1570 Supplemental Security Income (SSI) for Children in Foster Care
CPS May 2021
Supplemental Security Income (SSI) benefits are based on financial need and disability. Benefits include monthly maintenance payments and Medicaid coverage. If a child is receiving SSI Medicaid, DFPS puts the child on a foster care-related Medicaid with Star Health coverage unless the child is in a placement that requires SSI Medicaid to cover the cost of care or to pay for the placement. This does not affect the SSI payment.
The regional CPS SSI coordinator applies for SSI benefits from the Social Security Administration (SSA) on behalf of a child who appears to meet the necessary criteria for SSI eligibility. When SSA approves these benefits, DFPS becomes the representative payee of the benefit. DFPS generally uses the benefit to offset the cost of the child’s foster care payment.
A child entering foster care may be receiving SSI or Retirement, Survivors and Disability Insurance (RSDI) benefits. The SSI coordinator submits a Representative Payee Application (SS-11) to SSA requesting that DFPS be the representative payee of the child’s benefits. When SSA approves the payee change, DFPS becomes the representative payee of the benefit. DFPS remains the representative payee of the benefit until managing conservatorship ends. SSI coordinators consult with the state office Federal and State Support Division before allowing another entity to become the representative payee of a child’s benefit.
1571 Effect of SSI Eligibility on Title IV-E Foster Care
CPS May 2021
A CPS SSI coordinator may apply for SSI benefits on behalf of a child who is also eligible for Title IV-E foster care assistance. If DFPS claims Title IV-E foster care assistance for the child’s maintenance payment, DFPS asks SSA to suspend the child’s SSI benefits.
When an SSI coordinator decides to apply for SSI benefits for a child who is eligible for Title IV-E assistance, the SSI coordinator takes the following steps:
- Submits a letter of intent to file an application to SSA.
- Informs the regional foster care eligibility specialist about the letter's submission.
In IMPACT, the eligibility specialist does both of the following:
- Leaves the child’s Actual Eligibility as Title IV-E.
- Changes the child’s Selected Eligibility to State-paid effective the first date of the month in which the letter of intent was submitted to SSA.
If the child’s SSI application is denied, the SSI coordinator notifies the eligibility specialist. In IMPACT, the specialist changes the child’s Selected Eligibility to Title IV-E effective the first day of the month in which letter of intent was submitted to SSA.
The child’s service level affects DFPS’s decision whether to continue receiving the child’s SSI benefit or claim Title IV-E funds for the child’s cost of care.
- If the child’s service level is Basic, DFPS leaves the child on SSI and changes the child’s eligibility to state-paid. In IMPACT, the eligibility specialist keeps the child’s Actual Eligibility as Title IV-E but changes the child’s Selected Eligibility to State-paid.
- If the child’s service level is raised to Moderate or above, DFPS keeps the child Title IV-E eligible instead of receiving the SSI benefit. The SSI coordinator contacts SSA and requests the suspension of the child’s SSI benefits. In IMPACT, the eligibility specialist keeps the child’s Actual Eligibility status as Title IV-E and changes the child’s Selected Eligibility status to Title IV-E. The effective date of the eligibility change is the first day of the month following the request to SSA to suspend benefits.
- If the child’s service level is later reduced to Basic, the eligibility specialist changes the child’s eligibility to state-paid and contacts the SSI coordinator to resume the child’s SSI benefits. The SSI coordinator contacts SSA and requests resumption of the child’s SSI benefits. In this case, the child’s Actual Eligibility status remains Title IV-E and the eligibility worker changes the child’s Selected Eligibility to State-paid effective the first day of the month in which SSA begins issuing the SSI benefit to DFPS.
DFPS pays the single source continuum contractor a Blended foster care rate for a child in a contracted CBC catchment area. If a child in a CBC catchment area is eligible for both SSI and Title IV-E and is in paid foster care, DFPS suspends the child’s SSI benefits and claims Title IV-E foster care funding. The SSI coordinator contacts SSA and requests the suspension of the child’s SSI benefits, and the foster care eligibility specialist keeps the child’s Actual and Selected Eligibility statuses as Title IV-E in IMPACT.
The table below illustrates this policy:
| Child from CBC Catchment Area |
Child’s Service Level |
IMPACT Actual Eligibility Status |
IMPACT Selected Eligibility Status |
Foster Care Funding Source |
|---|---|---|---|---|
Yes |
Blended |
Title IV-E |
Title IV-E |
Title IV-E |
No |
Basic |
Title IV-E |
State-paid |
SSI and State-paid |
No |
Moderate, Specialized, or Intense |
Title IV-E |
Title IV-E |
Title IV-E |
Once SSA suspends the child’s SSI benefits, the SSI coordinator informs the foster care eligibility specialist to change the child's Selected Eligibility from State-paid to Title IV-E effective the first of the month following the month that the child’s SSI is suspended. The SSI coordinator does the following:
- Informs the DFPS accounts receivable accountant that the child’s SSI benefit has been suspended.
- Provides the effective date of the suspension.
If a child who is eligible for both SSI and Title IV-E is later placed in a relative or kinship placement, the SSI coordinator asks SSA to unsuspend the SSI benefits. Once the SSI is unsuspended, the SSI coordinator must inform the foster care eligibility specialist to change the child's Selected Eligibility from Title IV-E to State-paid effective the first of the month that the child’s SSI is received.
1572 Effect of SSI Eligibility on State-Paid Foster Care
CPS May 2021
A child who is determined to be ineligible for Title IV-E foster care assistance is deemed eligible for state-paid foster care assistance. DFPS elects to receive the SSI benefits for a child who is eligible for state-paid foster care assistance and uses the SSI to offset the child’s monthly foster care payments. The child’s state-paid foster care payments do not affect the child’s eligibility for SSI or the amount of SSI benefits a child receives.
1573 Effect of SSI Eligibility on MAO Foster Care
CPS May 2021
A child receiving SSI benefits must remain active on foster care Medicaid while in DFPS managing conservatorship in order to remain under STAR Health managed care. In certain situations, it is in the child’s best interest to discontinue foster care Medicaid and use the child's SSI Medicaid coverage.
Using the child's SSI Medicaid coverage might be needed to facilitate a placement or to provide the child access to other medical services. Staff obtain approval from the CPS State Office division administrator of the Federal and State Support Division before terminating the foster care Medicaid of any child in the conservatorship of DFPS.
1574 SSI Applications for Youth Aging Out of Care
CPS May 2021
The Social Security Administration (SSA) requires each SSI recipient or potential recipient who is 18 years old or older to be evaluated according to the adult listings of impairments. If a youth has a significant disability and will require the appointment of a legal guardian, the CPS caseworker notifies the SSI coordinator when the youth turns 17 years old. The SSI coordinator submits an SSI application on behalf of the youth.
Although the youth will be re-evaluated sometime after he or she turns 18 to determine whether the criteria of an adult with a disability are met, the medical evidence will already be on file with SSA when the youth eligibility is established. For more information about a youth’s long-term care needs, see 10340 Preparation for Long-Term Care or Support in Adulthood for Youth with Disabilities.
State office sends a quarterly report to regional SSI coordinators identifying youth in foster care who are 17 years old and potentially eligible for SSI. The regional SSI coordinators are responsible for submitting SSI applications for the identified youth regardless of eligibility for Title IV-E assistance. For more information about the report, see 1585.2 Seventeen-Year-Old SSI Report.
1575 Home and Community-based Services (HCS) Placement
CPS May 2021
The HCS program provides individualized services and support to people with intellectual and developmental disabilities who are living in any of the following settings:
- With their families.
- In their own homes.
- In other community settings such as small group homes.
In most cases, a person is placed on a waiting list to obtain HCS services since there are more people than Medicaid slots available.
A child who is eligible for an HCS waiver slot placement must have active Supplemental Security Income (SSI) eligibility before placement. When the child is placed, DFPS allows the HCS provider to become the representative payee of the child’s SSI benefit. The HCS provider uses the child’s SSI monthly benefit to pay for room and board. The caseworker placing the child notifies the HCS provider of the need to become the child’s representative payee for the child’s SSI benefits. When the child is placed, the caseworker documents the child’s HCS placement as a Non-FPS Paid placement type, as DFPS does not pay for the child’s cost of care in these settings.
