Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: UPDATED AGED, BLIND, AND DISABLED SUPPLEMENT (IM-1ABDS)
FORM REVISION #
IM-1ABDS
IM-1ABDS (Spanish)
IM-1ABDS (Large Print)
DISCUSSION:
The IM-1ABDS has been updated for clarity and to request additional information needed by Family Support Division (FSD) staff to complete an eligibility determination for MO HealthNet for the Aged, Blind, and Disabled (MHABD) programs.
Changes to the IM-1ABDS include:
- Updated instructions advising that applicants under the age of 18 years old must also include their parent’s information.
- Added fields for the name of the participant and spouse, Departmental Client Number (DCN), Social Security number, and date of birth.
- Updated all questions to clarify that information is requested for the applicant and their spouse.
- Updated all questions to have consistent Yes or No responses.
- Added fields identifying household members receiving Social Security Disability, Supplemental Security Income, or neither.
- Added a field identifying household members requesting assistance to pay their Medicare premiums.
- Added a field to provide a nursing home or residential care facility’s address.
- Added fields to provide shelter expense amounts.
- Moved the question about household members who are blind/visually impaired to appear immediately above the Blind Pension (BP) and Supplemental Aid to the Blind (SAB) declaration questions.
- Added a field for BP/SAB participants to provide their doctor’s information.
- Added additional fields to list assets.
- Updated question regarding life insurance and prepaid burial policy.
- Added a field for additional information.
- Added information regarding how to return the form to FSD.
The revised IM-1ABDS shows a revision date of 8/2022. The IM-1ABDS with a revision date of 7/2021 is now obsolete. The obsolete form may still be accepted as valid, but staff should begin using the revised form and encourage community partners to do the same.
The updated IM-1ABDS is available in large print (IM-1ABDS-LP) and Spanish [IM-1ABDS (Spanish)] for participant and staff use. The IM-1ABDS, IM-1ABDS-LP, and IM-1ABDS (Spanish) have been updated in the public forms manual and the internal forms manual.
The IM-1ABDS and IM-1ABDS (Spanish) can be ordered by designated staff from the E-store.
The online Aged, Blind, and Disabled Supplement form has been edited to reflect the changes made to the IM-1ABDS.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Discard and destroy blank IM-1ABDS forms with 7/2021 revision date.
- Begin using IM-1ABDS with 8/2022 revision date immediately.
- Share with community partners and contacts.
KE/cj