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5.00                                                                                                                            DETERMINATION OF ECONOMIC NEED                                                 

 

Introduction

 

The Economic Need Policy considers the financial need of the consumer and his/her household to determine the extent of consumer participation in the cost of vocational rehabilitation services. 

 

General Policy

 

Economic need status will be determined for all consumers based on the adjusted gross income of the consumer's household as reported to the Internal Revenue Service.  This should be discussed with consumers during intake.

 

When to Determine Economic Need

 

The determination of economic need may be completed at any point but must be completed when it is determined that the plan of services will include items which are contingent upon economic need.

 

Redetermination of Economic Need

 

Economic need status will be redetermined:

 

1. annually, or

 

2. when there is a change in the consumer's circumstances which would affect economic need status.

 

Exception

 

An individual who met the criteria for economic need at the time of application who becomes employed as part of the individual's plan for employment will not have that new income counted in redetermining economic need.

 

Applicants for Post-Employment Services are not included in this exception.  A new determination of economic need status must be made when providing Post-Employment Services (see Chapter 11.00 Post-Employment Services).

 

Persons Who Are Exempt From the Economic Need Test

 

NYSCB will provide services to individuals who receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) without consideration of their financial resources.  Copies of benefits statements must be provided to NYSCB to verify benefits status.

 

How Economic Need is Determined

 

Economic need is determined by the NYSCB counselor by comparing the adjusted gross income of the consumer's household as reported on the most recent Federal Tax return with the economic need allowance level appropriate for that consumer.

 

The economic need allowance level is based upon the number of wage earners in the consumer's household and household size.

 

Allowable Income Deductions

 

Four income adjustments will be applied, as appropriate, to the adjusted gross income. These income adjustments are:

 

1. non-reimbursed medical and dental expenses

 

2. court ordered obligations other than alimony

 

3. post-secondary educational expenses of other family members or loans being repaid by the consumer for their own post-secondary educational expenses (up to the maximum reimbursement which NYSCB allows for college students).

 

4. unusual one-time expenses incurred during the period for which the available resources are calculated that are not within the discretion of the consumer or his/her family such as flood/fire damage not covered by insurance, loss due to theft, necessary replacement of a well.  These expenses must be approved by the District Office manager prior to including them in the economic need calculations.

 

Economic Need Allowance          

 

The economic need schedule is as follows:

 

For one wage earner:

 

if the household size is one, the allowance is $38,000.

 

if the household size is two, the allowance is $51,000.

 

if the household size is three, the allowance is $62,000.

 

if the household size is four, the allowance is $72,000

 

For two or more wage earners:

 

if the household size is two, the allowance is $58,480..

 

if the household size is three, the allowance is $69,480.

 

if the household size is four, the allowance is $79,480

 

In households with more than four members, add $7,480 to the allowance for each additional member.

 

Consumer's Household

 

1. Wage Earners:  The following individuals, when residing with the consumer, are considered to be members of the consumer's household when determining household wage earners:

 

a. consumer

b. consumer's spouse

c. consumer's parents, stepparents or legal guardians

 

Note:  Resources from non-supporting divorced parents or spouses who have abandoned and are not contributing to the household are not considered in the economic need calculations.

 

2. Household Size:  Household size is determined by the number of individuals listed on the Federal Tax Form or the Income Calculation Form for all wage earners.

 

Refusal to Provide Information

 

If the consumer refuses to provide the information necessary to determine participation, no service requiring such determination may be authorized.  If the consumer cannot obtain the information from another member of the household the counselor and senior counselor should attempt to persuade the household member to release the information.  If the household member still refuses to provide the information, no service requiring economic need determination may be authorized.

 

Confidentiality of Information

 

NYSCB will strictly observe the confidentiality of all financial information obtained from the consumer and household members.

 

Collection of Financial Information

 

The consumer and his/her household members should be the primary source of information regarding resources.  The counselor must ask the consumer to produce evidence of the resource information (e.g., copies of tax returns, benefits statements, wage statements, etc.) and these must be scanned into the ECF.  If the consumer claims to be independent from family resources, they should be asked to demonstrate emancipation or their means of self-support.