For more information about HCS placements, see:
4118 Additional Actions for Placing Children with Intellectual or Developmental Disabilities
Foster and Licensed Facility Placements Resource Guide,Home and Community-Based Services (HCS) Program
1575.1 SSI Coordinator and Foster Care Eligibility Specialist Responsibilities
CPS May 2021
The regional SSI coordinator and the foster care eligibility specialist have specific responsibilities to ensure that:
- The representative payee of the child’s SSI benefits transitions from DFPS to the HCS provider.
- The child’s foster care Medicaid coverage transitions to an SSI Medicaid coverage before and after the HCS placement.
When the plan for the youth is to be placed in an HCS placement, the regional developmental disability specialist (DDS) contacts the regional SSI coordinator to verify whether the child’s SSI benefits are active, suspended, or denied. The SSI coordinator may need to contact the local SSA office to verify SSI status.
Within three days of being contacted, the SSI coordinator notifies the DDS, the caseworker, and the foster care eligibility specialist about the benefit status. If the child’s SSI benefits have been denied or the child never had SSI, the SSI coordinator must submit an application for SSI to SSA. A pending SSI application must not prevent the caseworker from accepting an HCS waiver slot.
The child’s SSI benefit status determines what procedures the SSI coordinator and the foster care eligibility specialist follow.
See:
1575.11 If the Child’s SSI Benefits are Active
1575.12 If the Child’s SSI Benefits are Suspended by SSA
1575.13 If the Child Never Had SSI Benefits or They Were Suspended
1575.11 If the Child’s SSI Benefits are Active
CPS May 2021
When an HCS waiver slot is offered to a child and the child’s SSI benefits are active, DFPS receives the child’s monthly SSI benefit. The SSI coordinator informs the DDS, the caseworker, and the foster care eligibility specialist that the SSI benefits are active. The SSI coordinator reminds the caseworker to inform the HCS provider to apply with SSA to be the child’s representative payee of the SSI benefits after the placement is made.
When the child is later placed with the HCS provider, the caseworker records the placement as a Non-FPS paid placement. This automatically sends the foster care eligibility specialist a task in IMPACT. At that time the eligibility specialist does the following:
- Notifies the SSI coordinator about the placement.
- Changes the child’s Selected Eligibility type to MAO effective the date of placement, which allows the child to remain eligible for Star Health Services. If the child is 18 years old, the specialist ends the Eligibility, which transitions the child to SSI-related Medicaid.
The SSI coordinator does the following:
- Contacts SSA to resign as representative payee for the child’s SSI benefits and explains that the HCS provider will be applying to be the successor payee.
- Notifies the DFPS Children’s Income Accounting (CIA) unit to return any SSI benefits received after DFPS resigned as the representative payee. If DFPS remains the managing conservator of the child, DFPS does not return the child’s conserved funds in a checking, savings, or dedicated account to SSA unless instructed to do so by SSA.
1575.12 If the Child’s SSI Benefits are Suspended by SSA
CPS May 2021
When an HCS waiver slot is offered to a child and the child’s SSI case is active but SSA is not issuing monthly benefits, the SSI coordinator does all of the following:
- Requests that SSA reinstate the child’s SSI monthly benefits effective the following month.
- Contacts the foster care eligibility specialist to change the child’s Selected Eligibility from Title IV-E to State-paid foster care maintenance payments effective the first day of the following month. This ensures that Title IV-E foster care maintenance payments are not claimed while the child remains in the paid placement.
- Informs the regional developmental disability specialist (DDS) and the caseworker that the SSI benefits are being reinstated and reminds the caseworker to inform the HCS provider that the provider must apply with SSA to be the child’s representative payee of the SSI benefits after the placement is made.
- Contacts the DDS, the caseworker, and the foster care eligibility specialist when the award letter from SSA is received notifying them that the child’s SSI benefits have been reinstated.
When the child is later placed with the HCS provider, the caseworker selects Non-FPS Paid as the Placement Type. This automatically sends the foster care eligibility specialist a task in IMPACT. At that time the eligibility specialist:
- Notifies the SSI coordinator about the placement.
- Changes the child’s Selected Eligibility type to MAO, effective the date of placement, which allows the child to remain eligible for Star Health Services. If the child is 18 years old, the specialist ends the Eligibility, which transitions the child to SSI-related Medicaid.
The SSI coordinator:
- Contacts SSA to resign as representative payee for the child’s SSI benefits and explains that the HCS provider will be applying to be the successor payee.
- Notifies the DFPS Children’s Income Accounting (CIA) unit to return any SSI benefits received after the representative payee resignation. If DFPS remains the managing conservator of the child, DFPS does not return the child’s conserved funds in a checking, savings, or dedicated account to SSA unless instructed to do so by SSA.
1575.13 Child Never Had SSI Benefits or SSA Denies Benefits After Suspension
CPS May 2021
SSA requires a new application to reinstate the SSI benefits in either of the following situations:
- The child never had SSI.
- DFPS suspended the SSI benefits, and then SSA denied the benefits.
When the plan for the youth is to be placed in an HCS placement, the SSI coordinator does all of the following:
- Informs the regional DDS, the caseworker, and the foster care eligibility specialist that the child does not have SSI benefits and that an application for SSI benefits must be submitted.
- Requests a protective filing date from SSA as notice of intent to file an application for SSI.
- Contacts the foster care eligibility specialist to change the child’s Selected Eligibility from Title IV-E to State-paid foster care maintenance payments effective the first day of the month in which the protective filing date request is sent to SSA. This ensures that Title IV-E foster care maintenance payments are not claimed while the SSI application is pending approval and the child remains in the paid placement;
- Submits a full application for SSI to SSA within 60 days of requesting the protective filing date.
- Contacts the DDS, the caseworker, and the foster care eligibility specialist when the child’s SSI benefits have been approved and reminds the caseworker to inform the HCS provider to apply with SSA to be the child’s representative payee of the SSI benefits after the placement is made.
SSI Approved Before HCS Placement
When the child is later placed with the HCS provider, the caseworker records the placement as a Non-FPS Paid placement. This automatically sends the foster care eligibility specialist a task in IMPACT. At that time, or when the eligibility specialist is notified by the caseworker about the placement, the eligibility specialist does the following:
- Notifies the SSI coordinator, who then resigns as representative payee of the SSI benefits.
- Changes the child’s Selected Eligibility type to MAO effective the date of placement, which allows the child to remain eligible for Star Health Services. If the child is 18 years old, the specialist ends the Eligibility, which transitions the child to SSI-related Medicaid.
SSI Approved After HCS Placement
When the child is placed with the HCS provider before SSA approves the SSI application, or if an SSI application had not been submitted, DFPS continues the child’s foster care Medicaid coverage. In these situations, the eligibility specialist does one of the following:
- Notifies the SSI coordinator about the child’s placement.
- Changes the child’s Selected Eligibility to MAO effective the date of the placement with the HCS provider if the child is younger than 18 years old.
- Ends the child’s foster care eligibility effective the date of the placement with the HCS provider if the child is 18 years old or older.
The SSI coordinator contacts the CPS state office SSI program specialist for consultation.
When the child’s SSI is subsequently approved, the SSI coordinator does all of the following:
- Notifies the CPS caseworker, the regional DDS, and the foster care eligibility specialist.
- Reminds the caseworker to inform the HCS provider to apply with SSA to be the child’s representative payee of the SSI benefits.
- Contacts SSA to resign as representative payee for the child’s SSI benefits and explains that the HCS provider will be applying to be the successor payee.
- Notifies the DFPS Children’s Income Accounting (CIA) unit to return any SSI benefits received after the representative payee resignation. If DFPS remains the managing conservator of the child, DFPS does not return the child’s conserved funds in a checking, savings or dedicated account to SSA unless instructed to do so by SSA.
When notified that the child’s SSI has been approved, the foster care eligibility specialist changes the child’s Selected Eligibility type to MAO effective the date of placement, which allows the child to remain eligible for Star Health Services. If the child is 18 years old, the specialist ends the Eligibility, which transitions the child to SSI-related Medicaid.
1575.2 Medical Assistance Only (MAO) Eligibility in HCS Placements
CPS May 2021
A child must have active SSI eligibility before placement in an HCS home. If the child is younger than 18 years old, DFPS keeps the child on foster care-related Medicaid. When the child turns 18 years old, the eligibility specialist ends the child’s foster care-related Medicaid by ending the child’s Medical Assistance Only (MAO) eligibility in IMPACT. This sends a denial request to TIERS and may transfer coverage to an SSI-related Medicaid if the child has active SSI eligibility as described in 1575 Home and Community-based (HCS) Services Placement.
Within three days of ending the child’s MAO eligibility, the foster care eligibility specialist verifies that the child’s medical coverage transferred from foster care-related Medicaid to SSI-related Medicaid by searching the child’s Medicaid History screen in TIERS. The eligibility specialist confirms that the Medicaid History screen has a denial date for the foster care-related Medicaid and a begin date for the SSI-related Medicaid.
- If the foster care-related Medicaid has not been denied, the eligibility specialist emails the DFPS FC-ADO Medicaid Exceptions mailbox to request that the foster care-related Medicaid be denied and to have HHSC reinstate the SSI-related Medicaid.
- If the foster care-related Medicaid has been denied but the SSI Medicaid is not active, the eligibility specialist emails the DFPS FC-ADO Medicaid Exceptions mailbox to request that HHSC reinstate the SSI Medicaid.
If HHSC notifies DFPS FC-ADO Medicaid Exceptions mailbox that it cannot reinstate the child’s SSI-related Medicaid, the following notifications are made:
- The DFPS FC-ADO Medicaid Exceptions mailbox notifies the eligibility specialist.
- The eligibility specialist notifies the caseworker.
- The caseworker the notifies the HCS provider, who is the new SSI benefits representative payee, to contact SSA about the problem with the SSI-related Medicaid.
1576 Child-Specific Contract Placements
CPS May 2021
In rare instances, DFPS may enter into child-specific contracts (CSCs) with providers, including HCS providers, for a child’s care. If DFPS receives a monthly SSA benefit for the child, DFPS uses those monthly benefits to pay the child’s cost of care.
Title IV-E funds cannot be used for HCS placements, as HCS providers are not considered to be licensed foster homes or licensed child care institutions under a child-specific contract. If a child eligible for Title IV-E funds is placed in an HCS provider under a child-specific contract, the eligibility specialist changes the child’s Selected Eligibility to State-paid foster care maintenance payments. This ensures that Title IV-E foster care maintenance payments are not claimed while the child remains in the HCS placement.
The child remains on foster care-related Medicaid after turning 18 years old as long as the child-specific contract remains in place.
1577 Establishing a Dedicated Account Using a Supplemental Security Income (SSI) Lump Sum
CPS May 2021
Dedicated Accounts
Federal law requires an SSI lump sum award that exceeds six times the current Federal Benefit Rate to be placed in a “dedicated account.” Dedicated accounts are not regarded as a resource under Social Security Administration (SSA) rules. Dedicated accounts are excluded from the resource limits for both Title IV-E and state-paid foster care and Medicaid.
SSA determines when an award requires a dedicated account and notifies the representative payee. The regional SSI coordinator is the region’s point of contact for facilitating the establishment of a dedicated account.
SSI awards that do not exceed six times the current Federal Benefit Rate are handled in accordance with 1581 Managing SSI and RSDI Lump Sums.
Other Types of Lump Sums
The requirement for a dedicated account applies only to SSI lump sums. No other type of lump sum award may be mixed with the SSI lump sum in the dedicated account. For information about handling other types of federal benefits such as Retirement, Survivor, Disability Insurance (RSDI) or Veteran's Administration (VA) benefits, or any other types of benefits awarded in a lump sum, see 1580 Managing an SSI Lump Sum or RSDI Lump Sum for a Child Receiving SSI.
Establishing a Dedicated Account
The following procedures are used to establish a dedicated account:
- The regional SSI coordinator receives an award letter from SSA naming the child and the amount of the award and stating that a dedicated account is required.
- The regional SSI coordinator emails the state office SSI program specialist to request that a dedicated account be established and attaches a copy of the award letter to the email.
- The SSI program specialist forwards the request to state office accounting. State office accounting submits the required documentation to the bank to open a dedicated account.
- Once the account is established, state office accounting sends the account number to the program specialist. The program specialist forwards the account information, including the bank routing number, to the SSI coordinator.
- The SSI coordinator sends the account number and bank routing number to the SSA office that sent the award letter.
- The SSI coordinator notifies the Children’s Income Account (CIA) accountant that a dedicated account has been established. The CIA accountant checks the Child has a dedicated Account indicator box in IMPACT located on the child’s Financial Account Detail page.
- The SSA deposits the award via wire transfer to the account.
- For large award amounts, SSA may deposit the award in installments. The award letter indicates the total amount of the award and the amount of the first installment. If the SSI coordinator receives a notice when SSA pays each installment, the coordinator sends a copy to the SSI program specialist, who forwards a copy to state office accounting.
- If SSA inadvertently issues a lump sum award in excess of the amount requiring a dedicated account without requesting that a dedicated account be established, the SSI coordinator consults with the SSI program specialist.
How to Request and Process Expenditures
Expenditures from the dedicated account can be made only with SSA approval and must be related to the child’s impairment. The process for requesting expenditures is as follows:
- The CPS caseworker sends the request to the regional SSI coordinator. The request includes a cost estimate or invoice showing the cost of the item or service to be purchased.
- The SSI coordinator emails the CPS supervisor, the program director, and the regional developmental disability specialist, if appropriate, to request approval of the expenditure.
- If the request is approved, the SSI coordinator contacts the local SSA office to obtain approval from SSA.
- If the SSA approves the expenditure, the SSI coordinator notifies the SSI program specialist in state office and includes the cost estimate or invoice for the item or service and vendor information where the item or service will be purchased. If the approval by SSA is in writing, the SSI coordinator sends the approval to the SSI program specialist as well.
- The SSI CPS state office program specialist has a check issued payable to the vendor. The check is sent by overnight mail to the SSI coordinator. The SSI coordinator forwards it to the caseworker, or to whoever will pay the designated vendor of the approved goods or services.
- For audit purposes, copies of all receipts for purchases must be maintained in the child’s financial record by the Children's Income Accounting unit.
Closing a Dedicated Account
Unless directed by SSA to return the dedicated account funds, DFPS maintains the child’s dedicated account as long as the agency is the representative payee of the child’s SSI benefits or if the youth enters extended foster care. DFPS always returns dedicated account funds to SSA directly and never forwards the funds to the beneficiary or a subsequent representative payee. See 1562.4 Deceased Children’s Income for handling the dedicated account funds for children who die while in DFPS managing conservatorship.
The following are procedures to close a dedicated account:
- The SSI coordinator informs the local SSA that DFPS is no longer the managing conservator of the child, or that the youth is 18 years old and has left CPS care. The SSI coordinator provides SSA with the name and address of the people with whom the child currently resides.
- The SSI coordinator notifies the local SSA that DFPS will return the balance of funds remaining in the child’s dedicated account to SSA. The SSI coordinator obtains the name and address of the SSA staff to send the money via certified mail.
- The SSI coordinator emails the following information to the SSI program specialist:
- The child’s name, Social Security number, and date of birth.
- The date DFPS conservatorship was terminated.
- The name, relationship, address, and phone number of the person with whom the child currently resides.
- The name and address of the SSA contact to whom the conserved funds are sent via certified mail.
- The SSI program specialist contacts state office accounting to request closure of the account and that the bank issue a check of the account balance.
- Once the check is received, the SSI program specialist sends a letter and the check via certified mail to the SSA contact identified by the SSI coordinator. The program specialist sends a copy of the letter to the SSI coordinator.
