General Eligibility
FORMS
AF Program
Acronyms
All things AF
100

$2000.00 for individuals

$3000.00 for couples

Resources

100

Form that doctor completes to tell us if a client is disabled or not

MED-9

100

This program provides interim cash assistance to customers age 18 through 59 (unless diagnosed with blindness, then age 0 through 59); who are disabled or blind but have not been approved for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI)

AND-SO Aid to the Needy Disabled - State Only
100

OAP

Old Age Pension

100

Bank accounts, CD's, Mutual Funds, secondary vehicles, RV's, Secondary Properties, cash, bonds, trusts.

Countable Resources

200

These forms shall be required at initial application, and at each re-examination date for AND-SO

MED-9 and IM-14

200

Form that needs to be complete at application and every RRR so that the county gets reimbursed for monies paid out to client

IM-14

200

This program provides financial assistance for low-income adults age 60 or older who meet basic eligibility requirements

OAP Old Age Pension

200

AND-SO

Aid to the Needy Disabled – State Only is a program that provides interim financial assistance to people who are awaiting approval for SSI

200

One Vehicle per Household

Primary residence

Irrevocable pre-paid burials

Life Insurance with face value of $1500.00 or less

Income tax refunds

Exempt Resources

300

Clients must apply for their early retirement to be considered for this program

OAP Old Age Pension

300

DAILY DOUBLE!!

Form that is completed after a client that was on Medicaid passes away so that they may be eligible to receive benefits that cover funeral expenses

IM-100

300

Benefits are available for eligible customers to cover reasonable and necessary costs for (funeral, burial and/or cremation) providing the total burial costs do not exceed $2,500

Burial Assistance Program

300

PNA

The Personal Needs Allowance is a payment to persons who are institutionalized with income under the PNA standard. It allows customers to pay for items which are not covered by the institution such as cell phone bills, newspaper subscriptions, or haircuts

300

Income deductions allowed for Adult Financial programs

Disregards

400

Clients must have a pending application for this type of Social Security money in order to receive AND-SO

SSI Supplemental Security Income

400
Form that is completed for OAP and AND-CS Only. This is for clients who do not pay their fair share of housing costs.

ISM worksheet / Formula

400

This program provides a supplemental payment for customers age 0 to 59 who are receiving SSI due to a disability or blindness, but are receiving an SSI payment that is less than the full SSI grant standard

AND-CS  Aid to the Needy Disabled-Colorado Supplement

400

IM-14

This is the Interim Assistance Agreement form used for AND-SO which allows for recovery of AND-SO payments from the first retroactive SSI payment received by the customer

400

Maximum Adult Financial grant payment that can be provided to a customer based on each specific Adult Financial program

Grant Standard

500

Counting income of a non-recipient spouse or parent toward a client

Deeming

500

This form is used for three (3) purposes: 1) To obtain written, signed proposals of the charges for the disposition of the recipient (decedent); 2) To authorize the State contribution amount; and 3) For the County to authorize the cremation or burial when: a) No written choice of the manner of disposition was made by the decedent; or b) No authorized relative has been located; or c) No authorized relative of the decedent has made a written choice within seven (7) days of the death and the county has determined the most cost-effective option for disposition.

IM-101 Form - Provider Charges, Authorized State Contribution, and County Authorization for Cremation or Burial

500

DAILY DOUBLE!!

A special cash payment made to a client, five (5) years of age or older for the purpose of securing in-home, personal care services. It is designed to serve customers with the lowest functional abilities and the greatest need for paid care

HCA  Home Care Allowance

500

ISM

In-kind Support and Maintenance is income for certain customers who are not paying their fair share of shelter costs

500

Interface for Title II benefits: SSA retirement, SSA disability, and SSA Survivors benefits

BENDEX

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