Participant Guide - Traincolorado

Adult Financial-PG Version: 15

Release Date: March 2020 1

Expanding Foundations:

Adult Financial

Participant Guide

7800 E Orchard Road, Suite 280 Greenwood Village, CO 80111 [email protected]

mailto:[email protected]

Expanding Foundations: Adult Financial Participant Guide

_____________________________________________________________________________________ Adult Financial - FG Version:15 Release Date: March 2020

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Acknowledgments The Health Care and Economic Security Staff Development (SDC) would like to thank all of the individuals and agencies that provided assistance during the Expanding Foundations development and continue providing feedback to update material as needed. The SDC would also like to thank the staff from the Colorado Department of Human Services (CDHS), the Colorado Department of Health Care Policy and Financing (HCPF), and the Governor’s Office of Information Technology (OIT). Their willingness to share their program and systems knowledge with the SDC has been invaluable. Introduction The Health Care and Economic Security Staff Development Center (SDC) presents this guide as a framework for the precision delivery of Expanding Foundations curriculum. Expanding Foundations will prepare health and human service professionals to use the Colorado Benefits Management System (CBMS) to determine eligibility for Food, Medical and Cash Assistance. In the spirit of the SDC’s vision, which is to provide an efficient, non-duplicative, and responsive training array for staff that promotes an integrated and holistic service delivery system, we are offering this guide to standardize and formalize across Colorado the way county staff are trained. Standardization of Expanding Foundations and precision delivery of the curriculum will assure that all staff receives and attains the same high standard of competency through training. Common Terms and Phrases There are terms and phrases found throughout this Guide that have other common names associated with them. These terms and phrases are used based on accuracy, appropriateness, and general understanding to provide consistency. They are listed below with other associated common names.

● Cash Assistance: Colorado Works (CW) and Adult Financial(AF) ● Client: applicant, customer, recipient, household ● Colorado Works: Temporary Assistance for Needy Families (TANF) is the federal program ● Eligibility Worker or Public Assistance Professional: user, eligibility technician, program

specialist, eligibility professional, worker ● Food Assistance: Supplemental Nutrition Assistance Program (SNAP) is the federal program,

food stamps ● Medical Assistance: Medicaid and Child Health Plan Plus (CHP+); not Medicare



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● Public Assistance: Food, Medical, and Cash Assistance programs; human services, social services

Welcome Introductions: Getting to Know You!! Introduce yourself with the following information:

● Name ● Length of time as an eligibility worker ● Length of time working Adult Financial (AF) cases ● One thing you like about your job

Your facilitator will pair you with another participant for the next activity Group Expectations

● Stay Present ● Put-cell phone on vibrate, wait until scheduled break to check emails, phone, etc.

● If you need to take a phone call or use the restroom, please do so respectfully and quietly ● Respect everyone’s right to learn.

● Avoid engaging in side-conversations and other distracting behavior. ● Critique ideas, not individuals.

● Keep the focus on challenging perspectives in a thoughtful and respectful manner. ● Own your own learning.

● Commit to being accountable for learning the material by asking questions, taking notes and participating in activities.

● Challenge yourself. ● Find ways to develop a deep understanding of concepts through self-reflection and

open communication. ● Take care of yourself. ● Participate at your comfort level.

Housekeeping

● Location of bathrooms ● Breaks and lunches ● Safety ● Computer use ● Food and drink ● Clean-up



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● Training materials Pair and Share Discuss the below facts with your partner(s) and then introduce your partner with this information:

➢ Favorite holiday (and why) ➢ Most hated food ➢ Dream vacation ➢ A random interesting fact about yourself

Notes _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Program Overview Objectives:

● Outline the Adult Financial programs ● Describe the administration and funding of Adult Financial programs ● Identify populations served by each Adult Financial program ● Recite Adult Financial program benefits

Carousel Teach

1. State Aid to the Needy Disabled State Only (AND-SO)



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________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Aid to the Needy Disabled: Colorado Supplement(AND-CS) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Old Age Pension (OAP) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Home Care Allowance (HCA)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Burial Assistance ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

General Eligibility Requirements Objectives:

1. Identify basic eligibility requirements for AF such as residency, age, citizenship and lawful

presence and know how the requirement is met. 2. Identify when a face to face Interview is required. 3. Determine household composition and living arrangement and understand how it applies to

the eligibility determination process. 4. Explain program specific requirements for each Adult Financial program and the type and

amount of benefits provided.



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5. Evaluate customer scenarios to determine what programs might best fit their needs. 6. Recall when proof of marital status is required and what types of verification can be

accepted. 7. Recall what program-specific forms are required and when and how to use them. 8. Accurately data enter an AND-SO case into CBMS.

Application 3.520.1.C

The county department shall require a written application, signed under penalty of perjury, using the State Department's prescribed public assistance application form.

● The date of application shall be the first working day the county department receives a signed application form, indicating the client's desire to receive public assistance benefits.

● Incomplete applications shall be denied following the policies outlined in Section 3.554.

● For clients who have been committed to a facility by order of the district or probate court or who have been made a ward of the State, application for an Adult Financial program shall be completed by the facility's administration or the client's guardian.

● The application form shall be used as the primary source of information and to be considered complete, shall contain, at a minimum the name of:

● Name ● Address

▪ If address is not provided, another means of contact (i.e., phone or email) shall be used to obtain address.

● Signature

Interviewing 3.520.4.C

● An interview is required at Initial Application and once every 12 months ● Only one interview can be required per application ● Answer any unanswered questions on application ● Interviews can be conducted in person (Face-to-face) or via telephone (Phone) ● Face-to-face interviews can be at the county office or the customer’s home.

