Fees
for Service
by
Herbert D. Hinkle, Esq. and Ira Fingles, Esq.
Herbert D. Hinkle
Law Office
2651 Main Street
Lawrenceville, New Jersey 08648
(609) 896-4200 or (215) 860-2100
Can a client of the Division of Developmental Disabilities ("DDD")
keep more than 50% of his or her social security benefits under the
new fee for service procedures? Right now, it is still too early to
tell for sure, but here are some suggestions for families to follow.
By way of background,
last fall the DDD launched a policy of systematically obtaining reimbursement
from clients in residential services. A month or so before the annual
IHP, families will receive a questionnaire from Maximus seeking financial
information. (Unless the client is under 18, parents should provide
no information about their own finances.) At the IHP meeting, families
will be asked to fill out a budget worksheet. For example, if a client
receives $520 a month in social security benefits, DDD will deduct
$40 for a monthly personal need allowance and then seek 50% of the
remaining amount plus any additional amount that cannot be
budgeted into these categories: clothing, recreation, travel, medical\dental
and funeral.
In the example
above, suppose Joyce receives $520 a month. She can keep a $40 personal
need allowance, DDD will take half, or $240 [($520 - $40)/2] and the
family can use the other $240 so long as it is budgeted into one or
more of the previously mentioned categories.
Suppose the client's
expenses exceed $280 a month ($40 + $240), what should the family
do? Go to the IHP meeting prepared. At the IHP meeting, ask the caseworker
to allow you to show additional expenses on the worksheet. The caseworker
is probably not permitted to do this. Therefore, if the caseworker
declines, then ask to attach a letter to the IHP outlining the actual
expenditures. Do not sign the IHP or in any way indicate agreement,
if you are in disagreement.
A few weeks after
the IHP meeting, the family will receive a letter from Maximus advising
how much to turn over to DDD each month. The family can appeal that
decision, and the letter provides an address where to send the appeal.
Will an appeal
succeed? As of this writing, we have filed a handful of appeals, but
none have yet been decided. There is federal caselaw which bars the
state from forcing a mandatory contribution. We do not know if DDD
will voluntarily follow this or how successful an appeal will be.
However, in the authors' opinion, the more directly the requested
funds relate to the developmental needs of the client, the stronger
the case.
Copyright 1999
H.D. Hinkle. All rights reserved.
Mr. Hinkle maintains
a multi-state law practice with offices in Lawrenceville, Florham
Park, and Marlton, NJ, and Yardley, Pa. Mr. Hinkle and his colleagues
Ira Fingles, and Paul Prior lecture and write frequently on topics
of law, aging, and disability, and are available
to speak to groups in New Jersey and Pennsylvania
at no charge. Call (609) 896-4200.
