This section discusses different ways in which personal allowance can be spent. This is not all-inclusive. The person may spend their personal allowance on many different items and services. This section is designed to provide some ideas and things to consider. Questions can be referred to your local Revenue Support Field Office (RSFO). Contact your regional office to reach your RFSO.
Entertainment & Dining Out
What a person spends on entertainment should be based on their preferences. Many people like seeing a movie and eating out with their friends. Rather than taking everyone from a residence out in one large group to see the same film, it is better if each person uses their personal allowance to choose a specific movie they want to see with one or two close friends. Others may prefer a live concert, a Broadway show, a sporting event or a county fair.
Consider opportunities that involve sensory experiences. The sights, sounds, smells and tastes of the neighborhood are a good place to start. Individuals may enjoy the fragrance of a perfume counter, and the feel of lotions and creams from bath and body stores. Going to a local bakery can involve all the senses. Attending local festivals and fairs can provide chances to try new foods, hear new music and meet new people. Repeat trips also offer a good opportunity to become a valued customer.
People can experience many sensory experiences when they become regular customers at spas where they can enjoy a manicure, facial, or massage. Even those who like their “own space” may enjoy the relaxation and soft touch of these experiences. Spas and hair salons can provide sensory experience, interaction with community members, relaxation and can make a person feel good about themselves. Receiving compliments on a new hairstyle or manicure can make the experience even more rewarding.
For those who like bright lights, think about going to the local arcade or dance club, or to fairs and other events that offer fireworks displays. Personal allowance may cover admission fees to these places and events. A person can buy tickets to films or shows that offer different sights and sounds, but the event should match the person’s interests and preferences, and their ability to sit for an extended period.
People who enjoy music can attend concerts in the park or local theaters and purchase music for enjoyment at home. If people enjoy watching TV, look for something that can make their TV time more fun, like a special chair, DVDs of their favorite shows, or special snacks for different shows. For someone who likes making music, try to arrange music lessons in the community from a music student or local instructor.
Be creative! If someone enjoys listening to music, expand on that: try attending a concert, local production of a musical, or renting/purchasing a musical instrument to discover other ways to explore music. Someone who likes shopping may enjoy a local craft fair. Personal allowance can be used to allow someone to expand their experiences and develop new interests. It is appropriate to use personal allowance to try new things as well as pursue current interests.
Residential agencies are required to supply basic cable service to residents. This is typically provided in common areas, such as a living room. The cost associated with providing cable in a common area is the responsibility of the residential agency.
Individuals may also request cable service in their bedrooms. In this case, it is appropriate to use personal allowance funds to pay for the increase in cable costs (if there is one) associated with providing service in the bedrooms. When there are additional charges related to cable in a bedroom, the personal allowance may typically be used to pay the additional charges. Because there are a variety of plans and cable companies statewide, this manual can’t cover every possible situation. If there are no additional charges to have cable available in a bedroom, the provider may not charge the person for any portion of the service.
If several people in a house request to share the cost of additional channels, such as premium channels or sports passes, the agency must ensure that they follow the prior approval rules regarding group purchases. In that case, for premium cable channels or sports passes to be considered an appropriate use of personal allowance funds, all the criteria for group purchases must be met. These criteria are outlined in the group purchases section of this manual. The agency must be able to clearly distinguish between the fees for services and items they are required to provide and the fees individuals pay for the enhanced service.
When a person is hospitalized, they may request TV service in their hospital room. This may be an appropriate use of personal allowance if it is the individual’s choice and for their entertainment, not at the request of staff. TV for entertainment is not a medical expense, even if it is viewed in a hospital room.
As with any planned expenditure from personal allowance, the PEP should be revised as necessary to reflect a recurring expense related to cable, if applicable, so that the funds are available for paying the bills when they are needed. As a reminder, providers cannot pay the bill and reimburse themselves from an individual’s personal allowance; rather, the agency should establish a method of setting aside money from the person’s personal allowance each month so that the money is available when the bills are due. Any arrangement of this nature must involve the person and members of the team.
Personal allowance can be used for dining out in a restaurant with preferred or ethnic foods and specialties. Personal allowance can be used for meals while shopping with friends or family, and it can be used to support people going to breakfast, lunch, or dinner with friends and family. People can become regulars at a local lounge, club, café or coffeehouse.
While personal allowance can be used for meals out, it CANNOT substitute for the three daily meals and snacks the residence is required to provide. If the person needs special foods because of nutritional requirements, this is the agency’s responsibility. If the person is supposed to be on a low-calorie diet, the agency should bear the cost of food, even if it is pre-packaged, frozen meals. If the person has no medical condition that requires a specific diet but just likes a particular frozen dinner, they can use personal allowance to purchase their choice of meals. The residence should seek to purchase the types of foods the people living there like, but personal allowance can be used for special items that would not normally be purchased.
If a person wants to dine out and can express their desire to, it is appropriate for that person to use personal allowance to pay for the meal. If the person is unable to express preferences, the guiding principles are those of prudence and the person’s best interest. Care should be taken to guarantee that there is no inappropriate use of the individual’s funds to pay for dining out, such as over tipping, paying for others’ meals, going to an overly expensive restaurant when someone has limited funds or a restaurant without options to meet their dietary requirements.
Personal allowance CANNOT be used for dining out when the person has no choice. For example, if everyone living in a residence is going out for pizza in August because it is hot and the staff does not want to use the stove or oven due to the hot weather, personal allowance may not be used. However, if people decide to go out for pizza because that is what they want to eat for dinner and the staff is prepared to provide a meal at home, then personal allowance can be used.
Inappropriate uses are:
- Dining out solely for the ease of the staff
- Spending the person’s funds in an unequal manner (e.g., Carlos pays extra to cover the costs of Sam’s meal)
- Reimbursing staff for money loaned to an individual to cover the cost of their meal (staff is prohibited from loaning money to individuals)
- Spending personal allowance on food or dining out that the person did not choose
- Spending personal allowance on food needed to meet a person’s nutritional or dietary requirements
Personal allowance can be used to host a party if the individual receives a benefit from doing so. The individual should enjoy parties, invite people of their choosing and the food, entertainment, venue and decorations should reflect their preferences. Personal allowance can be used to purchase food for the person and their guests while hosting a party, not for staff. The PEP should reflect the planned expenses for parties as well. Documentation of the person’s preferences and benefits from hosting a party should be maintained.
Decorating/Customizing Personal Space
Decorating a person’s room is one of many ways to use personal allowance. Décor can reflect a person’s unique interests, style and experiences. The residential agency is responsible for the basic furnishings of the person’s bedroom. The individual’s personal tastes should be considered when staff selects items such as the curtains, bed linens and the bedspread, even when the agency’s funds are used for the initial purchases or when replacements are needed. The individual’s personal funds can be used if their taste changes after the room is furnished, not if the furnishings must be replaced because they are worn out.
The residential agency must provide basic furniture. If the person or their advocate wants to buy special furniture to better reflect the person’s likes, the personal allowance may be used. If the personal allowance is used to purchase special furniture for outdoor use, such as a swing, the item must be portable and able to be moved if the person moves. Before buying the item, factor in the cost by reviewing the person’s expenditure plan. Determine if the furniture purchase will negatively affect the other items in the person’s plan. When personal allowance is used to buy furniture, the person should be involved in choosing the item in a community store and take part in the purchase.
Personal allowance should not be used to decorate common space in the home. It should not be used for items in the common area that are not dedicated to the person’s use. The individuals’ funds cannot be used to purchase basic furniture (e.g., a couch) for the common area.
Things to think about when considering the use of personal allowance for room décor are:
- The person’s interests
- Their favorite color
- The types and styles of collectibles they have or want
- Their preference or participation in sports and teams
- Their hobbies
Personal allowance can be used to:
- Buy flowers
- Start or add to a collection the person can display in their personal space (e.g., model cars or trains, figurines, or baseball caps)
- Show the person’s interest in a team or an artist with posters and pennants
- Purchase, enlarge and frame photos, favorite pictures and artwork, as these can add to each person’s story
- Buy a TV, DVD player, tablet, or computer for the person’s room
Keep in mind that when purchases are made in the person's neighborhood, they will be a valued customer with purchasing power in the community.
Be sensitive to the person’s ethnicity. For example, if a person responds when family or caregivers speak in Spanish, support purchases at stores with Spanish-speaking vendors. The person may shop at neighborhood bodegas.
Travel, Vacations and Trips
Vacations are a great way to use personal allowance when tailored to the person’s interests. You may want to consider vacations that lead to one-on-one interactions with members of the community or visits to families and friends. Travel and vacations to places or attractions that the person enjoys are good options to explore. Some not-for-profit travel organizations offer vacation packages customized for people with disabilities. Personal allowance can be used to pay for a trip arranged by one of these organizations.