Goal: Participants will outline the general eligibility



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● All interviews must be well documented in case comments including the type of interview conducted.

The CDHS Interviews page is added to the Interactive Interview page queue whenever a CDHS program is added to a case. The CDHS Interviews page allows you to perform different tasks related to the interview requirements for all CDHS programs. This page is mandatory and is used to indicate if a customer is required to complete an interview while identifying the date, and type of interview completed.

Residency 3.520.64

● Customer must be a resident of Colorado ● Cannot have a permanent place of residence in another state or country. ● Cannot be receiving Adult Financial payments in another state (Dual Participation)

● Established the 1st day the customer declares that they are a resident ● No requirement for duration or intent to stay ● Fixed residence is not required

A move or change of residency can be established by actions including (but not limited to):

● Buying or leasing a home in another state ● Moving personal belongings to another state ● Obtaining a driver’s license or registering to vote in another state ● Applying for public assistance in another state ● No fixed residence is required (homeless individuals can be considered residents)

Exceptions when a customer is out of state temporarily include:

If a customer moves out of Colorado or is shown

to be resident of another state, they are no longer considered a resident of Colorado.

If a customer is out of state temporarily, they are still considered a resident of Colorado.



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● Customer leaves the country for 30 consecutive days ● Customer leaves the state for 90 or more consecutive days (unless for medical treatment) ● Customer leaves the state for more than 6 months in a calendar year ● Customer leaves the state for 180 consecutive days to care for an immediate family

member injured in the line of military

Citizenship 3.520.67

Citizenship can be self-attested 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 ● Client Statement is now an acceptable verification source for Citizenship in CBMS because

you may be able to verify the customer’s citizenship via an interface. ● Query the SVES/SCHIP Interface. If the interface query is unsuccessful, citizenship is

considered questionable. In these cases, request verification of citizenship from the customer.

● Do not use a name, accent, language ability, or appearance that seems foreign to make citizenship questionable.

● This is discrimination. ● Additional information about verification and non-citizens is available in the

Verifications and Interfaces Web-Based Training and the Non-Citizen WebBased Training.

● More information is available through our website, http://traincolorado.com.

Lawful Presence 3.520.66

Customers must verify that they are lawfully present in the United States

● This is unique to Cash Programs ● Customers must sign an affidavit stating they are lawfully present, and provide a document

to verify ● This is the only time AF requires verification of identity. ● This affidavit is on the Single Purpose Application (SPA). ● Only one box should be marked and the Lawful Presence Affidavit and signed. If more

than one box is marked the form is invalid. ■ Check Box One when the customer is a citizen.



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■ Check Box Two when the customer is a Qualified Non-Citizen. ■ Check Box Three when the customer is a non-citizen who is lawfully present

but not aQualified Non-Citizen. ● Access the below website to confirm which states are currently compliant with the Federal

REAL ID requirements (i.e. acceptable out of state ID’s for financial assistance) https://www.dhs.gov/current-status-states-territories

● Non-Compliant states/Territories do not satisfy Lawful Presence criteria.

Note: Colorado Digital ID (Digital ID) has been approved by the October 31, 2019 Executive Order to show proof of identity and age, but does not yet meet the requirements for Lawful Presence.

SSN 3.520.65

● Verification of a customer’s SSN card is not required unless the SSN already exists in CBMS and a merge must be completed or if the information provided is questionable.

● Once proof of an application for an SSN has been provided, processing should not be delayed.

● Closure would occur if a customer is unable to provide an SSN after applying (unless good cause exists).

● Best practice is to verify every SSN through SVES (SOLQ-I). Make sure to match individual demographics to the information the Social Security Administration has (as seen on documentation) so that interfaces will work.

Marital Status 3.520.63

Customers must have a marital status of single, married, legally separated, divorced, widowed, or civil union.

All Adult Financial customers must provide their SSN

If the customer does not have their SSN, they must apply for one and show proof of application

Failure to provide and SSN or proof of application will lead to denial or clos re



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● If married/civil union are declared, client statement is an acceptable verification source. Use ‘Other’ as the Source in CBMS if written verification is not provided.

● Customers who are separated, but not legally separated continue to have a marital status of ’married’.

● If the customer is divorced or legally separated (even if they were common law married), documentation of the marital status need not be obtained, unless questionable.

● “Client Statement” is an acceptable value for Adult Financial. ● On the Demographics page in CBMS, new radio buttons have been added associated to

the Marital Status. These new fields will show whether the Status is Questionable or not (Title of field: Status Update Questionable Yes/No). This new field should default to No upon new records being created.

● When the Status Update Questionable = Yes, a Verification Checklist must be sent for Adult Financial (with the standard AF VCL Due Date). If the verification is not received by the due date, AF will fail for failure to provide verification (using the current logic for failure to provide verification for AF).

■ Note: To access the Marriage/Dissolution Search Index website, have your security administrator

request access from state contact [email protected].

Fact or Fiction

Household Composition and Living Arrangement 3.510

mailto:[email protected]



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

● A household includes the applicant, their spouse, and their dependent children. ● Please note: income of the child is only countable toward the child. It is not

countable toward the parent or caretaker of the child. ● If there are dependent children in the home that are the natural or adoptive children of the

applicant (the customer is potentially eligible for Colorado Works), the applicant must apply for Colorado Works first.

● Exception: SSI mandatory applicants. ● We also need to know everyone living in the home to determine if the customer is paying

their fair share of shelter costs. ● Fair Share is determined by totaling the rent and utility costs for the residence and

dividing it by the number of people living in the household including children.

Colorado Works 3.520.71.F Customers receiving Colorado Works cannot receive Adult Financial assistance.

● Customers must apply for Colorado Works if they might be eligible. This includes those who have exhausted benefits but, can request an extension.

