Identification Number:
SI 00835 TN 87
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Living Arrangements and In-Kind Support and Maintenance
Type:POMS Transmittals
Program:Title XVI (SSI)
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 008 – Income
Subchapter 35 – Living Arrangements and In-Kind Support and Maintenance
Transmittal No. 87, 07/11/2019

Audience

FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

07/26/2019

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

SI 00835.712 Exclusion of In-Kind Support and Maintenance for Residents in Private Nonprofit Residential Care Institutions

Changed "MSSICS" to "SSI Claims System" throughout this document to reflect the new claim system, per modernization updates. The term “Non-MSSICS” has not changed.

Changed "CR" to "CS" throughout the document to reflect the name change from "Claims Representative" to "Claims Specialist".

 

SI 00835.713 Determining In-Kind Support and Maintenance for a Member of a Religious Order Who Moves into a Private Nonprofit Residential Care Institution

Subsection E - Under the 5th bullet changed "MSSICS" to "SSI Claims System" to reflect the new claim system, per modernization updates.

 

SI 00835.714 In-Kind Support and Maintenance Provided Residents of Educational or Vocational Training Institutions

Changed "MSSICS" to "SSI Claims System" throughout this document to reflect the new claim system, per modernization updates. The term “Non-MSSICS” has not changed.

Changed "CR" to "CS" throughout the document to reflect the name change from "Claims Representative" to "Claims Specialist".

Subsection B - Under "EXAMPLE 1" changed "ISM to one" to "ISM only to the Claimant" to reflect the title of POMS SI 00835.400.

Subsection C - Updated "ISM to one" to "ISM only to the Claimant" to reflect the title of POMS SI 00835.400.

 

SI 00835.790 Non-institutional Care Situations

Changed "MSSICS" to "SSI Claims System" throughout this document to reflect the new claim system, per modernization updates. The term “Non-MSSICS” has not changed.

Change "noninstitutional care" to "non-institutional care" or "Non-Institutional Care" throughout this document to reflect modernization updates.

Changed "CR" to "CS" throughout the document to reflect the name change from "Claims Representative" to "Claims Specialist".

Subsection B.4. - Under "EXAMPLE" changed "On MSSICS this case is processed as follows" to "This case is processed within the SSI Claims System as follows".

Subsection B.4. - Under "EXAMPLE" updated MSSICS screens to SSI Claims System pages to reflect the modernization update. Changed "LRES screen" to "Residence Address and Jurisdiction page"; changed "LNON screen" to "Non-Institutional Care page"; and changed "LIID screen" and "LISM screen" to "In-Kind Support and Maintenance page".

Subsection C - Under "References" updated the MS link for "Non-Institutional Care screen" and "In-Kind Support and Maintenance screen".

SI 00835.712 Exclusion of In-Kind Support and Maintenance for Residents in Private Nonprofit Residential Care Institutions

CITATIONS: Social Security Act, as amended, section 1612(a)(2)(A) ; Regulations, 20 CFR 416.1144

This section applies only when the eligible individual lives in a private nonprofit residential care institution.

When the private nonprofit institution pays for some or all of the individual's food and shelter, it is necessary to determine whether the food and shelter counts as In-kind Support and Maintenance (ISM). This section provides the instructions to make that determination.

A. Procedure for developing ISM in private nonprofit institutions

1. Individual or third party pays the current market value (CMV)

When the recipient or a third party pays the CMV for all of the food and shelter, to determine whether the individual receives countable ISM, follow the instructions in SI 00835.706 and SI 00835.707. It is not necessary to develop whether the exclusion for support and maintenance applies.

2. Some or all food or shelter paid for by institution

When the private non-profit institution pays for some or all of the food, or shelter, or both, the following procedure applies:

  1. a. 

    Determine whether the ISM provided by the institution is excludable under the support and maintenance exclusion (“Church amendment”). To determine if the “Church amendment” applies, use the procedures in SI 00835.712B. NOTE: The name “Church Amendment” refers to the late Senator Frank Church who drafted this legislation. This provision is not exclusive to religious organizations such as churches.

