Section 90. Participation by individuals in the cost of services

A. The service provider shall apply consideration of consumer financial participation uniformly so that all individuals who are eligible for IL services are treated equally. The service provider shall maintain written policies covering the specific types of IL services for which a financial needs test will be applied. The service provider shall document in the consumer service record the individual's participation in the cost of any IL services, including the individual's financial need.

B. Consumer financial participation shall apply only to the following services:

1. Rehabilitation technology goods and services but not the needs assessment;

2. Prostheses and other appliances and devices;

3. Accommodations to or modifications of vehicle or home or any space used to serve or be occupied by individuals with significant disabilities; and

4. Other tangible goods.

C. The consumer is exempt from financially participating in the cost of IL services in any year the consumer's income includes:

1. General Relief.

2. Temporary Assistance for Needy Families (TANF).

3. Supplemental Security Income (SSI).

4. Social Security Disability Income (SSDI).

5. Workers' compensation benefits.

6. Veterans' disability benefits.

D. The consumer's annual financial participation amount is determined by the financial needs test. The financial needs test is the annual taxable income less income taxes paid, FICA withholdings, dependent allowance, cost of living allowance, tax-deferred retirement account contributions, health insurance premiums, alimony paid, and disability-related expenses.

1. For consumers under age 18, income of the parents/legal guardian is to be considered only if the consumer was claimed as a dependent on the parent/legal guardian's most recent federal income tax return. For other consumers, only the income of the consumer, and not other family members, shall be considered.

2. A dependent allowance is allowed for each person (including the consumer) claimed on the tax return. The department must update the dependent allowance annually and notify the service providers. The allowance is the amount for each additional family member in the Table of Poverty Guidelines for the 48 Contiguous States and the District of Columbia, which is published annually by the U.S. Department of Health and Human Services.

3. The department will determine the cost of living allowance and notify the service providers.

4. Retirement contributions, insurance premiums, and disability-related expenses paid or reimbursed by the employer or another resource may not be deducted from income.

Historical Notes

Derived from VR595-02-1 § 9, eff. November 1, 1987; amended, Volume 20, Issue 09, eff. February 11, 2004.

Statutory Authority

§ 51.5-14 of the Code of Virginia.