Personal allowance can pay the travel expenses of family or friends coming to see the person where they live. You must document that the individual will benefit from seeing the family member or friend. The costs involved must be reasonable and must not negatively impact the person and their normal activities. If possible, the family member or friend should pay the travel expenses and then submit receipts for reimbursement. Cash advances should be used only as a last resort and the family member or friend must agree to return receipts along with any unspent money. If they do not return receipts after the trip, future requests for cash advances should not be granted.
If a person goes on vacation with a certified family care provider, the amount paid by the individual is based on how much that person shares or consumes during the vacation (see example 2 – Travel and Vacation).
If a person attends public school, and their class is going on a trip, personal allowance is an appropriate source for activity fees unless the activity is listed in the person's Individualized Education Plan (IEP).
If someone goes to bingo, on a scout outing, or a field trip organized by their garden club, personal allowance can be used for fees connected with those trips. Personal allowance should not be used for activities in day habilitation where the fee is built into the agency rate or for an activity or service required in the person’s ISP/ Life Plan.
For State employees, no expenses can be paid from personal allowance funds.
A voluntary residential agency may be able to use the person’s saved Social Security and/or SSI funds for out-of-pocket staff expenses. You must obtain prior approval from Social Security for expenses over $100 per person. Staff salary, benefits or fringe benefits cannot be paid or supplemented from personal allowance.
In the past, allowable expenses have included:
- Companion tickets on transportation
- Admission tickets
- Cost of the portion of the hotel room apportioned to the staff
If one staff person will be overseeing two or more people on an outing or vacation, the staff out-of-pocket expenses should be divided equally among all participating individuals.
Example 1 - Travel and Vacation
Ron and Shawn live in an IRA. They took two short vacations with the voluntary agency in an agency-owned van and paid expenses that were questioned during an audit. The expenses for the trip were equally divided by the number of people in the van. The expenses included repairs to the van, cab fare to and from the stalled van, tires, a fire extinguisher for the van, a repair to the lift cable on the trailer, oil change, etc. There were also receipts for food and snack items eaten during the rides. Some of the items may be appropriate uses of personal allowance and many others are not appropriate. The expenses related to the breakdown and repair of the van are the sole responsibility of the owner of the van – in this case, the voluntary agency. Those expenses must not be shared with or spread among the individuals taking the trip. The snacks that were purchased may be an appropriate use of Shawn’s and Ron’s personal allowance if they chose the snacks and ate them.
Example 2 - Travel and Vacation
Carol lives in a family care home. Her family care provider, spouse, children and Carol go on a vacation to a theme park in Florida by car. The guidelines for an appropriate share of costs follow. Carol should pay for her proportionate share of any items shared by all the travelers. Anything used by Carol only, she pays for herself. Since they are all riding and sharing in the car to Florida, gas, tolls and parking expenses are split equally. The provider would pay 5/6 of the costs and Carol 1/6. If they are sharing hotel rooms, the same applies. If Carol has her own room, she pays for her room. Meals depend on the circumstances. Any restaurant meals eaten by Carol on the trip are her responsibility. Meals eaten by the provider and the family are the provider’s responsibility. If the group prepares meals together (BBQ, meals in a kitchenette), the provider pays for the cost of the meals for the family and for Carol. For the admission tickets, Carol is only responsible for her own ticket. The provider is responsible for tickets for themselves and their family members. If Carol wants to buy a souvenir, she pays for the souvenir. The provider is responsible for souvenirs that they or their family wants. If they all rent a boat together, that cost is proportionally shared. If they rent bicycles, Carol pays for her own bike and the provider pays for the bikes used by her family.
Transportation is all about getting people to and from work, recreational sites, family visits and other events and activities in the community. Typically, the day or residential habilitation program is responsible for transportation, but what about situations outside of the ordinary? When can personal allowance be used and when can it not be used?
For the most part, personal allowance cannot be used for transportation. Programs must pay the transportation expenses related to program activities. Vacations and day trips that are not included as part of a formal plan are an exception, as these transportation activities are not related to program activities.
Generally, only personal allowance derived from the exempt portion of wages can be used for transportation to and from work. The earned income exclusion ($65 plus half the remainder of gross wages) is to be used for work-related expenses such as uniforms and transportation. If that amount is insufficient to cover travel to and from work on public transportation, personal allowance funds must not be used. These excess expenses are the responsibility of the residential provider. If the person is living in a family care home, it is the sponsoring agency’s responsibility to pay the excess transportation costs. However, if an individual does not want to use the transportation that the residential agency provides and chooses different transportation, the individual’s personal allowance funds may be used. The agency must seek alternatives to reduce cost.
