• Money Management Client Referral

    All information entered and submitted is HIPAA-compliant

  • Important note as of 10/7/26: 

    The SCES Representative Payee program is at capacity and is currently unable to accept new referrals.

    If you need to contact us, please feel free to email:

    lindsey.smilack@eldercare.org

    rachelmartagreenberg@eldercare.org

     

  • Thank you for your interest in our Money Management program! Please read these details before you get started.

    The Money Management Program includes two service options -- the Bill Payer and Representative (Rep) Payee.

    The Bill Payer program assists individuals who have capacity to participate in financial and bill-paying tasks, but benefit from a volunteer's support with initiating payments, organizing and understanding bills, budgeting, etc. Bill Payer clients retain control of their financial affairs and all decision making. The program is optional (clients may opt in/out) and we generally do not charge a fee. Note: We are required to have access to bill payer clients’ monthly bank statements for account monitoring. It is best to ensure that the individual is amenable to sharing this information before submitting a referral.

    The Representative Payee program supports individuals who lack capacity to engage with their finances and/or may be ineligible for a volunteer match to due to behavioral, mental health, or other challenges. For Rep Payee referrals, our team applies to Social Security to directly receive and manage the individuals benefits on their behalf. A Rep Payee assignment is not always optional, and individuals may need to seek a doctor/clinician recommendation to reverse a Rep Payee assignment. In most cases, we charge Rep Payee clients a monthly fee, up to the maximum set by SSA. Note: In order to submit a Rep Payee application to SSA, we are required to include three forms, which we ask the referring party to include when submitting this referral form (see below for details and form download links).

     ** Both programs have a lengthy client waitlist. Rep Payee referrals may experience particularly long delays due to slow processing times by the Cambridge SSA office. **

    Please note, the Money Management Program is not able to assist with a number of tasks, including:

    • Tax preparation or filing
    • Investment advice
    • Driving individuals to appointments
    • Providing money or loans to individuals
    • Completing public benefits or housing applications
    • Acting as intermediary in family financial conflicts

     

    Please answer the following questions to help determine what level of support will most benefit the individual.

  • Is the individual readily reachable by phone?*
  • Is the individual at risk of or facing eviction?*
  • Does the individual have any behavioral or mental health conditions, including addiction, gambling, impulse control?*
  • Has the individual been a victim of financial exploitation or abuse?*
  • Is the individual agreeable to participating in Money Management?*
  • Would you characterize the individual's financial situation as urgent?*

  • Per our manual,

    "The Massachusetts Money Management Program utilizes HUD State Income Limits to set the program income and asset guidelines ... [and] will always utilize the Low-Income (80%) value." 

    See the following site for the most recent available income limits.  

    • https://www.huduser.gov/portal/datasets/il.html
    • (Select Massachusetts and click "View State Calculations")

     A client's primary residence and automobile are excluded from assets.  

    If there's any concern about eligibility due to the income and asset limits, please discuss with us.

  • Forms Rep Payee Referrals Only:

    The Social Security Administration requires that we submit three forms in our application to be selected as Rep Payee. Please download these forms and coordinate their completion before continuing with the referral. The referral form provides an upload button so that forms can be included with submission. Get in touch with us if any questions. 

    SSA-787: to be completed by a physician who has recently seen the client. Clinician must indicate that they believe a Rep Payee is necessary on pages 2 and 3
    SSA-787 - Medical Source Opinion of Patient's Capability to Manage Benefits

    SSA-827: authorization to disclose information to SSA, to be signed by client
    SSA-827 - Authorization to Disclose Information to SSA

    SSA-4164: to be signed by client, confirming that they are agreeable to having SCES serve as Rep Payee
    SSA-4164 - Advance Notification of Representative Payment

     

  • Income & Asset Limits

  • Based on your responses to these questions, it is possible that the individual may not be eligible for the Bill Payer program and might benefit more from Representative Payee support.

    If it is your and/or the individual's intent to make a referral for the Bill Payer program, we encourage you to contact Sunny Milligan (sunny.milligan@eldercare.org) to review options before taking the time to complete a full referral on the next page.

    If you wish to make Representative Payee referral, please proceed to the next page.

  • Based on your responses to these first questions, it is likely that the individual could be eligible for either the Bill Payer or Representative Payee programs.

    Please proceed to the next page to complete a full referral.

     

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Client date of birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Client gender*

  • Referral Type

  • What type of money management assistance would most benefit the client?*
  • Per Massachusetts guidelines, Bill Payer clients must agree to have their bank statements sent to the SCES office for account monitoring purposes. Have you discussed this with the client? If not, please discuss this requirement with the client BEFORE submitting referral.

  • The Social Security Administration requires that we submit three forms in our application to be selected as Rep Payee. In order to expedite our application, please complete these forms and use the upload button below to submit with this referral.

    • SSA-787: to be completed by a physician who has recently seen the client. Clinician must indicate that they believe a Rep Payee is necessary on pages 2 and 3

    SSA-787 - Medical Source Opinion of Patient's Capability to Manage Benefits

    • SSA-827: authorization to disclose information to SSA, to be signed by client

    SSA-827 - Authorization to Disclose Information to SSA

    • SSA-4164: to be signed by client, confirming that they are agreeable to having SCES serve as Rep Payee

    SSA-4164 - Advance Notification of Representative Payment

     

  • Upload Documents
    Cancelof

  • Client Communication

  • English Proficiency?*

  • Referral Source

  • Referring Organization
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Current Protective Arrangements

  • Indicate any existing protective arrangements

  • Client Income

  • Monthly income source(s) and amount(s)
    SSA
    SSI
    SSDI   
    MA SSP      
    Other      

  • Client Personal Information

  • Marital status*

  • For Rep Payee,

    Social Security requires that we provide:

    • Mother's First Name and Maiden Last Name,
    • Father's First Name and Last Name, and
    • Birthplace.
  • Birthplace: * * *  
  • Format: (000) 000-0000.

  • Living Information

  • Does client own a home?*
  • Does client live alone?*
  • Are others in household related to client?
  • Would others in the household be able to assist a volunteer?
  • Is client mostly homebound?*

  • Legal Representative of the Estate

    To whom should we remit funds in the event of the consumer's passing?
  • Does the client have a will?

  •  -
  •  -

  • Medical Coverage

  • Client medical coverage (check all that apply)*

  • Client Status

  • Why has the client been referred for money management assistance? Check all that apply*
  • Are there any behavioral or communication problems that could make the client inappropriate for volunteer assistance?*
  • In the past 2 years has the client received help from a social worker, psychologist, doctor or other mental health professional for stress, addictions, or an emotional or nervous problem?*
  • What method of bill payments are used?
  • Have you discussed the program with the client?*
  • Is the client agreeable to participating in the program? (reminder: Bill Payer clients must agree to have their bank statements mailed directly to SCES for monitoring)*
  • Is the client capable of understanding why s/he is being referred?*
  • Does the client smoke?*
  • Does the client have pets?*
  • Does the client have a checking account?*
  • To the best of your knowledge, is the client’s annual income below $55,950?
  • To the best of your knowledge, are the client’s liquid assets below $55,950
  • Should be Empty: