Identification Number:
SI 00835 TN 91
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. 91, 08/27/2019

Audience

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

Originating Component

OISP

Effective Date

Upon Receipt

Background

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

 

Summary of Changes

SI 00835.120 Rental Liability as LA Basis

Updated spacing issues throughout the POMS section.

Changed "Claims Representative" and "CR" to "Claims Specialist" and "CS" throughout the POMS section to reflect SSA updates.

Subsection A.3.b. - Under "NOTE" removed an unnecessary parenthesis and added language, "For more information about breakpoints, see SI 00835.510."

Subsection C.2.b. - Removed the term "MSSICS." Updated the abbreviation "RC" to "a paper Report of Contact (RC)."

Subsection C.4.a. - Changed "MSSICS" to "SSI Claim" to reflect SSI modernization.

Subsection D.2. - Removed the word "MSSICS." Changed "a paper Report of Contact" to "RC."

Subsection E.1.b. - Second bullet changed language from "signed or on DROC" to "on DROC screen or a signed RC."

 

SI 00835.350 Computation of In-Kind Support and Maintenance (ISM) from Outside a Household (Including Vendor Payments by a Third Party Outside the Household)

Changed "CR" to "CS" throughout the POMS section to reflect SSA updates.

Subsection C - Under EXAMPLE 1 changed "claims representative (CR)" to "Claims Specialist (CS)."

Subsection D.2. - Added period between "subsidy. See SI 00835.320".

Subsection D.2.c. - Changed " Obtain a signed statement from the recipient, or a DROC" to "Obtain statement from the recipient on DROC screen or on a signed paper Report of Contact."

Subsection D.3. - Deleted a period in the first sentence.

 

SI 00835.707 Procedures For Determining ISM Provided To Residents of Institutions

Updated spacing issues throughout the POMS section.

Changed "CR" to "CS" throughout the POMS section to reflect SSA updates.

Subsection A.2.b. - Changed "the MSSICS DROC screen" to "the DROC screen."

Subsection B.2. - Under "EXAMPLE" changed "claims representative (CR)" to Claims Specialist (CS)."

 

SI 00835.708 In-Kind Support and Maintenance Provided Residents of Private For-Profit Residential Care Institutions

Subsection C. - Under the second bullet changed "DROC screen on MSSICS" to "DROC screen."

Subsection C - Under third bullet changed "DROC screen on MSSICS" to "on the DROC screen."

Subsection D - Under EXAMPLE 1 and EXAMPLE 2 updated "CR" to "Claims Specialist CS;" and updated "CR" to "CS" throughout the subsection.

 

SI 00835.120 Rental Liability as LA Basis

A. Policy

1. Rental Liability

An individual is living in his own household when there is liability to the landlord for payment of any of the rental charges on the part of:

  • the individual;

  • the living-with eligible spouse;

  • any person whose income may be deemed to the individual.

2. ISM and Rental Liability

The PMV rule is used to determine ISM for an individual who has rental liability. The VTR never applies when an individual is in his/her own household.

3. Rental Liability Period

A rental liability period is the time span covered by a rental agreement.

a. Period Begins

The period begins with the first month for which the landlord requires payment of rent, but never before the month in which the rental arrangement is made, whether or not the tenant actually pays rent.

b. Period Ends

The period ends in the month in which:

  • the landlord informs the tenant that he/she is no longer required to pay rent; or

  • the tenant voluntarily terminates the agreement.

NOTE: The loss of rental liability is a breakpoint which is effective in the following month. For example, if rental liability ends in March, the new living arrangement would be effective in April. For more information about breakpoints, see SI 00835.510.

c. Rent Arrearage's Effect on Rental Liability Period

In the case of a rent arrearage (rent payment is overdue), the rental liability continues to exist through the date that landlord terminates the agreement.

Example: An individual with rental liability did not pay rent beginning 01/98. On 07/17/98, the landlord informed him that he did not have to pay the back rent. The individual has rental liability for the entire period in arrears (i.e., 01/98 through 07/98). His rental liability ended on 07/17/98. The loss of rental liability is effective the following month (SI 00835.510B.4.). Therefore, rent-free shelter is not an issue for January through July, but the Claims Specialist (CS) must develop the individual's living arrangements for August.

