To determine whether a consumer must participate in the cost of services and if the consumer has the financial ability to do so, use the following four-step procedure:
Step 1 - Determine the Requirement to Participate
When determining whether the consumer is required to participate in the cost of services:
- consider the monthly net income and liquid assets of:
- the consumer and the consumer's spouse; and
- the consumer’s parents (or foster parents, legal guardian, or conservator), if the consumer's parents claims the consumer as a dependent for purposes of federal income taxes; and
- compare the consumer's (combined with the parents’, if appropriate) monthly net income and liquid assets with the basic living requirement (BLR) levels. See Chapter 5: Application, 5.7 Basic Living Requirements for more information.
Step 2 - If Consumer Refuses to Disclose Income
Consumers have the right not to disclose their financial information. However, when a consumer declines to provide this information, you must assume that the consumer has resources that exceed the BLR level after including any allowable BLR additions. In such a case, the consumer must fully participate in the cost of planned services, except for the costs listed in 8.7 Services Exempt from Consumer Cost Participation.
Step 3 - Get Proof of Income and Expenses
When a person applies for services, request documented proof of:
- income (exclude any payment in-kind, such as food stamps or housing subsidies);
- liquid assets (cash, plus assets that are easily converted to cash);
- expenses; and/or
- any allowable additions to the BLR.
See 5.6 Types of Income, Liquid Assets, and Required Proof.
A person eligible for Social Security disability benefits (Supplemental Security Income or Social Security Disability Income) must provide only proof of Social Security eligibility.
When a parent claims the consumer as a dependent on the parent's income tax, get proof of income and expenses from both the consumer and the consumer's parent.
Step 4 - Calculate the Consumer's Contribution
The amount that the consumer pays for goods and/or services is the amount that the consumer's liquid assets exceed the BLR level, after including any allowable BLR additions. The consumer pays the amount monthly.
The consumer must contribute the difference between the consumer's monthly net income and the BLR level after including any allowable BLR additions. The consumer's contribution must not exceed the cost of the goods and services.
Inform the consumer that failure to provide complete and accurate financial information violate federal and Texas law and results in a denial or delay of services.
If you determine that the consumer must participate in the cost of goods and/or services, then:
- inform the consumer that he or she must pay the service provider directly; and
- document in ReHabWorks that the consumer understands.