Another aspect of transportation involves a person’s moving expenses. Costs associated with moves between living arrangements that are within the jurisdiction of the DDSOO or residential agency are the responsibility of the DDSOO or agency. The residential agency a person is moving from is responsible for moving expenses when someone moves to a certified living arrangement with a different agency.
If the person lives in a certified living arrangement and is moving into a non-certified living arrangement, moving expenses are the responsibility of the DDSOO or residential agency that the person is leaving. Moving Assistance and/or Community Transition Services (CTS) funding may be available to assist with expenses for setting up housing for individuals who are HCBS Waiver enrolled. Funds under these waiver programs are limited; and after being used for other allowable expenses, there may not be enough remaining to cover all moving expenses. Therefore, if waiver funds are not available to the individual or if the person’s moving expenses exceed the amount of funds available to the person, the DDSOO or residential agency the person is leaving is responsible for paying the balance.
Example 1 - Transportation
Anthony works about 5 miles from his residence in a certified program. The program provides transportation by bus, which he can use. However, he does not like the bus and wants to take a taxi. The cost of the taxi may be more than the earned income exclusion portion of Anthony’s wages. His residential provider argues that this is a matter of choice and that it is Anthony’s responsibility. Anthony’s advocate says that the certified program is responsible for the cost.
In this situation, Anthony can pay for the taxi out of his personal allowance because transportation is available, he is able to use the bus and he is opting to use alternate transportation. His preference to use a taxi has nothing to do with his disability. The agency should try to find an alternative, such as a volunteer service or car-pooling, to help cut costs.
Example 2 - Transportation
James is employed at a local bakery. There is a local taxi service that provides accessible transportation. James is unable to take public transportation because of his disability. James can use the amount of his earned income disregard ($65 plus half of the reminder of gross wages) to pay for his transportation costs to work. His residential provider must cover the cost in excess of the earned income exclusion.
The cost of his transportation may be considered as an Impairment Related Work Expense (IRWE) for Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or Medicaid eligibility. The Social Security Administration makes the determination for SSDI or SSI benefits, and the Medicaid district makes the decision for Medicaid applicants/recipients. The person must pay these costs out of pocket to qualify as an IRWE. Information on IRWEs can be found in the Benefit Development Resource Guide available on OPWDD’s website.
Example 3 - Transportation
Jenny lives in a certified residence and the agency handles her personal allowance. Her mother bought a van for the sole purpose of transporting her. The van’s air conditioning broke, and it will cost about $850 to repair it. Per the care manager, Jenny is willing to pay for the repairs and has enough money. She understands what money is and can decide what to buy. As much as Jenny may want to help her mother, it is inappropriate to use personal allowance to pay for the van repair because it is the responsibility of the person who holds the title to the vehicle to pay for any repairs.
Gift-giving is a normal part of life. While the people we serve may want to give gifts like others around them, care must be taken to protect their interests.
Use of personal allowance for gifts depends on the person’s ability to understand the purchase. If the person cannot participate in the decision and cannot consent to the gift, personal allowance money cannot be used unless it is clear that the individual will benefit in some way from the gift-giving as described below. As people communicate and participate in decision making in various ways, staff should be aware of the individual’s abilities. How a person is involved in gift-giving and how they agree to the gift must be documented.
Gift-giving should be included in the person’s expenditure plan. When writing the PEP, carefully consider the reasonable value of the anticipated gifts. There is no specific dollar amount to define “reasonable” in terms of gift-giving. The sample PEP includes gift-giving so the team and person can consider this use of personal allowance. By involving the planning team, the person can receive appropriate guidance for gift-giving.
Personal allowance can be used to buy gifts for family members if the person is involved in the decision. The person must be able to give meaningful consent regarding the use of personal money for a gift. Sometimes family members will ask for personal allowance to be used for presents for other relatives, even when the individual cannot participate in the decision. A family may give residential staff a shopping list of gifts for family members, stating the person would want this if they were able to participate in the decision. Often, the family is actively involved with the individual, and staff members don’t want to offend the family by saying no. For gift-giving to be appropriate, the individual must benefit from the gift-giving process and should participate in the gift selection as much as possible. One way to tell if the person is benefiting from giving gifts is by the person’s facial expressions or other nonverbal communication when the gift is given and opened. The person’s personal allowance funds should not be used if there is no benefit to the individual.