4. Rental Liability — Room Rental Within a Private Dwelling

Room rental within a private dwelling is a form of rental liability.

  • When an individual lives in the same dwelling with the landlord, he/she must be in a separate household from the landlord's in order to have rental liability.

  • A separate household functions as a separate economic unit, and more than one economic unit may exist in a single dwelling. If the individual and the landlord do not function as separate economic units, the individual is not in a separate household and cannot have rental liability.

5. Flat Fee for Food and Shelter

A flat fee for room and board is a form of rental liability. It is a variation of separate room rental within a private dwelling. With flat fee, the individual maintains a separate household from the landlord and pays a flat rate for food and shelter.

B. Definitions

1. Landlord

A landlord is a party who provides living quarters in return for rent. For purposes of LA and ISM, a landlord and his or her tenant(s) cannot be members of the same household.

2. Rent

Rent is a consideration which consists of cash only and which is due to the landlord or his/her authorized agent under a rental agreement. Services provided in return for shelter do not constitute rent. See SI 00835.020 for further discussion of the term “rent.”

C. Procedure — curtailed development of rental liability

1. Initial Claim — Signed Statement Only

Accept an individual’s statement, signed or on DROC screen, that the individual or living-with spouse has rental liability if:

  • the individual lives alone; or

  • the only other household member(s) is the individual's spouse, his/her deemor, or any child (whether or not related).

2. Initial Claim — Continuous Rental Liability

If SI 00835.120C.1. does not apply, accept the individual’s statement, signed or on DROC screen, that the individual or living-with spouse has rental liability in the following situations.

  1. a. 

    The individual or his living-with spouse has had continuous rental liability since the current period of residence began and every other household member either:

    • falls into one of the categories listed in SI 00835.120C.1.; or

    • met the definition of “child” at the beginning of the current period of residence (SI 00501.010).

  2. b. 

    Document on DROC screen or a paper Report of Contact (RC) the rationale for the determination that rental liability exists based on continuous rental liability.

3. Initial Claim — Evaluating Household Member Status as a Child

  1. a. 

    Accept an allegation of a child's past or present school attendance in applying SI 00835.120C.1. or SI 00835.120C.2.

  2. b. 

    Use the full development procedure below (SI 00835.120D.) if the individual alleging rental liability is a child.

4. Posteligibility (PE)

  1. a. 

    In PE situations, redevelop rental liability only if the individual's allegation is inconsistent with the information on the SSR or the SSI Claim pending file.

    NOTE: Be alert to situations where rental liability may need to be developed for the month after an eligible child turns 18.

  2. b. 

    Follow SI 00835.120C.1., SI 00835.120C.2., or SI 00835.120C.3. above as appropriate if redevelopment of rental liability is needed.

D. Procedure — full development of rental liability

Use this procedure for initial claims and PE situations if you cannot curtail development under SI 00835.120C. Use one of the following methods to document rental liability.

1. Rental Agreement

  1. a. 

    Obtain a copy of the rental agreement (e.g., a lease).

  2. b. 

    Record the following rental agreement information on the evidence screen (EVID):

    • who has rental liability;

    • who is the landlord;

    • where the living quarters are; and

    • the amount and frequency of the required rent.

2. Landlord Contact

Contact the landlord and document the information in SI 00835.120D.1.b above on DROC screen or an RC:

3. Rent Receipts

  1. a. 

    Obtain copies of one or more recent rent receipts which must show:

    • the name of the individual, spouse, or deemor as the person paying the rent;

    • the amount paid;

    • the period covered by the payment; and

    • the signature of the landlord or his/her authorized representative.

  2. b. 

    Record the above rent receipt information on the EVID screen.

E. Procedure — room rental in a private dwelling

Follow this procedure if there is an allegation of a separate room rental in a private dwelling (e.g., a house or an apartment unit).

1. Separate Household Development

  1. a. 

    Document the individual's allegation of rental liability using the instructions in SI 00835.120D.

  2. b. 