● They must accept it if eligible. ● Certain customers do not have to apply for Colorado Works.

● Grandparents or other specified caretakers, who are not parents, who are applying for Colorado Works for a child and are not requesting assistance themselves.

● These are Child Only cases. ● Responsible adult should be marked as ‘In The Home’ but not ‘Requesting Aid’ in

CBMS, and ‘Responsible Relative’ should be selected on the Household Relationships Detail page.

If a customer is denied or discontinued for 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.



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Incarceration 3.520.61.B

Inmates of a city, municipal, county, state, or federal correctional institution, and fleeing felons, shall not be eligible for AF programs.

● Verification of the status of incarceration or fleeing felon is required. The jail report is not sufficient verification.

● Some customers may answer the fleeing question on the application as “yes” when they are not a fleeing felon but have a prior felony conviction and do not understand the question.

● Make sure to double-check with customers who check “yes”. ● Half-way houses under the supervision of the Department of Corrections are not a valid

living arrangement for Adult Financial programs.

Age 3.520.61 and 3.520.62 AND-CS

● 0-59 AND-SO

● If an individual is not 18 at the time of application, but they will turn 18 within 30 days, they will become eligible and begin receiving benefits on their 18th birthday.

● For ongoing cases, if an individual is turning 60, they will begin receiving OAP benefits on the 1st of the month they turn 60.

OAP ● CBMS automatically assigns the customer to the appropriate OAP program based on age.

● Ages 60-64 will be placed on OAP-B ● Ages 65+ will be placed on OAP-A

HCA ● 5 years or older

Burial ● No requirement beyond the programs they are connected to

Knowledge Check # 1 Rick Jones, an eligible applicant, applies June 6. His 18th birthday is June 28th. What is the date Rick’s AND-SO benefits will begin?



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Choose one answer: a) June 1st b) June 28th c) July 1st d) June 6th

Knowledge Check # 2 Anna Wilkins is currently receiving AND-SO benefits. She is 59, and her 60th birthday is on June 21st. How and when will her benefits change? Choose one answer:

a) She will remain on AND-SO until July 1st b) Benefits will end June 30th c) Benefits will end June 21st d) She will being receiving OAP benefits on June 1st

Knowledge Check # 3 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? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



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Adult Financial Scenario Practice Activity

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 ● More information regarding resources will be provided in a later module

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 ■ More information regarding income will be provided in a later module



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Let’s Talk Q-Fit The Q-Fit utilizes data provided in the Public Assistance Quality Assurance (PAQA) Monthly Reports. Q-Fit provides quarterly accuracy rates and the top three contributing payment errors for each program. For each payment error, PAQA identifies what regulation requires and what Quality Assurance (QA) reviews find. Then through collaboration with Program Area provides guidance on how to resolve the issue based on current training and identifies recommendations to monitor progress at the county level.

Old Age Pension This program provides medical and financial assistance to low-income adults aged 60 or older who meet basic eligibility requirements.

● For new cases, if an individual is turning 60, they will become eligible for OAP on the date

they turn 60. For individuals who are currently receiving AND -SO, they will become eligible for OAP the first of the month they turn 60.

○ Be sure to add Medical Assistance when you “AI” an Old Age Pension application. ● 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 OAP- HCP.

Medicaid vs. OAP Health Care Program (HCP)

Old Age Pension Financial Assistance

Supplements income up to $821 (2020)

Old Age Pension Medical Assistance

Provides Medical Assistance to

individuals who



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OAP Adult Financial entitles customers to Medical Assistance through either: ● Medicaid

● OAP-A ● OAP-B ● MAGI Adult or Magi Parent/Caretaker Relative Or

● Health Care Program ● OAP HCP-A ● OAP HCP-B

● OAP Medical Assistance customers may be subject to Medicaid Estate Recovery. ● Customers may refuse Medical Assistance and still receive the financial payment.

Factors impacting Medicaid eligibility:

● Citizenship ● Resources (life insurance and burial plans) ● Customer who are non-citizens and ho not meet the 5 year bar, but qualify for OAP due to a

hardship exception, will receive OAP-HCP

OAP – Applying with Social Security

OAP customer 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

● There is no disability requirement for Old Age Pension. However, ● You must have verification of an SSI/SSDI application for those customers declaring to

have a disability.

To Refer or Not Refer to SSA: That is the Question Activity



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Aid to the Needy and Disabled

Aid to the Needy and Disabled - State Only(AND-SO)

● Provides interim financial assistance to customers who are waiting to be approved for SSI and are:

● Age 19-59 who are physically or mentally disabled OR ● Age 0-19 who are diagnosed with blindness ● AND have been determined to be diabled for a period for 6 months or more

● Grand Standard: $217 monthly Interim Assistance Payments made to and AND-SO client while their SSI claim is pending, in suspense, terminated or in appeal status.

● It is a ‘loan’ that is paid back when a client is approved for SSI and receives a lump sum payment

Explaining the Interim Assistance Reimbursement Process

● All AND-SO payments made to the customer are potentially recoverable upon approval for SSI benefits.



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● The IM-14 form gives the State permission to recover AND-SO payments under certain conditions.

● The IM-14 form is required for the following Aid Codes: AND-SO, AND-HCA, and AND- PNA. The state can collect all these payments under the IAR agreement. Please discuss the definitions of these aid codes with participants.

● The IM-14 form must be filled out in its entirety; it is considered a legally binding document. ● Name, Address, and SSN must be completed at the top of page one. ● Only one box can be checked on page one of this document. ● The customer must sign the IM-14. The eligibility worker must sign the IM-14 as well,

but the worker cannot sign and date it prior to the customer signing it. ● A new IM 14 must be signed at every RRR. The signature date must be within 60 days

prior to the Adult Financial RRR due date or not more than 30 days past the RRR due date.

