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Instructions for the completion of the CBAS Eligibility Screening Tool during the transition from ADHC to CBAS, detailing eligibility categories and screening processes.
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How to fill out cbas eligibility screening tool

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How to fill out CBAS Eligibility Screening Tool

01
Gather all necessary personal information such as name, date of birth, and contact details.
02
Review the eligibility criteria for the CBAS program to ensure the applicant meets the requirements.
03
Begin with Section 1 of the Screening Tool, which focuses on demographic information.
04
Complete Section 2, which assesses the applicant’s functional limitations and health conditions.
05
Fill out Section 3, which may include additional questions about the applicant's support system and living situation.
06
Verify that all information is accurate and complete.
07
Submit the finished Screening Tool to the appropriate agency or program coordinator for evaluation.

Who needs CBAS Eligibility Screening Tool?

01
Individuals who are aged 18 and older and require assistance with daily activities.
02
Individuals with physical, cognitive, or emotional challenges that impair their ability to remain independent.
03
Caregivers or family members seeking services for someone who may benefit from the CBAS program.
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Qualification is based on the poverty line for each state and allows for adjustments based on the local cost of living. The government requires that individuals or families seeking assistance prove that their annual income falls below the federal poverty level (FPL).
The individual is 18 years of age or older and has one or more chronic or post-acute medical, cognitive, or mental health conditions, and a physician, nurse practitioner, or other health care provider has, within their scope of practice, requested CBAS services for the person.
Who is eligible? Qualify for Medi-Cal if your income is up to 138 percent of the Federal Poverty Level (FPL) for adults, and up to 266 percent FPL for children. Check Shop and Compare to see if you qualify. Learn more on the Department of Health Care Services website.
The individual is 18 years of age or older and has one or more chronic or post-acute medical, cognitive, or mental health conditions, and a physician, nurse practitioner, or other health care provider has, within their scope of practice, requested CBAS services for the person.

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The CBAS Eligibility Screening Tool is an assessment instrument used to determine an individual's eligibility for the Community-Based Adult Services (CBAS) program, which provides support and services to adults with disabilities or chronic conditions.
Individuals seeking to access CBAS services or their caregivers are required to file the CBAS Eligibility Screening Tool to demonstrate eligibility based on their health and functional needs.
To fill out the CBAS Eligibility Screening Tool, individuals must provide personal information, detail their medical history, describe their functional abilities, and indicate any specific needs for support services. It is recommended to work with a healthcare professional who is familiar with the process.
The purpose of the CBAS Eligibility Screening Tool is to evaluate and verify whether individuals meet the criteria necessary to qualify for the CBAS program, ensuring that recipients receive appropriate care and resources tailored to their needs.
The CBAS Eligibility Screening Tool must report information such as demographic details, health status, functional abilities, cognitive capacity, and any other relevant medical or behavioral conditions that could impact the individual's need for community-based services.
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