Overview of Form TABLE OF CONTENTS

Transcription

1 Overview of Form Purpose of Document To determine low income seniors eligibility for financial subsidy How to use this document The subsidy assessment tool will enable CNAP agencies to use standard parameters to evaluate a client s eligibility for financial subsidy. Areas of standardization include: income, expenses, income and expense verification tools, Low Income Cut-Off (LICO #) and subsidy determination percentages. The following evaluation areas need to be determined at the agency level based on a review of past financial and service reports and available resources: list of available subsidized programs, unit costs, full rate, and maximum subsidy available per program. The current program options, rates, unit costs and subsidy max are based on internal program planning at SPRINT Senior Care. Agencies are welcome to utilize these formulas if relevant or customize to match individual program plans. This tool recommends that couples apply for subsidy individually. Each client that s part of a couple - should report an individual income for section 2a and will be evaluated on shared household expenses for section 2b. The tool automatically splits expenses in half for couples and corresponding numbers for larger households. Slight differences may exist for those using the fixed plus variables form which reflects some of the practices of St. Clair West Services for Seniors. Source SPRINT Senior Care TABLE OF CONTENTS How to Complete the Form Section I: Demographics Page 2 Section II: Income and Expenses Page 3-4 Section III: Income Verification Page 4 Section IV: Program/Service Request Page 5 Backend Formulas for Determining Subsidy Amounts Page Validations for Drop Down Sections Of Form Page 8

2 Section I: Demographics Subsidy Completed by: Indicate staff member completing subsidy form Date: Date form is completed Provide personal client identifies: Client Name Age Client s address Client s telephone number Other contact: for example: caregiver, family member, friend, neighbour, power of attorney, public guardian or trustee, or service provider for client being assessed for service and subsidy eligibility Type of Subsidy Request: a. New brand new assessment b. Revised new information being presented requiring revision of subsidy c. Renewal at expiry date for reassessment of eligibility Does the receive CCAC services: d. Yes e. No f. Unknown 2

3 Section II: Income and Expenses INCOME Please collect all gross monthly income statements for client being assessed Guidelines: Single vs. Couple/family income (See notes in Part A: How to use this document ) Definitions: Old Age Security (OAS): Monthly benefit to seniors 65 or older. This benefit includes basic old age security and guaranteed income supplement Canadian Pension Plan (CPP): Monthly pension paid to retired seniors aged 65 or older. To qualify the individual must have worked, made one valid contribution to CPP and at least 60 years old. Benefits do not start automatically, individual must apply. Guaranteed Annual Income System (GAINS): Ontario guaranteed annual income system ensures a guaranteed minimum income for Ontario seniors 65 or older. Based on combined income for married couples (including private pension plans), implemented if OAS payments and total income from other sources are below provincial levels Ontario Disability Support Program (ODSP): Helps people with disabilities in financial need pay for living expenses such as: food, housing, etc. Individuals must be 18 years or older, in financial need, have substantial mental or physical disability expected to last 1 year or more, unable to care for self or take work Private Pension (RRIF/Interest/Annuities): Investment, interest and other income from all other non-governmental sources Allowance Program/Social Assistance/Welfare: The Allowance is a monthly benefit for low-income seniors (aged 60-64) whose spouse or common-law partner is eligible for, or currently receiving, the Old Age Security (OAS) pension and the Guaranteed Income Supplement (GIS) Financial Support: Family or caregiver regular support/contribution Wages: Money that is received from an entity or organization for work performed often paid hourly, daily, or weekly. Other: Any other income such as rental income Total Monthly Income: Auto-fill Estimated Annual Income: Auto-fill 3

4 EXPENSES Guideline Determine if the application is for a single applicant, couple, or other family live-in financial support. Be sure to insert corresponding number of household occupants and contributors to match total household expenses. Definitions Rent: Amount of money paid to an organization or individual for living accommodation Mortgage: Money paid to a lending institution on a regular basis for own home Condo Fees: Maintenance or other fees for condo unit Property Taxes: Municipal government taxes for home ownership Utilities Hydro, Gas, Water (All averaged monthly) Medications not covered by OHIP: Cost of prescription drugs not covered by any government plans (example: OHIP, Ontario drug benefit, etc.) Incontinence Pads: The cost of purchasing incontinence pads Assisted Devices: Other medical support needs based on individual medical condition Total Household Fixed Costs: Auto-fill Estimated Household Annual Costs: Auto-fill Section III: Income verification Effective Month: Enter the month which the subsidy will become in effect. Number of Months: Enter the total number of months the subsidy will apply. Select Income Verification: 1. Tax Return 2. Notice of Assessment Indicate number of individuals who live and/or contribute to household: 1. Include all children, grandchildren, other relatives or tenants who have a source of income and contribute to the household. 4