- The SSI coordinator notifies the Children’s Income Account (CIA) accountant that a dedicated account has been closed. The CIA accountant unchecks the Child has a dedicated Account indicator box in IMPACT that is located on the child’s Financial Account Detail page.
1578 Money Earned by Foster Children From Full- or Part-Time Employment
CPS May 2021
Personal Bank Accounts
A child in foster care who earns income from full- or part-time employment is entitled to keep any money earned. The child may also deposit the money in a personal bank or savings account for the child’s own use before or after leaving foster care. The child has the sole responsibility of the control and management of the account subject to Texas Finance Code §34.305(a). The child is the owner of the account and retains ownership even when he or she returns home. DFPS is not involved in managing the personal account. The account is separate from any DFPS savings account that DFPS may have opened for the benefit of the child.
Income and Resources
Any money DFPS or the child places in a bank account is considered a resource and may affect the child’s eligibility for Supplemental Security Income (SSI) benefits. For any child receiving SSI benefits who is working, the child’s caseworker reports the earnings and the balance of any funds in the child’s personal bank account to the SSI coordinator. To remain eligible for SSI, a child’s resources cannot exceed the $2,000 limit. When a child’s earnings are close to the $2,000 limit, the child’s caseworker ensures the child’s resources are appropriately spent to a point where the resources are under the $2,000 limit.
1579 Third-Party Resources for Medical Care Services
CPS May 2021
Third-party payers are entities or people who are legally responsible for paying the medical claims of Medicaid recipients. As a condition of eligibility, Medicaid recipients assign their rights to medical support and payment for medical care from any third party to Medicaid.
According to federal and state law, the Medicaid program is the payer of last resort. This means all other available third-party liability resources must meet their legal obligation to pay claims before the Medicaid program pays for the care of someone eligible for Medicaid.
1579.1 Third-Party Payers
CPS May 2021
A third-party payer is any person, entity, or program that is, or may be, liable to pay for any medical assistance provided to a Medicaid recipient. The most common sources of third-party resources which may be available to children covered by Medicaid include:
- Group medical insurance provided through a parent’s employment.
- Private medical insurance paid for by the child’s parents or other relatives.
- TRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). This is a health care program of the U.S. Department of Defense Military Health System. TRICARE provides civilian health benefits for military personnel, military retirees, and their dependents, including some members of the reserve component. The TRICARE program is managed by TRICARE Management Activity under the authority of the assistant secretary of defense (Health Affairs).
- Direct medical providers who provide medical services at no cost to the child such as military and public health clinics.
- Liability and casualty insurance and court settlements. Usual sources of payment for medical expenses or accidental injury situations are:
- Automobile insurance
- Homeowner insurance
- Landlord and tenant insurance
- Products liability insurance
- Medical malpractice insurance
- Workers’ compensation
- Lawsuit settlements
- Wills and estates. Instructions in a will may direct that proceeds of the estate be used to provide or reimburse for medical care provided on behalf of a Medicaid-eligible child.
1579.2 Reporting Third-Party Payers
CPS May 2021
Staff uses the following procedures for reporting and using third-party resources for children certified for Medicaid through foster care, Title IV-E, or the state-paid adoption assistance program.
The caseworker determines whether third-party resources are available to the child at the time the child is removed from the home. The caseworker asks the child’s parents or caretakers if the child has any medical coverage provided through individual, group, or governmental health insurance. The caseworker reports insurance coverage to the foster care eligibility specialist on the Foster Care Assistance Application in IMPACT.
For a child receiving Adoption Assistance, which includes Medicaid, the adoptive parent reports whether he or she will have any medical insurance coverage for the child other than Medicaid. The adoptive parent reports this on Form 2250 Adoption Assistance Request and submits the form to the adoption worker. The adoption worker sends a copy of this form to the adoption assistance eligibility specialist.
Staff uses Form 1039 Medical Insurance Input to report the coverage to the address below. For a child or youth in conservatorship, the foster care eligibility specialist completes the form and reports the coverage. For a child or youth receiving Title IV-E or state-paid adoption assistance, the adoption assistance eligibility specialist completes the form and reports the coverage.
Staff must report insurance coverage of a child or youth receiving medical assistance to:
Texas Medicaid & Healthcare Partnership
TPL Department
PO Box 202948
Austin, TX 78720-2948
Phone: 1-800-846-7307
Fax: (512) 514-4225
For a child in DFPS conservatorship, the caseworker notifies the parent or other policyholder that when the child needs medical care, DFPS will ask the medical provider to file for benefits from insurance before filing for Medicaid. The caseworker asks the policyholder to report any changes in insurance coverage to the caseworker. The adoptive parent must tell the medical provider about available insurance coverage other than Medicaid.
1580 Managing a Supplemental Security Income (SSI) or RSDI Lump Sum
CPS May 2021
Some children in DFPS conservatorship receive Supplemental Security Income (SSI) benefits based on the child’s physical or mental disabilities. A child receiving SSI may also receive a Retirement, Survivors, and Disability Insurance (RSDI) benefit, as a result of a parent’s disability or death. SSI and RSDI are federal benefits administered by the Social Security Administration (SSA).
To receive SSI payments, the child cannot have more than $2,000 in resources.
When the Social Security Administration (SSA) approves a child for SSI or RSDI, this may generate a lump sum payment (called an “underpayment” by SSA). This lump sum payment covers the monthly payments due between the original application date and the date SSA determines the child’s eligibility, which is generally three to six months after the application is submitted.
The SSI coordinator manages the child’s SSI and RSDI lump sums so that they will not affect the child’s newly determined SSI eligibility. This management includes getting approval for expenditures for the child’s appropriate needs. The SSI coordinator works with the following:
- CPS caseworker.
- Foster care eligibility specialist.
- DFPS Children’s Income Account unit.
All SSI and RSDI lump sums are deposited into the regional Children’s Income Accounts. The only exception is when SSA requires the lump sum to be deposited and held in a dedicated savings account.
See:
1577 Establishing a Dedicated Account Using a Supplemental Security Income (SSI) Lump Sum)
1581 Managing SSI and RSDI Lump Sums
1581.1 Dedicated SSI Account
CPS May 2021
For a child younger than 18 years old, an SSI lump sum that is six times more than the amount of the monthly SSI payment is placed in a dedicated account. This account can only be used for certain expenditures, such as:
- Education.
- Job training skills.
- Therapy or rehabilitation not covered by Medicaid.
- Other items and services approved by SSA.
The funds in the dedicated account do not count as a resource when SSA determines SSI eligibility. Once a dedicated account is established for a child, any subsequent past-due SSI benefits or subsequent SSI underpayment may be placed in the dedicated account if the funds are less than or equal to six times the child’s monthly SSI payment.
See 1577 Establishing a Dedicated Account Using a Supplemental Security Income (SSI) Lump Sum.
1581.2 Approvals for Lump Sum Expenditures
CPS May 2021
Staff may use SSI (non-dedicated account) and RSDI lump sums for items or services that improve the child’s daily living conditions. These expenditures from the lump sum are allowed under certain conditions and with regional management review and approval, as described in the following:
1582 Use and Conservation of SSI and RSDI Lump Sums for Children Receiving SSI
Appendix 1581.1 Appropriate Needs
At a minimum, the regional SSI coordinator, the CPS supervisor, and the CPS program director give approvals. Each region establishes procedures for reviewing and approving lump sum expenditures.
Once the funds have been placed into a savings account for the child, items or services may be purchased at a later time if necessary. Staff should be aware of the child’s ongoing needs when making expenditure requests and approvals.
For more information about the approval process, see Appendix 1581.1 Appropriate Needs.
1581.3 Nine-Month Exclusion Period for SSI and RSDI Lump Sums
CPS May 2021
To be eligible for SSI, a person’s total countable resources must not exceed $2,000. SSA considers cash or any other personal property owned by a beneficiary to be a resource. This also includes money in a regional Children’s Income checking or savings account.
