10.5 Financial Participation

Throughout the DVR process, payment for most services or goods for individuals, other than individuals who are eligible to receive SSI/SSDI benefits for disability or blindness, is based upon the economic need of the individual. The DVR counseling team shall conduct a determination of the individual's economic need prior to the preparation and approval of an Individualized Plan for Employment or Business Exploration Agreement whenever the plan contains a vocational rehabilitation service that is not exempted from financial participation. While some financial information is reported by individuals at time of application for purposes of required federal reporting, the information documented at the time the individual’s economic need is determined may be different and shall be supported by verifying documents and information. DVR shall use agency approved forms to document differences in reported financial information.

DVR does not require the financial participation of the individual for the following vocational rehabilitation services:

• Assessment services to determine eligibility and vocational rehabilitation needs, including transportation necessary to participate in the assessment(s);

• Vocational rehabilitation counseling and guidance.

• Referral services.

• Professional fees to providers of vocational adjustment and personal adjustment training, independent living skills training, job coaching, on-the-job training and job seeking skills training, rehabilitation technology training, or business consultation services provided through a Business Exploration Agreement.

• Interpreter services and note-taking services for individuals who are deaf.

• Reader services and note-taking services for individuals who are blind.

• Personal assistance services.

• Auxiliary aids needed for an individual with a disability to participate in the vocational rehabilitation program.

• Job-related services.

• Occupational goods and services.

• Self-Employment goods and services.

• Pre-Employment Transition Services.

Re-determinations of the individual's economic need shall be conducted and documented within 45 days of any change to the individual's financial circumstances. If rehabilitation services are not immediately needed following a change to the individual’s financial circumstances, the review may be postponed until services resume. This may occur when the DVR counseling team is monitoring the individual’s employment without the ongoing provision of vocational rehabilitation services, when the individual’s services are interrupted because they are not immediately available to participate in services, or in other similar situations. During such periods of time, services are limited to necessary assessment, information and referral, and vocational counseling and guidance required to resume case progress or monitor the stability of the individual’s employment.

Individuals eligible to receive SSI or SSDI benefits for disability or blindness who pursue self-employment are subject to DVR policies addressing individual contribution of start-up costs. Please see Chapter 16 for more detailed information.

All economic need determinations shall be documented on the DVR Financial Need Analysis (FNA) document. Individuals who are currently eligible for SSI and/or SSDI benefits due to disability or blindness are exempt from financial contribution. Therefore, no additional financial information is required. The DVR counseling team shall document the exemption on the FNA and the individual is not required to sign and date the FNA document. When an eligible individual is anticipated to require only services that are exempt from financial need analysis, the DVR counseling team shall document this exemption on the FNA and the individual is not required to sign and date the FNA document. In all other circumstances, the FNA shall be signed and dated by the DVR counseling team and the individual.

When possible, the individual shall provide documented proof of financial status. Proof of financial status may include: pay stubs, W-2 forms, bank statements from checking and savings accounts, canceled checks, payroll documentation, earnings statements, employment security wage reports, unemployment records, letters from previous employers with last day worked, incarceration records or releases, retirement program documents, copies of current or previous year’s federal income tax returns, and documentation from public or private economic support programs.

If proof of financial status is unavailable or cannot be obtained, this shall be documented and the statement of the individual and/or member of their family unit shall establish data used to complete the economic need determination. Services shall not be delayed if proof of financial status is unavailable.

If an individual who is not exempt from financial contribution requirements declines to provide available proof of financial status or refuses to share sufficient information to determine whether available monthly resources exist, DVR shall be unable to provide any services that are subject to financial needs analysis.

DVR shall strictly observe the confidentiality of all financial information obtained from the individual and/or family members.

The family unit consists of the individual, the spouse of the individual, and any other persons whom the individual claims as a dependent for income tax purposes. When the individual is dependent upon their parents, the parents and persons for whom the parents are financially responsible shall be considered part of the family unit. An individual who is living with their parents is considered a dependent unless the parents have not claimed the individual as a dependent for income tax purposes for the tax year previous to the financial need determination and do not intend to claim the individual as a dependent in current and future years.

When there is a clear indication that the individual is not receiving financial support, they may be considered their own family unit regardless of dependent status for income tax purposes.

Financial need determinations shall consider the gross income from all sources for all individuals in the family unit. Income reported for a period greater than one month or weekly income shall be calculated to determine a monthly amount. Income that comes in one lump sum is considered as part of liquid assets.

Monthly income includes:

1. The gross amount of income from wages, salaries, tips, and commissions. Amounts deducted from paychecks due to garnishment of wages for court-ordered payments are to be included in the amount reported as income. (Court-ordered payments shall be considered as deductions.)