  2. b. 

    If the ISM is not excludable under the “Church amendment,” decide whether the ISM provided by the institution is excludable under the Support and Maintenance Assistance (SMA) exclusion in SI 00830.605.

  3. c. 

    If the ISM is not excludable under the SMA exclusion, to determine whether the individual receives countable ISM, follow the procedures in SI 00835.707B.3.

3. Distinguishing between donations and third party payments

Donations to the institution are not third party payments. They do not count as ISM. Use the following procedures if the issue of a donation is present:

  1. a. 

    Do not routinely inquire about, or document, the existence of donations to the institution on behalf of the eligible individual.

  2. b. 

    If a question material to the ISM determination arises about whether funds provided to the institution are a charitable donation or a third party payment for food and shelter, contact the institution and determine the nature of the funds in question.

  3. c. 

    Accept the institution's allegation without further development and document the file, using the Report of Contact (DROC) screen in the SSI Claims System or, for non-MSSICS cases, the paper SSA-5002 (Report of Contact).

EXAMPLE: Donations to a private nonprofit institution

Frank Stone, an eligible individual, lives at the Mount Royal Retirement Home. A religious organization operates the home and it is tax-exempt under section 501(c) of the Internal Revenue Code.

During the interview, Mr. Stone tells the claims specialist (CS) that several of his relatives send money regularly to Mount Royal.

The CS contacts Mount Royal and learns that neither Mr. Stone nor any third party pays for his food and shelter.

Upon admission, the retirement home informs relatives of the residents that it costs $500 per month per resident and asks them to contribute whatever they can afford to the facility. NOTE:The facility does not send bills to the relatives and the facility does not maintain billing accounts for the individual residents.

The CS determines that the funds provided by Mr. Stone's relatives are donations as defined in SI 00835.710B.3. Therefore, such payments are not countable as ISM.

Since neither Mr. Stone nor any third party pays for his food and shelter, the CS must determine whether to count the food and shelter provided by the institution as ISM or to exclude it under the criteria for the “Church amendment” or under the SMA exclusion in SI 00830.605.

B. Procedure for determining if the “Church Amendment” applies

Determine that the “Church Amendment” ISM exclusion applies when the case meets all three criteria:

  1. a. 

    Neither the individual nor the institution (or its controlling organization) have an express obligation to provide full support and maintenance;

  2. b. 

    The institution has tax-exempt status; and

  3. c. 

    The institution does not receive payment to provide support and maintenance.

1. No express obligation to provide full support and maintenance

Determine whether an individual or a representative of the institution has an express obligation to provide support and maintenance using the following criteria.

  1. a. 

    There is an express obligation to provide full support and maintenance because of either:

    • a lump-sum payment, or

    • membership in an organization.

  2. b. 

    If the contact alleges that an express obligation exists, accept the allegation and determine that the exclusion does not apply.

  3. c. 

    If the contact alleges that no such obligation exists, verify the arrangement by obtaining a copy of an appropriate document (e.g., membership certificate, entrance agreement, organizational constitution, bylaws, etc.).

  4. d. 

    If the document establishes that an express obligation exists, the ISM exclusion does not apply. ISM provided by the institution is countable unless otherwise excluded (e.g., under the SMA exclusion in SI 00830.605).

  5. e. 

    If you obtain a document to verify the express obligation issue, put a copy in the file (Non-Disability Repository for Evidentiary Documents (NDRED) or Certified Electronic Folder (CEF) or record the pertinent information on a DROC screen in the SSI Claims System.

  6. f. 

    If the development establishes that there is no express obligation, the ISM exclusion may apply. Develop for the institution's tax-exempt status.

2. Determine whether the private nonprofit institution or the controlling organization is tax-exempt

a. If a SEANET 8045 precedent exists for the institution

If a SEANET 8045 exists:

  • Review the 8045 precedent to determine whether the institution or its controlling organization is tax-exempt under section 501(a) of the Internal Revenue Code and is of the kind described in sections 501(c) and 501(d) of that code. NOTE: This includes organizations covered under section 501(c)(3).

  • Document the file by recording the information pertinent to the tax-exempt status on a DROC screen (SSA-5002 for non-MSSICS cases).

  • If the institution is tax-exempt, then the ISM exclusion may apply. Develop whether the institution is paid to provide the eligible individual's support and maintenance per SI 00835.712B.3.in this section.

b. If no SEANET 8045 precedent exists check the Atlanta Precedent and Contact (APAC) website

If an APAC precedent exists:

  • Determine if the institution is an IRS-approved tax-exempt organization by entering the name of the organization and searching Atlanta Precedent and Contact (APAC) intranet site:

  • Create a DROC for the SSI Claims System cases or use an SSA-5002 for non-MSSICS cases, to document the APAC precedent as proof of the organization’s tax-exempt status; and

  • If the institution is tax-exempt, then the ISM exclusion may apply. Develop whether the institution is paid to provide the eligible individual's support and maintenance per SI 00835.712B.3.in this section.

c. If no SEANET 8045 or APAC precedent exists

If no precedent exists:

  • Request the institution to fax or send a copy of its State nonprofit certification or its determination letter from the IRS. Verify the tax-exempt status and document the file by recording information pertinent to the tax-exempt status on a DROC screen (SSA-5002 for non-MSSICS cases). If provided, fax the certification or IRS letter into the appropriate electronic folder.

  • If the institution or controlling organization is not tax-exempt, determine that the ISM exclusion does not apply and count the food and shelter provided by the institution as ISM unless it is otherwise excluded (e.g., under the SMA exclusion). For more information on the SMA exclusion, see SI 00830.605).

  • If the institution or controlling organization is tax-exempt, then the ISM exclusion may apply. Develop whether the institution is paid to provide the eligible individual's support and maintenance.

d. Verifying questionable tax exempt status

Use the following steps to verify the organization’s tax exempt if there is an indication that the IRS revoked its tax-exempt status:

e. Documenting that an organization lost its tax-exempt status

If the organization lost its tax-exempt status, do not apply the ISM exclusion. Document the following on a DROC within the SSI Claims System or on an SSA-5002 for non-MSSICS cases:

  • The date the organization was added to the IRS “Revocations” list;

  • The source of this information; and

  • “ISM exclusion does not apply.”

NOTE: For additional information on verifying an organization’s tax-exempt status, please see SI 00830.750E.

3. Documenting whether the Institution received payment to provide support and maintenance

Use the following steps to document whether the institution received payment to provide support and maintenance:

  1. a. 

    Contact the institution to determine if the institution provides support and maintenance for which it does not receive payment.

  2. b. 

    Document the file with the response of the institution using the DROC screen within the SSI Claims System or an SSA-5002 for a non-MSSICS case.

  3. c. 

    Determine that the exclusion does not apply if the institution does not provide at least some support for which it does not receive payment.

  4. d. 

    Determine that the exclusion applies if the institution provides at least some support for which it does not receive payment and meets the two other criteria.

NOTE: If the individual or a third party makes some payment for the individual's food and shelter, the unpaid portion provided by the institution is still excludable if the institution meets all three requirements listed in SI 00835.712B.1. through SI 00835.712B.3. in this section.

EXAMPLE: Individual makes a partial payment

Henry Jackson, an eligible individual, resides in St. Joseph's Retirement Home, a nonprofit residential care institution. A charitable organization operates the home and the organization is tax-exempt, and a precedent is on file with the FO. St. Joseph's provides Mr. Jackson with support and maintenance. In return, he agreed to turn over all of his current assets and to surrender all or part of any additional income or property he may receive in the future. The CS obtains a copy of the agreement from the institution.

The CS determines that the institution provides some support and maintenance without payment because the value of the support and maintenance exceeds what Mr. Jackson can pay. The support and maintenance provided is not due to membership in an organization nor due to a lump-sum prepayment given to St. Joseph's to provide lifetime care. Mr. Jackson, in accordance with the written agreement, must make further payments should he become financially able to do so in the future. The CS determines that St. Joseph's does not have an express obligation to provide support and maintenance. Therefore, because the institution meets all three requirements, the CS determines that the support and maintenance provided by the institution is not ISM because the “Church amendment” exclusion applies.

C. Reference

SI 00830.605 Home Energy Assistance and Support and Maintenance Assistance (HEA/SMA)

SI 00835.713 Determining In-Kind Support and Maintenance for a Member of a Religious Order Who Moves into a Private Nonprofit Residential Care Institution

CITATIONS:

Social Security Act, as amended, section 1612(a)(2)(A)(ii); Regulations, 20 CFR 416.1144; Social Security Ruling 78-33

A. Introduction

This section provides instructions for determining whether a member of a religious order receives in-kind support and maintenance (ISM) when the member moves into a private nonprofit residential care institution. Such a move may occur when, due to age or illness, the member requires more care than what is provided in a convent (or comparable facility).

B. Policy - ISM for Members o Religious Orders (nuns, priests, monks, etc.)

As explained in SI 00835.710, the law provides an exclusion for ISM that is provided by a private nonprofit residential care institution to its residents. However, this exclusion applies only if the institution or its controlling organization does not have an express obligation to provide support and maintenance for its residents.

We presume that a religious order has an express obligation to provide full support and maintenance for members of the order who have taken a vow of poverty. Because the religious order has this express obligation, the ISM exclusion in SI 00835.710 does not apply, and food and shelter provided by the order to its members who have taken a vow of poverty is countable. In addition, SI 00810.700B.3. states that income turned over by a member to the order is considered to be in fulfillment of the vow of poverty and is not considered a contribution toward the food and shelter received from the order.

However, some members of religious orders live outside of the convent (or comparable facility). If a member moves from the convent (or comparable facility) to a private nonprofit residential care institution that operates as a separate entity from the order, that institution would not have an express obligation to provide support and maintenance for the member. If the institution does not have an express obligation to provide support and maintenance to the member, the ISM exclusion in SI 00835.710 may apply.

C. Policy - Applying the ISM Exclusion when the Member Moves to a Private Nonprofit Residential Care Institution

If a member of a religious order leaves the convent (or comparable facility) and moves to a private nonprofit residential care institution, ISM continues to be countable if the order directly or indirectly continues to provide for the member's support and maintenance in the institution. If the institution is affiliated with the order and is not operating as a separate entity, we assume that the order is providing support and maintenance under an express obligation to provide full support and maintenance for members of the order who have taken a vow of poverty.

However, if the institution operates as a separate entity from the religious order, the institution does not have the same express obligation to provide support and maintenance to the members as the order does. If the separate institution is a private nonprofit residential care institution (e.g., board and care home, personal care home, etc.), the food and shelter it provides is not counted as ISM if all the following 3 requirements in SI 00835.710C.1. are met.

  • The institution does not have an express obligation to provide full support and maintenance to the member.

  • The institution has tax-exempt status under section 501(a) of the Internal Revenue Code (IRC) and is of the kind described in section 501(c) or (d) of that code.

  • The institution itself provides the member with food and shelter for which it does not receive payment expressly on behalf of that member (or it receives payment only from the member or from another private nonprofit organization that is similarly tax exempt). This requirement is not met if the order pays specifically for the member's support and maintenance in the institution.

NOTE: When the ISM exclusion in SI 00835.710 applies, the food and shelter provided by the institution is completely excluded. Therefore, when the ISM exclusion applies, it is not necessary to determine the actual value of the food and shelter provided to the member by the institution or whether the member's contribution equals the actual value of the food and shelter provided.