Economic Status Report

 

The Economic Status Report is a financial statement of the consumer's adjusted gross household income and documentation for the record of services of the consumer's economic need status.

 

Income Calculation Form

 

The Income Calculation Form is a financial data collection form.  It should be completed by each wage earner who has not filed a Federal tax return.  Information from the Income Calculation Form should then be entered on the Economic Status Report to determine whether the consumer meets economic need.

 

Consumer Participation in Services Contingent Upon Economic Need

 

Individuals whose adjusted gross household income falls below their allowance level meet economic need and can obtain services that are contingent upon economic need without having to participate in the cost of those services as long as they continue to meet economic need.

 

Individuals whose adjusted gross household income equals or exceeds their allowable level do not meet economic need and will not receive services contingent upon economic need unless they provide for the costs of such services.

 

Note:  Consumers whose adjusted gross household income equals or exceeds their allowance level should be reconsidered if changes in the economic need standard occur during the time their case is open.

 

Comparable Benefits

 

Where appropriate, a full consideration of comparable benefits must be made prior to utilizing vocational rehabilitation funds for individuals who meet economic need.

 

Provision of Service Under Economic Need

 

There are specific services which are contingent upon economic need.  There are also specific services which are not contingent upon economic need.  For a complete listing of the services and their governing guidelines, see pages 5.00.06 - 5.00.10.

 

Post-Employment Services

 

The decision to provide post-employment services (PES) is not contingent upon economic need.  However, each specific or support service provided under the category of PES may or may not be contingent upon economic need.

 

Services Contingent upon Economic Need

The services listed below, if provided, will only be provided to persons who meet economic need.  Full consideration and application of comparable benefits will be required.

 

1. Medical restoration and other medical services. 

 

Medical and hospitalization services will be provided only when not covered by Medicaid, Medicare or other public or private  medical or hospitalization plans.  The deductible portions of Medicare or private insurance coverage may be authorized.  Medicaid allowances are considered payment in full and cannot be supplemented.

 

a. Medical Services - medical care for acute conditions arising during the course of vocational rehabilitation that can be corrected or substantially improved within 30 days.

 

Physical restoration services may be provided if directly related to the success or completion of the vocational rehabilitation plan.  Services may include the following:

 

1. Physician's services

2. Surgery and treatment

3. Hospitalization

4. Prosthetic/Orthotic appliances (including hearing aids) 

Exception:  Hearing aids are not contingent upon economic need for individuals who meet the NYSCB definition of deafblind and are coded as deafblind on the RSA-911.

5. Nursing or convalescent home care

6. Dental care

7. Psychiatric/psychotherapeutic services (non-assessment)

 

2. Equipment - including equipment recommended by rehabilitation engineering or technology evaluations (Assistive equipment provided in conjunction with rehabilitation teaching and orientation and mobility services is exempt.)

 

3. Training - including tuition and related fees at colleges and universities (Training at approved community rehabilitation programs, work study training, on-the-job training, orientation and mobility and rehabilitation teaching training, are exempt from this requirement.)

 

4. Books and Supplies

 

5. Maintenance - (except in support of services which are not contingent upon economic need and assessment services, including extended evaluation)

 

1. During training programs, including college training

 

2.As a support service when providing medical care for an acute condition arising during the course of vocational rehabilitation, not to exceed 30 days

 

3. In connection with placement, until the consumer receives his/her first paycheck

 

4. For consumers in self-employment, not to exceed 60 days from the time the consumer begins employment

 

6.Transportation - (except in support of services which are not contingent upon economic need; assessment services, including extended evaluation and to attend an initial review, administrative review, mediation or administrative hearing)

 

