NOTE: If the source of the third party payments for the care is federally funded income
based on need (e.g., foster care under title IV-E), the total payment is counted as
cash
income to the individual and the SSI payment is reduced dollar for dollar. Such a
payment is considered the individual's own payment toward the care rate and does not
result in countable ISM (SI 00830.170).
EXAMPLE 1: Both Individual and Third Parties Pay
The County Department of Social Services places Lucille Green, a disabled child, in
Mrs. Smith's home which is licensed to provide foster care. The care rate is $500
per month. For 05/99, Lucille's parent, James Green, pays $300 to Julie Smith for
James child's care. The County pays $200 from its protective services program which
is funded by the State. The Claims Specialist (CR) determines that the County's payment
is assistance based on need (SI 00830.175). Thus, the County's $200 payment does not result in ISM.
The excludable County payment is subtracted from $500 care rate which leaves an unpaid
balance of $300. The parent's s $300 payment pays this balance. However, a one-third
exclusion is applied to payments made by an absent parent (SI 00830.420). Therefore, the$300 payment is counted as $200 for 05/99. Since this $200 payment
still exceeds the PMV ($186.66) Lucille is charged with the PMV.
For 06/99, James pays only $150 and the County protective services program pays $350.
The excludable $350 County payment is subtracted from the care rate of $500. This
leaves an unpaid balance of $150 that is not excludable and may be counted as ISM.
James pays the $150 balance. However, since one-third of Mr. Green's payment as an
absent parent is excluded, only $100 is counted as ISM for Lucille.
In 07/99, Lucille's SSI benefits start. Lucille's SSI benefits are used to pay the
$500 to Julie Smith. Since Lucille pays the entire care rate from Lucille's own funds,
no ISM is counted for July.
EXAMPLE 2: Computing ISM in Most Advantageous Way for the Individual
Arthur, who resides in a foster care home, files for SSI disability in 7/99 (Arthur
is ineligible for title II benefits). The placing agency advises that the care rate
for the home is $400 per month. The home's monthly charge is $700. The DO learns that
the additional $300 is for attendant care services. Arthur pays the provider $300
per month from their monthly earnings of $400. Arthur's sibling pays the balance of
$400 to the home, with none of the money earmarked for any particular expense.
At first, the claim specialist (CS) determines that Arthur is getting countable ISM
of $100 ($400 care rate minus Arthur's own payment of $300). However, the CS identifies
IRWE when evaluating Arthur's wages because Arthur is required to pay the cost of
the attendant care services ($300) provided by the home. The CS calculates the IRWE
to be $300 because all of the attendant care services are provided to enable Arthur
to work.
The CS uses the IRWE and attributes Arthur's payment to the home as follows: $300
towards attendant care; and $0 towards the care rate. By using this apportionment
of the payment, the actual value of ISM Arthur receives is $400 (capped at the PMV
— $186.66). The CS deducts the $300 IRWE from Arthur's $400 wages when the claim is
adjudicated because this yields a higher SSI payment than the benefit that would be
paid if we assume that Arthur's $300 monthly payment to the home is for the care rate.