Expanding Foundations General Eligibility Requirements 1 Goal and

Expanding Foundations General Eligibility Requirements 1

Goal and Objectives v Course Goal: Participants will outline the general eligibility requirements for Adult Financial (AF) programs v Objectives: • • • Identify basic eligibility requirements for AF such as residency, age, citizenship and lawful presence and know how the requirement is met. Identify when a face to face interview is required. Determine household composition and living arrangement and understand how it applied to the eligibility determination process. 2

More Objectives § § § Explain program specific requirements for each Adult Financial program and the type and amount of benefits provided. Evaluate customer scenarios to determine what programs might best fit their need. Recall when proof of marital status is required and what types of verification can be accepted. Recall what program-specific forms are required and when and how to use them Accurately data entry an AND-SO case into CBMS. 3

Interviewing All Adult Financial applicants must complete an interview • Answer any unanswered application questions • No more than 1 interview can be required per application • If a customer misses an interview and does not reschedule, the county shall assume the customer is withdrawing their request for benefits and deny or discontinue the case 4

Face To Face or Phone? A face-to-face interview is required at initial application unless there is good cause If the customer can show good cause, a telephone interview shall be conducted 5

Good Cause Hospitalization Customer resides in a long-term facility Customer has regular contact with a Single Entry Point case manager Travel for the customer would cause serious medical or physical harm Other good cause determined by the county department using prudent person principle 6

Residency Customer must be a resident of Colorado 1 st Established on the day a customer declares they are a resident • Cannot have a permanent place of residence in another state or country • Cannot be receiving Adult Financial payments in another state (Dual Participation) • No requirement for duration of or intent to stay • Fixed residence is not required 7

Residency If a customer moves out of Colorado or is shown to be a resident of another state, they are no longer considered a Colorado resident If a customer is out of state temporarily, they are still considered a resident 8

Citizenship • Eligible based on citizenship • • US Citizens Qualifying, documented non-citizens 9

Citizenship ▪ Verification of citizenship by customer statement is acceptable unless: ▪ ▪ The claim is inconsistent with statements made by the customer or on the application/previous applications The claim is inconsistent with statements made by another source 10

Lawful Presence Customers must verify that they are lawfully present in the United States This is unique to Cash programs They must sign an affidavit stating they are lawfully present, and provide a document to verify • If a document is not available, they must request a waiver from the Colorado Department of Revenue 11

Social Security Number (SSN) All Adult Financial customers must provide their SSN If the customer does not have an SSN, they must apply for one and show proof of application Failure to provide an SSN or proof of application will lead to denial or closure 12

Marital Status • Customers are determined to be one of the following: • • Single, never married Married Widowed Divorced or legally separated • Married couples must have separate cases if both apply for or receive Adult Financial assistance 13

Fact or Fiction? ? Client statement is acceptable for the marital status of “Married” Fact Should a common law marriage end in divorce, client statement is acceptable Fiction 14

Living Arrangement It is important to capture household composition at application to determine whether the people in the household are required members for Adult Financial programs 15

Colorado Works ▪ Customers receiving Colorado Works cannot receive Adult Financial assistance ▪ Customers must apply for Colorado Works if they might be eligible ▪ They must accept it if eligible 16

Colorado Works If a customer was denied or discontinued from Colorado Works due to a sanction or withdrawing before benefits were exhausted, they will be ineligible for Adult Financial until the sanction is removed or they have exhausted the benefits 17

Incarceration Ø Ø Inmates of a city, municipal, county, state, or federal correctional institution are ineligible for Adult Financial programs Fleeing felons are also ineligible 18

Age v Varies by program • AND-SO 18 -59 (0 -59 if diagnosed as blind) AND-CS 0 -59 OAP A 65 and older OAP B 60 – 64 OAP C 60 and older Adult Foster Care 18 and older HCA and Burial Assistance No requirements beyond the programs they are connected to 19

Benefit Start Date At initial application, benefits cannot start until the customer achieves the minimum age If the customer is active on AND-SO or AND-CS, OAP benefits will start on the first of the month that they turn age 60 20

Age ▪ Rick Jones, an eligible applicant, applies June 6. His 18 th birthday is June 28 th. What is the date Rick’s AND-SO benefits will begin? a) b) c) d) June 1 st June 28 th July 1 st June 6 th 21