    Document the allegation of separate households.

    • Explain to the individual and the landlord the SSI meaning of “separate household” as described in SI 00835.120A.4. above.

    • Obtain statements on DROC screen or a signed RC, from both the individual and the landlord as to whether they consider themselves members of the same household or separate households.

    NOTE: If the landlord will not affirm or deny the individual's allegation of separate households, the separate household determination must be based on the individual's allegation and any available evidence. Document on DROC screen or an RC why the information is not available from the landlord.

  3. c. 

    Determine whether separate households exist within the dwelling by considering the separate household allegation in relation to factors such as the following.

Household Organization: Although not conclusive by itself, a “yes” answer to any of these questions is an indication that the individual may not be in a separate household within the dwelling.

  • Do the individual and landlord make joint decisions regarding home repairs, improvements, and other aspects of daily activities (e.g., food purchases, TV cable service, phone service)?

  • Is the individual responsible for any bills connected with the operation of the residence (e.g., are any bills in the individual's name)?

  • Do the individual and the landlord pool money for any household expenses?

Rent: Although not conclusive by itself, a “yes” answer to any of these questions is an indication that the individual may be in a separate household.

  • Does the landlord charge rent (or a flat fee for food and shelter) based on the current market value?

  • Would the landlord ask the individual to move out if individual stopped paying rent?

  • Would the landlord continue to hold the individual responsible for back rent if the individual stopped paying rent?

Meals: Although not conclusive by itself, a “yes” answer to any of these questions is an indication that the individual may be in a separate household.

  • Does the individual purchase most of his/her food separately from the rest of the household?

  • Does the individual store food separately from the rest of the household?

  • Does the individual prepare or eat meals separately from the rest of the household?

Access: Although not conclusive by itself, a “yes” answer is an indication that the individual may be in a separate household.

  • Does the individual have access to only part of the residence?

  • Does the individual have a bedroom, cooking facilities, or a bathroom for his/her exclusive use?

NOTE: The above factors are listed to assist the adjudicator in determining whether separate households exist. Each factor may not apply in every case. No single factor is controlling. The determination must be based on the adjudicator's judgement after considering all of the facts in the case.

  1. d. 

    If the individual lives in a separate household, determine that rental liability is the LA basis. If the individual does not live in a separate household, determine that rental liability does not exist and proceed with sequential development (SI 00835.001B.).

  2. e. 

    Document the separate household/rental liability determination in the file.

2. Flat Fee for Food and Shelter

The development for flat fee is essentially the same as for room rental in a private dwelling except for the additional consideration that the individual's payment is a payment for both food and shelter.

  1. a. 

    Document the allegation of rental liability per SI 00835.120D. above. In addition, document that the individual's payment to the landlord is for food and shelter.

  2. b. 

    Document the allegation of separate households per SI 00835.120E.1.b.

  3. c. 

    Determine whether separate households exist per SI 00835.120E.1.c.

  4. d. 

    If the individual lives in a separate household, determine that a flat fee for room and board exists and that rental liability is the living arrangement basis. If the individual does not live in a separate household, determine that the individual does not have rental liability and proceed with sequential development.

F. Procedure — shelter for services

Follow these steps if the individual alleges that the landlord accepts services in lieu of cash payment for rent.

  • Determine that the individual does not have rental liability if the individual alleges that the required rent is services only (SI 00835.390).

  • Determine that the individual has rental liability if the alleged rent payment consists partly of services and partly of cash.

  • Document that rental liability exists using curtailed or full development as appropriate.

G. Examples

EXAMPLE 1: Separate Households in a Private Dwelling

Mr. Smith, an eligible individual, lives with a family. Mr. Smith rents an upstairs bedroom and bathroom for $200 per month. Mr. Smith tells the CS that he considers himself to be living in a separate household from the family. He tells the CS that he eats some of his meals in restaurants. The landlord states that Mr. Smith does not pool his money with the family's for food and utility bills or pay any money toward property taxes or household repairs. Mr. Smith is allowed to make local phone calls but pays for any long distance calls he makes. He frequently uses the family's kitchen to prepare his own food which he stores on a shelf reserved for him in the family's refrigerator. Based on the facts in this case, the CS determines that Mr. Smith is living in a separate household and documents the file as required. The CS determines that Mr. Smith has rental liability based on “room rental in a private dwelling.”

