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SPECIALIZED FAMILY CARE Provider Training

Category: Financial

Title: Room & Board, Social Security Benefits & Representative Payee

Materials:

Handouts: Article from SFC Pre-Service Manual; WVDHHR Room & Board Policy for Individuals with Developmental Disabilities 02/15; Social Security On-Line Publications: A Guide for Representative Payees 07/15; When a Payee Manages Your Money 01/15; Frequently Asked Questions (FAQs) for Representative Payees; What is the Difference Between Social Security & SSI Disability 11/09; Can I Be Eligible for SSI and Social Security Disability at the Same Time?”

Goal:

Provider knows how to manage an individual’s benefits in conjunction with the Specialized Family Care Program

Credit Hrs. 2 Hours Date Developed: February 2009, Updated 2010 by Donna McCune, Updated January 2017

Developed by: Update information January 2017 compiled by Carol Brewster, SFC Program

This skill-building instruction has been approved for Specialized Family Care Provider training by:

Specialized Family Program Manager Date

Content Reviewed and updated by: Carol Brewster, FBCS Date

Training Objectives:

Specialized Family Care Provider knows the WV Dept. Of Health & Resources policy regarding

Specialized Family Care Room and Board rates

Specialized Family Care Provider knows the definition of Room and Board Services

Specialized Family Care Provider knows the allowable expenditures from an individual’s monthly

allowance

Specialized Family Care Provider understands the Social Security Administration’s

Representative Payee Program

Specialized Family Care Provider knows the difference between Social Security Benefits and SSI

Training Procedures: Specialized Family Care Provider initiated self-study Test completed by Specialized Family Care Provider Review of test responses by Family Based Care Specialist and Specialized Family Care Provider

I certify that I have completed all the materials associated with this training module. I feel that I have a basic understanding of the material completed.

Specialized Family Care Provider Start Time End Time Date Reviewed by: ________________________________________________________________________ Family Base Care Specialist Date This Program is funded by the WV Department of Health & Human Resources, Bureau for Children & Families and administered by the Center for Excellence in Disabilities, West Virginia University. WVDHHR/CED/SFC/Training/Room-Board, Social Security Benefits and Representative Payee/ Revised January 2017

01-17-2017

1/17/2017

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Specialized Family Care Providers

Specialized Family Care Providers are expected to be financially stable. They are expected to have a source of income outside of the Specialized Family Care Program that meets their family’s basic needs.

Room and Board and Personal Needs Money

Specialized Family Care Providers receive room and board payments, when an individual is placed in their home. They also receive the individual’s personal needs funds. The Room and Board payments are to provide for food, clothing, personal hygiene items, recreational materials and outlets, adequate sleeping facilities, and space for personal belongings as needed. Personal needs funds are usually considered pocket money to purchase items and snacks and can be an opportunity for an individual to learn money and management skills. What a Specialized Family Care Provider receives for room and board is determined by an individual’s circumstances, designation, and the individual’s financial situation. The room and board rate for children in the custody of DHHR is $20.00 per day. This includes the child’s personal needs money. The room and board rate for adults is $17.50 per day. This includes the individual’s personal needs money. Personal needs money is determined by the individual’s IPP team. Specialized Family Care Providers receive financial reimbursements for the services that they provide to individuals. The two major funding sources are: Personal Care and Title XIX Medicaid Waiver. Both of these funding sources are through Medicaid. Personal Care reimburses for the personal care services provided to an individual as determined by the Nursing Plan of Care. Title XIX Medicaid Waiver reimburses for the training services provided to an individual as determined by the IPP team. Delays in payment can be common with these funding sources that are rarer and usually determined on an individual basis. Most of the individuals in Specialized Family Care receive disability benefits. The representative payee for these benefits can be the DHHR, the local case management agency, the legal guardian, and in some cases, the Specialized Family Care Provider. Specialized Family Care Providers are discouraged from

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being representative payee to avoid the appearance of a conflict of interest. Disability benefits are used to pay for room and board and medical expenses not covered by Medicaid. Excess disability benefits can be used to purchase personal belongings, such as clothing, bedding, recreational materials, and therapeutic items for the individual. Though the room and board payments may not fully meet the individual’s needs, the Specialized Family Care Provider is still expected to meet these needs.

West Virginia Department of Health and Human Services

Room and Board Policy for Individuals with Developmental Disabilities

Original Effective Date: April 1, 2002

Revision Effective Date: January 1, 2007 Revision Effective Date: January 1, 2009 Revision Effective Date: March 1, 2015

RE: Room and Board Rate for Specialized Family Care Homes and Non-ICF/IDD group homes servicing individuals with developmental disabilities.

BACKGROUND Historically the Medley Management Team has set the rate for Specialized Family Care Homes and non-ICF/IID group homes charge a resident for the cost of room and board. The rate for the Specialized Family Care Homes had not been adjusted since 1989 and the rate for non-ICF-IDD homes since 1996. The Medley Management Team formed a committee of Department staff, providers, and advocates to review these rates. The committee met several times and developed recommendations that were adopted by the Medley Management Team in November 2001. The Medley Management Team last reviewed the policy In December 2008 meeting and recommended a $1 a day increase and an increase occurred in January of 2009. The Medley Management Team again reviewed the policy and rate at its January 2015 meeting and recommended a $1.50 a day increase. The committee looked at information from the Consumer

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Price Index and the annual inflation increase from the Standard monthly SSI payment. The standard monthly SSI rates are as follows:

In 1989 SSI monthly payment was $368

In 1996 SSI monthly payment was $470

In 2002 SSI monthly payment was $545

In 2008 SSI monthly payment was $603

In 2009 SSI monthly payment was $674

In 2012 SSI monthly payment was $698

In 2013 SSI monthly payment was $710

In 2014 SSI monthly payment was $721

In 2015 SSI monthly payment was $733

In 2017 SSI monthly payment was $735

It has been determined that the use of consumer’s benefits and entitlement by case management agencies for the residential care of individuals with ID/DD shall be standardized at $17.50 per day effective March 1, 2015. This was an increase from the previous rate of $16.00 a day for Specialized Family Care and non-ICF/MR group homes. The personal allowance will be the difference of the monthly residential care charge of $542.50 per a 31 day month (Room and board calculated: 17.50 per day x 31 day month = 542.50) and the recipient’s monthly entitlement. It is recommended that the IDT team develop a budget for the individuals’ personal allowance.