Some people residing in family care homes want to give presents to the provider and their family members on birthdays and holidays. Gift-giving is normal in a family; thus, it is not prohibited in family care homes. However, gift-giving by individuals to providers is not encouraged. Gifts to State employees are strictly prohibited by the New York State Public Officer’s Law.
Personal Allowance may be used for gifts when:
- The Care Manager or advocate is involved in decision making
- The provider does not ask for the gift
- The gift is not intended to gain favor with the provider
- The provider is not a State employee
If a person is close to a long-term voluntary agency staff member, using personal allowance for a gift may be allowed, IF all the following criteria are met:
- The person must be able to participate in the gift-giving decision process
- The gift must not have been solicited or encouraged by the voluntary agency or staff member
- The gift is not extravagant
- The gift cannot be intended to gain favoritism of a staff person and result in different treatment from peers
- The staff person is not a State employee working for OPWDD
Personal allowance can be used to promote community involvement via membership in associations and societies, through worship and participation in clubs or other interest groups. If there is a club that matches the person’s interests or preferences, personal allowance can pay for expenses related to those clubs and interests. This includes:
Membership dues for an organization, including a health club
- Subscriptions to an associated newsletter, magazine, or periodical
- Donations toward meeting expenses of an organization (e.g., coffee/lunch donations)
- Supplies for a craft or hobby – either at a store or another location where supplies might be available
- Classes at a local high school, college, or continuing education program
- Contributions to local causes and associations where people will meet others who share their interest or hobby (e.g., house of worship, drama club, or volunteer fire department)
If a person wants to donate to a charity or organization to support a cause, they must be able to participate in the decision-making process and agree to the donation. The annual personal expenditure plan should include these charitable donations. Donations must never be made to groups, individuals, or organizations that provide services to the person. This includes staff, State agencies and voluntary agencies.
If a person receives services from an agency and wants to go to a special ticketed event or fundraiser for that agency, they can use personal allowance to buy a ticket. The person must pay an amount equal to only the value they will receive. For example, if the ticket price to an event is $50, and $20 is the cost for dinner, the person pays only $20. The individual does not receive the $30 tax deduction that donors who paid $50 would receive. Their ticket should look like all other tickets, and they should receive the same benefits at the event that everyone else does.
Example 1 - Associational Life
Jim’s aunt is his advocate. She told Jim’s care manager that she thought Jim wasn’t getting enough exercise. Jim’s aunt wanted to know if a personal trainer would help Jim exercise more. She also wanted to know if his personal allowance could pay for the trainer. This is an acceptable use of personal funds if it is Jim’s choice and it is not medically necessary. Jim, his aunt and his care manager talked about him exercising with someone who could make working out more fun and teach him about the equipment at the local YMCA. They looked at his expenditure plan and decided that Jim had enough funds to pay for a trainer once a week and would still have enough for the other activities in his plan. Jim and his care manager found a trainer that he liked and he is now enjoying working out more.
Example 2 - Associational Life
Sheila is a staff person working at Stephanie’s day habilitation program. She also operates a dog rescue foster home. Stephanie loves dogs, but can’t have one since her roommate is allergic. She always asks Sheila about her dogs and wants to see pictures. Sheila is prohibited from accepting monetary donations from Stephanie and other people to whom she provides services. Stephanie can volunteer time helping to care for the dogs at Sheila’s or donate to another dog rescue.
Clothing is one way people express who they are. Personal allowance may be used to buy clothing that reflects a person’s individual tastes. Before shopping for clothes with personal allowance, the provider needs to ensure that the basic requirements have been met.
Every person in a certified residential setting must have a clothing supply that is in good repair and which ensures that they are outfitted daily in clean clothing, appropriate to the season, to the occasion and to their age, sex and size. Appropriate sleepwear is also required. The residential agency is required to pay for or provide laundry and dry cleaning of the basic clothing supply that the agency bought. Clothing purchased by the residential service provider is the responsibility of the agency. Items bought with personal allowance can be dry-cleaned using personal allowance.
Funds for clothing in ICFs, DCs, SRUs, OPWDD-certified schools and specialty hospitals are incorporated into the overall rate.
In Voluntary Operated Community Residences, Voluntary Operated Individualized Residential Alternatives, and both State and Agency Sponsored Family Care homes, OPWDD provides funds twice a year for each person for clothing, recreation and incidental expenses. This money must be used for clothing before personal allowance funds can be used.