● GR Code must be completed. Direct the participant to their lead worker or supervisor for their county’s GR Code.

● Copy of the form must be given to the customer.

Exploring the IM-14 Activity

SSI Application Requirements 3.520.71.B

● Customers must apply for SSI to be eligible for AND-SO benefits. When the customer applies for SSI, Social Security will also do an assessment to determine if the customer qualifies for SSDI. It is important to be sure that the customer has applied for SSI and not just SSDI.



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● Customers can be approved for AND-SO if they have not applied for SSI yet. However, they have to meet all other eligibility criteria to be approved. This is called Conditional approval.

● Once approved for AND-SO, an SSI application must be in a pending or appeal status at all times.

● AND-SO customer must appeal all negative decisions and is allowed 30 days to verify appeal/pending status of SSI in ongoing mode

Conditional Approval For all Adult Financial programs other than AND-SO, clients referred to the SSA to apply for any SSA related benefit will have ten (10) calendar days to provide verification of application for SSA benefits.

● For AND-SO, clients will be required to provide verification of application for SSI within sixty (60) calendar days from the initial interview date with the county department

● CBMS will monitor the customer’s SSI application status to ensure the interview appointment is kept.

● If no proof interfaces that the customer has attended their SSI interview appointment, CBMS will send the customer a speed letter requesting proof.

● If proof is not provided, the case will discontinue. ● If the customer is denied SSI, they must appeal the denial. CBMS will also monitor SSI

denials and appeals for active AND-SO cases. ■ CBMS will allow 10+1 days to provide verification of the appeal

● Customers should appeal SSI denials, as opposed to reapply. This will benefit them. See rule 3.520.71B

● Customers DO NOT need a lawyer to appeal 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 customer with securing a protected filing date for Supplemental Security Income (SSI) within ten (10) days. The Guide must assist the customer in completing and submitting a thorough application for SSI. This Guide may be selected by the customer and must be:

● An attorney ● SOAR certified (SSI/SSDI Outreach, Access, and Recovery)



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● Employed and endorsed by an organization that has experience in assisting with the SSI application process

CBMS Checks for Conditional Approval

● CBMS will check to see if proof of an SSI application has been received ● CBMS will check to see if proof of an SSI application has been received ● If no proof is found, CBMS will send a speed letter to the customer

Disability AND-SO Disability Requirements

● ARG Diary Date ● Diary date is entered on the Med Condition page under AF Re-Exam Date ● Do not need Med-9 form

● Med-9 ● Box 1-Qualifying disability

■ 12 month disability ● Box 2-Qualifying disability

■ Expects to last 6-12 months ● Box 4-Must receive treatment from an ADAD Facility

■ Primary Diagnosis of Drug or Alcohol Addiction

Med-9 Form ● This form is used to determine disability for AND-SO

● Customers must be both disabled (with a qualifying disability) and have a social factor preventing them from working in order to be totally disabled.

● 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, or Licensed Ophthalmologist for blindness. See the current Med 9 to determine what additional providers can complete the Med 9 form.

● For AND-SO, medical certification is required. The customer must have a Med-9 signed by an authorized Medical Provider or have a favorable disability determination by the State Disability Contractor (currently Arbor Review Group (ARG)) to be considered disabled.



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■ If the customer is applying for both LTC and AND-SO, both the Med-9 and the Medical Assistance Disability application should be provided as the ARG decision could take up to 70 days.

● If the customer has an existing favorable disability determination by the State Disability Contractor (currently Arbor Review Group) the diary date can be used as theAF Med-Re-exam date.

Review the form for completeness and length/type of disability

For data entry reference the process manual titled Entering a Med-9

Disabled Due to Substance Abuse This disability applies to customers with a primary diagnosis of drug or alcohol abuse

Section 1: The name and location of the professional completing the form Section 2: The individual’s diagnosis

Section 3: The individuals disability level



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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. ● This type of disability is seen less often than physical or mental disabilities.

● 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

○ https://www.colorado.gov/pacific/cdhs/find-behavioral-health-help ○ https://www.colorado.gov/ladders

2. Not test positive for alcohol and/or drugs two times in any 3-month period. 3. Sign a “Consent for the Release of Confidential Alcohol or Drug Treatment”

information form. The treatment center will typically notify the county if the customer tests positive.

Data Entry: AI (AND-SO)

Aid to the Needy and Disabled - Colorado Supplement (AND-CS) A cash assistance program that provides a monthly payment to an SSI recipient who is NOT receiving the full SSI benefit amount

2020 Standards Individual Couple

In own home $783 $1175

● Colorado Supplement does not supplement withholding from SSI due to overpayments and

ISMs. ● Most Colorado Supplement customers are:

● Married couples who receive SSI and are paying their fair share of shelter costs OR



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● Children who receive at least $1 or more of SSI

Home Care Allowance (HCA) A special cash payment made to the customers to pay for in-home, personal care services for activities of daily living that they cannot do themselves

● Payment is an “add on” to the Adult Financial grant for OAP, AND-CS, or AND-SO ● Customers cannot be on HCBS or Adult Foster Care at the same time they are receiving

Home Care Allowance. ● HCA does not provide medical benefits. ● Customer must have SSI or AND-SO.

■ Exception: Customers who were on both HCA and OAP on 12/31/2013 and continue to be eligible for both HCA and OAP are grandfathered in and do not have to have SSI. These customers must not have a break in their HCA payments. If there is a break they are no longer eligible for HCA. Examples of when this might occur would be:

○ Customer’s RRR was late or not returned (without good cause) ○ Customer entered a nursing home or hospital and the case manager

closed the HCA case OR ○ Customer became over resources or over income.