EXAMPLE 2: Not Separate Households

Ms. Jones, an aged individual, lives with her brother, Mr. White, in a home he owns. Ms. Jones signs a statement that she considers herself a separate household and pays $200 a month rent to her brother each month. To determine whether Ms. Jones' payment is actually a rent payment, the CS proceeds to develop whether Ms. Jones is in a separate household. The CS discovers that Ms. Jones pays $200 per month most of the year, but pays more in the winter when utility bills are higher. Ms. Jones states that she and her brother each put $125 in a drawer on the first of the month and use this money for groceries. They take turns shopping and cooking, and if the grocery money runs out before the end of the month, they both contribute additional money. Mr. White confirms this information and tells the CS that the amount his sister pays is based on what it costs to operate the home. Based on all the facts, the CS determines that Ms. Jones and Mr. White are not in separate households operating as separate economic units. Therefore, the CS rules out rental liability and flat fee, and proceeds with sequential development per SI 00835.001B.

H. References

SI 00835.350 Computation of In-Kind Support and Maintenance (ISM) from Outside a Household (Including Vendor Payments by a Third Party Outside the Household)

A. Actual value (AV) of ISM provided from outside the household

The purpose of this ISM computation is to determine the AV of food and shelter someone outside a household provides to a recipient. The result of this computation is added to the result of the computation described in SI 00835.340 Computation of In-Kind Support and Maintenance from Within a Household if the recipient receives ISM both from outside the household and from within the household (other than the value of the one-third reduction (VTR)). The sum of the AV's of ISM from within, ISM from outside a household, and ISM benefiting only one person is subject to the presumed maximum value PMV, see SI 00835.400 In-Kind Support and Maintenance (ISM) to One Person.

NOTE: If a recipient alleges a loan for the value of food or shelter received from outside the household, the following instructions do not apply. Develop such a loan allegation per SI 00835.482 Loans of In-Kind Support and Maintenance.

B. Procedure for determining outside ISM

1. Who is a household member

To use this ISM computation, refer to the definitions in SI 00835.020 Definitions of Terms Used in Living Arrangements (LA) and In-Kind Support and Maintenance (ISM) Instructions. Consistent with the definition of “household,” do not count persons who live under the same roof but who are not members of the recipient's economic unit as household members. To be a household member, a person must reside in the household as of the first moment of the month.

2. Determine the current market value (CMV) of food and shelter

In computations of ISM from outside a household, use the CMV of the item of food and shelter after conversion (if necessary) as described in SI 00835.470 ISM and Households - Conversions.

Deduct from this amount the cash payment made by all members of the household toward that item, if any. The payment by the household toward the item of ISM is generally equal to the household operating expense for that item in the month(s) in which the household receives ISM from outside the household.

Occasionally, you must convert vendor charges for food and shelter shown on a bill or statement to monthly amounts, see SI 00835.470 ISM and Households - Conversions. If you convert a CMV for this reason, you must convert the household payment in the same manner.

EXAMPLE: If a household pays $600 of its annual $1,200 real property tax bill and a third party pays the remainder, divide the $1,200 CMV by 12; divide the $600 household payment by 12. Subtract the converted household payment from the converted property tax bill. Use the resulting $50 household payment in the computation of monthly outside ISM.

3. Rent-free shelter or prepayment of rent

See SI 00835.370 Rent Free Shelter, which explains special rules applicable to household payments in rent-free situations. Also, SI 00835.380 Rental Subsidies defines prepayments of rent (a type of household payment) and discusses situations in which a household prepays rent in both rent subsidy and other rental liability situations.

4. Allocate ISM to household members

The final step in the computation of ISM from outside a household is to allocate the ISM equally among all household members.

Use this formula to compute ISM from outside the household.