The “clothing allowance” is not exclusively for clothing and can also be spent on items such as cultural events, trips and incidentals. These funds:
- Do not belong to the person
- Must not appear anywhere in the personal allowance account ledger
- Must not be commingled with the person's own funds
- Must be accounted for on a ledger separate from the individual’s personal allowance ledger
- Must be forwarded to the new provider if a person moves to another certified residence and there is a balance remaining
- Must be returned to OPWDD’s Central Operations unit if the person is unable to use them
Personal allowance funds may be used to purchase clothing for a person, subject to the following restrictions:
- All current and foreseeable future needs are met
- if the person resides in a Voluntary Operated Community Residence, Voluntary Operated Individualized Residential Alternative, or Family Care home, the funds provided by OPWDD must have already been used
- In all instances, the last $100 of a person's available personal allowance cannot be spent on clothing
When a person shops for clothing using their personal allowance, they should be involved as much as possible in choosing what clothes to purchase. The person can use their personal allowance to buy clothing that is:
- Trendy or fits in with people in the community
- From a neighborhood store where the person can interact with other members of the local community
- Shows the person's support for a team, a hobby, or other individual preferences
- For a special event, such as a family reunion, funeral, wedding, or party
- from a shop that expresses the person's ethnic, linguistic and cultural heritage
- A souvenir from a vacation or event
- Personal allowance can also be used for sunglasses, jewelry, hair or nail accessories, handbags, or other items the person chooses that support their own style and make them happy with how they look when they go out.
Example 1 - Clothing
Lucy wants to purchase a pair of designer brand jeans from a local boutique. She has a supply of clothing, including a pair of jeans, but likes how she looks in the trendy designer jeans and likes shopping at this boutique. She has sufficient funds to make this purchase and can use her personal allowance. In this instance, the PEP should reflect that Lucy prefers designer jeans and enjoys shopping locally at this boutique.
Example 2 - Clothing
Debbie lives in a certified residential setting. Her parents and sisters live nearby and visit Debbie often. Debbie and her sisters like clothes, and she enjoys shopping with them to search out the best bargains. She often comes home with a new purchase to show off. Last week, Debbie used her personal allowance to buy a new winter coat for herself, even though one was already purchased for her by the residential agency. The new wool coat fits her well and is very stylish, but it will need to be dry-cleaned at the end of winter. Debbie’s personal allowance may be used to pay for dry-cleaning for the new winter coat she bought with her own money because she chose to buy her coat in addition to the coat that was purchased for her by the agency.
Example 3 - Clothing
Ray has been invited to a family member’s wedding and he wants to attend. The wedding is formal and he wants to purchase a new suit to wear to the event. There is a local store where he prefers to shop, and Ray finds a suit he likes there. Ray can use his personal allowance to buy the suit; and after the wedding, pay for the dry-cleaning costs to keep his suit in good condition.
The type of residential setting a person lives in determines whether personal allowance can be used to pay for haircuts.
If a person lives in an ICF, DC or SRU, haircuts are included in the residential program’s rate. If a person lives in an IRA, CR or family care, a personal allowance may be used.
If a person needs to go to a podiatrist for foot care such as trimming nails, personal allowance cannot be used. Someone who chooses to go to a salon or spa for a pedicure may use personal allowance.
Burial planning can be a part of the person’s overall expenditure planning. If all current and upcoming wants of the person are being met, it is acceptable to use personal allowance to establish a burial fund, burial agreement, or purchase burial space items. Burial planning is one of the lowest priorities for personal allowance because improving a person’s current quality of life is more important.
There are several different ways to plan and save for funeral expenses. Additional information is available in the Benefit Development Resource Guide.
Burial funds are easy to establish. They can be comprised of money set aside at the residential agency or in a separate bank account for burial-related expenses. Burial funds, up to $1,500 in principal (plus accumulated interest), are exempt resources for Medicaid and SSI. For the burial fund to be exempt from countable resources, it must be clearly identified as a burial fund and cannot be commingled with other funds. Typically, the residential agency’s business office can help set up and add to the burial fund.
A pre-need funeral agreement also called an irrevocable burial trust (IBT), has no maximum exemption amount for Medicaid and SSI if the agreement is set up correctly and contains specific language related to Medicaid. The agreement can cover all the details of a person’s burial and funeral and is arranged with the help of a funeral home. Consider including a statement in the agreement that if the individual dies before the arrangements are fully paid, the services and items will be renegotiated.
Certain burial space items are exempt as a resource for Medicaid (e.g., plot, vault, casket, headstone, urn).
