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
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
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 father, Mr. James Green, pays $300 to Mrs. Smith for his daughter'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 father's $300 payment pays this balance. However, a one-third exclusion is applied to payments made by an absent parent (SI 00830.420). Therefore, his $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, Mr. Green 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. Mr. Green 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. Her SSI benefits are used to pay the $500 to Mrs. Smith. Since Lucille pays the entire care rate from her own funds, no ISM is counted for July.
EXAMPLE 2: Computing ISM in Most Advantageous Way for the Individual
Mr. Arthur, who resides in a foster care home, files for SSI disability in 7/99 (he 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. Mr. Arthur pays the provider $300 per month from his monthly earnings of $400. His brother pays the balance of $400 to the home, with none of his money earmarked for any particular expense.
At first, the claim specialist (CS) determines that Mr. Arthur is getting countable ISM of $100 ($400 care rate minus his own payment of $300). However, the CS identifies IRWE when evaluating Mr. Arthur's wages because he 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 Mr. Arthur to work.
The CS uses the IRWE and attributes Mr. Arthur's payment to the home as follows: $300 towards attendant care; and $0 towards the care rate. By using this apportionment of his payment, the actual value of ISM Mr. Arthur receives is $400 (capped at the PMV — $186.66). The CS deducts the $300 IRWE from Mr. 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 Mr. Arthur's $300 monthly payment to the home is for the care rate.