Age • Anna Wilkins is currently receiving AND-SO benefits. She is 59, and her 60 th birthday is on June 21 st. How and when will her benefits change? • She will remain on AND-SO until July 1 st • Her benefits will end June 30 th • Her benefits will end June 21 st • She will begin receiving OAP benefits on June 1 st 22

Age • Joe Ryan is applying for Adult Foster Care. He is 64 and is receiving OAP. Is he eligible based on his age? • Yes (older than 18) • Nancy Archer was receiving MAGI Medical Assistance, and passed away. She was 42 when she died. Is she eligible for Burial Assistance based on her age? • Yes (no requirement) 23

Adult Financial Scenario Practice 24

Resources ▪ Resources are countable for Adult Financial programs ▪ All Adult Financial programs have the same resource limit ▪ ▪ $2, 000 for individuals $3, 000 for married couples 25

Income • Income limits vary by Adult Financial program • The customer’s income must be below the program’s grant standard • Four types of income are considered • • Earned In-kind earned Unearned In-kind unearned 26

Let’s Talk Q-Fit 27

Old Age Pension (OAP) This program provides medical and financial assistance to lowincome adults aged 60 or older who meet basic eligibility requirements. 28

What is OAP? Old Age Pension Financial Assistance • Supplements income up to $809 monthly (2019) Old Age Pension Medical Assistance • Provides Medical Assistance to individuals who receive OAP Financial Assistance 29

OAP Medicaid vs. OAP Health Care Program (HCP) ▪ OAP Adult Financial entitles customers to Medical Assistance through either: ▪ ▪ Medicaid ▪ OAP-A ▪ OAP-B ▪ Magi Adult or Magi Parent/Caretaker Relative OR Old Age Pension Health Care Program ▪ OAP HCP-A ▪ OAP HCP-B 30

OAP Medicaid or OAP-HCP? • As Medicaid has different eligibility rules than OAP Adult Financial, some customers may be eligible for OAP Adult Financial but not Medicaid. These customers will receive OAPHCP • Factors impacting Medicaid eligibility: • • Citizenship Resources (life insurance and burial plans) 31

OAP – Applying with Social Security • OAP customers must apply for Social Security and/or SSI benefits as appropriate: • Customers 60 years of age and older who report a disability • Customers 60 years of age and older who may be eligible for Social Security survivor benefits • Customers 62 years of age and older who may be eligible for early Social Security retirement benefits • Customers 65 years of age and older who may be eligible for Social Security retirement benefits and/or SSI benefits if the customer's income from any source is less than the SSI grant standard plus $20. 00 32

Refer or Not Refer? Mary is 65 and has income of $500 in SS Retirement ▪ Refer her to apply for SSI Richard is 61 and is widowed. He has no income and is not disabled ▪ Refer him to apply for SSA Survivor benefits Martha is 62 and has no income ▪ Refer her to apply for SSA Early Retirement Rita is 61 and is not disabled ▪ Don’t refer her to apply for SSA until she turns 62 33

Aid to the Needy Disabled – State Only (AND-SO) Provides interim financial assistance to customers who are waiting to be approved for SSI and are: • Age 18 – 59 who are physically or mentally disabled OR • Age 0 – 59 who are diagnosed with blindness • AND have been determined to be disabled for a period of 6 months or more Grant Standard: $217 34

What is interim assistance? • Payments made to an AND-SO customer while their SSI claim is pending, in suspense, terminated, or in appeal status • It is a “loan” that is paid back when customer is approved for SSI and receives a lump sum payment 35

Explaining the Interim Reimbursement Process ▪ All AND-SO payments made to the customer are potentially recoverable upon approval for SSI benefits ▪ The IM-14 form gives the State permission to recover AND-SO payments under certain conditions 36

Explaining the Interim Reimbursement Process As a condition of eligibility for ANDSO, the customer must sign the “Authorization for Reimbursement of Interim Assistance” (IM-14) at application and at every Redetermination. Properly completed IM-14 s allow recovery of AND-SO funds paid from the first retroactive SSI payment (typically a lump sum) 37

Exploring the IM-14 38

SSI Requirements AND customers must apply for SSI AND customers must appeal all negative decisions Failure to appeal will result in AND closure 3. 520. 71