● There are several types of customers who do not need to fill out a separate application for Home Care Allowance (HCA). They include: those who are actively receiving OAP and are also receiving at least $1.00 of SSI, those who are on AND-CS, and those who are on AND-SO.

● There are no RRRs for HCA. HCA is an ‘add on program’. The RRR is associated with the Adult Financial programs it is attached to. The RRR is for that program.



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Referral Process ● When a customer requests HCA, the Single-Entry Point (SEP) must be notified to complete a

functional assessment. ● Refer to your county procedures for SEP referrals. ● The customer receives the HCA payment on their EBT card or by Direct Deposit. The

customer is responsible to pay the HCA amount to the provider. ● HCA is not income to the customer but is considered earned income to the HCA

provider.

HCA Benefits

● There are 3 levels of care at which the customer can be assessed. Each level is a different amount of financial payment the customer can be entitled to receive.

● Home Care Allowance starts on the first of the following month after a successful SingleEntry Point assessment.

● If determined functionally eligible, the customer will be approved for one of three tiers. The higher the tier, the higher the customer’s need is for non-skilled care.

Need for Paid Care Score Home Care Allowance Level

1-23 $330

24-37

38+

$472

$605



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Personal Needs Allowance (PNA) A payment to a client who is currently in a facility intended to cover additional personal needs costs not usually covered by the provider. Examples: pedicures, cable TV, lotions and soap, haircuts, etc. How much is PNA?

● The Grant Standard is $79.00 (Effective 1/1/2019). ● Income must be below the Grant Standard to qualify.

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.

● OAP customers who become institutionalized are only allowed to receive PNA and cannot receive both OAP and PNA. Their OAP benefit will decrease once institutionalized.

● Most PNA recipients have no income or receive SSI only ● When an SSI recipient is institutionalized, and SSI is their only form of income, SSA

reduces their SSI to $30.

Burial Assistance 3.590 The Burial Assistance Program is designed to cover reasonable and necessary costs for burial services- Burial grant is $1500 for all aid codes

● The deceased customer must have been receiving OAP, AND-SO or AND-CS, and/or eligible for Colorado Medicaid assistance at the time of death.

● Applications must be filed within 12 months of death. The interview process varies by county.



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● Burial Assistance is provided if the resources of the legally responsible person(s) for the support of the deceased customer are insufficient, even with contributions from the customer’s estate, to enable the legally responsible person(s) to pay all or part of such expenses.

● Payments are made to the provider. ● If any payment was made to the cost of the burial prior to the benefit being

approved, there will be no reimbursement to the customer. ● Make sure to select the correct provider! There are a lot of providers in CBMS, many

with similar names, and it can be a challenge to find the right one. If you make a mistake, you can go into issuance right away and cancel it.

● Any assets the deceased customer owns are countable toward burial. ● If the customer is survived by a spouse, the spouse is allowed $2,000 in countable

resources. Exempt resources continue to apply to the surviving spouse (e.g., one vehicle and primary residence is exempt).

● Best practice is to pull a Motor Vehicle interface to determine if there are undeclared vehicles.

● Verification of resources is required. ● The total cost of the burial services cannot exceed $2,500.

■ If it does, we are not permitted to help with burial payment. ● The cost of a burial plot is not included in the $2,500 maximum if the plot has a

value of $2,000 or less at time of purchase or is donated by someone other than the deceased customer.

● There are times when a customer passes away and the family does not sign on the bank account. The family may report they do not have access to the funds. The funds can be accessed using a small estate affidavit.

● Link to Colorado Courts Small Estate Affidavit: https://www.courts.state.co.us/Forms/PDF/JDF%20999T%20Small%20Estate%20Affidavit%20R 6%2015%20(FINAL).pdf

Income The Basics Adult Financial supplements a customer’s income up to a certain amount, the grant standard, for each program.

● The customer must make reasonable attempts to pursue any income at their disposal.

https://www.courts.state.co.us/Forms/PDF/JDF%20999T%20Small%20Estate%20Affidavit%20R6%2015%20(FINAL).pdf

https://www.courts.state.co.us/Forms/PDF/JDF%20999T%20Small%20Estate%20Affidavit%20R6%2015%20(FINAL).pdf



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● When monthly income fluctuates or is paid over a part of the year for the entire year, an average monthly income is calculated for the year.

● For exceptions to countable income rules, see 3.520.781.G.

Potential Income A benefit or payment the customer, spouse of a customer, or sponsor(s) of a customer may be entitled to and could secure

● Examples include but are not limited to: Retirements, pensions, annuities, disability benefits, veterans’ benefits, workers’ compensation, Social Security retirement or disability benefits, SSI, and Unemployment.

Reasonable Effort

● Customers must take reasonable steps to apply and accept all income that may be available. ● If the customer refuses or fails to make reasonable effort the income shall be considered as

if available unless the customer can show good cause. ● If the customer cannot show good cause for failure to pursue a source of income and the

amount of that income cannot be determined, action should be taken to deny or terminate assistance.

● If the customer fails to pursue all available income, deny the case in individual compliance for ‘Failure to pursue other sources of income’. If you have enough time, have participants navigate to the Individual Compliance page to see this drop-down.

Earned Income A Payment in cash or in-kind received by a customer or spouse of a customer for services performed as an employee or because of the customer or spouse being engaged in Self-Employment

● Earned income disregards are applied, even to in-kind earned income. ● In-kind income is counted at the current market value. ● Examples of Earned Income:

● Wages ● Salaries ● Tips



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Read and Highlight Activity Review and highlight or underline what’s important. Volume 3.520.782:

1. Earned income is monetary wages received by the customer for services performed as an employee or as profit from self-employment.