REMINDER: If a member moves into a medical facility such as a hospital or nursing home, ISM is not countable per SI 00835.706A. However, the $30 payment limit applies if Medicaid pays at least 50% of the cost of care.

D. Policy - Determining Whether an Institution Operates Separately from the Religious Order

1. Institution Is Not Affiliated With the Order

If the member of the order moves to an institution that is not affiliated with the order, determine that the institution operates separately from the order. Do not count support and maintenance from the order unless the order pays for the member's support and maintenance in the institution.

Assume that an institution is not affiliated with the order if it is not owned by the order either wholly or as a subsidiary, and no member of the order participates in the management of the institution.

2. Institution Is Affiliated With the Order

If the member moves to an institution that is affiliated with the order, it is necessary to determine whether the institution operates separately from the order. Using the following 2-step process, the adjudicator must evaluate all the facts in the case and determine whether an affiliated institution is operating as a separate entity from the order.

a. Step 1

The following 2 factors must be present in order to determine that an institution affiliated with the religious order is operating as a separate entity:

  • The religious order does not pay the institution specifically for the member's support and maintenance; and

  • The member's funds (e.g., SSI/T2 benefits if present) are used to pay the institution for the care provided.

b. Step 2

In addition to the 2 required factors in Step 1, there must be some additional evidence that the institution is operating as a separate entity. The adjudicator should consider all the facts in the case to determine whether the institution operates as a separate entity. The following factors support a determination that the institution is operating as a separate entity.

  • The institution is incorporated as a separate entity.

  • The institution is licensed by the State or local government to operate as a business or to provide board and care or similar services to residents.

  • The institution has been granted its own tax exempt status under section 501(a) of the Internal Revenue Code and is of the kind described in sections (c) or (d) of that Code.

  • The institution accepts private individuals as well as members of the order as residents, and the residents sign an admissions agreement that obligates them to pay for their care.

  • The institution has its own financial account that is used to receive payments from residents or pay its operating expenses.

NOTE: These are not the only factors that may be considered when making a determination. However, the presence of one or more of these 5 factors is a strong indication that the institution is operating as a separate entity. The presence of all 5 of these factors is not required to conclude that the institution is operating as a separate entity, and no single factor is determinative.

E. Procedure - Member of Religious Order Moves to an Institution that May Be Operating Separately from the Order

Follow this procedure when a member of a religious order moves to an institution that may be operating as a separate entity.

  • Contact the administrative staff of the institution or the order to obtain information about whether the institution is, or is not, affiliated with the order.

  • If the institution is not affiliated with the order, document that fact with a Report of Contact and determine that it operates as a separate entity from the order. The SEANET 8045 for that institution may also be used if it establishes that the institution is not affiliated with the order.

  • If the institution is affiliated with the order, obtain sufficient documents from the institution to establish whether the institution is operating as a separate entity from the order under the guidelines in SI 00835.713D. and, if pertinent to the particular case, when it became a separate entity. Such documents can include the articles of incorporation, or a State or local government license to operate a business or board and care facility, or the resident's admissions agreement, or a bank statement for the institution's operating account.

  • Document the file with the evidence required in SI 00835.712 to establish whether the ISM exclusion in SI 00835.710 applies.

  • Prepare a written determination on whether the institution operates as a separate entity from the order, whether the ISM exclusion in SI 00835.710 applies, and if not, whether the institution itself or a third party is providing countable ISM. Use the SSI Claims System DROC screen or any appropriate paper form. The determination should also document the administrative finality determination, if applicable (SI 00835.713F.).

  • Document the file with the date the member moved to the institution. Moving to the institution is considered a “change of residence” breakpoint which is effective in the month after the move (SI 00835.510).

F. Reopening Prior ISM Determinations

If a member of a religious order requests SSA to change his or her ISM determination because he or she lives in an institution that is separate from the order, follow the rules for reopening in SI 04070.010.