2. Self-employment income considering the gross amount of earnings minus necessary business expenses. Self-employment income includes income generated by providing day care services.

3. SSI/SSDI payments received by family members other than the individual.

4. Monthly public assistance that comes to any member of the family unit in the form of cash payments or coupons expended as cash.

5. Any disability installment payments not identified as public assistance payments that come to any member of the family unit in the form of cash payments or coupons expendable as cash.

6. Child support payments received. If they are not received on a regular basis, divide an estimated amount received by the estimated number of months between payments to determine the monthly income amount.

7. Cash remaining after the payment of tuition, fees, books, and supplies from need-based student financial aid, grants, or scholarship awards which come to the individual who is or will be a student. Divide the remaining amount by the number of months in the award period to determine the monthly amount to report as income. Remaining cash resulting from a student loan (after payment of tuition/fees, books, and supplies) that shall be repaid by a member of the family unit is not considered income.

8. Investment income including installment income from trusts, inheritances, liquid assets, and net rental income (after rental property expenses).

9. Other income including but not limited to alimony payments received, with the monthly amount calculated in the same manner as child support payments; Social Security retirement benefits; all other retirement benefits, pensions, and unemployment insurance payments.

Monthly deductions are allowed for any member of the family unit for the following:

1. Impairment-related expenses:

Expenses related to the impairment of any member of the family unit are allowable deductions. Deductions are limited to those that the family unit is currently paying and shall continue to pay under the Individualized Plan for Employment or Business Exploration Agreement. The deduction shall reflect the amount actually expended, after insurance payments and other subsidies, for required medical or other specialized services to treat a disabling condition. Expenditures for routine medical care, normal illnesses, and conditions not expected to impose permanent functional limitations are not allowed unless needed to prevent exacerbation of a disabling condition. Expenditures for the purchase of health insurance are not an allowable deduction. Allowable deductions for impairment related expenses include:

• Prescription and non-prescription medications ordered to treat a disabling condition and monitored on an ongoing basis by the treating physician.

• Required medical supplies/equipment to treat disabling conditions.

• Payments for ongoing treatment and therapy for a disabling condition ordered by the treating physician.

• Attendant care provided by an individual not included in the family unit.

• Maintenance on required assistive devices.

• Expenditures necessary to maintain the health and vitality of a guide dog or other service animal if the animal enables the person to overcome functional limitations in order to work (e.g., training, food, licenses, and veterinary services); documentation to assess the need for the service animal is required.

2. Debt payment on previously incurred impairment related expenses:

Deductions for debt payment on previously incurred impairment related expenses for any member of the family unit’s disabling conditions are allowable and shall be based on the actual amount expended or the minimal amount required each month, whichever is less. The maximum deduction allowed for previously-incurred impairment related expenses is 20 percent of the family unit’s total monthly income or the actual amount expended, whichever is less. Previous expenses for routine medical care, normal illnesses, and conditions not expected to impose permanent functional limitations are not allowed unless needed to prevent exacerbation of a disabling condition. Allowable deductions for debt reduction of previously incurred impairment related expenses include:

• Payments for medications ordered and monitored by the treating physician.

• Payments for disability treatment and therapy ordered and monitored by the treating physician.

• Payments for residence modifications needed for a family member’s disabling conditions.

• Payments for modifications to an automobile required for a family member’s disabling conditions. This does not include payments for the vehicle.

3. Court-Ordered Payments:

The amount actually being expended or the amount legally required, whichever is less, for court-ordered payments required of any member of the family unit are an allowable deduction. This deduction is only available when payments are for the support of an individual(s) not included in the family unit. Allowable categories of court-ordered payments include:

Child support payments that are being made.

Alimony payments that are being made.

Restitution payments that are being made to an individual other than a member of the family unit.

Court-ordered treatment for conditions that do not constitute a disability. (Treatment for a condition that would meet DVR’s eligibility standards for impairment should be deducted as an impairment related expense and not deducted under the court-ordered category.)

4. Cost of Living Allowance:

Standardized allowances for normal living costs are determined by the size of the family unit. DVR establishes these rates annually, based on an established percentage of the federal poverty guidelines as identified by the U.S. Department of Health and Human Services. These allowances are documented on DVR’s agency approved form for documenting the individual’s Financial Need Analysis.

Liquid assets of all members of the family unit, including family members other than the individual receiving SSI/SSDI, are considered as part of the economic need determination. Liquid assets are any assets that are or may be readily converted into cash. Do not include assets that generate a periodic income. Rather, consider the periodic income from these under monthly income.