Referral to Apply for SSI Customers cannot be approved for AND-SO until they have applied for SSI and have an interview appointment date unless they are working with a Disability Benefits Guide Proof of the appointment is required Social Security will also evaluate the customer for SSDI when they apply for SSI 40

Med 9 This form is used to determine disability for AND-SO The form should be provided and explained at interview It must be completed and signed by an approved medical provider: • Licensed Physician, Licensed Psychiatrist, Physician’s Assistant, Advance Practice Nurse, Registered Nurse, Licensed Clinical Social Worker, Licensed Professional Counselor 41

AND Disability Requirements • Diary Date is entered on the ARG Diary Med Conditions page under AF Re-Exam Date • Do not need Med-9 form • Box 1 - Qualifying Disability • 12 months • Box 2 -Qualifying Disability Med-9 • Expected to last 6 -12 months • Box 4 - Must receive treatment from an ADAD Facility • Primary Diagnosis of Drug or Alcohol Addiction

Med 9 Disability Determinations Review the form for completeness and length/type of disability Section 1: The name and location of the professional completing the form Section 2: The Individual’s diagnosis Section 3: The individuals disability level 43

Disabled Due to Substance Abuse This disability applies to customers with a primary diagnosis of drug or alcohol abuse There is a 12 month lifetime limit for AND-SO benefits when Substance Abuse is the primary diagnosis on the Med 9 Customers must agree to participate in addiction treatment 44

Treatment Requirements ▪ ▪ Customers will only be eligible for AND-SO payments while actively participating in a treatment program The customer will need to: 1. Choose a state approved Division of Behavioral Health Treatment Center ▪ To find a provider, go to ▪ ▪ 2. 3. https: //www. colorado. gov/pacific/cdhs/find-behavioral-health-help https: //www. colorado. gov/ladders Not test positive for alcohol and/or drugs two times in any 3 month period Sign a “Consent for the Release of Confidential Alcohol or Drug Treatment” information form 45

Conditional Approval • AND-SO can be approved “conditionally” when proof of the SSI interview appointment is received OR • The customer is working with a Disability Benefits Guide AND • The customer meets all other eligibility criteria for the program 46

Disability Benefits Guide “Disability Benefits Guide (Guide)” means a representative appointed to assist an individual to work with the Social Security Administration (SSA). The Guide is responsible for assisting the client with securing a protected filing date for Supplemental Security Income (SSI) within ten (10) days. The Guide must assist the client in completing and submitting a thorough application for SSI. This Guide may be selected by the client and must be………… 3. 510

Who Can Be a Disability Benefits Guide? Attorney SOAR certification (SSI/SSDI Outreach, Access, and Recovery) Employed and endorsed by an organization that has experience in assisting with the SSI application process

Disability Benefits Guide • AND-SO benefits should be approved conditionally when the customer is working with a Guide • Guide assists in completing a thorough SSI application • Customer may receive conditional approval for up to 60 days from AND-SO interview date

CBMS Functionality • CBMS will perform a series of checks • 11 days before the Working with Guide conditional eligibility ends OR • 11 days after the SSI interview date has passed • CBMS will check to be sure that • The customer is following through with their SSI application process 50

11 Days After SSI Interview Date • CBMS will check to see if there is proof that the customer kept their SSI interview appointment • This may occur by interface or user data entry • If no proof is found, CBMS will send a speed letter to the customer 51

SSI Status Speed Letter

11 Days Prior to the Guide End Date or When the customer Stops Working with a Guide……… CBMS will automatically perform this series of checks Proof of SSI appointment kept? SSI Interview date in future? No? Speed Letter is sent

Working with Guide Speed Letter ▪ Add screen shot of WWG S. L.