Definition Room and Board Services: Room and Board is defined as the provision of food and shelter including private and common living space; linen, bedding, laundering and laundry supplies; housekeeping duties and common lavatory supplies (i.e. hand soap, towels, toilet paper); maintenance and operation of home and grounds, including all utility costs.

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Discussion In keeping with the principle of normalization, individuals should be given the opportunity to learn to manage their own finances. Certainly, for many this will be difficult goal to reach. Nonetheless all persons can take part in determining the use of their personal finances to some degree. The means of carrying this out should be individually tailored for each consumer. Weekly allotments may prove best for many individuals. The method for distributing such allowances should be established in the IPP.

The following list represents appropriate expenditure items for an individual’s monthly allowance:

Modest savings (no more than ½ of the monthly allowance amount per month not to exceed $2,000 total: the team should be aware that savings $2,000 and over could have a direct impact on benefits)

Special purchases (those articles where the expenses exceed normal economical cost for such items: (i.e. the individual wishes to buy $200.00 jacket).

Personal care items (i.e. individual preferred soap, shampoo, cologne, deodorant, etc.…)

Entertainment (i.e. movies, concerts, gym membership, radio, television,) Note: Such expenditures are primarily for the individual consumer. If others in the household benefit the consumer shall only pay his or her pro-rated share of the cost.

Gifts (i.e. special occasion, Birthdays, Holidays…)

Other personal items and services (I.e. watch, jewelry, make-up, tobacco products, haircuts, manicures…)

For tangible items receipts should be kept for bookkeeping purposes. For some other items (i.e. popcorn at the movies) it would be impractical to

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always get a receipt. When care providers help manage their allowance, a monthly listing of the items should be documented.

Personal allowance funds shall not be used for basic living expense. (i.e. regular meals, household paper supplies, and other general household expenses.) Social Security Administration rules shall be followed regarding use and

accounting of benefits and actions of representative payees. The Room and Board Rate will be reviewed every two years and economic standards such as the Consumer Price Index will be considered when adjusting the rate.

The Following Social Security Guides are included:

Social Security, A Guide for Representative Payees published July 2015

When a Payee Manages Your Money, published January 2015

Frequently Asked Questions FAQ’s for Representative Payees

What are the Differences Between Social Security & SSI Disability published November 2009

Can I Be Eligible to for SSI and Social Security Disability as the Same Time? To view a copy of these guides go to www.ssa.gov and typing in the name of the guide under the search engine. You may order a copy from: Social Security Administration, Office of Supply and Warehouse Management, Attention: Requisition & Quality Control Team, 2508 Robert M. Ball Building, 6401 Security Blvd., Baltimore, MD 21235. Phone: 410-965-2039 or Fax: 410-965-2037

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What’s inside the “A Guide for Representative Payee by Social

Security"

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Helping you manage your new responsibility . . . . . . . . . . . . . . . . . . . 10 How you must use monthly benefits. . . . . . . . . . . . . . . . . . . . . . . . . . .11 How to handle a large payment of past benefits. . . . . . . . . . . . . . . . .11 How to hold funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Changes to report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

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Contact Social Security Visit our website, www.socialsecurity.gov, you can: • Create a my Social Security account to review your Social Security Statement, verify your earnings, print a benefit verification letter, request a replacement Medicare card, change your direct deposit information, and more. • Apply for Extra Help with Medicare prescription drug plan costs; • Apply for retirement, disability and Medicare benefits; • Get the address of your local Social Security office • Find copies of our publications; and • Get answers to frequently asked questions. Call us toll-free at 1-800-772-1213 or at our TTY number, 1-800-325-0778, if you’re deaf or hard of hearing. We provide general information by automated phone service 24 hours a day. You can also use this automated response system to tell us a new address or request a replacement Medicare card. We can answer your case-specific questions from 7 a.m. to 7 p.m., Monday through Friday. You’ll generally have a shorter wait time if you call after Tuesday. We treat all calls confidentially, and a second Social Security representative monitors some telephone calls, because we want to make sure you receive accurate and courteous service.

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Introduction

More than eight million people, who get monthly Social Security or Supplemental Security Income (SSI) benefits, need help managing their money.

In these cases, we can appoint a relative, friend, or other interested party to serve as the “representative payee.” We thoroughly investigate those who apply to be representative payees to protect the interests of Social Security beneficiaries, because a representative payee receives the beneficiary’s payments and is given the authority to use them on the beneficiary’s behalf.

If you agree to serve as a representative payee, you’ve taken on an important responsibility that can make a positive difference in the beneficiary’s life.

With certain exceptions, a payee may not collect a fee for services provided to the beneficiary. You can’t collect a fee for services from the beneficiary, unless Social Security allows it, or you’re the legal guardian authorized by a court to charge a guardian fee.

This booklet provides basic information on how to be a representative payee and isn’t intended to answer all questions. For specific information about your situation, you should talk with a Social Security representative at your local Social Security office.

Helping you manage your new responsibility

As a representative payee, you must know what the beneficiary’s needs are so you can decide the best use of benefits for his or her care and well-being. This is especially important if the beneficiary doesn’t live with you.

Each year, Social Security will ask you to complete a form to account for the benefits you’ve received. Social Security will mail a form to you. You can either fill out the form and return it to Social Security or go online at www.socialsecurity.gov/payee to file the report. You can use the worksheet in the center of this booklet to keep track of what you spend (see sample form on page 19 of this hand out).

As a representative payee, you’ll also need to tell Social Security about changes that may affect the beneficiary’s eligibility. A list of these changes is on pages 16-17 of this hand out.

Remember, the law requires representative payees to use the benefits properly. If a payee misuses benefits, he or she must repay the misused funds. A payee who’s convicted of misusing funds may be fined and imprisoned.

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NOTE: We appoint a representative payee to manage Social Security funds only. A payee has no legal authority to manage non-Social Security income or medical matters. A representative payee, however, may need to help a beneficiary get medical services or treatment.

Family members often use a power of attorney as another way to handle a family member’s finances. For Social Security purposes, a power of attorney isn’t an acceptable way to manage a person’s monthly benefits. Social Security recognizes only the use of a designated representative payee for handling the beneficiary’s funds.