Burial funds, burial agreements, and burial space items should be considered when creating or revising the annual PEP, but only after all the person’s other interests have been considered. Burial funds, burial agreements and burial space items can also help to maintain a person’s entitlement to government benefits as a way of protecting their resources.
Personal Restitution for Damages
Sometimes a person damages items that belong to someone else. Personal allowance can be used to help pay for damages, but only if it is included in the PEP and documented that:
- If the damage was caused by inappropriate behavior, the residential agency has addressed the person’s inappropriate behavior; and
- The expenditure planning team has determined that financial restitution is appropriate and has meaning for the person; and
- The person’s representative payee, if other than the director of the residential agency, has given written agreement for the person’s personal allowance to be used for restitution; and
- A human rights committee formed under 14 NYCRR 633.16 (f), or a part of the committee, responsible for protecting the individuals’ rights, has approved the time-limited use of the personal allowance for restitution.
Restitution for damages caused by an individual is not a legal obligation.
Example - Personal Restitution for Damages
Stefan lives in a Voluntary Operated Individualized Residential Alternative. He has an older brother, Joe, who takes him skateboarding at a nearby terrain park. Stefan is athletic and aggressive when skateboarding. He likes to be able to keep up with his brother and learn new tricks.
One afternoon, when Joe came to take him skateboarding, Stefan discovered that his board was cracked and couldn’t be fixed that day. Not wanting to miss a chance to be with his brother, Stefan borrowed a skateboard from another individual. While using the board to do tricks at the park, Stefan crashed and broke the rear wheel assembly.
When he returned home later that day, Stefan was sorry that he had broken his housemate’s board. Stefan offered to pay to have the board fixed or replaced at a nearby repair shop. All the people involved in Stefan’s care had to agree that he could use his personal allowance to pay for the board. Stefan needed to understand that paying for the board meant that he wouldn’t have that money available for other things for the rest of the month. Both his representative payee and the committee for the residence also had to agree that Stefan’s personal allowance could be used.
Personal allowance may be used for legal expenses in certain situations. It can pay for guardianship fees, but the fees must be such that the person still has enough money to meet other current and foreseeable wants. SSA guidelines on guardianship fees are valid for all guardianship situations (not just where personal funds are due to saved Social Security or SSI funds). These guidelines allow fees if the guardianship is in the best interest of the person. Fees are not allowed if any of the following are true:
- The guardianship is for the convenience of the provider
- The guardianship petition is denied by the court
- The person’s funds will be depleted by fees to the point where there are unmet personal wants
- Personal allowance can be used to meet legal obligations such as child support and fines imposed by a court of law.
Personal Allowance may be used to support an individual’s dependents if all current needs are met for the individual. Title II Social Security benefits allow for the support of dependents. For SSI recipients, the agency should get prior approval from SSA to use personal allowance from SSI to support a dependent.
Anyone with the capacity to do so can execute a Last Will & Testament and choose what will happen to their property. If a person wants to establish a Will, documentation should support their ability to make this decision and be reflected in the PEP. If they name an agency that serves them in their Will as a beneficiary, there should be strong documentation of the person’s capacity and choice. The agency cannot encourage or solicit the person to include them as a beneficiary in their Will. The circumstances associated with the creation of the person’s Last Will & Testament may be subject to scrutiny.
Group purchases are usually made when most of the people in a certified residence want to buy a certain item to share. Group purchases have been used to buy large screen TVs, DVD players and sewing machines. The representative payee or agency handling personal allowance must follow many requirements before making a group purchase. Failure to follow these requirements could result in the agency being forced to pay back the people who bought the item.
If any portion of the personal allowance funds to be used are from Social Security or SSI benefits, your local Social Security Field Office must approve the decision to pool the personal funds of several people to purchase an item for the group. Requests for prior approval must be made in writing and must be approved before spending the group’s money.
It is important to document that all the requirements below have been met before a group purchase can be made:
- The group purchase must meet the common desires of the entire group (not just a few members of the group), the item must meet a specific want of each person in the group, and it should help to enhance each person’s life
- The cost of the item must be divided among the purchasers in proportion to their use of the item
- Everyone in the group must be able to participate in the decision-making process and be willing to have their funds used for such a purpose
- Everyone participating in the group purchase must have a balance in their account equal to at least 2 months’ benefits after the purchase (SSA may, at its discretion, waive the 2-month requirement)
- If a person has unmet needs, they should not participate in the group purchase
- If an individual’s personal allowance is needed for something else that is more important, the person should not participate in the group purchase
- The item cannot be something that the residential agency, Medicaid, Medicare, or any other service provider should be supplying
- Any person expected to leave the residence soon should not participate in the group purchase or must be able to benefit from the purchase to an extent at least equal to the value of their contribution
SSA recommends that if a person moves unexpectedly, the representative payee should pay back the person a reasonable amount based on how much they paid toward the item. If an item purchased by the group needs repairs, it is the responsibility of all individuals involved if everyone still uses the item and agrees to the repairs. If someone doesn’t want to use the item anymore, they can request not to pay their share of the repairs; however, they no longer can use the item.