The 12 th Day after Speed Letter CBMS will check the to see if an SSI application is pending or an SSI interview date is in the future • If Yes – AND case will continue to pass • If No – AND case will fail the first day of the month following the due date on the Speed Letter • If the due date falls on or after batch a valid AF claim will be created

AND-SO Data Entry Exercise in entering a case into CBMS for a basic AND-SO customer 56

What is the Colorado Supplement Program? A cash assistance program that provides a money payment to an SSI recipient who is not receiving the full SSI benefit amount • 2019 Colorado Supplement Maximum Grant Amount • $771 57

2019 SSI Standards In own home Individual Couple $771 $1157 Example: A couple applies. They live in their own home. They each receive $578. 50 in SSI. Supplement up to the $771 for each applicant. 58

Population Served Most Colorado Supplement customers are: • Married couples who receive SSI and are paying their fair share of shelter costs OR • Children who receive at least $1 or more of SSI 59

What is Home Care Allowance? Home Care Allowance (HCA) is a special cash payment made to customers to pay for in-home, personal care services for activities of daily living that they cannot do themselves It is an “add on” to the Adult Financial grant for OAP, AND-CS, or AND-SO 60

HCA Eligible customers must be in receipt of SSI or AND-SO • Exception: Those who were receiving both OAP and HCA as of December 31, 2013 and remain continuously eligible for both benefits, can receive HCA Customer can be of any age 61

Referral Process § When a customer requests HCA, a referral needs to be made by the worker to their Single Entry Point case management agency § The case manager will evaluate the customer to determine their level of need 62

HCA Benefits ▪ Need There 3 levels at which forare Paid Care of care. Home Carethe client. Score can be assessed. Allowance Level ▪ Each level 1 -23 is a different amount $330 of financial payment the client can be entitled to receive 24 -37 $472 Home Care Allowance 38+ starts on the first of the following $605 month after a successful Single Entry Point assessment 63

Personal Needs Allowance Exploring the Desk Aid

Personal Needs Allowance Definition: a payment to a customer who is currently in a facility intended to cover additional personal needs costs not usually covered by the provider

Personal Needs Allowance ▪ Who is eligible? ▪ Customers receiving OAP and AND (SO and CS) who have met program requirements and have been in a facility for at least 30 consecutive days ▪ Most hospitals, long-term care facilities, and psychiatric facilities if the customer is age 65 or older

Personal Needs Allowance Who is not eligible? • Inmates in a penal institution • Residents in an unlicensed private or uncertified public facility

Personal Needs Allowance ▪ Personal needs allowance cannot exceed $86. 95/month that the customer is in an approved facility

What is Adult Foster Care? • A non-medical facility licensed by the Department of Public Health and Environment (CDPHE) that: • • Provides 24 hour residential care • Serves people who do not require 24 hour medical care but who cannot return to their home and need 24 hour non-medical supervision Serves the frail, elderly, physically or emotionally disabled adults who are 18 or over • Must be receiving SSI or OAP 69

Eligibility Must have a financial need – application must be submitted unless the customer is already on OAP or AND-CS AFC is an “add-on” program to OAP, AND-CS or SSI needs standard Single Entry Point Case managers assess potential customers for the program functionally 70

Basic Need Standards and Add-On Amounts Basic Need Standard OAP $809 SSI $771 Add-On Amount OAP $594 AND/AB $632 SSI $632 71

Burial Assistance Ø The Burial Assistance Program is designed to cover reasonable and necessary costs for burial services when: 1. A deceased customer was receiving OAP, AND-SO or AND-CS, and/or eligible for Colorado Medicaid assistance at the time of death 2. The deceased customer's estate and legally responsible person(s)’ resources are insufficient to pay all or part of the burial services, AND 3. The total cost for all burial services does not total more than $2, 500 72

Burial Plot Does not count toward the $2, 500 maximum A prepaid burial plot owned by the decedent valued at $2, 000 or less at the time of purchase A burial plot purchased by someone other than the deceased customer and donated to the deceased customer 73

Burial Benefit § § § § Maximum State payment $1, 500 for customers receiving: OAP Colorado Medicaid programs for persons 60 years of age and older Colorado Medicaid for families and children, including Adult MAGI Maximum State payment $1, 000 for customers receiving: AND-SO AND-CS Any other Colorado Medicaid program for customers under sixty years of age at the time of death 74

Determining Payment ▪ If the customer was single, any asset the customer owned at the time of death (exempt or countable) is considered available and is subtracted from the maximum burial benefit ▪ Example: A deceased OAP customer owned a bank account with a balance of $50 and a car valued at $500 ▪ ▪ $550 would be subtracted from the burial benefit payment $1, 500 - $550 = $950 is the burial payment 75