2. In-kind earned income is non-monetary benefits received by the customer for services performed as an employee or as self-employment profit, such as shelter as payment for building maintenance or babysitting or other barter goods in exchange for services.

a. In-kind income received in exchange for employment is employment income and shall have the appropriate earned income disregards applied to the total value of the income.

b. The amount considered as earned income when the customer is paid in-kind shall be the value of the item supplied. The current market value of the item is used if the value of the item is not provided.

Self-Employment Income Profit -making activities: Money from sales of self employment capital goods, services and property

● Deduct the cost of doing business: ● Business expenses (rent for business premises, wholesale cost of merchandise,

utilities, interest, taxes, labor, upkeep of equipment, etc.). ● Do not include depreciation of equipment, cost of or payment on principal of loans for

capital assets or durable goods, or personal expenses. ● Self-employment expenses can be self-declared.



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Self-Employment Special Cases ● Farm income

● Farm income shall be considered on a yearly basis. Net income for the prior year shall be determined and averaged for the succeeding year and counted as earned income. 3.520.783.C.

● (If time allows, navigate to the rules via the Colorado of Secretary of State Web Site. Look at some of the rules in this section and discuss with the class.)

● Rental income ● Customer must actively manage property at least 20 hours per week for it to be

considered self-employment. Average the rental income over a twelve (12) month period to determine monthly earned income.

● Room and Board ● Room (to provide a person with lodging only) payments to the customer shall be

considered earned income in the month received. For each boarder calculate the documentable expenses directly related to the provision of the room. Subtract the result from the room payment to determine the countable earned income.

● Room and board (to provide a person regular meals and lodging) payments shall be considered earned income in the month received. For each boarder, calculate the documentable expenses directly related to the provision of room and board. Subtract the result from the room and board payment to determine the countable earned income. 3.520.783.C.2.d.

● Licensed child care providers ● For the first child for whom day care is provided, deduct $55; and, for each

additional child deduct $22. ● Subtract the total allowances from the documented expenses to determine the

earned income. ● If the customer can document a cost of doing business that is greater than the

amounts above, follow the procedure at 3.520.783.B. ● Donated Work Hours

● Considered countable earned income when all of the following apply: ■ Regular and scheduled ■ More than 5 hours/week ■ Is a necessary service ■ Would require a staff member to be hired if not completed by the client

● The value is calculated by taking the greater of: ■ The going rate in the community for the same type or similar work, OR ■ The Current minimum wage

● Volunteerism



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● Volunteer work for the betterment of the community that averages less than 30 hours per week is not considered as income.

Unearned Income AF recipients are more likely to have unearned income than earned income

● Remember, unearned in-kind income is countable for AF. ● Unearned income that is being garnished is still counted.

Exempt Income Some income types are not countable for Adult Financial programs:

● Income tax refunds ● The remainder of any tax refund after 12 months will count as a

resource ● Earned Income Tax Credit (EITC)

● Home energy assistance ● Includes LEAP payments ● From a non-profit or supplier, including in-kind, voucher, or vendor payment

● Emergency or general assistance ● Received as a one-time cash or in-kind payment from a county or other agency

● Work-study income ● If work-study income exceeds the need-based grant, it is countable earned income

● Wages received by customers who are at least 55 years old under the SCSEP ● SCSEP = Senior Community Service Employment Program, under Title V of the Older

Americans Act – AARP and Rocky Mountain SER are example employers. Customers will normally come in with a letter

● Income set aside for PASS approved by the SSA ● PASS = Plan to Achieve Self Support

● Child Support



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Income Quiz Game!

Disregards Disregards will be applied prior to the gross test

● Prior to conducting the Gross Income test for all AF aid codes (except for burial), if the case includes earned income, allow the following earned income disregard:

● Deduct $65 from the gross earned income and divide the remainder by 2. The result of this earned income disregard is the countable earned income. The gross income test must occur after all income disregards are given (earned and unearned – see requirement _011).

● **‘Earned’ income includes any income in CBMS that is currently looked at as Earned Income (such as Earned, Self-Employment, Rental, Room and Board)

Earned Income Disregard

● “65 and a half” rule ● The earned income disregard is only for the following types of customers:

● OAP, AND-SO Recipients



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$20 Disregard ● The $20 disregard is given to customers who have unearned income other

than SSI ● Examples are retirements, pensions, and deemed income. ● The $20 disregard is applicable to customers and spouses who receive OAP, AND-SO

or AND-CS. ● Only one $20 disregard is allowed for married couples. ● If both members of the couple are receiving AF, split the $20 in two: $10 each. ● If only one member of the couple is receiving AF, give the full $20 to the AF

customer. ● The $20 disregard does not apply to customers who have SSI only,

no income, or earned income only. ● The $20 disregard does not apply to customers living in Adult Foster Care facilities.

● Deemed income is considered unearned income.

Data Entry: Income

In-Kind Support and Maintenance (ISM) In-Kind Support Maintenance (ISM) is income for certain customers who are not paying their fair share of shelter costs.

● Occurs when a OAP or AND-CS customer is NOT paying his or her fair share of housing costs ● Customers receiving SSI and being charged an ISM by the Social Security Administration (SSA)

shall be charged a matching ISM for Adult Financial. ● SVES will show “J” or “H” unearned income in Title XVI



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● If the customer is paying their fair share of shelter costs, refer them back to SSA. When SSA removes all or part of their ISM, match it in CBMS.