However, SSA excludes the unspent portion of the SSI lump sum payment from being a countable resource for nine months following the month it is received by DFPS. The nine-month exclusion period begins the month after the payment is received and ends at the end of the ninth month. If SSA makes the lump sum payment in installments each installment is subject to the nine-month exclusion period as well.
1581.4 Conserved Funds From Prior Payee
CPS May 2021
If a prior representative payee returned conserved funds to SSA, SSA may reissue these funds to DFPS when DFPS becomes the new representative payee. SSA does not consider reissued conserved funds to be an underpayment, and they are not eligible for the nine-month exclusion period.
SSA considers these funds to be a countable resource beginning the month after the month of receipt. The SSI coordinator is responsible for ensuring the funds are disposed by the end of the month so they do not affect the child’s SSI eligibility. See 1580 Managing an SSI or RSDI Lump Sum for a Child Receiving SSI. The SSI coordinator must contact SSA to have the child’s SSI suspended if the child’s resources exceed $2,000.
1581.5 Returning Conserved Funds to SSA
CPS May 2021
When a child’s SSA benefits are returned to SSA, the regional SSI coordinator is responsible for ensuring the funds are returned to the appropriate SSA office. DFPS always returns conserved funds to SSA and never forwards them to the beneficiary or a subsequent representative payee.
The SSI coordinator works with the DFPS Children’s Income Accounting (CIA) unit to begin this process.
The SSI coordinator does all of the following:
- Approves all funds and amounts to be returned for a child.
- Requests that the CIA accountant do both of the following:
- Create a check payable to SSA or to the source of the parental entitlement for each child with funds to be returned.
- Send the funds to the coordinator.
- Creates a letter explaining why the funds are being returned.
- Takes or mails the funds with the letter to the local SSA office.
1581.6 Receipt and Deposit of SSI Lump Sum
CPS May 2021
The Social Security Administration (SSA) electronically deposits most SSI lump sum awards into the regional Children’s Income Account at the financial institution holding the accounts. SSA notifies the regional SSI coordinator of the lump sum award with an award letter.
Lump Sum is Received via Direct Deposit or as a Paper Warrant
When the lump sum is received via direct deposit or paper warrant, the Children’s Income Accounting unit notifies the regional SSI coordinator.
The Children’s Income Accounting unit deposits the lump sum into the regional children’s income account, if received by paper warrant. The unit moves the lump sum funds into a savings account to keep them separate from a child’s regular monthly benefit. This allows the funds to accrue interest and ensures these funds are not spent on monthly cost of care.
1581.7 SSI Overpayments
CPS May 2021
SSA may notify DFPS that SSA has issued overpayments to the child. An overpayment occurs when the child has received an SSI payment during a month when the child’s eligibility has lapsed (for example, resources are over the $2,000 SSI limit).
If a legitimate overpayment exists, SSA must be repaid. Regional staff contacts Federal and State Support division staff to determine how to repay SSA. Generally, staff uses funds from the SSI or RSDI lump sums to reimburse SSA.
SSA reimbursement takes priority over appropriate needs, current cost of care, or establishing a savings account, as having an overpayment leads to future SSI payments being reduced. Non-SSI lump sum awards may not be used to pay back the SSA for any outstanding SSI overpayment claims.
1582 Use and Conservation of SSI and RSDI Lump Sums for Children Receiving SSI
CPS May 2021
When a child is in paid DFPS care, staff follows the steps in:
- 1582.1 Step 1: Consider the Appropriate Needs of the Child
- 1582.2 Step 2: Maintain Funds in a Savings Account
- 1582.3 Step 3: Apply Balance to Nine Month’s Cost of Care
- 1582.4 Step 4: Determine Whether There Will Be Excess Funds
The steps must be followed in the order listed to ensure that the child remains eligible for SSI and does not receive an overpayment notice from SSA. Staff proceeds through each step until the entire lump sum payment has been spent, conserved, or allocated for expenditure.
The staff involved with processing a lump sum includes the following:
- Regional SSI coordinator.
- CPS caseworker.
- CPS supervisor.
- CPS program director.
- State office Children’s Income Accounting (CIA) unit.
Once the decision is made about the use of funds, the regional foster care eligibility specialist is notified (see 1582.3 Step 3: Apply Balance to Nine Month’s Cost of Care). SSI coordinators are ultimately responsible for ensuring the lump sum is handled according to policy.
1582.1 Step 1: Consider the Appropriate Needs of the Child
CPS May 2021
Within 30 days of receiving notice of the SSI or RSDI lump sum award, the SSI coordinator works with appropriate regional staff to do all of the following:
- Identify any appropriate needs the child receiving SSI might have, which includes items or services that will improve the child’s daily living conditions. Expenditures may be, but do not need to be, related to a disability, but they must meet the definition of “appropriate needs” as found in Appendix 1581.1 Appropriate Needs. Staff does not use the lump sum award to purchase items that can be purchased by the child’s Medicaid benefit or that are included in the child’s foster care maintenance payment.
- Get a cost estimate (invoice or purchase order) of all appropriate needs identified.
- Get approval of the expenditure as authorized by the SSI coordinator, CPS supervisor, and the regional program director.
See 1565.5 Lump Sum Distribution for details on obtaining expenditure approvals.
1582.11 Expenditure Request Form
CPS May 2021
Staff must document approvals of lump sum expenditures on the Expenditure Request Form. Staff must complete a separate form for each vendor to whom a lump sum expenditure will be made.
The SSI coordinator and the caseworker’s supervisor and program director (PD) must sign the form, which verifies their approval for the expenditure. Original signatures are not required on the form. The approver can sign the form and then scan and email it to the next approver for signature. The region has the discretion to determine the staff member responsible for getting the required signatures on the form. The SSI coordinator must submit the completed form with signatures to the regional Children’s Income accountant in DFPS accounting.
After getting approval, the child’s caseworker has 30 days to purchase the approved items or services. The DFPS Children’s Income Accounting (CIA) unit issues a check to the caseworker, made payable to the vendor, for the amount of the approved items or services.
If there is a difference in the purchase price and approved amount greater than 10 percent, the SSI coordinator submits a new form with the new amount and gets new signatures for approval. The region must return the check with the incorrect amount to the accountant so it can be voided in IMPACT before a new check with the new amount can be issued.
The caseworker sends receipts for purchases to the regional CIA unit. The CIA unit holds these receipts in accordance with 1568 Records Retention Requirements for Transactions Involving Children’s Funds. The SSI coordinator is responsible for ensuring expenditures are made in a timely manner.
1582.2 Step 2: Maintain Funds in a Savings Account
CPS May 2021
Within 30 days after the lump sum expenditure is made, or if no appropriate needs are identified and approved, the SSI coordinator requests that the Children’s Income Accounting unit retain any remaining funds in the savings account for the child. For children receiving SSI benefits, the amount of the lump sum retained in the savings account cannot exceed $1,150 and the child’s total countable resources cannot exceed $2,000. The $1,150 account limit does not apply to children who receive RSDI benefits only.
Funds in a savings account can be spent as additional appropriate needs are identified. In addition, if at any time the account balance exceeds the allowable limit at the end of a month, the excess can be spent down for any appropriate need as described in 1582.1 Step 1: Consider the Appropriate Needs of the Child. If no appropriate needs are identified, the excess is used on cost of care until the balance is below the allowable limits.
1582.3 Step 3: Apply Balance to Nine Months’ Cost of Care
CPS May 2021
For a child receiving SSI, the remaining lump sum funds must be applied to up to nine future months cost of care. No lump sum funds may be applied to the cost of care for months previously paid to a DFPS foster care provider. Within 30 days of creating a savings account, if additional funds exist, the DFPS CIA accountant does all of the following:
- Calculates the amount of foster care to be paid in nine months and determines whether any lump sum amount would remain, using the instructions in 1582.4 Step 4: Determine If There Will Be Excess Funds.
- Applies the lump sum funds to the portion of care not covered by the SSA monthly payments for up to the next nine months.