NOTE: Remember to consider retrospective monthly accounting (RMA) when changing the payment determination for months at the beginning of the administrative finality period (See SI 04070.030F.). For example, if the ISM determination is reopened for 2 years, it will be necessary to go back 26 months to delete the Type H income. It will be necessary to determine whether the institution was operating as a separate entity for this entire period of time and whether the member was in the institution during the entire period.

G. Referring Cases to the Regional Office or Central Office

If you determine that the institution is not operating separately from the order and ISM will be counted, contact your Regional Office SSI program staff for assistance prior to effectuating the determination. Regional Office staff should refer the case to the Office of Income Security Programs staff before processing the determination if ISM will be counted.

SI 00835.714 In-Kind Support and Maintenance Provided Residents of Educational or Vocational Training Institutions

A. Introduction

To determine ISM for residents of educational or vocational training institutions, use the instructions in (SI 00835.706 and SI 00835.707). However, be alert for the following issues:

1. SSI Ineligibility While In a Public Institution

Many ED/VOC training institutions are public institutions. Individuals in public institutions generally are not eligible for SSI. However, an individual who is participating in an ED/VOC training program as described in (SI 00520.400) is not considered a resident of a public institution for purposes of determining eligibility. The SSA-8045 precedent file should identify an institution which is an ED/VOC facility. If a precedent is not available, see (SI 00520.400) for making ED/VOC determinations.

2. Temporary Absence from Permanent Living Arrangement

Eligible individuals, particularly eligible children, who are staying at ED/VOC training institutions may be temporarily absent from their permanent living arrangements. Since temporary absence can affect whether countable ISM is received while in the institution, it is necessary to determine whether a temporary absence is involved before making the ISM determination. See (SI 00835.042) for the policies that apply to a child who is temporarily absent from the permanent living arrangement due to school attendance.

B. Procedure

Determining ISM In ED/VOC Institution

  • Determine first whether the individual's permanent living arrangement is the ED/VOC institution or whether this is a temporary absence (SI 00835.040 and SI 00835.042).

  • If the individual's permanent living arrangement is the ED/VOC institution, follow the procedures in (SI 00835.707) to determine whether the individual receives countable ISM and to compute the monthly value.

  • If the stay in the ED/VOC institution is a temporary absence, develop ISM only in the permanent residence, unless the individual is a child subject to deeming (SI 00835.042).

  • If the stay in the ED/VOC institution is a temporary absence, and the individual is a child subject to deeming, develop ISM in both the ED/VOC institution (SI 00835.707) and in the permanent residence (SI 00835.042).

NOTE: When a local/State education agency makes a third party payment for the food and shelter provided at the ED/VOC institution, determine that the recipient receives countable ISM if these funds are not otherwise excludable (SI 00835.706C.6.).

EXAMPLE 1: Child Subject To Deeming is Away at School

Lucy Jones, a 14-year-old eligible child, is a resident at the State School for the Hearing-Impaired. She will live at school during the school year (09/10/98 - 06/10/99). Lucy lives with her parents between semesters and during vacations. The claims specialist (CS) determines that Lucy's permanent residence is her parents' home where she is subject to deeming. And, the CS identifies this as a situation where ISM development is needed for both the parents' home and the school. Per (SI 00835.042), when a child subject to deeming is away at school, ISM is potentially countable in both the permanent residence (her parents' home) and in the school.

After developing the living arrangements, the CS determines that Lucy receives no ISM in her parents' home. But, the CS learns from the parents that they do not pay for Lucy's food and shelter at the school. Further development reveals that the State Department of Education pays for Lucy's food and shelter which is valued at $400 per month. The CS determines that this third party payment results in countable ISM for Lucy. Lucy is charged with ISM capped at the PMV for each month that she is at school including September and June. See SI 00835.400, " ISM only to the Claimant" for detailed instructions for processing this type of case within the SSI Claims System.