 

Enter Converted Current Market Value

 

          

Deduct Household Payment Toward Item

 -

          

Balance

 

          

Divide by Number of Household Members

÷

          

Actual Value to Individual

 

          

Compare the amount yielded by this computation to the PMV for the recipient. The lesser is “H” income if the recipient is not receiving any other ISM.

C. Procedure for determining AV for a couple or eligible child

For eligible couples, the AV that results from the computation above is the AV of ISM to each member. Multiply this amount by 2 and compare the result to the PMV for a couple receiving no other ISM.

For an eligible child, when an absent parent provides the ISM, apply the one-third exclusion explained in SI 00830.420B.2. to the AV and then compare this amount to the PMV and charge the lesser amount.

EXAMPLE 1: Conversion of a bill and household payment

Bernie and Alex Bell are cousins who are both supplemental security income (SSI) recipients. They share the household operating expenses of the house in which they live. Bernie Bell has ownership interest in the house, and he receives a $1,300 real property tax bill for a prospective 12-month period beginning June 1. His sister, who lives elsewhere, pays $400 directly to the county in June; the cousins pay the remaining $900. After the Claims Specialist (CS) converts the CMV to $108.33 ($1,300 divided by 12), the CS also converts the household payment to $75 ($900 divided by 12). The CS then computes the AV to them as follows:

Converted CMV $108.33

Less Converted Household Payment Toward Item - $75.00

Balance = $33.33

Divided by Two Household Members 2

Actual Value to Each beginning June 1 = $16.66

NOTE: The CS divides the household payment of $900 by 12, just as it divided the vendor charge by 12. It is immaterial whether Bernie and Alex split the household payment equally; both receive the same amount of outside ISM.

EXAMPLE 2: Computing AV of ISM to a Couple

Bruce O'Neill is an eligible recipient who lives with his eligible spouse, Gracie, in a home they own jointly. The only other household member is their 25-year-old daughter. Each March, an adult son (who lives elsewhere) pays all of their annual real property taxes. These taxes, due in March, are $1,300 and cover services for the following 12 months. Thus, the O'Neill’s receive ISM from outside their household in each month of the year (See SI 00835.474B. and SI 00835.360). To compute the amount of ISM to charge the couple, the CS performs the following calculation for the period beginning April 1, 2010.

  1. 1. 

    Vendor Charge (annual taxes) $1,300.00

  2. 2. 

    Divide by 12 = Converted CMV of $108.33

  3. 3. 

    Less Household Payment - 0 = $108.33

  4. 4. 

    Divide by 3 household members = Actual Value to each $36.11

  5. 5. 

    Multiply by 2 = Actual Value to couple $72.22

Since this AV is less than the couple's PMV, the couple's “H” income is $72.22.

EXAMPLE 3: Third Party Vendor Payment Involving an Arrearage

Bessie Marshall, an ineligible parent, has two eligible children, Karen and Jacob. She also has two ineligible children. They all live in an apartment, which Mrs. Marshall rents for $210 per month. In February 2010, Mrs. Marshall's brother (who lives elsewhere) pays part of Mrs. Marshall's rent ($150) to help her out. This payment is a gift, and he sends it directly to the landlord. Mrs. Marshall pays an additional $35 and still owes $25. She elects rebuttal and furnishes evidence of these facts. The CS computes ISM from outside the household to the two eligible children as follows.

1.

Rent Due

$210.00

2.

Rent Arrearage  

$25.00

3.

Converted CMV

$185.00

4.

Less Household Payment

- $35.00

5.

Balance (Paid by Third Party)

$150.00

6.

Divided by 5 Household Members

÷ 5

7.

Actual Value to Each

$30.00

Since $30 is less than the PMV for a recipient, we charge each disabled child “H” income of $30 for February, the month in which the third party makes the vendor payment.

EXAMPLE 4: Individual Receives both Inside and Outside ISM

Michael O'Keefe, an eligible recipient, lives in a household with three other persons. A third party outside the household pays the entire mortgage of $235, directly to the bank. The household expenses are $407. (NOTE: These expenses do not include the mortgage paid by the third party.) Mr. O'Keefe is not paying his pro rata share ($101.75) of all household operating expenses, but he is paying his share ($50) of the food expenses for the household ($200) with his earmarked contribution of $60. Therefore, Mr. O'Keefe is federal living arrangement (FLA-A) based on contributing an earmarked share of household food costs.