- Completes Form 8107 Lump Sum Distribution Checklist, documenting the use of the lump sum award, and places a copy in the child’s folder maintained by the CIA unit.
- Sends a copy of Form 8107 to the regional eligibility specialist and the SSI coordinator, informing them how many months of care will be paid with the lump sum award and if any funds remain after paying nine months’ cost of care.
To determine how many months of care the child’s remaining lump sum balance covers after steps 1 and 2 have been completed, the DFPS CIA accountant does all of the following:
- Multiplies the number of days in the month by the child’s service level daily rate to get the total monthly cost of care.
- Subtracts the monthly benefit amount from the total monthly cost of care to get the portion of care not covered by the monthly SSI payment.
- Divides the remaining lump sum balance by the above number to get the number of months that could be paid.
To determine the remaining balance after the cost of nine months of care, regional billing staff does both of the following:
- Multiplies the portion not covered by the monthly SSI payment by nine to get the projection for the state’s nine-month cost of care.
- Subtracts the remaining lump sum amount from the projection.
1582.4 Step 4: Determine If There Will Be Excess Funds
CPS May 2021
If less than $1,000 in lump sum funds remain after Step 3, the funds are used on the child’s cost of care. If $1,000 or more remains, the SSI coordinator notifies SSA the month before the nine-month lump sum exclusion period ends to suspend the SSI until the child’s resources do not exceed the $2,000 limit.
1583 Child Receiving SSI Not in Paid DFPS Care
1583.1 Child Receiving SSI Is Not in DFPS Paid Placement
CPS May 2021
When a child moves to a non-DFPS paid placement, the SSI coordinator reports the change in placement to SSA within 10 days after receiving notice of the placement change. SSA then determines if the SSI payment is:
- Reduced, such as when the child is placed in a medical facility.
- Suspended, such as when the child’s placement is one that SSA considers to be a public institution (for example a juvenile justice detention center or jail).
1583.2 Child Resides With a Kinship Caregiver or Other Unpaid Caretaker
CPS May 2021
CIA staff forward the current monthly SSI or Retirement, Survivors and Disability Insurance (RSDI) to the child’s caregiver when the situation meets the following criteria:
- The child resides with a kinship caregiver or other unpaid caretaker who is not the child’s parent.
- DFPS retains conservatorship.
Kinship care does not create a credit-debt relationship between any parties. If DFPS receives an SSI or RSDI lump sum, DFPS does not issue any of the lump sum to the caregiver even when the child resided with that caregiver for the specific months the lump sum covers. Further, SSA policy is that a payee is not even required to repay a beneficiary’s past debt unless that debt involves an SSA overpayment, IRS levy, or certain income garnishments applicable to adults. Instead, staff uses the lump sum for the child’s appropriate needs and conserves the remaining funds if the child’s resources will not total over $2,000. The CIA unit tracks the child’s account balance to ensure the child’s resources will not be over the SSA resource limit.
1584 How Monthly Payments are Distributed
1584.1 Child Resides With a Kinship Caregiver or Other Unpaid Caretaker
CPS May 2021
CIA staff forwards the current monthly SSI, RSDI, or any other monthly payment that is appropriate to pay for the child’s cost of care to the child’s caregiver when both of the following are true:
- The child resides with a kinship caregiver or other unpaid caretaker who is not the child’s parent.
- DFPS retains conservatorship.
1584.2 Child is in an Adoptive Placement
CPS May 2021
While the child is in an adoptive placement, the handling of the child’s benefits from SSA or another source depends on the following:
- The type of benefit the child receives.
- Whether the child is eligible for an Adoption Assistance (AA) payment.
Before issuing any SSA or other monthly payments to prospective adoptive parents, Children’s Income Accounting staff contacts the adoption assistance eligibility specialist to verify the child’s AA eligibility and whether a deferred AA agreement was negotiated for the child.
See:
1584.21 Child is Eligible for Adoption Assistance Payments and Receives SSI
CPS May 2021
The Adoption Assistance negotiator generally negotiates a deferred Adoption Assistance Agreement with the prospective adoptive parents when the situation meets both of the following criteria:
- The child receives SSI (the child may also receive RSDI or another monthly payment).
- The child is eligible for Adoption Assistance payments.
The deferred agreement delays payment of the Adoption Assistance benefit until the adoption is consummated. Children’s Income Accounting (CIA) staff forwards the SSI and any other monthly payment that is appropriate to use for the cost of care to the prospective adoptive parents. DFPS remains representative payee of the child’s benefits until the adoption is consummated and keeps the child’s conserved funds in the child’s savings account.
If a deferred agreement was not negotiated, SSI coordinators or CIA staff consults with the state office Federal and State Support division for guidance before issuing any SSA benefits.
After consummation, the SSI coordinator does the following:
- Resigns as the representative payee for the benefits.
- Ensures the following funds are returned to SSA or the entity issuing the monthly payment:
- All conserved funds, including those in a dedicated savings account.
- Any monthly benefits received by DFPS after the adoption was consummated.
For additional information on Adoption Assistance and SSI benefits, see:
1715.4 Supplemental Security Income SSI Payments and Adoption Assistance Payments
1577 Establishing a Dedicated Account Using a Supplemental Security Income (SSI) Lump Sum
1584.22 Child is Eligible for AA Payments and Receives RSDI or Another Monthly Payment but Does Not Receive SSI
CPS May 2021
When a child who is eligible for Adoption Assistance payments also receives RSDI benefits or another monthly payment that is not SSI, Children’s Income Accounting (CIA) staff forwards the RSDI payment and any other monthly payments appropriate to use for cost of care to the prospective adoptive parents. DFPS also pays the adoptive parent the monthly Adoption Assistance payment. DFPS remains representative payee of the child’s benefits until the adoption is consummated and keeps the child’s conserved funds in the child’s savings account.
After consummation, the SSI coordinator does the following:
- Resigns as the representative payee for the benefits.
- Ensures the following funds are returned to SSA or the entity issuing the monthly payment:
- All conserved funds, including those in a dedicated savings account.
- Any monthly benefits received by DFPS after the adoption was consummated.
1584.23 Child is Not Eligible for Adoption Assistance Payments and Receives SSI, RSDI, or Other Monthly Payments
CPS May 2021
When a child receives SSI, RSDI, or benefits from another source and is not eligible for Adoption Assistance payments, CIA staff forwards the SSI, RSDI, and any other monthly payments appropriate to use for cost of care to the prospective adoptive parents. DFPS remains representative payee of the child’s benefits until the adoption is consummated and keeps the child’s conserved funds in the child’s savings account.
After consummation, the SSI coordinator does the following:
- Resigns as the representative payee for the benefits.
- Notifies the child’s caseworker to inform the child’s adoptive parents that their child was receiving SSA benefits while in care and that the parents should contact their local SSA office to inquire about possible benefits for the child.
- Ensures the following funds are returned to SSA or the entity issuing the monthly payment:
- All conserved funds, including those in a dedicated savings account.
- Any monthly benefits received by DFPS after the adoption was consummated.
1584.3 Child Returns to Parents
CPS May 2021
When a child is placed with his or her parents for a trial home visit, DFPS does not serve as representative payee for SSI or RSDI even though DFPS may retain managing conservatorship. SSA eligibility rules require that the income and resources of the parents be used to determine the child’s eligibility for SSI benefits.
The SSI coordinator does all of the following:
- Contacts SSA to inform it of the placement and resigns as representative payee.
- Ensures that any monthly benefits received after the child’s return home are returned to SSA.
- Contacts the state office Children’s Income Accounting unit to return the child’s funds in savings when asked by SSA to return the conserved funds.
- Notifies the child’s caseworker to inform the child’s parents that their child was receiving SSA benefits while in care and that the parents should contact their local SSA office to inquire about possible benefits for the child.
1584.4 Child is No Longer in DFPS Conservatorship
CPS May 2021
When a child is no longer in DFPS conservatorship, DFPS may not serve as representative payee for any payments. The exception is for youth in the Extended Foster Care program where SSA allows DFPS to remain the representative payee for the youth’s benefits.
