Form 2027, Home-Delivered Meals Waiver Request

Instructions for Opening a Form

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Documents

Effective Date: 6/2025

Instructions

Updated: 6/2025

Purpose

A provider of home-delivered meals (HDM) funded through Title XX completes Form 2027 to request a waiver from the Texas Health and Human Services Commission (HHSC). Texas Administrative Code (TAC), Title 26, Part 1, Chapter 281, Section 281.21 provides the basis for HDM waiver requests. Shelf-stable meals will not be an approved alternate meal through this waiver request process. However, shelf-stable meals may be provided during an emergency or inclement weather and do not require waiver approval for these limited circumstances.

Each provider who requests an HDM waiver will only submit one Form 2027. The form allows multiple waiver requests to be entered on the same form. The form must be completed electronically.

Providers may request waivers for one or more of the following:

  • To deliver meals less than five days a week.
  • To deliver a combination of hot, frozen and chilled meals.
  • To deliver meals outside 10:30 a.m. to 1:30 p.m.

Once an HDM waiver is approved, providers must contact each person included in the waiver by phone or in person at least three times per week.

The waiver is an amendment to the provider’s contract for the dates the waiver request is approved by HHSC.

An HHSC caseworker must give authorization when a person who receives meals through Title XX requires delivery of fewer than five meals a week. In those cases, the provider does not submit Form 2027.

Procedure

When to Prepare

Form 2027 allows multiple waiver requests to be included on one form. The waiver is based on the meal delivery pattern rather than the waiver areas or location when using this form. Waiver areas or locations may be combined if the meal delivery pattern for one or more areas is identical. To add another meal delivery pattern for one or more areas, click on the Add Waiver Request button to insert another HDM waiver request. Add as many meal delivery patterns and waiver areas as needed.

Transmittal

The provider must fill in the form completely and email it to the designated contract manager. The waiver will be approved or denied and returned to the provider.

Detailed Instructions

Name of Legal Entity – Enter the legal entity’s name as it appears on the contract.

Signature Authority – Enter the name of the person who has signature authority for the legal entity.

Mailing Address, City, State, ZIP – Enter the provider's address as it appears on the contract.

Waiver Begin Date – Enter Oct. 1 and odd-number year for the beginning of the biennium budget period or a begin date when it doesn’t align with the budget period.

Waiver End Date – Enter Sept. 30 and odd-number year for the end of the biennium budget period or an end date that does not exceed the biennium budget period.

Example:

Begin Date: Oct. 1, 2023

End Date: Sept. 30, 2025

Meal Delivery Pattern – Use the drop-down menu to select the number of hot, frozen and chilled meals delivered to people each week. Select 0-7 to indicate the number of hot, frozen and chilled meals a person will receive each week.

Meal Deliver Times – Enter the delivery begin time and delivery end time.

Waiver Area – Describe the city and county or the portions of the city and county the waiver will cover. The waiver area box will expand so multiple areas or locations may be added if the meal delivery pattern for each area is identical.

Contacting People – Enter the number of times people will be contacted in person and by phone.

Alternate Meals or Delivery Times

Estimated number of people who will receive alternate meals under this waiver each week – Enter the estimated number of people who will receive alternate meals on a modified delivery schedule.

Shortest distance, number of miles, from the meal preparation site to a person served under this waiver – Enter the number of driving miles from the meal preparation site to the person.

Estimated number of people who will receive meals outside 10:30 a.m. and 1:30 p.m. – Enter the estimated number of people who will receive the meals outside the delivery schedule.

Add Waiver Request – Click Add Waiver Request button to complete a request for another meal delivery pattern. Once selected, a new HDM waiver request will appear below the initial waiver request, and so on. Complete the HDM waiver request information for each area where the meal delivery pattern changes.

Select all circumstances that make this waiver necessary. – Select one or more of the listed circumstances to indicate why the provider is requesting a waiver. If other was selected, explain the circumstances that make this waiver necessary.

Assurances – Providers must review the waiver requirements before signing the Home-Delivered Meals (HDM) Waiver.

Signature – Signature Authority – The person who has signature authority for the provider must sign on this line or complete an electronic signature.

Date – Type or clearly print the date the person with signature authority for the provider signs the form.