A special note about children who get Supplemental Security Income (SSI) payments

If you’re a payee for a child receiving SSI payments, you must seek treatment for the child’s medical condition when it’s necessary. If you don’t get medical treatment for the child, Social Security may appoint a new representative payee.

How you must use monthly benefits

First, you must take care of the beneficiary’s day-to-day needs for food and shelter. Then, you must use the money for the beneficiary’s medical and dental care that’s not covered by health insurance. You can also pay for the beneficiary’s personal needs, such as clothing and recreation. You must save any money left after you pay for the beneficiary’s needs, preferably in an interest-bearing account or U.S. Savings Bonds.

If the beneficiary is in a nursing home or institution, use their benefits to pay the fees. In this case, you should set aside a minimum of $30 each month to use for the beneficiary’s personal needs.

If the beneficiary is in an institution and gets Medicaid, or is a member of a family on Temporary Assistance for Needy Families, contact Social Security about using benefits for the family.

You may not take a fee from the beneficiary’s funds for your services as a representative payee. If you have questions about this, contact your local Social Security office.

How to handle a large payment of past benefits

The benefits for some claims take a while to approve. When this happens, we pay back benefits all at once, in a large payment. First, you must spend the money on the beneficiary’s current needs such as rent and a security deposit, food, or furnishings. After paying these expenses, you may spend the money to improve the beneficiary’s daily living conditions or for better medical care. Spend the

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money wisely. You should use the money in the beneficiary’s best interests. If there’s money still left over, you must save it, preferably in U.S. Savings Bonds or an interest-paying bank account, insured under either federal or state law.

Improve daily living conditions After you’ve provided for the beneficiary’s basic needs, you may spend the

money to improve the beneficiary’s daily living conditions or for better medical care. You may decide to use the beneficiary’s funds for major health-related expenses, if they’re not covered by the beneficiary’s health insurance. Examples of these expenses are reconstructive dental care, a motorized wheelchair, rehabilitation expenses, or insurance premiums.

You could use the money to arrange for the beneficiary to go to school or get

special training.

You may also spend some money for the beneficiary’s recreation, such as movies, concerts, or magazine subscriptions.

Special purchases You may want to make some of the following special purchases for the

beneficiary.

A home — Use funds for a down payment. Use the money for payments on a house owned by the beneficiary.

Home improvements — Pay for repairs and changes to make the beneficiary’s home safer and more accessible; for example, install a ramp or widen doorways for wheelchair access.

Furniture — Buy furniture for the beneficiary’s personal use. You can buy items such as a television the beneficiary can share with others in the household.

A car — Use funds for a down payment. Use the money for monthly car payments as long as the car is used for and owned by the beneficiary. If you’re not sure if it’s okay to use money for a specific item (for example, paying a bill owed before you became payee), contact Social Security before you spend the money.

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A special note about SSI beneficiaries

To continue receiving SSI, a beneficiary must not have resources worth more than $2,000 ($3,000 for couples). We don’t count all resources, however, some items you buy could cause the beneficiary to lose their SSI benefits. Any money you don’t spend could also count as a resource. Check with us before making major purchases for an SSI beneficiary.

A special note about blind or disabled children receiving SSI

Sometimes, blind or disabled children will receive large, past-due SSI payments covering more than six months of benefits. Usually, these payments must go directly into a separate banking account. We call this a “dedicated account” because funds in this account are only for certain expenses related to the child’s disability. The child’s dedicated account must be separate from other accounts. Except for certain past-due payments, no other funds may be put into the account. We don’t count money in the dedicated account as a resource, and we don’t count interest earned on the money as income or as a resource. You can only use money in a dedicated account for the following expenses:

Medical treatment and education or job skills training;

Personal needs related to the child’s disability — such as therapy and rehabilitation, special equipment, and housing modifications; and

Necessary items or services related to the child’s disability, such as legal fees for the child’s benefit claim.

You should get approval from us before spending money on the items listed above.

You must keep a record of all money taken from this account and receipts for all items or services bought, because we’ll review these records at least once a year. If you knowingly use money from the dedicated account for anything other than the expenses listed above, you must repay us from your own funds. If you have questions about dedicated accounts, contact us.

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How to hold funds

Asking us to deposit monthly benefits directly into a bank account is a good idea. We recommend that you hold benefits in a checking or savings account to protect against loss or theft. Also, don’t mix the beneficiary’s funds with your own or other funds.

You must save any money left over after meeting the beneficiary’s day-to-day and personal needs. The preferred ways of saving is U.S. Savings Bonds or an interest-paying bank account that’s insured under either federal or state law. Interest earned belongs to the beneficiary.

The checking or savings account title must show the beneficiary’s ownership of the funds and show you as the financial agent. Neither you as the payee, nor another third party, can have any ownership of the account. The beneficiary must never have direct access to the account. Any account title (under state law) that shows beneficiary ownership of the account with you as the financial agent is acceptable. Don’t use joint accounts. Here are two ways we recommend to title the accounts:

“(Beneficiary’s name) by (your name), representative payee.”

“(Your name), representative payee for (beneficiary’s name).” Your bank will provide help if you have more questions.

An exception for parents and spouses who are representative payees

A common checking account for all family members living in the same

household who receive benefits may show a parent or spouse as the owner of the

account. Children’s savings, however, must be in separate savings accounts for

each child, showing the child as the account owner.

Keeping records

As a representative payee, you’re responsible for keeping records and reporting on how you spend the benefits by completing a Representative Payee Report (Form SSA-623, SSA-6230, or SSA-6233). We’ll mail the proper form to you once a year. You can also file the report online at www.socialsecurity.gov/payee.

You must complete the report even if you’re the beneficiary’s legal guardian.

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You may choose to use the worksheet in the center of this booklet to help you keep track of the money you spend. When you need to fill out the Representative Payee Report, you can add the amounts in each column of your worksheet and put the totals on the accounting form. If you need extra worksheets, call 1-800-772-1213 (TTY 1-800-325-0778).

Paying income tax

Some people who get Social Security will have to pay federal income tax on their benefits. At the beginning of each year, Social Security will mail you a Social Security Benefit Statement (Form SSA-1099) that shows the total benefits paid during the previous year. Give this statement to the beneficiary’s tax preparer to determine if any taxes are due on the benefits.

Organizations that serve as payees Sometimes nursing homes or other organizations place funds for several

beneficiaries in a single checking or savings account known as a “collective account.” This is usually acceptable, but special rules apply to these accounts:

Account titles must show the funds belong to the beneficiaries and not the representative payee; The account must be separate from the organization’s operating account; Any interest earned belongs to the beneficiaries; There must be proper procedures to document credits and debits with clear, current records of each beneficiary’s share; and The organization must make the account and supporting records available to us when we ask for them. Some examples of collective account titles are: “Sunnydale Nursing Home, representative payee for Social Security beneficiaries.” “Sunnydale patients’ fund for Social Security beneficiaries.”

If you have any questions about collective accounts, contact us.

You’ll need approval from us first, if your organization serves as payee and wants to charge a beneficiary for the cost of past care. We also need to approve any decision to “pool” the funds of several beneficiaries for an item such as a television that’ll benefit the group.

More information about being a payee is available in the Guide For Organizational Representative Payees (Publication No. 17-013) that’s available at www.socialsecurity.gov/payee or from any local Social Security office. You can also order a copy by calling 1-800-772-1213 (TTY 1-800-325-0778).

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A special note about beneficiaries receiving SSI

If Medicaid pays more than half the cost for an SSI beneficiary in a medical

facility, we limit SSI payments to $30 a month, plus any extra money the state

pays. We also apply this limit to children under age 18, if private health insurance

— or both private insurance and Medicaid — pay more than half the cost of their

care in a medical facility. You must use the entire payment for the beneficiary’s

personal needs. After meeting all the beneficiary’s needs, you must save any

money left over on his or her behalf.

Changes to report

You need to tell Social Security about any changes that may affect benefit

payments. As payee, you’re responsible for repaying money you receive for the

beneficiary, if any of the events listed below occur, and you don’t report them. For

example, tell us if

The beneficiary moves.

The beneficiary starts or stops working, no matter how little the earnings

amount.

A disabled beneficiary’s medical condition improves.

The beneficiary starts receiving another government benefit or the benefit

amount changes.

The beneficiary travels outside the United States for 30 days or more.

The beneficiary is imprisoned for a crime that carries a sentence of more

than one month.

The beneficiary is committed to an institution by court order for a crime

committed because of a mental impairment.

Custody of a child beneficiary changes or a child is adopted.

The beneficiary is a stepchild, and the parents divorce.

The beneficiary gets married.

The beneficiary no longer needs a payee.

The beneficiary dies.

You must also tell us if

You’re no longer responsible for the beneficiary.

You move.

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You no longer wish to be payee.

You’re convicted of a felony.

You’re violating a condition of your probation or parole imposed under

federal or state law.

You must tell us if you or the beneficiary have an outstanding arrest warrant for

a felony in the state where you or the beneficiary live. In states that don’t classify

crimes as felonies, you must also tell us if you or the beneficiary have an

outstanding warrant for a crime punishable by death or imprisonment for more

than one year.

A special note about SSI benefits

If the beneficiary gets SSI benefits, you must also report the following

changes:

The beneficiary moves to or from a hospital, nursing home,

correctional facility or other institution;

A married beneficiary separates from his or her spouse, or they begin

living together again after a separation;

Someone moves into or out of the beneficiary’s household; or

The beneficiary or their spouse has a change in income or resources.

A child’s SSI benefit amount may change if there are any changes in the

family’s income or resources.

If you fail to report any actions to Social Security, we may pay the beneficiary too

much money. In that case, you may have to return the money the beneficiary

wasn’t due and the payments may stop. If you intentionally withhold information

to continue to receive payments, you may face criminal prosecution. Criminal

penalties can include fines and imprisonment.

Also, payees for people on SSI should remember the limits for savings and resources are $2,000 for singles and $3,000 for couples. All interest earned on savings counts toward that limit. Money in a child’s dedicated savings account (see page 14) doesn’t count toward the resource limit. For more information, read What You Need To Know When You Get Supplemental Security Income (SSI) (Publication No. 05-11011).

Medicare and Medicaid

Payees may need to help beneficiaries get medical services or treatment. This is a requirement for the payees of children on SSI. You should keep a record of

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medical services and medical expenses not covered by Medicare and Medicaid. For information about Medicare coverage, read Medicare (Publication No. 05-10043).

If the beneficiary has low income and few resources, the state may pay Medicare premiums and some out-of-pocket medical expenses. A person may qualify even if his or her income or resources are too high for SSI. For information, contact the state or local medical assistance (Medicaid) agency, social service office, or welfare office.

The beneficiary may also be able to get Extra Help paying for the annual deductibles, monthly premiums, and prescription co-payments related to the Medicare prescription drug program (Part D). The beneficiary may qualify for Extra Help if he or she has limited income and resources. These income and resource limits usually change each year.

Beneficiaries will automatically get Extra Help and don’t have to apply if:

They have both Medicaid with prescription drug coverage and Medicare; or

They have Medicare and Supplemental Security Income; or

The state pays for his or her Medicare premiums.

For more information about getting Extra Help with Medicare prescription drug plan costs, call Social Security’s toll-free number, or visit our website. You can also help the beneficiary apply for Extra Help online at Social Security’s website.

If you stop being a payee If you’ll no longer be the payee, you must notify Social Security immediately.

This is important, because we’ll have to select a new payee as soon as possible. When you’re no longer responsible for the beneficiary, you must return any benefits, including interest and any cash you have, to Social Security. We’ll reissue the funds to the beneficiary or the new payee.

If the beneficiary dies If the beneficiary dies, any saved benefits belong to his or her estate. You must

give them to the legal representative of the estate, or the savings must be handled according to state law. If you need information about state law, contact the probate court or an attorney.

When a person who receives Social Security benefits dies, no check is payable for the month of death, even if he or she dies on the last day of the month. You must return any check received for the month the beneficiary died. An SSI check, however, is payable the month of death. But you must return any SSI checks that come after the month of death.

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Social Security Administration SSA Publication NO. 05-10076 A Guide for Representative Payees ICN 468025 Unit of Issue – HD (one Hundred) July 2015 (Recycle prior editions) You can order a copy by calling 1-800-772-1213 (TTY 1-800-325-0778).

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Representative Payee Program Guide

When A Representative Payee Manages Your Money

This leaflet will help you understand why Social Security has selected a representative payee to help you manage your money and how that affects you.

Although there could be other reasons, we usually decide you need a payee because we have information that indicates you need help in managing your money.

We try to select someone who knows you and wants to help you. Your payee should be someone who sees you often and knows what your needs are.

If there is someone you want to be your payee, tell a Social Security representative, and we’ll consider your request. Social service agencies, nursing homes, or other organizations also can offer to be your payee.

If you don’t agree that you need a payee, or if you want a different payee, write to Social Security within 60 days to appeal that decision.

If, after reading this leaflet, you still have questions, visit our website at www.socialsecurity.gov/payee, or call our toll-free number, 1-800-772-1213 (TTY 1-800-325-0778).

What a payee does for you

Your payee receives your monthly benefits and must use the money to pay for your current needs, including

Housing and utilities; Food; Medical and dental expenses; Personal care items; Clothing; and Rehabilitation expenses (if you’re disabled).

After paying those expenses, your payee can use the rest of the money to pay any past-due bills you may have, give you spending money, support your legal

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dependents, or provide entertainment for you. If there’s money left, your payee should save it for you.

Your payee must keep accurate records of how they spend your money. Your payee must also regularly report this information to Social Security. Social Security will mail your payee a form. Your payee can either fill out the form and mail it to Social Security or go online at www.socialsecurity.gov/payee to file the report.

If you live in an institution such as a nursing home or hospital, your payee should pay the cost of your care and provide money for your personal needs.

What you must tell your payee

Tell your payee if you:

Get a job or stop working; Move; Get married; Take a trip outside the United States; Go to jail or prison; Are in the hospital; or If you get disability benefits and are no longer disabled.

If you get Supplemental Security Income (SSI)

If you receive SSI, you must also tell your payee if you:

Get money from another source; Apply for help from a welfare department or other government agency; or Save any money. Social Security may pay you too much money if you or your payee don’t report any of these actions to us. If we overpay you, we may stop your payments and ask you to return the money you weren’t due. If we discover that you or your payee withheld information to get payments, you or your payee may face criminal prosecution.

What to do if you have problems with your payee

You and your payee should talk about how much money you receive from Social Security and how to spend it on your needs. Then talk with your payee about how you want to use your money. If you can’t agree on how to spend your money, or if you believe your payee is misusing or stealing your funds, contact Social Security.

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How to spend a large back payment for past benefits

You may get a large one-time payment when there has been a delay approving your benefits. If that happens, your payee must spend the money on your current needs and use the rest of the money for medical services, your education, improvements to your home, or your debts. If your back payment benefits are for more than one year, we may pay your back benefits in several small payments.

If you receive SSI, you can’t have more than $2,000 ($3,000 for a couple) in cash and property (other than your home and car). You must spend enough of your back payment within nine months to keep your total resources below $2,000 ($3,000 for a couple). If your resources are higher than $2,000 ($3,000 for a couple), your payments may stop.

Contacting Social Security

Visit www.socialsecurity.gov anytime to apply for benefits, open a my Social Security account, find publications, and get answers to frequently asked questions. Or, call us toll-free at 1-800-772-1213 (for the deaf or hard of hearing, call our TTY number, 1-800-325-0778). We can answer case-specific questions from 7 a.m. to 7 p.m., Monday through Friday. Generally, you’ll have a shorter wait time if you call after Tuesday. We treat all calls confidentially. We also want to make sure you receive accurate and courteous service, so a second Social Security representative monitors some telephone calls. We can provide general information by automated phone service 24 hours a day. And, remember, our website, www.socialsecurity.gov, is available to you anytime and anywhere

From: Social Security Administration When a Representative Payee Manages Your Money SSA Publication No. 05-10097 ICN 468634 Unit of Issue - HD (one hundred) January 2015 (Recycle prior editions)

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Representative Payee Program Guide FAQS for Representative Payee

What is a Representative Payee?

A representative payee is a person or an organization. We appoint a payee to receive the Social Security or SSI benefits for anyone who can’t manage or direct the management of his or her benefits. . A payee’s main duties are to use the benefits to pay for the current and future needs of the beneficiary, and properly save any benefits not needed to meet current needs. A payee must also keep records of expenses. When we request a report, a payee must provide an accounting to us of how he or she used or saved the benefits.

NOTE

Being an authorized representative, having power of attorney, or a joint bank account with the beneficiary is not the same as being a payee. These arrangements do not give legal authority to negotiate and manage a beneficiary's Social Security and/or SSI benefits. In order to be a payee, you must apply for and be appointed by Social Security.

What is a Beneficiary?

A beneficiary is a person who receives Social Security and/or Supplemental Security Income (SSI) payments. Social Security and SSI are two different programs. We administer both.

Who Needs a Representative Payee?

The law requires most minor children and all legally incompetent adults to have payees.

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We presume an adult is capable to manage his or her own benefits. If it appears this may not be true, we gather evidence to decide if we need to appoint a representative payee.

How Do I Apply to be a Representative Payee?

Contact the Social Security office nearest you to apply to be a payee. You must complete form SSA-11 (Request to be selected as payee) and show us documents

to prove your identity. You will need to provide your social security number, or if you represent an organization, the organization's employer identification number. Usually, you must complete the payee application with us face-to-face.

What Are the Duties of a Representative Payee?

A payee acts for the beneficiary. A payee is responsible for everything related to benefits that a capable beneficiary would do for himself or herself. We encourage payees to go beyond just managing finances and be actively involved in the beneficiary’s life. The following lists the required duties of a payee.

Required Duties:

Determine the beneficiary’s needs and use his or her payments to meet those needs;

Save any money left after meeting the beneficiary’s current needs in an interest bearing account or savings bonds for the beneficiary's future needs;

Report any changes or events which could affect the beneficiary’s eligibility for benefits or payment;

Keep records of all payments received and how you spent and saved them; Provide benefit information to social service agencies or medical facilities

that serve the beneficiary; Help the beneficiary get medical treatment when needed; Report to us any changes that would affect your performance or your

continuing as payee; Complete written reports accounting for your use of funds; and Return to us any payments to which the beneficiary is not entitled.

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What About "Power of Attorney"?

Power of attorney is a legal process where one individual grants a third party the authority to transact certain business for that individual. It does not lessen the rights of the individual and does not usually grant the third party the right to manage the individual's assets. It typically makes no finding about the individual’s

capability or competence. The Treasury Department does not recognize

power of attorney for negotiating federal payments, including Social

Security or SSI checks.

This means, if you have power of attorney for someone who is incapable of managing his or her own benefits, you must still apply to serve as his or her payee.

Can I Collect a Fee for Serving as a Representative Payee?

No, unless you are a qualified organizational payee approved in writing by Social Security to collect a fee. We never approve an individual to charge a fee for payee services. We can allow some organizations to collect a fee from a beneficiary’s monthly payment for providing payee services. An organization must apply and qualify under the law, for fee collection. Social Security must approve the fee collection in writing. To qualify as a “fee for service payee”, an organization must be:

A community based, nonprofit social service organization, bonded and licensed in the state in which it serves as payee, or

A state or local government agency responsible for income maintenance, social service, health care, or fiduciary duties, and

Regularly serves as a payee for at least five beneficiaries, and Not be a creditor of the beneficiary (some exceptions apply), and Submit an SSA-445 (Application to Collect a Fee) to us, and Be authorized in writing by us to collect a fee.

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Can I Use Beneficiary's Funds to Pay Myself for a Beneficiary Expense I Paid?

You may reimburse yourself for reasonable, actual out-of-pocket expenses you pay on behalf of the beneficiary. For example, we consider the cost of transporting the beneficiary to a doctor’s appointment (such as cab fare, mileage and tolls), postage to pay the beneficiary’s bills, and fees for money orders as out-of-pocket expenses. The amount of reimbursement must equal the expense you incurred for the beneficiary. You must keep records of your out-of-pocket expenses.

Note: If you are a fee for service payee, the cost of postage is not reimbursable.

We do not permit payees to be reimbursed from the beneficiary’s funds for overhead expenses. For example, you cannot reimburse yourself from the beneficiary’s funds for the costs associated with your utilities, rent, office equipment and supplies.

What Type of Bank Account Should I Set Up for the Beneficiary?

A checking account is better in some ways, because you will have cancelled checks or statements that show how you spent the funds. If you decide to use a checking account, consider that some beneficiaries cannot keep balances high enough to avoid service charges. But if you must pay bills through the mail, a checking account might still be cost effective because cashier's checks and money orders have charges associated with them, as well. You should set up an account that minimizes fees and enables you to keep clear records. We encourage using interest-bearing accounts. You must title the bank account so it is clear the money in the account belongs to the beneficiary.

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What Is the Proper Use of Benefits?

You should use benefits for current needs (such as food, clothing, shelter, utilities, dental and medical care, and personal comfort items), or for reasonably foreseeable needs. If not needed for these purposes, you must conserve or invest the benefits for the beneficiary. Where the beneficiary has unmet current maintenance needs, saving benefits does not serve a purpose and would not be in his or her best interests.

You must use benefits in the best interests of the beneficiary, according to your best judgment.

What Are Some Examples of What Payees Cannot Do?

A payee cannot:

Sign legal documents, other than Social Security documents, for a beneficiary.

Have legal authority over earned income, pensions, or any income from sources other than Social Security or SSI.

Use a beneficiary's money for the payee's personal expenses, or spend funds in a way that would leave the beneficiary without necessary items or services (housing, food, medical care).

Put a beneficiary's Social Security or SSI funds in the payee’s or another person's account.

Use a child’s "dedicated account" funds for basic living expenses. (This only applies to disabled and blind SSI beneficiaries under age 18.)

Keep conserved funds once you are no longer the payee.

Charge the beneficiary for services unless authorized by SSA to do so.

Are there other limits on what a payee can do?

Unless a payee is also a guardian, he or she may not sign legal documents, other than Social Security documents, for a beneficiary. Payees have no legal authority over earned income, pensions, or any income from sources other than Social Security or SSI, unless the payee is also a legal guardian or has power-of-attorney.

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The Beneficiary Wants to Spend Money on Things That Do Not Meet My Approval. What Is My Responsibility?

Your main duty is to make sure the current needs of the beneficiary are met. Once you have met these needs, he or she has a right to some discretionary spending money, even if you do not approve of all of his or her choices. With drug or alcohol abuse, you may want to give him or her only small amounts of spending money. Or you can buy food, rather than giving him or her cash for food. If you think he or she is spending money on illegal or dangerous items and activities, you should seek help from a social service agency. You can ask for guidance from your local Social Security office or by calling us toll-free at 1-800-772-1213.

How Should I Use Benefits For An Institutionalized Beneficiary?

When someone lives in an institution, you should allot a reasonable share of benefits for the institution's usual charges. You need to consider the institution's usual charges and the beneficiary's other current need. You should not pay an amount for current maintenance over the legal maximum set up by the State.

If a beneficiary receives care in a State, Federal, or private institution that doesn’t receive Medicaid funds for him or her, you should give highest priority to his or her current maintenance. Current maintenance is not just the institution’s usual charges. Current maintenance includes costs for items that will aid in his or her recovery or release from the institution, or improve his or her condition while in the institution. You should conserve or invest any remaining benefits not needed for other proper uses. Other proper uses may include temporarily maintaining his or her home outside the institution, unless a doctor certifies he or she is unlikely to return home.

If an SSI beneficiary enters a facility report the admission to SSA. If he or she receives substantial Medicaid payments for the cost of care and the $30 personal needs allowance, you cannot use the benefit for current maintenance.

If current needs are met, and he or she has a dependent (spouse, child, or parent) living at home, you may be able to use part of the benefit to support the legal dependents. Contact your local Social Security office for guidance.

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How Much Money Should I Set Aside for Personal Needs of a Person In An Institution or Nursing Home?

You should set aside a minimum of $30 each month. Use this $30 to pay for the beneficiary's personal needs or save it for him or her.

If Medicaid pays more than 50% of the cost of care in the institution, a beneficiary's Federal SSI benefit is $30. In these cases, the $30 must be used for his or her personal needs. Note: Some States supplement the $30 SSI benefit.

How Do I Handle Large Sums of Money (for example, if a beneficiary receives a large retroactive payment covering several months, or even years, of benefits)?

The main thing to keep in mind is that you must spend the money wisely and in the best interests of the beneficiary. Your priority is to make sure you meet the beneficiary's current needs (food, shelter, medical care and other comfort items). After you provide for those needs, you could spend the money on things that would improve his or her daily living conditions or provide better medical care. You may also use leftover money to satisfy his or her debts. However, if you are a creditor, we must approve your use of money to pay any debt that he or she owes to you. Save any remaining funds for him or her.

If the beneficiary receives SSI, he or she cannot have more than $2000 ( or $3000 for a couple) in countable resources. You should spend the back payment within 9 months so that his or her total resources are below $2000 ($3000 for a couple). If you don't spend the money within 9 months after the month of receipt, an overpayment may occur and benefits may stop if countable resources exceed the $2000 ($3000) threshold.

What If I Receive a Large Sum of Money as the Payee for a Child Receiving SSI?

We must deposit certain large past-due payments that cover more than six months of SSI benefits to blind or disabled children directly into a separate account in a financial institution. We call this separate account a "dedicated account." We do not count the money in this account and the interest that it earns as an SSI resource. You may use funds in this account only for certain expenses primarily related to the child's disability.

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Why do I need to put large sums of money for the child in a dedicated account?

The law requires you to put large retroactive amounts received by a disabled child in a dedicated account. Congress passed this law to assure that funds would be available to pay for the disability-related expenses of the child.

How will I know if I must place funds in a "dedicated account"?

When we approve a child for disability benefits, we will tell you about the child's monthly payments, and any past-due SSI payments that you must place in a dedicated account. Our letter will also tell you how to set up an account.

How Do I Spend "Dedicated Account" Funds?

You must use money in the "dedicated account" for the following allowable expenses:

Medical treatment and education or job skills training; If related to the child's disability, personal needs assistance; special

equipment; housing modification; and therapy or rehabilitation; or Any other item or service related to the child's disability.

You must use money in the "dedicated account" for the following allowable expenses:

What Happens If I Spend "Dedicated Account" Funds for Things Other Than Allowable Dedicated Account Items?

If you use "dedicated account" funds for anything other than the allowable "dedicated account" fund expenses, you must repay us, from your own funds, an amount equal to what you spent.

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What Changes or Events Do I Need to Report to Social Security?

You must report the following events as soon as possible. Call us at 1-800-772-1213, or contact your local Social Security office. Note: there are additional changes and events for SSI beneficiaries at the end of the list.

The beneficiary dies; The beneficiary moves; The beneficiary marries; The beneficiary starts or stops working, even if the earnings are small; A disabled beneficiary's condition improves; The beneficiary starts receiving another government benefit, or the benefit

amount changes; The beneficiary plans to leave the U.S. for 30 days or more; The beneficiary is imprisoned for a crime that carries a sentence of over

one month; The beneficiary is committed to an institution by court order for a crime

committed because of mental impairment; Custody of a child beneficiary changes or a child is adopted; The beneficiary is a child (including a stepchild), and the parents divorce; You can no longer be payee; or

The beneficiary no longer needs a payee.

Additional events that you must report for SSI beneficiaries:

The beneficiary moves to or from a hospital, nursing home, or other institution;

A married beneficiary separates from his or her spouse, or they begin living together after a separation;

Somebody moves into or out of the beneficiary's household; The beneficiary has any change in income or resources (i.e., a child's SSI

benefit check may change if there are any changes in the family income or resources); or

Countable resources exceed $2000 ($3000 for a couple).

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How Often Do I Need to Report to Social Security on How I Used Benefits?

We will send you a "Representative Payee Report" once a year. When you receive the Report, fill it out promptly and mail it back, or follow the directions that you receive with the Report and submit the Report online. Whether you choose to complete the paper report or the online version, the report is simple to complete if you keep clear records of how you spent or saved the money throughout the year.

Why did I receive two Representative Payee Report forms during the same year and what should I do with them?

Some individuals are entitled to Social Security benefits on two different Social Security numbers (SSN). In this case, you will receive two different Representative Payee Report forms during the same year. Each report form will show a different SSN and will ask you about the amount of benefits that were paid on that SSN. It is important that you read each report carefully and respond to each report form. Explain how you used the funds that each report asks about.

I Lost the Annual Report That I Received in the Mail. What Should I Do?

You may call SSA at 1-800-772-1213 between 7 a.m. and 7 p.m. on business days, or contact your local SSA office to obtain another report.

Who Do I Contact If I Have Problems or Questions?

You may call us at 1-800-772-1213 between 7 a.m. and 7 p.m. on business days, or contact your local Social Security office between 9 a.m. and 4 p.m. on business days. People who are deaf or hearing impaired may call our toll-free "TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. on business days. You can find answers to many questions by visiting our website at www.socialsecurity.gov/payee

You can view this online at:

https://www.ssa.gov/payee/faqrep.htm

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Fact Sheet Guide by Social Security Administration

Social Security and Supplemental Security Income (SSI): What’s the difference? (November 2009)

There is often confusion about Social Security and Supplemental Security Income (SSI) because you apply for both programs with the Social Security Administration. But, the programs are different. The Social Security benefit programs are “entitlement” programs. This means that workers, employers and the self-employed pay for the benefits with their Social Security taxes. The taxes that are collected are put into special trust funds. You qualify for these benefits based on your work history (or your spouse or parent). The amount of the benefit is based on these earnings. SSI is a needs-based program for people with limited income and resources. Resources are assets or things that you own. The program is paid for by general tax revenues -- not from the Social Security trust funds. The benefit amount is based on Federal and State laws which take into account where you live, who lives with you and what income you receive. Look at the FACT Sheet by Social Security Administration, November 2009 below to help you understand the difference between the two programs: Social Security SSI Benefits based on earnings Benefits based on need_______ Financed by employer and wage Financed by General Revenues Contributions_______________________________________________________ No income limit Limited Income_____________ No resource limit Limited resources____________ Must have enough work credits No work credits are required___ Medicare Medicaid (Medi-Cal in California) Benefit Types: Benefit Types:

- Retirement (age 62 or older) - Aged (age 65 and older) - Survivor - Disability (any age, includes

children) - Disability (includes blindness) - Blindness (any age, includes

Children) _______________ Provides benefits to eligible family members No family benefits___________ Benefit amount based on average lifetime Benefits amount based on

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earnings Federal and State laws______ Other income does NOT affect benefits Other income MAY affect (Except wages may affect benefits under benefits-report any income you Full retirement age or disability benefits) receive___________________ Where you live or who live with you does Where you live or who lives with not affect benefits May affect benefits – report all changes

Social Security Questions and Answers: Question: Mary, a Native American elder, is 67-years old and receives retirement benefits. She retired from her job after working 30 years. She receives $600 per month. Her daughter and grandson move into her home. Does Mary have to report this to Social Security? Answer: No. Mary does not have to report a change in her living arrangements. Social Security benefits are not affected if someone moves into or out of your home or if you move into or out of someone’s home. Question: Mary just received her quarterly per capita distribution from her tribe’s Revenue Sharing Trust Fund. Does she need to report this to Social Security? Answer: No. Mary does not need to report her per capita distribution. Mary only needs to report her wage if she returns to work. SOMETIMES earnings from work affect Social Security benefits. A representative will tell you if our earnings will affect your check.

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SSI Questions and Answers: Question: John and Lilly, Native American elders, are both 68-years old. They have been receiving SSI benefits for 2 years. Last week, John and Lilly moved in with their son. They both have direct deposit. Do they have to report to Social Security that they now live with their son? Answer: Yes. If you receive SSI payment you must report changes in your living arrangements right away. This report must be made to Social Security and not your tribal social worker. Question: John just received his quarterly per capita distribution from his tribe’s Revenue Sharing Trust Fund. Does he need to report this to Social Security? Answer: Yes. John is required to report ALL income he receives from ANY source. Social Security representatives will determine if the income will affect his SSI payments. Since per capita distribution vary by tribe, there are different rules for each type of distribution. When in doubt, report the income to Social Security.

You may view this Fact Sheet online at: https://www.ssa.gov/sf/FactSheets/aianssavsssifinalrev.pdf Some people receive both Social Security and SSI benefits. Anytime you receive SSI you must report changes in your living arrangements and income. Social Security representatives are your best source for information. If you have any questions about your benefits, or you are not sure if you receive Social Security or SSI, please call us toll-free at 1-800-772-1213. We will be happy to answer any questions you may have. You may also call or visit your local Social Security office. To find out the address of your local office you may call our toll-free number or visit our website at www.socialsecurity.gov.

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CAN I BE ELIGIBLE FOR SSI AND SOCIAL SECURITY DISABILITY AT THE SAME TIME?

Some claimants only apply for Social Security Disability Insurance (SSD or SSDI for short) benefits. Others only apply for Supplemental Security Income (SSI) benefits. However, in some instances claimants may qualify for both SSDI and SSI benefits. Applying for both types of benefits is called a “concurrent claim.”

Concurrent Claim

Under certain circumstances, a claimant may be eligible to collect SSI and SSDI at the same time (called “concurrent benefits”). This typically happens when a disability applicant is approved for SSDI but only receives a low monthly payment.

[Note: A low SSDI payment can be caused by not working much in recent years or making low wages.]

Qualifying for SSI

In order to qualify for an SSI payment in addition to (or concurrently with) an SSDI payment, the claimant must have less than $735 per month of unearned income (this is the rate in 2017). Generally speaking, the SSI income limits can be fairly complicated. The income limit is higher in some states than others. And if you are working and making some earned income, an even different limit applies. The SSI program also has asset limits, which means that you can only have a limited amount of cash savings, valuable property and other assets to qualify for SSI. Similar to qualifying for food stamps, you must prove you are “poor enough” to qualify for SSI.

In the end, if (1) your monthly income and overall assets are low enough to qualify for Supplemental Security Income, and (2) you have also worked long enough in one or more jobs and paid sufficient Social Security taxes into the Social Security Disability Insurance (SSDI) system to earn enough work credits, you may qualify to receive both types of benefits at once.

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However, you keep in mind that your SSDI payment is included as income in calculating whether you are eligible for SSI. In some cases, your SSDI payment will be so high you may not qualify for SSI benefits.

Monthly Payment of Concurrent SSDI and SSI Benefits

SSDI and SSI benefits do not “stack” on one another. In other words, you don’t add the entire amount you may qualify for under each program together. You cannot receive a higher monthly combined benefit than you would otherwise receive under the SSI program alone. Your SSI payment amount will be lowered by the amount of your SSDI payment to match the maximum SSI payment amount.

For example, if your SSDI benefit is under $735.00 (the current maximum SSI monthly payment amount in 2017) and you qualify for SSI, you will receive an SSI payment for the difference between your SSDI benefit and $735. For example, if you are eligible to receive $500 in SSDI benefits and you are eligible to receive SSI, you would receive $500 in SSDI and $235 in SSI ($735 minus $500) each month for a total of $735.

In short, if your SSDI benefits are less than $735 per month, you may receive both SSI and SSDI benefits at once.

How You Apply for Concurrent Benefits

Most claimants are not aware that there are two programs of disability with the Social Security Administration. So how can you be sure to apply for the right one or both? Whether you apply for SSI, SSDI (also called SSD), or both, your local Social Security district office will evaluate your income and assets and determine whether your claim is concurrent. The category of your disability claim (SSI, SSDI, or both) will not make a difference as to how the medical evaluation of the claim is processed. In other words, an SSI claim will be medically reviewed in exactly the same way as an SSDI claim. The same definition of disability and the same disability evaluation process is used for both programs of benefits.

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The Benefits of a Concurrent Claim

The benefit to collecting SSI when you are collecting monthly SSDI benefit of less than $735 a month is that the SSI payment will raise your total benefits up to $735 per month.

On the flip side, a benefit to being able to collect SSDI when you are also eligible for SSI is that you may be eligible to receive Medicare health insurance benefits as an SSDI recipient. [Note: There is a two-year wait time before Medicare benefits kick in. You must wait two years from when your SSDI eligibility begins to qualify for Medicare benefits.]

In contrast, SSI recipients are eligible to receive Medicaid benefits alone. Although Medicaid does provide payment for more services overall than Medicare, more doctors accept Medicare coverage, so it may be easier to find a Medicare provider.

Mr. Ortiz has represented thousands of Social Security disability claimants and has over a decade of experience in handling disability claims.

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