When conservatorship is dismissed, the SSI coordinator does all of the following:
- Notifies SSA that DFPS is no longer the managing conservator of the child and can no longer serve as representative payee.
- Follows the procedures in 1581.5 Returning Conserved Funds to SSA.
- Follows the procedures in 1577 Establishing a Dedicated Account Using a Supplemental Security Income (SSI) Lump Sum, if the child has a dedicated savings account.
- Notifies the child’s caseworker to inform the child’s parents or caregiver that the child was receiving SSI benefits while in care, and that the parents or caregiver should contact the local SSA office to inquire about possible benefits for the child.
- Ensures that any monthly benefits received after DFPS’s conservatorship was dismissed and any conserved funds are returned to SSA.
Unless directed by SSA to return the conserved funds, DFPS may continue to manage the conserved funds of youth in the Extended Foster Care program even when SSA has appointed the youth to be his or her own representative payee.
As an organizational payee, DFPS must follow SSA guidance and return any conserved SSA funds to SSA. Therefore, when a youth ages out of care or a young adult leaves extended foster care, his or her conserved funds are returned to SSA. The SSI coordinator informs conservatorship staff that there are conserved funds that will be sent to SSA and gives staff the SSA contact information. The youth who is aging out of care or the young adult can use this contact information when he or she leaves care in order to obtain his or her conserved funds.
1585 Supplemental Security Income (SSI) Reports
1585.1 SSI Tracking Report
CPS May 2021
Introduction
Some children in DFPS conservatorship may be eligible to receive SSI benefits based on their disabilities. Regional SSI coordinators are responsible for applying for these benefits from the Social Security Administration (SSA) on behalf of these children.
To ensure that children receive SSI benefits, DFPS uses a tracking system to provide the names of all potentially eligible children who meet the necessary criteria and to track the status of the children’s SSI applications.
SSI Tracking Report
The regional SSI coordinator manages the regional SSI tracking report and makes updates continually. Quarterly, the state office SSI program specialist sends the regional SSI coordinators an electronic list of potentially eligible state-paid and Title IV-E foster care recipients targeted for SSI benefits. The SSI coordinator screens the children on the list and applies on behalf of those who may qualify.
The SSI Tracking Report is an Excel spreadsheet with three sections:
- Client Information/Characteristics (CIC)
- Status - Application Status (APP)
- Award Status (AWD)
See Appendix 1583.1 Guide to the SSI Tracking Report.
Receiving and Processing the SSI Tracking Report
- The state office SSI program specialist sends a quarterly memo prompting the SSI coordinators to email their current SSI tracking reports to state office. SSI coordinators do not update their regional SSI tracking report until the program specialist returns the tracking report updated with the new names.
- Within five working days after receipt of each quarterly regional tracking report, the SSI program specialist updates the regional tracking reports with the names (color-coded in red) of children potentially eligible for SSI and returns the updated SSI tracking reports to the regional SSI coordinators.
- After the SSI coordinator receives the updated tracking report, the SSI coordinator screens the list to eliminate children who meet any of the following criteria:
- Whose SSI applications are pending.
- Who have recently been denied SSI benefits.
- Who have left DFPS conservatorship.
- Who have too much income.
- Who are Title IV-E eligible with a higher than Basic service level.
- Who are Title IV-E eligible and are in a Community-Based Care (CBC) catchment area.
- Who are current SSI recipients.
- The SSI coordinator submits a cover letter to SSA with the list of children who are potentially eligible for benefits and for whom the SSI coordinator will submit an application. In the letter, the SSI coordinator requests a protective filing date that allows DFPS to receive children’s SSI benefits retroactive to the filing date instead of from the time the application is actually submitted.
SSI and Emergency Assistance (EA) and Title IV-E Eligibility
A child cannot simultaneously receive SSI benefits and EA or Title IV-E foster care assistance. Before submitting the request to SSA for a protective filing date for a child, the SSI coordinator ensures that the child is not eligible for EA and Title IV-E. The quarterly listing of potentially eligible children produced by state office indicates whether the child is eligible for EA or Title IV-E. The state office SSI program specialist gives this information to the SSI coordinators when the SSI program specialist updates the region's SSI Tracking Report. The SSI coordinators ensure that the child’s EA and Title IV-E eligibilities are ended in IMPACT using the following method.
Title IV-E Eligibility
The decision to deny a child’s Title IV-E eligibility has a fiscal impact on DFPS by preventing the agency’s ability to offset a child’s cost of care with federal funds. The SSI coordinator reviews these cases carefully to ensure that the child qualifies for SSI. Though the best interest of the child remains the overriding concern, the SSI coordinator does not pursue application of SSI benefits for Title IV-E eligible children when it is clear that the child will not qualify for SSI benefits. In addition, SSI coordinators do not pursue SSI benefits for a child who meets both of the following criteria because it is better for the child and the agency to claim Title IV-E funds than receive the SSI benefit:
- The child is eligible for Title IV-E.
- The child has higher than a Basic service level or is in a CBC catchment area.
For an exception to this policy see:
1574 SSI Applications for Youth Aging Out of Care
1583.2 1Child Resides with a Kinship Caregiver or Other Unpaid Caregiver
If the SSI coordinator decides to pursue SSI eligibility for a child who is eligible for Title IV-E, the child’s Title IV-E eligibility must end on the first date of the month that the SSI coordinator requests a protective filing date with SSA. The SSI coordinator contacts the child’s foster care eligibility specialist to change the child’s Selected Eligibility from Title IV-E to state-paid.
Emergency Assistance (EA) Eligibility
An SSI application cannot be made for any child until the child’s EA eligibility is denied. When the SSI coordinator decides to pursue SSI or applies to be the representative payee, the coordinator contacts the DFPS Customer Service Center (CSC) at 1-877-642-4777 to request denial of the child’s EA eligibility. The coordinator informs the CSC representative that:
- The request is time-sensitive and needs to be expedited.
- The SSI coordinator is the “approving supervisor” on the data change.
- The reason for the EA denial is that the SSI coordinator is making an application for federal funding on behalf of the child from another source (SSI) and the continued EA eligibility creates a dual receipt of federal benefits that is not allowed under existing federal law and regulation.
- The child’s EA Deny date needs to be the last day of the month prior to the month the SSI coordinator submits the protective filing date letter to SSA.
The CSC assigns the EA denial request a ticket number. Each SSI coordinator tracks the requests. If more than two weeks pass before any action is reported, the coordinator reports the delay to the state office program specialist for the SSI.
Since EA eligibility might not have been determined at the time an application is filed, the SSI coordinator verifies the child’s EA status at the time a Notice of Award is received.
Submitting Applications to SSA for Benefits
Applications for SSI benefits must be accompanied by legal, psychological, and medical documents. The SSI coordinator requests these documents from the child’s caseworker. The SSI coordinator must follow up with the caseworker’s supervisor or program director if the caseworker does not provide the necessary documentation to support the SSI application. The SSI coordinator submits the application within 60 days after notifying SSA of DFPS’s intent to file an application for benefits. SSI coordinators must have a method for tracking the return of the required application information from field staff.
Updating the Regional Tracking Report
The SSI coordinator records the status of each child screened for eligibility for SSI on the APP Status worksheet on the regional SSI tracking report. The SSI coordinator enters one of the following:
- The date the application was submitted to SSA under the APP SUB column.
- The code indicating the reason the child was screened out in the STATUS column.
See Appendix 1583.1: Guide to the SSI Tracking Report for the entire list of codes and their descriptions. The coordinator updates the APP STATUS worksheet on an ongoing basis to reflect the dates the applications were submitted to SSA.
On an ongoing basis, the SSI coordinator updates information about SSI awards and current monthly benefits on the AWD (award) Status worksheet of the region’s SSI tracking report.
Regional Oversight
Supervisors of SSI coordinators verify that the coordinators have screened the potentially eligible children and updated the status on their SSI tracking reports. Supervisors check that the SSI coordinator did both of the following:
- Made an entry in the STATUS column in the APP STATUS worksheet.