This case has issues of both ISM from within the household (in the form of shelter) and ISM from outside the household (in the form of a third party vendor payment resulting in shelter). The computation of ISM from within the household is as follows.

1.

Total Household Operating Expenses

$407.00

2.

Divided by Number of Household Members

÷ 4

3.

Mr. O'Keefe's Pro Rata Share

= $101.75

4.

Less Mr. Okeefe's Contribution

- $60.00

5.

Actual Value

= $41.75

6.

The computation of ISM from outside the household is: CMV of Mortgage

$235.00

7.

Less Household Payment

- 0

8.

Balance

= $235.00

9.

Divided by Number of Household Members

÷ 4

10

Actual Value

$58.75

11.

Add the two results:

12.

Actual Value of ISM From Within

$41.75

13

Actual Value of ISM From Outside

+ $58.75

14.

Total Actual Value

$100.50

Since the total AV is less than the PMV for an individual, the CS charges Mr. O'Keefe “H” income of $100.50.

D. Develop and document ISM from outside the household

1. When to develop ISM from outside a household

Develop ISM from outside a household when its receipt is alleged or otherwise indicated and the recipient is not subject to the VTR. See SI 00835.320 for instructions on when to offer a rebuttal and an explanation of the rebuttal rules. See SI 00835.370 and SI 00835.380 for additional development instructions for outside ISM in the form of rent-free shelter and rental subsidy.

2. When to obtain evidence of the AV of outside ISM

Obtain evidence of the AV of outside ISM whenever the recipient wishes to rebut the PMV or rental subsidy. See SI 00835.320 for an explanation of the rebuttal rule. The following describes evidence of the factors that determine the AV of outside ISM.

a. Evidence of the CMV

We base the CMV of an item of food or shelter provided by someone outside the household on the vendor charge if there is a vendor charge associated with it or the provider's estimate of the CMV of the item if there is no vendor charge associated with it.

Obtain evidence of the CMV in accordance with the chart below.

Type of ISM

Evidence
(Signed Statement or DROC)

Food

A statement from the person who paid for the food or a statement from the provider.

Shelter

A copy of the bill or receipt, or a statement from the person who paid the bill or a statement from the provider.

NOTE: If you cannot obtain the CMV from the provider, contact a knowledgeable source (e.g., a real estate or rental agent for the value of rent) and document the contact on a report of contact (DROC) screen or other form.

b. Evidence of the household payment

If the household makes any payment towards the item of food or shelter (e.g., the household pays part of its electric bill and a third party pays the rest), obtain evidence of the payment. Preferred evidence is a receipt, a cancelled check, or a corroborative statement from the third party who paid the rest of the bill or from the householder (if the recipient does not have ownership interest or rental liability). If no preferred evidence is available, accept the statement, signed or on DROC screen, of the eligible recipient.

c. Evidence of household composition

Obtain statement from the recipient on DROC screen or on a signed paper Report of Contact, as to the number of household members in the month in which the recipient receives ISM (household membership always includes persons who are temporarily absent, see SI 00835.040). It is not necessary to corroborate this statement.

3. Breakpoints and a change in ISM

Breakpoints are certain identifiable events that may indicate that the ISM the recipient receives changed (See SI 00835.510 for an explanation of breakpoints). Report of breakpoints may be timely or they may come to our attention during a redetermination. We should evaluate breakpoints to see if they actually affect ISM and we should document any change in ISM according to the rules in SI 00835.350D.2. in this section. Changes due to breakpoints are effective with the breakpoint effective month.

See SI 00835.520C. for an explanation of when to redevelop outside ISM at a redetermination.

SI 00835.707 Procedures For Determining ISM Provided To Residents of Institutions

The following general procedures are used for determining ISM received by residents of all types of institutions. However, see the following sections for additional instructions applicable to specific institutions:

A. Procedure — developing and documenting ism in institutions

1. Developing ISM In Institutions

  1. a. 

