver Policy Manual, Section 5500 and 26 TAC Section 307.5.
     • Discharge is because of the requirement that participants maintain active Medicaid coverage to receive YES Waiver services per YES Waiver Policy Manual, Sections 2300 and 5500 and 26 TAC Section 307.5.
     • Discharge is because your child or youth is living in an out-of-home or institutional placement for more than 90 consecutive calendar days per YES Waiver Policy Manual, Section 5500 and 26 TAC Section 307.5.
     • Discharge is because of the age requirement that participants be between 3 and 18 per YES Waiver Policy Manual, Sections 2100 and 5500.
     • Discharge is because the cost neutrality guidelines were not met per the YES Waiver Policy Manual, Section 5500 and TAC Section 307.9.
     • Discharge is due to DFPS conservatorship and the new guardian choosing not to continue services per the YES Waiver Policy Manual, Section 5500.
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4. Select Adobe PDF or Print to PDF option in the Printer section.
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6. At this point, the PDF will be flattened and you will no longer have the option to edit the form.