● The maximum amount of ISM is determined by taking the current SSI grant standard and multiplying in by 33.33 % and then adding $30

Exceptions

● ISM Provisions Do Not Apply to Persons: ● Live in and own their own residence ● Live in subsidized housing ● Are homeless ● Are paying their fair share of shelter costs ● Are paying shelter costs equal to or greater than the current ISM

amount

Fair Share and Fair Market Value ● Fair share is determined by totaling the actual cost of tent and utilities. Unlike Food

Assistance (FA), Adult Financial (AF) uses the actual amount of the utility allowance. ● All utility expenses must be for a physical dwelling. ● Phone Expenses are not used in determining Fair Share.

Example: A customer pays $400 in rent. They pay $25 for water, $25 for trash and $70 for phone. AF would only look at $450 (for the actual cost of shelter and allowable utilities)

Verification ● Shelter verification is only needed if declared shelter cost is less than the current ISM

amount ● All other Adult Financial Aid Codes would no longer request shelter expenses.

Apply the full ISM

● When the customer is NOT paying any shelter costs and all shelter costs are supplied in full ● WhenThe customer receives an educational loan or grant that provides shelter in full ● When the customer fails to provide verification of their declared shelter expenses.



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Determining an ISM Amount Step One:

Step Two:

Step 3:



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Data Entry: ISM

Deeming The income of spouses and non-citizen sponsors is countable towards the applicant. We call this type of income “deemed”.

● NRSI: Non-recipient Spousal Income ● All countable earned and unearned income received by the non-recipient spouse.

● NRPI: Non-recipient Parental Income ● All countable earned and unearned income received by the non-recipient parent and

the spouse of the non-recipient parent are deemed to the un-emancipated child.



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Information to Gather ● Earned and unearned income.

● For AND-SO, information about mandatory withholding from earned income should be gathered.

● Only medical expenses not covered by other sources will be considered and require verification if questionable.

Deeming Spousal Income If a spouse is receiving an Adult Financial grant, Supplemental Security Income (SSI), or Medicaid and their income is equal to or less than the current year’s Old Age Pension (OAP) grant standard for OAP or equal to or less than the current year’s SSI limit for Aid to the Needy Disabled (AND) cases, then their income will not be deemed to the customer. If the spouse’s income is above those limits, the income will be deemed to the receiving spouse.

● If the spouse's income is above the grant amounts, income deeming applies. ● For AND-SO and AND-CS clients, the spouse’s earned income will deem after allowing

the $65 and ½ earned income disregard. The spouse’s unearned income will deem after allowing the $20 unearned income disregard. Please note that the unearned income disregard is split between the client and their spouse, giving each spouse a $10 disregard, as applicable.

● For OAP clients, the spouse’s earned income will deem after allowing the $65 and ½ earned income disregard. The spouse’s unearned income will deem after reducing the income by the OAP limit, dependent and medical disregards, and allowing a deduction for court ordered obligations.

● For clients whose spouse is in a Nursing Facility and are given a spousal allowance, the spouse’s income will deem as described above after the spousal allowance is deducted from their income.



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OAP Income Deeming Scenarios Activity

Resources

Resource Race Activity!

The Basics Resources are real and personal property

● Non-Liquid Resources ● Difficult to convert into cash

■ Homes, vehicles, land, valuable collections etc. ● Liquid Resources

● Easy to convert into cash ■ Checking and savings accounts, IRA accounts Etc.



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● The customer must make reasonable attempts to pursue any available resources at their disposal.

● Countable resources are those that were held as of the first day of a calendar month or as of the date of application if not counted as income for the application month.

● If a customer or spouse or parent of a minor child is receiving SSI, we will not request verification of resources

● Does not apply to Resources of Sponsor or Sponsor’s Spouse

Resource Limits

Availability of Resources ● If a customer is actively attempting to sell, liquidate, or legally acquire a resource, the

county department shall not delay action on an application. ● As with income, customers must attempt to access all resources available to them.

● Benefits shall be continued without adjustment until the resource becomes available ● Attempts to access the resource should be verified and monitored to ensure that reasonable

effort to secure the resource continues. ● If the customer refuses or fails to make reasonable effort to secure the resource, it should

be considered countable. If the resource puts the customer over the resource limit, benefits should be denied or terminated.

Exempt Resources

$2000 for: An unmarried customer

$3000 for: A married customer

One vehicle per household

Household goods and personal effects

Primary residence client resides in or lived prior

to becoming institutionalized

Retroactive SSI or SSA retirement or SSA

disability lump sums**



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**Retroactive SSI or SSA retirement or SSA disability lump sums are exempt for up to 9months.

More Exempt Resources ● Income tax refunds

● Exempt up to 12 months. ● Monies from a bona fide loan

● Exempt only in month received. ● Proceeds from sale of primary home if funds are intended to purchase or build a

replacement home. ● Exempt up to 6 months: Funds remaining the month following purchase are a

countable resource. ● Proceeds from fire or casualty insurance

● Exempt: For Restoration 3 months/Replacement 6 months. ● Irrevocable prepaid burial funds

● Exempt up to any value ● Revocable burial funds

● Exempt up to $1,500 each for customer and the customer’s spouse ● Life insurance with face value of $1,500 or less (all policies combined)

● Exempt up to $1,500 each for customer and the customer’s spouse – OAP allows for higher face values

● Non-business property producing goods necessary for daily activities. ● Exempt up to $6,000

● Non-business income producing property ● Exempt up to $6,000 – Income is countable

Oil and Mineral Rights

● Exempt if located on the land of the primary residence ● This is a resource that also may produce income.

● Oil and mineral rights may fall into the non-business income producing property section.

● A maximum of six thousand dollars ($6,000) of the equity value of such property is an exempt resource, if the property produces a net annual income of at least six percent (6%) of the excluded equity.