- Included a date entry in the APP SUB (date application submitted) column for items marked with a P (current - pending approval) status in the same worksheet.
This date must be no later than 60 days after the screening deadline for the current listing included on the quarterly memo. By adhering to this 60-day time frame, the SSI coordinator ensures that, if the application is approved, the child’s eligibility will be retroactive to the protective filing date.
Preventing Overpayments
The SSI coordinator will receive an award letter indicating that a child will be eligible for SSI benefits. The award letter indicates the amount of the child’s monthly SSI payment and if the child will receive a lump sum payment.
Upon receipt of the award letter, the SSI coordinator:
- Reviews the child’s case to confirm that the child’s Title IV-E foster care eligibility was changed to State-paid effective the first date of the month that the SSI coordinator requests a protective filing date with SSA.
- Pulls the child’s Person Eligibility report in IMPACT to verify that that the child’s EA Eligibility has been Denied effective the last day of the month prior to the month the SSI coordinator submits the protective filing date with SSA.
If the SSI coordinator determines that eligibility for either Title IV-E or EA was mistakenly reinstated, the coordinator follows the procedures in the SSI and Emergency Assistance (EA) and Title IV-E Eligibility subheading earlier in this section to deny Title IV-E or EA eligibility. The SSI coordinator determines if the child was therefore not eligible for part or all of the award and the amount that must be returned to SSA to prevent and overpayment based on dual receipt of SSI and Title IV-E or EA federal benefits.
The SSI coordinator receives the monthly SSI/RSDI Recipients With Eligibility Mismatches report to identify overpayment situations with children receiving SSI benefits and simultaneously having Title IV-E or EA eligibility. The report is described in 1585.3 SSA Change Reports.
1585.2 17-Year-Old SSI Report
CPS May 2021
DFPS has an interest in supporting youths who are transitioning from foster care to adulthood. The agency pursues Supplemental Security Income (SSI) eligibility for youths before they age out of care at 18 years old regardless of their eligibility for Title IV-E assistance. By establishing SSI disability benefits for youth before their 18th birthday, DFPS ensures that youth will have monthly SSI benefits to support their transition out of foster care.
State office issues a quarterly report to the regional SSI coordinators identifying youth in foster care who are 17 years old and potentially eligible for SSI. SSI coordinators screen the regional listing to determine whether an SSI application has already been submitted to SSA, an application needs to be submitted, or SSI eligibility should not be pursued. The SSI coordinator updates the quarterly report with the decision and the status of the youth’s SSI application on the DFPS SharePoint site to which the coordinator has been given access.
Regional contacts are designated to ensure that each quarterly list is researched and updated by the SSI coordinator on the SharePoint site and to assist the SSI coordinator if the coordinator is having difficulty obtaining the medical documentation from a child’s caseworker.
When an SSI Application Has Been Submitted to SSA
On the report, the SSI coordinator selects the status of the application from the options in the drop-down box: Pending, Awarded, or Denied.
- If the application is “pending” with SSA (SSA has not yet made a decision), the SSI coordinator enters the date that the application was submitted to SSA.
- If SSA “awarded” or approved the application (the SSI coordinator received an SSI award letter from SSA), the SSI coordinator notifies the caseworker of the child’s approval for SSI.
- If SSA “denied” the application more than two years previously, the SSI coordinator assesses if the child’s current disability warrants the submission of another application.
When an SSI Application Has Not Been Submitted to SSA
If DFPS has not submitted an SSI application for a youth on the list, the SSI coordinator has 30 days from date of issuance of the Regional Tracking Report by state office to complete the following tasks:
- Screen the report to determine if DFPS should submit an SSI application. The SSI coordinator may consult the state office SSI program specialist to help determine if an SSI application is appropriate for a youth.
- Contact the caseworker to request all medical documentation that will support an SSI application. The caseworker sends documentation to the SSI coordinator no later than two weeks from the date of the request. If the caseworker does not send the needed documentation to the SSI coordinator within two weeks, the SSI coordinator asks the designated regional contact for assistance in obtaining this documentation.
- Request a protective filing date from SSA upon receipt of the medical documentation from the caseworker.
- Coordinate with the foster care eligibility specialist to transition youth eligible for Title IV-E from Title IV-E to state-paid. The end date of the Title IV-E eligibility is the first day of the month in which the SSI coordinator requests a protective filing date with SSA. This ensures that Title IV-E funding ends on the last day of the preceding month and there is no dual federal funding.
On the report, the SSI coordinator indicates all of the following:
- The date the SSI coordinator requested documentation from the caseworker.
- The protective filing date or the reason why the SSI coordinator has not yet submitted the application.
- The status of the submitted application.
The SSI coordinator submits the full SSI application to SSA within 60 days from the date of issuance of the Regional Tracking Report by state office. After updating the report, the SSI coordinator contacts the regional contact to let him or her know the regional listing is updated and ready for review.
1585.3 SSA Change Reports
CPS May 2021
The regional SSI coordinators receive a set of reports called the SSA Change Reports on a monthly basis. The reports provide information from IMPACT that may affect the benefits of children receiving Supplemental Security Income (SSI) or Retirement, Survivors, and Disability Insurance (RSDI) benefits from the Social Security Administration (SSA). The three reports are the:
- SSI/RSDI Recipients with Conservatorship Dismissal Recorded
- SSI/RSDI Recipients with Placement Changes
- SSI/RSDI Recipients with Eligibility Mismatches
Each SSI coordinator is responsible for viewing and performing the duties outlined below on a monthly basis for the children listed under their region on the report. Duties may involve coordinating with the following:
- CPS caseworker
- Regional eligibility specialist
- Children’s Income Account (CIA) accountant
- Local SSA office
If an SSI coordinator determines that a child appearing on the report under his or her region is from a different region, the SSI coordinator contacts the SSI coordinator from the child’s region for handling.
SSI/RSDI Recipients With Conservatorship Dismissal Recorded
The report lists children receiving SSI or RSDI benefits who had a legal status entry, indicating that DFPS no longer has legal responsibility for the child, recorded in IMPACT during the prior month. These legal statuses include: CVS Not Obtained, FPS Responsibility Terminated, Adoption Consummated, and Child Emancipated. The SSI coordinator uses this report to begin the process of returning those children’s conserved funds to SSA.
The SSI coordinator reviews the children from his or her region and does one of the following:
- Notify the CIA accountants to prepare checks to return the child’s conserved funds to SSA.
- If the child will be remaining in Extended Foster Care after age 18, contact the CPS caseworker to ensure the Voluntary Extended Foster Care Agreement and Financial Attachment have been signed.
SSI/RSDI Recipients With Placement Changes
The report lists children receiving SSI or RSDI benefits who had a placement change recorded in IMPACT during the previous month. The SSI coordinator uses the report to inform SSA of placement changes for children receiving SSA benefits.
SSI coordinators review the children from their region and do all of the following:
- Enter the claim number in the Claim# field for children receiving RSDI benefits.
- Enter Yes or No for each child in the Remain Payee field depending on whether DFPS will remain payee for the child’s benefits.
- Send a copy of the report with the region’s listing to the local SSA office or follow the local SSA office’s procedures for reporting the placement changes within 10 calendar days from receipt of the report.
SSI/RSDI Recipients With Eligibility Mismatches
The report lists children who have SSI eligibility and either Emergency Assistance (EA) eligibility or Title IV-E foster care eligibility recorded in IMPACT. The report excludes children who meet any of the following criteria:
- Placed in Own Home or Relative/Kinship home placements.
- Children without an EA eligibility end date and whose EA eligibility deny date for that record is before the earliest financial transaction date for the report.
The SSI coordinator uses the report to identify children whose EA benefits need to be denied and to determine whether it is better to leave the identified children on SSI or Title IV-E benefits.
To deny EA benefits, SSI coordinators follow the instructions in 1585.1 SSI Tracking Report, under the Emergency Assistance (EA) Eligibility section.
To deny Title IV-E benefits, SSI coordinators follow the instructions in 1585.1 SSI Tracking Report, under the Title IV-E Eligibility section.