EXAMPLE 2: Child Not Subject To Deeming is Away at School

James Wilson, a 15-year-old eligible child, is a resident at the same school as in (SI 00835.714), Example 1. He lives at school during the school year and lives with his grandmother between semesters and during vacations. The CS determines that James' permanent residence is the grandmother's home where he is not subject to deeming. Following the temporary absence rules in (SI 00835.040 and SI 00835.042), the CS determines that any ISM James receives would be based on his permanent living arrangement, i.e., his grandmother's home. ISM he receives while at school (a temporary absence) is not counted per (SI 00835.040C.2.).

C. References

SI 00835.790 Non-institutional Care Situations

CITATIONS:

Regulations, 20 CFR 416.1143

If an individual is not a resident of an institution, the individual may be living in non-institutional care. Non-institutional care is often referred to as foster care, adult foster care, or family care.

A. Policy — ISM In Non-institutional Care Living Arrangements

1. Non-institutional Care

A non-institutional care situation exists when:

  1. a. 

    An individual is placed by a public or private agency under a specific program of protective placement such as foster or family care.

  2. b. 

    The placement is in a private dwelling (not an institution or commercial establishment) which is licensed or otherwise approved by the State to provide foster or family care.

  3. c. 

    The placing agency retains responsibility for continuing supervision of the need for such placement and of the services provided.

  4. d. 

    The individual, the placing agency, or some other third party pays for the food, shelter, and protective supervision provided.

2. ISM Rules for Non-institutional Care

  1. a. 

    An individual in non-institutional care is always considered to be living in his ownhousehold and the VTR cannot apply. ISM is valued under the PMV rule.

  2. b. 

    An eligible couple placed in non-institutional care is considered to be living in their own household separate from others living in the same residence.

  3. c. 

    Any other person residing in the same dwelling is in a separate household from the individual/couple in non-institutional care.

  4. d. 

    If an individual is placed under the provisions of a State foster care plan with his/her deemor, deeming is applicable.

NOTE: Any ISM provided by a person from whom income is deemed for the month has already been taken into consideration through the deeming process, and thus, ISM would not be charged from such a deemor.

3. Care Rate and ISM Determinations

  1. a. 

    The care rate established by the placing agency is the CMV of whatever food, and shelter that the care provider furnishes.

  2. b. 

    If the individual pays the CMV of the food, and shelter with his/her own funds, no ISM is countable.

  3. c. 

    If the individual incurs indebtedness for the CMV of the food, and shelter, no ISM is countable.

  4. d. 

    Any payment by the individual is presumed to be for the food, and shelter provided.

NOTE: In general, make the presumption that any payment made by the individual to the non-institutional care provider is a payment towards the CMV of the food and shelter. However, there may be instances (e.g., impairment-related work expenses (IRWE), plans for achieving self-support) when it might not be to the individual's advantage to apply this presumption. In such a situation, the individual's payment should be attributed in the manner that is most advantageous to the individual (SI 00835.790B., Example 2).

4. Care Provider Receives No Foster Care Payment

In some cases, State foster care agencies make non-institutional care placements in which the care provider does not receive a foster care payment or other reimbursement. Typically, this occurs when the child is placed with a relative who agrees to care for the child without being reimbursed.

  1. a. 

    If the placement meets the requirements in SI 00835.790A.1. (except for the payment requirement in SI 00835.790A.1.d.), the individual is considered to be in non-institutional care.

  2. b. 

    Because this individual is considered to be in non-institutional care, he /she is considered to be living in his own household.

  3. c. 

    Because the individual is living in his own household, the one-third reduction rule (VTR) does not apply. ISM is determined using the PMV rule.

  4. d. 

    The food, and shelter supplied by the care provider is countable ISM unless the individual pays the provider for it. See SI 00835.790B.4. for the procedures for determining ISM.

B. Procedure — Computing ISM For Non-institutional Care

1. Individual Pays

  1. a. 

    Contact the provider or the placing agency to determine the care rate (the CMV of the food and shelter).

  2. b. 

    Document the care rate with:

    • a copy of the placing agency's agreement; or

    • the pertinent information from the agreement recorded on the evidence screen (EVID); or

    • a DROC screen within the SSI Claims System.