Group purchases are not encouraged by OPWDD. Although they are not prohibited if the above criteria are met, the practice can result in vulnerabilities for the people we serve and risks to OPWDD service provider agencies.
Example - Group Purchase
Greg, Nick and Jordan all live in the same Voluntary Operated Individualized Residential Alternative. They all share a common interest in video games. They decide to purchase a gaming system which allows multiple people to play at once. One year after the system is purchased, it starts to overheat, and staff realizes the fan on the system is not working. The fan must be replaced, which will cost $60. House staff consults with Greg, Nick and Jordan to let them know it must be fixed to continue playing and will cost them each $20. Greg informs the staff that he no longer enjoys playing video games and doesn’t want to pay for the repairs. Nick and Jordan agree to pay $30 each for the part to be fixed. Going forward, Greg no longer uses the gaming system, but Nick and Jordan are still able to play.
Social Security Administration Prior Approval
SSA Prior Approval must be obtained to use Social Security or SSI benefits for group purchases or for voluntary agency out-of-pocket staff expenses exceeding $100 to accompany a person on a vacation or outing. The $100 level is for the entire outing, whether for an afternoon or a month’s vacation. Information on prior approval requests for group purchases is contained in the group purchases section.
Out-of-Pocket Voluntary Agency Staff Expenses
The information below does not apply to State staff. Personal allowance cannot be used for any State staff expenses.
Per OPWDD regulations, personal allowance funds may not be used for the out-of-pocket expenses of voluntary agency staff accompanying an individual on an outing, unless the following two criteria are met:
- Prior approval for large expenditures (e.g., vacation or overnight stays) from the Social Security Administration (SSA) has been granted, and
- The person is able to make this decision
If the situation meets the exception conditions stated above, the voluntary agency must follow the process provided below to obtain prior approval from SSA unless the voluntary agency staff out-of-pocket expenses are less than $100.
Prior approval requests for use of personal allowance funds to meet out-of-pocket staff expenses must include the following information:
- The person’s name and Social Security Number (SSN)
- A description of the trip or recreational activity, including a list of the expected out-of-pocket expenses for the person and accompanying staff member(s)
- A statement that the person’s current and foreseeable needs are met, payment for the staff expenses will not deplete the person’s funds, and their personal account balance will equal or exceed 1 month of the individual’s full Social Security/SSI benefit amount after the deduction for the trip
The requests must be sent to the manager of the SSA Field Office that oversees the residential agency. The request should be sent at least 4 to 6 weeks prior to the trip. If a request must be made under time constraints, the request should include an explanation of the need for a quick decision. Please be aware that SSA staff may not be able to handle rush requests.
SSA prior approval is at the discretion of the Social Security Administration (SSA) and if SSA does not approve, the voluntary agency can submit a written request for reconsideration, including an explanation, to SSA.
The SSA written prior approval must be retained on file. Each person’s file should be documented with receipts and/or vouchers for every amount deducted from personal funds. If the person is using funds from a source other than Social Security or SSI, prior approval from the SSA is not necessary. If funds are co-mingled with Social Security or SSI, the prior approval process must be followed. This prior approval process also does not apply when all the funds used for the vacation come from a Supplemental Needs Trust (SNT); however, money taken from an SNT may not be given directly to the individual to pay for vacation expenses. The trustee must directly pay hotel and restaurant charges, or a credit card can be used if the trustee pays the credit card bill from the SNT.
Sample Prior Approval Request
(Name and Address of Voluntary Agency)
Request for Pre-Approval
Individual’s Social Security Number:
Description of Activity/Trip:
Anticipated Out-of-Pocket Expenses:
Total Cost to Individual:
Example: How activity/trip would be in the “best interest” of the individual. Payment for the above expenses will not deplete the individual’s funds. After the deduction for the trip, the personal account balance will equal or exceed one month’s Social Security/SSI benefit. Provide the personal account balance after proposed expenditures. All the individual’s current and foreseeable needs will be met.