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Income Producing Property

● If the equity value of such income producing, non-business property exceeds $6,000, only the equity value above $6,000 will be counted as a resource.

● “Non-business” means that the property is not used in a trade or business as defined in ● Section 3.520.76. Non-business, income-producing property may include but is not limited to

houses or apartments for rent and land other than home property

Example: Mr. Smith has mineral rights in North Dakota.

● The actual value obtained from the county assessor is $6,500. ● Mr. Smith provided a 1099 from last year listing income from royalties at $500.

Since the rate of return is more than 6%, $6,000 of the equity value of the resource can be excluded. So, the countable value of Mr. Smith’s mineral rights is $500.

$6000 excludable

value of resource

.06 Percentage

of return

$360 - the amount of income a

$6000 resource must be produced



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Other Countable Resources ● Utility trailers and campers ● Recreational vehicles not used as primary vehicle or residence ● Oil and mineral rights not located on the primary residence property ● Boats not used as primary residence ● Cryptocurrency ● Electronic Currency ● EBT Balance (not including Current month issuance)

Shared Bank Accounts

● The balance in a joint account shall be considered available to the customer in proportion to the number of persons on the account unless:

● The co-owner of the account is the customer’s legal fiduciary (guardian, conservator, power of attorney, etc.), OR

● The co-owner is on the account to assist the customer with paying bills, purchasing groceries, etc.

In either of these circumstances, the account shall be 100% owned by the customer and all funds in the account shall be considered available to the customer. Shared accounts occur frequently with OAP customers

● A son or daughter may be on the account with the customer, but none of the funds in the account are theirs.

● They are on the account in case the parent needs help with paying bills, running errands, buying groceries, etc.

Vehicle

● KBB/NADA should be used to verify the fair market value of a vehicle. ● $400 standard value can be used when unable to verify through KBB/NADA.

Life Insurance

● Life insurance should be evaluated by original face value if known. ● OAP allows for up to $250,000 in cash value of life policies to be exempt as long as the

policy was purchased over 48 months prior to application. ● When the cash value of life insurance puts the customer over for OAP Med, the

customer will receive Medical Assistance under Adult MAGI or OAP-HCP.



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Burial Plans ● Revocable: Account can be sold or terminated. Customer can get their money back ● Irrevocable: Account cannot be sold or terminated. Customer cannot get their money back.

Types of Burial Funds

● Irrevocable burial funds do not reduce the $1500 burial exemption. ● For Medicaid, irrevocable burial funds reduce the revocable burial exemption dollar for

dollar. Customers who have revocable burial and irrevocable burial may not meet resource guidelines for OAP Med and may “roll” to MAGI Adult or OAP-HCP.

● Banks must be federally insured. ● Trust company must be under supervision of the State Banking Commissioner. ● Provides for payment of the trust funds without limitation as to place of burial or provider of

related services.

Trusts ● Revocable and irrevocable trusts will be a resource or income based on SSA guidelines

● SSA counts as either income or a resource depending on the access the customer has to the trust.

● Need to be sent to the HCPF Trust officer if the customer is receiving Medicaid.

Data Entry: Resources



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How Much Treasure Activity

Transfer without Fair Consideration (TWFC) ● A transfer of a resource to another person at a price that is below fair market value and was

● Voluntary ● Made during the 36 months prior to application, and ● For the purpose of becoming eligible for assistance; or ● Made while receiving Adult Financial benefits

● 36 months is the “look-back” period for AF.

What is the Penalty for a TWFC? ● The value of the resource minus any encumbrances (a claim, like a mortgage or loan) is

used to determine a penalty period for Adult Financial benefits. ● The value of the resource less encumbrances is amortized by the program grant standard for

which the customer has applied or is currently receiving. ● ‘Encumbrance’ means the valid and legal outstanding payments, loans, or liens on a given resource. ● “Amortize” means to pay money that is owed for something (such as a mortgage) by making regular

payments over a long period of time.

TWFC Penalty Calculation ● The Penalty Period is determined by taking the TWFC Monthly Penalty Period and dividing it

by the amount of the uncompensated value of the resource and rounding the result down to the nearest whole number. The result is the number of months of ineligibility for Adult Financial benefits.



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● Transfer without Fair Consideration (TWFC) Disqualifications for Adult Financial created on or after 01/01/2020 must have a maximum disqualifications period of 36 months.

● A penalty period may also be referred to as Period of Ineligibility (POI).

TWFC Formula

POI Formula The Penalty Period is determined by taking the TWFC Monthly Penalty Period and dividing it by the amount of the uncompensated value of the resource and rounding the result down to the nearest whole number. The result is the number of months of ineligibility for Adult Financial benefits

● The Penalty Period begins on the first day of the month that the transfer occurred.

Deciding When to Impose a Penalty Period ● The county department shall make a rebuttable presumption that the transaction was made

for the purpose of becoming or remaining eligible for Adult Financial benefits. ● The client shall be given the opportunity to disprove the presumption. The presumption shall

be nullified if the client can demonstrate to the county department that the transfer was for another purpose.

AF Grant Standard

Monthly Medical Costs

TWFC Monthly Penalty Value

Value of Resource

TWFC Monthly Penalty Value

# of Months of

ineligibility



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Hardships There may be circumstances related to the transfer of resources that indicate that the customer was experiencing hardship just prior to the transfer.

● Unemployment resulting in inability to pay shelter, food and bills ● Accident or severe illness requiring money to pay for medical care services ● Other hardship deemed reasonable by the county department using PPP

Transfer Without Fair Consideration (TWFC) Activity

Data Entry: TWFC



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Conclusion Two Things 1) Important thing you learned ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 2) Something you will change or start doing when you return to your job ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Documents

Participant Guide - Traincolorado