State Aid Funds Application
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Affiliate:
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Amount Requested:
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For TCM requests only:
Please check this box if Affiliate is only requesting payment for case management services during a crisis, for an individual not yet eligible for Medicaid.
Upload case notes to support reimbursement:
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Documentation of other available community resources previously exhausted:
Explain how funds may increase adaptive capabilities, productivity, independence, and/or inclusion:
Plan submitted that outlines the needs of the individual(s) to provide day or residential services, the equipment, modifications or supports that will address the barrier(s) and need(s) of the individual(s): * Bid requirements: One bid for anything under $10,000. Three bids for anything over $10,000.
Bids upload:
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Plan for addressing barriers:
For Affiliates requesting funds for case management services, emergencies, property damage, or community disasters; please explain the current situation:
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