7. Self-Employment Services

 

a. Purchase of initial stock

b. Business-related tools and equipment

c. Shelter as defined on page 10.02.10

d. Initial business license(s)

e. Installation and a maximum of three months maintenance of business phone

f. Utilities (a maximum of three months)

g. Business related insurance (a maximum of one year) such as fire, theft, burglary, and liability

h. Rent (a maximum of three months)

i. Advertising

j. Office supplies (not including office equipment)

k. Legal services - legal costs associated with establishing a business enterprise (i.e. closing costs for property transactions, transfer costs, loan closings)

l. Accounting services - costs associated with establishing an accounting system and maintenance for a three month period

 

8. Other Goods and Services

 

9. Services to Family Members

 

10. Home Modifications

 

Services Provided Without Regard to Economic Need

 

The services listed below may be provided by NYSCB without considering a person's financial resources after a full consideration and application of available comparable benefits has been made.

 

1. Assessment for Determining Eligibility and VR Service Needs

 

a. assessments

b. medical examinations

c. psychological and psychiatric evaluations

d. initial low vision evaluations and low vision follow-ups

Note:  Initial low vision evaluations and low vision follow-ups are always considered to be assessment services.

e. rehabilitation engineering evaluations and consultations

f. transportation and/or maintenance when provided in conjunction with an evaluation or other assessment service

g. all services provided in Extended Evaluation

 

2. Personal Assistance Services 

 

3. Counseling, Guidance and Referral Services

 

4. Social Casework Services

 

5. Placement Services

 

6. Training at approved community rehabilitation programs, work study training, on-the-job training, orientation and mobility and  rehabilitation teaching training

 

7. Interpreter's Services

 

8. Tutorial Services

 

9. Reader Services

 

Reader services may be provided as a support service to consumers not attending college when essential for completing vocational training or placement up to a maximum of $1,000 per calendar year.

 

Under certain conditions NYSCB may supplement State Education Department Readers Funds.  The total amount of reader funds provided by NYSCB and the State Education Department for consumers attending college should not exceed $2,000 per academic year.

 

The hourly rate for reader services should be negotiated on an individual basis by the consumer and the reader.

 

For further information see Section 8.09 - Reader Services.

 

10. Transportation Services in support of other services which are not contingent upon economic need; assessment services including extended evaluation, and to attend an initial review, administrative review or administrative hearing.

 

11. Maintenance Services in support of other services which are not contingent upon economic need and assessment services including extended evaluation.

 

12. Low Vision Devices.

 

13. Adaptive Equipment provided in conjunction with rehabilitation teaching and orientation and mobility services.

 

14. Hearing Aids for individuals who meet the NYSCB definition of deafblind and are coded as deafblind on the RSA-911.

 

Instructions for Completing the Economic Status Report

 

Use the following procedures for completing the Economic Status Report:

 

If the consumer refuses to provide financial information:

 

1. Check the “Refusal to Provide Financial Information” box

2. Date the form (complete the counselor and consumer signature fields).

3. Provide a copy of the completed form to the consumer

 

If the consumer is an SSI or SSDI recipient:

 

1. Check the SSI/SSDI Disclaimer box

2. Date the form (complete the counselor and consumer signature fields).

3. Attach supporting documentation to the form (verification of receipt of SSI or SSDI)

4. Provide a copy of the completed form to the consumer

 

If the consumer provides a completed tax return to enable you to determine his/her economic need status

 

1. Enter the adjusted gross income for all members of the consumer’s household into the appropriate fields.

2. If the consumer is a minor and you are entering information from a parent/step-parent or guardian’s tax return, select the appropriate person from the pick list in field 1C.

3. Enter the consumer’s household size, in 1D. 

4. Enter any applicable income exclusions, in fields 3A-3D

5. Verify that the form correctly designates the consumer as either meeting economic need or not meeting economic need

6.  Date the form (complete the counselor and consumer signature fields).

7. Attach supporting documentation (tax return documents) to the form.

8. Provide a copy of the completed form to the consumer

 

Note:   If federal tax returns have not been filed for any household member, complete an Income Calculation form for that individual prior to completing the Economic Status Report form.