Colorado MED-9 at a glance
What it is: The Colorado Department of Human Services Med-9 is used by County Departments of Human Services to determine medical eligibility for the Aid to the Needy Disabled (AND) Program.
Who signs: In order to qualify, a medical provider must certify the applicant's disability by filling out the Med-9 form based on an assessment of the applicant's medical condition.
A filled-in Colorado MED-9 example: a physician completes the Med-9
How to fill out Colorado MED-9, box by box
Name, address, county and effective date
Write Name, SSN, DOB, Address, Phone, Zip Code, City, County and Effective Date.
Your license or certification
The rest of this form must be completed by one of the following medical professionals licensed in Colorado.
Select the option that corresponds to your license/certification: Physician*, Physician Assistant*, Licensed Psychologist*, Advanced Practice Nurse*, Registered Nurse*, Licensed Clinical Social Worker*, Licensed Professional Counselor* or Optometrist*. *If Specialized, list your specialty.
Signature, name, license and exam date
Write the Medical Professional Signature, Printed Name, License Number, State, Date of Exam, Provider Address and Provider Phone.
Diagnoses
Select the individual's diagnosis(es): If a client has more than one diagnosis, mark the primary diagnosis with a star (*) on the box to right of each option.
Respiratory disorders, Cardiovascular disorders, Digestive disorders, Genitourinary disorders, Hematological disorders, Congenital disorders, Neurological disorders and Cancer.
Alcohol/Controlled Substance Addiction, Immune System disorders, Blindness (corrected visual acuity <=20/200 OR widest diameter of field of vision <= 20 degrees), Vision, Hearing, or Speech disorders, Musculoskeletal disorder and Other (please define).
Use this space to write any specific diagnoses or relevant factors to the disorder type/diagnoses selected on the left.
The first disability level and how long it lasts
Select only one of the two disability levels.
This individual has a physical or mental disability/diagnosis(es) listed in Diagnoses which in combination with other factors, such as age, training, experience, and social setting substantially precludes the individual from having any employment that exists in the community for which they have competence.
This disability is expected to last 6 months or longer.
How many months is this condition expected to last? Check one: 6-11 months 12+ months.
The social factors preventing employment
This individual does not have a physical or mental disability/diagnosis(es) that will last 6 months or longer and/ or does not have accompanied social factors that preclude the individual from having employment in the community for which they have competence.
Identify the social factors preventing the individual from employment: Training, Age, Experience, Social Setting or Other/Additional.
More rules for Colorado MED-9
You need a medical examination to determine your ongoing eligibility for Aid to the Needy Disabled (AND). Make an appointment with a medical provider. Ask the medical provider to read the instructions and complete all of the gray sections on the Med-9.
1. Evaluate the client's disability. 2. Complete all of the gray sections on the Med-9 form: a. Check only one disability level box. b. Your signature, provider type, name, address, phone number, license number, the state issuing your license, and date of exam. 3. Return the completed form to the client and you may send a copy to the county department to assist the process. You can obtain the county's fax number by visiting: https://www.colorado.gov/pacific/cdhs/contact-your-county a. The client's county of residence is located on the Med-9 form. b. On the website, select the corresponding county to locate the county fax number.
This form can also be completed and submitted by medical providers online.
The words "total disability" on the Med-9 form are derived from regulations. They are not intended to reflect medical prognosis terminology.
The county Human Services office and CDHS will consider your medical opinion expressed on the form.
Common questions about Colorado MED-9
What is a med 9 form in Colorado?
The Colorado Department of Human Services Med-9 is used by County Departments of Human Services to determine medical eligibility for the Aid to the Needy Disabled (AND) Program. AND provides a monthly payment to individuals that cannot maintain gainful employment due to a disability.
Is there a deadline?
You need to get the attached Med-9 form completed by a medical provider and then return it to your county office no later than the redetermination due date.
Where do I file it?
Return the completed Med-9 form to your county office by the due date. You can do this in person, through email, by fax, by mail or online through your PEAK account.
Sources
[1] Med-9, Colorado Department of Human Services (the Official source link on this page).
