The essential services voucher for significant disabilities

It is a voucher — a certificate issued directly to the person or their family — to buy the services an adult with a significant disability needs and that no other programme covers for them. The list of what it can pay for is long and concrete: from personal assistance and therapies to home modifications, medical equipment, transportation and respite services for the caregiver. The Act puts administration with the Department of Health and leaves the exact requirements to a regulation.

The Act describes the eligible person as one with significant disabilities between the ages of 21 and 59 “who lack the capacity for employment and independent living.” It adds that “Family size, income and expenses related to the services of the person with a significant disability shall be taken into account in determining eligibility.” But the Act publishes no thresholds: it expressly says eligibility “shall be determined according to the requirements set out in a Regulation drafted by the Executive Committee and adopted by the Lead Agency.” We did not read that regulation.

• Be a person with significant disabilities between the ages of 21 and 59 who lacks the capacity for employment and independent living.Verified against the official source
• Not qualify for the same service under another programme of the Government of Puerto Rico, its instrumentalities, corporations or municipal governments: the voucher may not be used to pay for those services.Verified against the official source

Information pending verification.

1. 1

   Step 1: What the voucher can pay for

   The list comes from the text and is worth reading whole because it is broader than people expect: “personal assistance, assistive technology, home modifications, nutritional assistance, medical assistance, medical materials and equipment, any type of therapy including but not limited to physical and occupational therapies, mental health services, transportation services, care, lodging and respite services, family counselling, socio-recreational services or activities, physical fitness services.” And the list stays open: “Any other service necessary for the population with special needs or significant disability must be included in the Regulation to be covered by this Act.”

2. 2

   Step 2: The rule most people hit: it does not duplicate other programmes

   It is written in the purpose article and it is blunt: “Families or individuals eligible for services under this Act may not use the voucher to pay for services for which they qualify under other programmes provided by the agencies of the Government of Puerto Rico, including its instrumentalities, corporations and municipal governments.” The voucher is meant for what is left uncovered, not to pay a second time for what another programme already covers you for.

3. 3

   Step 3: The voucher is decided case by case, with the family

   The Act does not hand out a fixed amount. It says: “Eligible participants shall receive a voucher to purchase services for persons with disabilities, based on the needs of the individual and their family. Cases shall be evaluated individually and, in coordination with the family, the services for which the voucher may be used shall be chosen. Vouchers shall be issued as a benefit to each family or individual.” The amount and conditions come from the regulation, not from the Act.

4. 4

   Step 4: Who administers: the Department of Health

   The Act defines “Lead Agency” as “the agency that shall oversee the implementation and administration of the services established in this Act,” and adds: “For purposes of this Act, the lead agency shall be the Department of Health.” That designation came in by later amendment, and the compilation we read, revised to February 26, 2021, already carries it.

5. 5

   Step 5: Who writes the rules: a committee of thirteen

   The Executive Committee has thirteen permanent members and its composition says a lot about the programme’s scope: a representative of the Department of Health; one from the Vocational Rehabilitation Administration; one from the State Independent Living Council; one from the Department of the Family; one from the Developmental Disabilities Institute of the University of Puerto Rico, Medical Sciences Campus; one from the University of Puerto Rico’s Technological Assistance Program; one from the Associate Secretariat of Special Education in charge of the Transition to Adult Life Program; one from the Advocate for Persons with Disabilities; one from the Advocate for Elderly Persons; one from the Patient’s Advocate; and three more — a community member, a programme participant and a relative of a participant — appointed by consensus of the other eight members.

6. 6

   Step 6: What the Act sends to the regulation, and therefore we cannot tell you

   Article 5 lists what the Executive Committee must write: “service definitions, eligibility criteria and requirements, service-provider criteria, family education and consumer education processes, criteria for the use of the vouchers, disbursement of allocated funds, penalties for non-compliance or misuse.” And Article 8 adds that beneficiaries’ duties and responsibilities “shall be set out in the Regulation.” That is nearly everything operational. We did not read that regulation, so we publish no income thresholds, amounts, form, or place to apply.

7. 7

   Step 7: The demonstration project, and why scale matters

   Worth knowing before assuming island-wide coverage. Article 7 provides that the Executive Committee, led by the Developmental Disabilities Institute, “shall design a Demonstration Project for the offering of the services provided in this Act,” established “in the area or areas where, in the judgement of the Committee members, the conditions exist for its development,” and that “The Project design shall provide services to at least 100 people with severe disabilities in the selected areas.” The Committee was to report to the Legislative Assembly after the first year. We did not read that report and do not know in which areas it operates today.

8. 8

   Step 8: A definitional tension we do not resolve

   We leave it visible because it may affect a concrete reader. Article 2 defines “Person with significant disabilities” as “every person over 21 who has no employment potential and cannot live independently,” with no upper age limit. But the purpose article and the eligibility article both bound the programme to ages “between 21 and 59.” We reproduce both texts and do not decide which controls. If you are 60 or older, that difference is exactly what you would need to clarify with the agency.

The lead agency is the Department of Health, which administers the services and adopts the regulation the Executive Committee drafts. The Act publishes no office, address, form or application window, and we do not invent one: the operational side lives in that regulation, which we did not read. If the person is 22 or older and what they need are comprehensive rehabilitation and independent living services, that is another Act and we have a separate guide.

• Expecting the Act to say how much the voucher is: the amount and conditions come from the Executive Committee’s regulation.
• Trying to use the voucher for a service another government programme already covers for you: the Act expressly forbids it.
• Thinking it covers only medical services: the list includes home modifications, transportation, respite, family counselling and socio-recreational activities.
• Assuming island-wide coverage: the Act orders a Demonstration Project in the areas the Committee selects, with at least 100 people.
• Taking the age limit for granted: Article 2 says “over 21” with no cap, while the purpose and eligibility articles say “between 21 and 59.”
• Looking for the application at the Department of the Family: the lead agency is the Department of Health.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov