Glossary of Personal Allowance Terms
Care Manager - A person who helps people with developmental disabilities access necessary services and supports appropriate to their needs and life goals. Qualified service/care managers use a person-centered process to develop, implement and maintain an Individualized Service Plan (ISP) or Life Plan (LP).
Choice, personal spending - The ability to express preferences on the use of one's personal money. When people do not use words, preferences may be expressed through body language, eye contact, facial expression, nonverbal cues and behavior. The power to exercise this act of free will is a right guaranteed by statute.
Community Residence (CR) - An OPWDD certified semi-independent living situation. There are two types of CRs: 1) Supervised: that provide housing with staffing available 24 hours; and 2) Supportive: that are limited to three people, with staff support varying according to individual need. Both types are referred to as Congregate Care Level II by Social Security.
Developmental Center (DC) - A facility for the care and treatment of the developmentally disabled that is operated by OPWDD.
Developmental Disabilities Regional Office (DDRO) – OPWDD offices that are the starting point to apply for services. The DDROs each cover several counties and work with local voluntary agencies to improve access to and coordinate services within the region (“catchment area”).
Developmental Disabilities State Operations Office (DDSOO) - OPWDD offices responsible for providing both residential and non-residential State-Operated programs in one or more counties. These offices, in conjunction with Developmental Disabilities Regional Offices, provide specially designed person-centered assistance to each individual with developmental disabilities as requested by that person or by their family.
Disregard – See Income Disregard.
Earned Income Exclusion - The first $65 of gross monthly wages plus half of the amount over $65 is excluded for Medicaid and SSI purposes. The purpose of the exemption is to provide a working person with funds for work-related expenses.
Family Care - A licensed residential program that provides a structured and stable home environment within a family unit to a person with a developmental disability, offering support, guidance and companionship. Family care providers receive a monthly stipend to provide services within their homes. Family care is referred to as Congregate Care Level I by Social Security.
Income Disregard - Certain income is disregarded (subtracted) from an individual's gross countable monthly income. Disregards are established by statute or regulation based on the needs-based benefit program that the individual is eligible for (Supplemental Security Income and/or Medicaid) and the source of the income. Any remaining countable monthly income is compared to the appropriate income level for the benefit program and the individual's living arrangement.
Income, earned - Medicaid Definition: Income received as a result of work activity including wages, salaries, tips, commissions and income received from self-employment. SSI Definition: Wages from a job, whether in cash or another form, net earnings from a business if the person is self-employed, payments for services performed in a sheltered workshop or work activities center, royalties earned in connection with publication of the individual’s work, and honoraria received for services rendered.
Income, unearned - Medicaid Definition: Income that is paid because of a legal or moral obligation rather than current services performed. It includes pensions, government benefits, dividends, interest, insurance compensation and other types of payments. SSI Definition: Income received from sources other than earned income sources. Unearned income includes Social Security benefits, pensions, State disability payments, unemployment benefits, interest income and cash from friends and relatives
Individualized Residential Alternative (IRA) - A certified home for one to 14 people that provides room, board and individualized protective oversight. This is a type of Community Residence.
Individualized Service Plan (ISP)/ Life Plan (LP) - The Individualized Service Plan (ISP)/Life Plan (LP) is a readable and usable written personal plan. It summarizes the help a person who has developmental disabilities wants and needs to achieve their own goals in life. These personal goals are known as the person's valued outcomes.
Intermediate Care Facility (ICF) - A residential treatment option in the community for persons with specified medical and/or behavioral needs. ICFs provide 24-hour on-site assistance and training, intensive clinical and direct care services, professionally developed and supervised activities, and a variety of therapies. ICFs are designed for individuals whose disability severely limits their ability to be independent.
Living Arrangement – Living at home, or in an uncertified residence, and settings licensed by OPWDD to provide housing and related services, operated by either OPWDD or not-for-profit agencies. These settings include supervised group living (a home with 24-hour staffing and supervision), semi-independent (or "supported") group living (a home with less-than-24-hour staffing and supervision), and other residential options (typically, homes for 15 or more people with 24-hour staffing and supervision).