    Determine the type of institution using the precedent at SEANET 8045.

  2. b. 

    Determine the CMV of the food and shelter provided to the individual by the institution. For ISM purposes, only the food and shelter portion of the total cost is considered. If the CMV is not shown on the precedent, contact the institution.

  3. c. 

    Determine the source, amount and applicable months of any payments made by the individual or a third party towards the CMV of the food and shelter by contacting the institution or the third party.

NOTE: If the institution is a multi-purpose facility (e.g., a residential section and a medical section), determine the purpose of the individual's confinement before determining whether the individual receives ISM. The following references provide guidance in determining the purpose of institutionalization:

2. Documenting the File

  1. a. 

    Reference the precedent or record the information about the type of institution and the CMV on the evidence screen (EVID). See SI 00520.800 if information is uncovered that indicates that the precedent should be updated.

  2. b. 

    Document the file with the source, the amount, and the months covered for any payments made by the individual or a third party toward the CMV of the food and shelter. Use a paper Report of Contact, the DROC screen, or a signed statement provided by the institution or third party. The signed allegation of the eligible individual is not sufficient.

B. Procedure — computing the value of ism

1. Individual Pays for the Food and Shelter

Compare the individual's payment with the CMV of the food and shelter.

  1. a. 

    If the individual's payment equals or exceeds the CMV, determine that there is no countable ISM.

  2. b. 

    If the individual's payment is less than the CMV, determine the countable ISM by computing the difference between the individual's payment and the CMV. The ISM is capped at the PMV.

  3. c. 

    If the individual's payment is less than the CMV, determine whether the institution itself or a third party pays the balance and develop accordingly.

NOTE: If the individual's payment is less than the CMV, and he/she lives in a private for-profit residential care institution, develop whether there is a “payment in full” agreement per SI 00835.708B. If there is such an agreement, determine that there is no countable ISM.

2. Third Party Pays for the Food and Shelter

  1. a. 

    Determine whether the third party payment is countable as ISM per SI 00835.706C.

  2. b. 

    If it is not countable, the individual does not receive ISM based on the third party payment.

  3. c. 

    If it is countable, compare the payment to the PMV and count the lower amount as ISM.

  4. d. 

    If the payment is less than the PMV and does not cover the entire CMV, determine whether ISM is being provided by another source (another third party or the institution itself) and develop accordingly.

EXAMPLE: Third party pays the institution (ISM excluded)

Gene Smith, who is filing for SSI, lives in a private for-profit residential home called Sunny Acres. The home charges $600 per month. Of this amount, $500 is for food and shelter (the CMV). The Homeless Outreach Project (HOP) pays the entire $600 for Mr. Smith's care. Following the instructions in SI 00830.605, the Claims Specialist (CS) checks the regional instructions and finds a precedent which confirms that HOP is certified by the State as a nonprofit organization which provides excludable support and maintenance assistance. Therefore, the CS determines that no ISM is countable.

3. Institution Pays for the Food and Shelter

If nobody pays the institution, the institution may be providing countable ISM.

  1. a. 

    Determine whether food and shelter provided by the institution itself can be excluded as support and maintenance assistance (SI 00830.605) or as assistance based on need (SI 00830.175).

  2. b. 

    Determine whether the ISM exclusion described in SI 00835.712 applies if the individual lives in a private nonprofit residential care institution.

  3. c. 

    If these exclusions are not applicable, compare the CMV of the food and shelter provided by the institution with the PMV and charge the lesser amount as countable ISM.

4. More Than One Source Pays for the Food and Shelter

When more than one source pays for the food and shelter (e.g., several third parties, or the individual and the institution) follow the procedure for third party payment. In addition, use the following guidelines.

  1. a. 

    Determine the source of the payments for the CMV of food and shelter. If any of the payments toward food and shelter can be excluded, use them in the computation first.

  2. b. 

    Do not count as ISM that portion of a payment to the institution that exceeds the CMV of food and shelter. For example, payments made to the institution to provide personal services to the individual are not ISM.