5 Section IV: Program/Service Request Programs: 1. Select/indicate programs/services being requested per week 2. Subsidy rate and applicable client fee will be calculated automatically 3. All other line items will be calculated automatically Override Subsidy percentage (%) to calculate more subsidy: 1. If the percentage (%) calculated does not meet the needs of the client, select yes in the override box. 2. The following message will appear: Un-hide Column J; Select Override Rates; and then Reset Requests per Week to re-calc totals. 3. After un-hiding column J, select the rates for each program that are suitable for the client. All other line items will be calculated automatically. Comments: Insert comments for director or executive director reference Reviewed by: Insert name of individual reviewing the document Executive Director: To be completed after the final approval has been received by the executive director or name of staff with final approval authority. 5

6 Backend Formulas for Determining Subsidy Amounts SUSIDY CALCULATIONS: Program *: List of programs which subsidies are applicable to. Type of Unit *: The delivery unit within the program that the subsidy is applied against Subsidy Max*: The maximum amount the agency chooses to provide to a client in that specific program area. When developing the Service and Program Requests, if the program total being requested by the client exceeds this maximum, an alert will appear stating that it EXCEEDS MAXIMUM CLIENT SUBSIDY and will not allow further calculations. If the client requires this additional service, the override feature is to be used. See Section IV for override feature instructions. This is an optional category and is not required for the calculator to work. Full Rate *: The rate charged to the client prior to subsidy being applied. Units per Week: Units of service requested per week by client at a subsidized rate. Full Cost per Week: Full cost of service per week prior to subsidy being applied. Monthly: Full monthly cost of service prior to subsidy being applied. Subsidy Percentage: Percent of subsidy applied to service requested. Override Rate: Percent of subsidy applied if override feature applied. Subsidized Rate in Dollars: Client portion to be paid once subsidy applied. Subsidy per Week: Total cost of service per week once subsidy applied. Agency Monthly Subsidized Portion: General monthly subsidized rate provided by agency. Agency Annual Subsidized Portion: General annual subsidized rate provided by agency. Approval Max: Formula that tests if subsidy exceeds maximum allocated subsidy amount. If amount exceeds allocation, an alert stating Exceeds Maximum Client Subsidy will appear on front page. Annual Ministry Funded Amount: Total annual funding provided by the ministry. Annual Client Fee for Service: Total annual cost for service. Funding Test for Validation: Tests for balancing of funding allocation. Alerts will be prompted if exceeds maximums. Client Monthly Cost Estimate: Approximate monthly client fee for service. 6

7 TOTAL SUBSIDY MAX*: The overall total annual subsidy maximum allocated to a client by the agency. When developing the Service and Program Requests, if the annual total being requested by the client exceeds this maximum, an alert will appear stating that it EXCEEDS MAXIMUM CLIENT SUBSIDY and will not allow further calculations. If the client requires this additional service, the override feature is to be used. See Section IV for override feature instructions. This is an optional category and is not required for the calculator to work. * This column requires agency specific information and must be customized to reflect figures unique to agency. This is an editable field in the form. INCOME AND EXPENSES: Income: Annual: Calculates client s annual income based on types of income received. Monthly: Calculates client s monthly income based on types of income received. Household Expenses: Annual: Calculates client s annual expenses based on individual expenses. Monthly: Calculates client s monthly expenses based on individual expenses. Household Occupant: Divides expenses by number of household members who have an income and contribute to household expenses. Balance of Remaining Income: Annual: Determines the balance remaining of annual income after subtracting expenses from income. Monthly: Determines the balance remaining of monthly income after subtracting expenses from income. Low Income Threshold: Low income cut-offs (LICOs) are intended to convey the income level at which a family may be in straitened circumstances because it has to spend a greater portion of its income on the basics (food, clothing and shelter) than does the average family of similar size. The LICOs vary by family size and by size of community. The LICOs vary by population density and vary depending on the district being served. The LICO number is the key qualify for subsidy. If a client s income falls above this number, they will not qualify for a subsidy. This message will appear if the income exceeds the LICO: CLIENT DOES NOT MEET ELIBILITY REQUIREMENTS FOR SUBSIDY PROGRAM DUE TO INCOME. Use this table to determine the LICO number in your area: 7

8 FORMULA FOR DETERMINATION OF PERCENTAGE OF SUBSIDY: Percent of Income Used for Household Expenses: This percentage is the formula used to determine the percent of subsidy offered. This section of the worksheet contains the explanation of the formula but does not house any actual formula. The percentages in this formula can be adjusted to agency specific requirements. These percentages are imbedded in the formula used in Column I to determine the percent of subsidy. Validations for Drop Down Sections of Form Type of Subsidy: List of new, renewal or revised subsidy application Income Verification: List of possible income verifications Subsidy Completed By: List of staff members able to complete the form Does the Client Receive CCAC: List of if client is receiving CCAC services Effective Month: Lists the months which the subsidy will become in effect Year for Income Verification: List of the year that the income verification references Length of Subsidy: Lists the total number of months the subsidy will apply 8