1. Cash or savings

The following shall be considered as cash or savings:

• Lump sum public assistance back-payments for disability, including SSI back-payments to someone in the family unit other than the individual.

• Lump sum SSDI back-payments to someone in the family unit other than the individual.

• Lump sum workers’ compensation settlements.

• Lump sum veteran’s benefit payments.

• Lump sum insurance cash settlements.

• Lump sum retirement payment.

• Other cash savings accounts.

• Do not include savings from PASS plans (Plan to Achieve Self-Support).

• Do not include savings held in a 529 College Investment Plan (these assets are considered exempt due to individual account restrictions).

2. Stocks, bonds, mutual funds, and money market funds

The amount recorded for stocks, bonds, mutual funds, and money market funds shall include their estimated current value minus estimated sales expenses. Include only those that can be converted to cash without incurring a penalty. If held in a retirement account, they are not considered liquid until the account holder is at least 59 ½ years old. Selling securities at a loss and payment of sales commissions are not considered penalties. For securities, such as Certificates of Deposit, which are expected to mature and therefore become liquid before the completion of the plan, a new financial need analysis shall be completed upon maturity. For securities held in retirement accounts where the owner shall become eligible to liquidate them without penalty before the completion of the plan, a new financial need analysis shall be completed when they become available.

3. Cash resulting from a loan that shall be repaid by a member of the family unit is not considered a liquid asset.

4. Exclusion of four times the cost of living allowance for the family unit is allowable in determining the net liquid assets. In order to convert the amount of net liquid assets (total liquid assets minus the allowable exclusion) into a monthly amount, divide net liquid assets by 12 at the time of completion or review of the financial need analysis form.

The total monthly gross income and the monthly available liquid assets represent the monthly gross amount of resources of the individual. This amount is reduced by the total monthly deductions and any remaining balance represents the monthly resources considered to be available to the individual.

When more than one member of a family unit is receiving DVR services, the financial need analysis for each individual shall include all members of the family unit. Income, deductions, and liquid assets shall be calculated for all members of the family unit. The available monthly resources shall be divided among all individuals in the family unit receiving services in accordance with the amounts that DVR is or shall be paying for services and goods under the plan so that the maximum amount of the family unit’s available monthly resources are used to help pay for non-exempt goods and services. The portion that each shall be required to contribute shall appear on the individual’s financial need analysis, along with a footnote explaining how the amount was established.

All available monthly resources of the family unit, where there are available resources as determined by the DVR financial need analysis document, shall be applied to the cost of vocational rehabilitation services other than those that are exempt from a financial need analysis or financial participation. When an individual chooses a more expensive service or good from among alternatives that all fully meet the individual’s vocational rehabilitation needs, available monthly resources of the family unit shall be used to defray DVR’s costs for all goods and services under the applicable plan before they can be applied to the excess costs of the more expensive alternative.

The available monthly resource shall be applied after the initiation of the applicable plan. Ongoing services and a one-time service are treated alike for the purposes of the use of the available monthly resource. Ongoing services might include monthly psychotherapy or vocational skills training. A one-time service might be the purchase of a rehabilitation technology device or another piece of equipment. The available monthly resource listed on the financial need analysis is not cumulative and does not carry over to the next month for the purchase of a non-exempt planned service or good after the initiation of the applicable plan.

The DVR Counselor and individual shall jointly determine what amounts the individual shall need to contribute, how the amounts shall be applied to specific goods and services, and a schedule for contributions.

The individual shall be notified, either as part of the written comprehensive assessment summary, on the IPE, or in another written form, of the amount they shall contribute to the cost of goods and services under the IPE.

The service record shall contain written documentation of determinations of economic need and how the available monthly resource shall be utilized in the provision of vocational rehabilitation services, where applicable. The IPE shall show use of the available monthly resource as a funding source for all or any portion of the service(s) and/or good(s) for which the individual is responsible.

The responsibilities section of the applicable plan shall document the individual’s commitment to their financial participation, what to do if their financial situation changes, and the potential consequence if the individual does not fulfill the agreed upon financial participation responsibilities.

If the individual’s financial situation, as per the financial need determination, has not changed when the time for the individual’s financial participation arrives and the individual does not have the money they have agreed to pay under the plan or is no longer willing to contribute toward the payment of goods or services, there shall be an interruption in provision of planned goods and services until:

• The individual can acquire resources to make the required contribution.

• The individual and DVR Counselor can redevelop the plan in terms of its employment outcome and/or necessary goods and services so that a financial contribution is not required.