EXAMPLE 1: Both Individual and Third Party Pay — No ISM

Ms. Malone resides in the Hillcrest Home for the Aged, a private for-profit residential home for the aged. The home's total charge is $800 per month, of which $425 is for food and shelter (the CMV). Ms. Malone uses her SSI benefits to pay $425 per month. Her sister pays the balance of $375. Because Ms. Malone pays the CMV of the food and shelter, she does not receive countable ISM. The $375 paid by her sister is for personal care and services and is not counted as ISM or income.

EXAMPLE 2: Both Individual and Third Party Pay — ISM Counted

Mr. Jones also resides in the Hillcrest Home. The home's total charge is $800 per month, of which $425 is for food and shelter (the CMV). Mr. Jones pays $300 per month for his own care. His brother pays the remaining $500 each month. Mr. Jones is charged with $125 of ISM ($425 CMV minus his payment of $300). Although his brother pays $500 per month, only $125 counts as ISM. Any payments the brother makes in excess of the CMV amount do not count as ISM.

C. References

SI 00835.708 In-Kind Support and Maintenance Provided Residents of Private For-Profit Residential Care Institutions

CITATIONS:

Regulations, 20 CFR 416.1145

A. Introduction

A private for-profit residential care institution is a facility that provides food, shelter, and some services to its residents. Often this type of facility is referred to as a rest home, a domiciliary care home, or a retirement home. It is not a penal, educational, vocational, or medical treatment facility.

ISM for an individual in this type of institution is determined using the policy instructions in SI 00835.706, the procedures in SI 00835.707, and the following additional instructions pertaining to a “payment in full” agreement.

B. Policy

Individual Liable For Payment In Full To Institution

The regulations state that when an individual lives in a private for-profit residential care institution, there is no countable ISM when the individual:

  • makes some payment which the institution accepts as payment in full, even though its usual charge or actual cost may be higher; or

  • has written legal indebtedness to the institution for the food and shelter regardless of whether the amount owed represents full market value, and the institution accepts the amount of the debt plus the individual's payment, if any, as payment in full.

C. Procedure

Developing And Documenting Payment In Full

If, when contacting the individual or the institution, or reviewing the precedent, there is an indication that the individual and the institution have either a “payment in full” or “legal indebtedness” agreement:

  • Determine whether such an agreement exists by contacting the institution; and

  • Document the file with a copy of the agreement or record information about the agreement on the evidence screen (EVID). You may also use a report of contact with the institution which summarizes the written agreement (DROC screen); and

  • Determine that there is no countable ISM and document the file with this determination on the DROC screen.

  • If it is determined that such an agreement does not exist, follow the general procedures in SI 00835.707 to determine whether the individual gets ISM from the institution and to compute the monthly value.

D. Examples

EXAMPLE 1: Payment Accepted by Institution as Full Payment

An eligible individual, Mr. Robertson, resides in a private for-profit retirement home during 03/99. He tells the Claims Specialist (CS) that he pays the home $425 per month and there is no third party payment. The CS believes that $425 is less than the CMV so she contacts the home for further information. The administrator tells the CS that the charges are higher sometimes, but that the home accepts $425 as payment in full for Mr. Robertson. The CS determines that no ISM is countable for the food and shelter provided by the home. The CS does not develop or document the file with the CMV of the food and shelter since it is immaterial.

EXAMPLE 2: Legal Indebtedness as Payment for Institution's Charges

Ms. Kelly, an aged individual, lives in a private for-profit adult care home which customarily charges $800 per month, of which $400 represents the CMV of the food and shelter. At the time of her application for SSI, Ms. Kelly has no cash income. The CS contacts the care home and learns that Ms. Kelly signed a document by which the home extends her credit (i.e., accepts her debt) in the amount of $350 per month. The administrator states that no other payment is to be made, either by Ms. Kelly or anyone on her behalf. Since the home accepts this legal indebtedness to pay $350 as payment in full, the CS determines that the food and shelter provided by the home is not income and puts a copy of the agreement in the file. (If the CMV of the food and shelter had been unknown, there would be no need to develop the value because it is immaterial.)


SI 00835 TN 91 - Living Arrangements and In-Kind Support and Maintenance - 8/27/2019