Medicaid - A medical insurance program for low-income individuals who are unable to pay for needed medical services such as care in a hospital, nursing home, or intermediate care facility; services provided by physicians and other enrolled medical/dental providers; day treatment; transportation to medical services; medication and medical supplies; services provided through OPWDD’s Home and Community Based Services Waiver and Medicaid Service Coordination/Care Coordination.
Medicare - Federal health insurance program for people aged 65 years or older, people under 65 with disabilities, and those with End-Stage Renal Disease. It includes 4 parts (A, B, C, D) that provide hospital, medical insurance, prescription drugs and other medical services. People with developmental disabilities may qualify for Medicare on their own, parents’, or spouse’s work record.
Net Available Monthly Income (NAMI) - For persons residing in ICFs, DCs, SRUs, specialty hospitals and nursing homes, the combined amount of earned and unearned income remaining after the calculation of personal allowance. This is the amount to be paid to the provider for cost of care.
OPWDD Certified School for the Developmentally Disabled - A residential facility for the developmentally disabled certified by the Office for People With Developmental Disabilities.
Overpayment - An overpayment occurs when a person receives more SSI or Social Security benefit money that was due. The amount of overpayment is the difference between the amount received and the amount due.
Planning team - those who provide person-centered care to the individual. The team must be comprised of the individual and/or their family member and/or their representative, Care Manager, primary providers of developmental disability services, primary physician and other providers either as requested by the individual and/or their family member and/or representative
Pledging - The prohibited practice of advancing money to an individual with the expectation of repayment from personal allowance monies.
Pre-need burial agreement - A contract in which money is paid to a funeral firm, undertaker, cemetery or other entity in return for specified services/merchandise upon the death of the person to whom the agreement pertains. Since January 1, 1997, for Medicaid and SSI to not count as an asset, the agreement must be irrevocable, meaning the individual pre-paid and now owns the services and items in the contract.
Rent - What the individual pays for rent in a congregate care setting. The rent is based upon the amount remaining from income after personal allowance has been deducted.
Representative payee - A person or an organization appointed to receive the Social Security or SSI benefits for anyone who cannot manage or direct the management of their benefits.
Revenue Support Field Office (RSFO) - Part of OPWDD’s Division of Enterprise Solutions, Revenue Support. There are nine RSFOs in New York State and each office develops and maintains benefits and entitlements for individuals served by their local DDSOOs. The RSFO is responsible for various revenue related support functions for individuals in Voluntary and State Operated programs.
Sheltered Workshop - A recognized program of training and rehabilitation for workers with disabilities.
Supplemental Needs Trust (SNT) - Special account for a person with disabilities who wants to protect income or resources, and who also wants benefits like Medicaid or SSI. A trust must be written properly to comply with state and federal laws. Monies from the trusts can be used to pay for items or services that Medicaid and SSI won’t pay for. SNTs can be used to protect an inheritance or money from a lawsuit, and help a person become financially eligible for Medicaid. What happens to the money in the trust when the individual passes away depends on how the trust was set up.
Social Security - Benefits/payments authorized by Title II of the Social Security Act. There are several categories of Social Security benefits through which a worker or certain family members of the worker may be paid benefits. These categories are Social Security Disability Insurance (SSDI), Social Security Retirement and Social Security Survivors.
Sponsoring agency - The operator of one or more family care homes. In the case of family care homes operated by OPWDD, the DDSOO is the sponsoring agency.
Supplemental Security Income (SSI) - A program established under Title XVI of the Social Security Act and administered by the Social Security Administration to provide monthly payments to adults who are blind, disabled, or age 65 or older and who have limited income and resources.
Supported employment - This service enables an individual with a disability to work in the community rather than in the sheltered workshop environment.
Third-Party Health Insurance (TPHI) - A contract or agreement whereby an individual, institution, corporation, public or private agency is or may be liable to pay all or part of the cost for medical care or services furnished to a person. An example is health insurance provided by an employer.
Underpayment - An underpayment occurs when monthly benefits were due and not received or the benefit payment is less than the amount due.