  3. c. 

    Determine the actual value (AV) of the ISM by subtracting the individual's payment from the care rate.

  4. d. 

    Determine that there is no countable ISM if the individual's payment equals or exceeds the care rate.

  5. e. 

    If the individual's payment is less than the care rate, and a third party is paying, see SI 00835.790B.2.

2. Third Party Pays

  1. a. 

    If a third party is paying towards the care rate, follow the instructions in SI 00835.706C. to determine whether the third party payments are countable as ISM or are excludable. Be alert to the possibility that the placing agency may not use its own funds to pay for the individual's care, but may be acting as an agent to collect funds from other programs.

  2. b. 

    If the third party payments are:

    • excludable they do not result in countable ISM;

    • not excludable they result in countable ISM capped at the PMV.

3. Both Individual and Third Party Pay

  1. a. 

    Subtract the individual's payment from the care rate.

  2. b. 

    Then, subtract from the remainder any third party payment that is not countable as ISM (SI 00835.706C.).

  3. c. 

    If part of the care rate is still unpaid, this remainder is countable as ISM capped at the PMV.

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 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.

4. Care Provider Receives No Payment

If the individual has been determined to be in non-institutional care based on SI 00835.790A.1., and there is an indication that no foster care payments are received by the care provider, it is necessary to determine whether the individual receives countable ISM.

  1. a. 

    Contact the placing agency and verify that no foster care payments or other reimbursement are made to the provider.

  2. b. 

    Document the file with a Report of Contact (paper RC or DROC screen within the SSI Claims System).

  3. c. 

    Contact the provider for an estimate of the CMV of the food, clothing, and shelter being provided, and the amount contributed towards the CMV by the eligible individual.

  4. d. 

    Document the provider contact with the provider's signed statement or a Report of Contact (paper RC or DROC screen).

  5. e. 

    Compute the ISM by subtracting the eligible individual's contribution from the CMV of the food, clothing, and shelter.

NOTE: In this type of case, the eligible individual is not a member of the care provider's household. This is true even if the individual is related to the provider. Therefore, the VTR rule should not be used to determine the ISM.

EXAMPLE: Child in Non-institutional Care — No Foster Care Payment

The county foster care agency places Thomas Smith, age 8, in the home of his uncle, Frank Johnson. The agency approved Mr. Johnson's home for foster placement and will retain responsibility for supervising Thomas's placement. Mr. Johnson has agreed to care for Thomas without receiving foster care payments.

The CS verifies this information by contacting the agency and documents the contact on the DROC screen within the SSI Claims System. Based on this contact, the CS also determines that Thomas is in non-institutional care. Then, the CS contacts Mr. Johnson for an estimate of the CMV of the food, clothing, and shelter that he provides to Thomas. Mr. Johnson states that the food, clothing, and shelter is worth $250 per month and that Thomas contributes $150 per month from his SSI check. The CS documents this contact on the DROC screen and determines, applying the PMV rule, that Thomas receives $100 of ISM.

This case is processed within the SSI Claims System as follows:

On the Residence Address and Jurisdiction page, the CS indicates that the residence type is “Non-Institutional care.” This puts the Non-Institutional Care page in the screen path. On the Non-Institutional Care page, the CS records the placing agency information. In the field titled "Current market value of monthly care" the CS enters $250 which is the CMV of the food, clothing, and shelter provided by Mr. Johnson. The CS enters “No” in the "Claimant pays entire current market value from own funds" field. And, the CS enters $150 in the "Amount paid by claimant" field. The SSI Claims System prefills a “Yes” on the In-Kind Support and Maintenance page and prefills $100 of ISM on the In-Kind Support and Maintenance page in the ISM "Monthly value" field. On the In-Kind Support and Maintenance page, the CS records the uncle's name and address as the source of ISM.

C. References


SI 00835 TN 87 - Living Arrangements and In-Kind Support and Maintenance - 7/26/2019