SI PHI01415.008 Administration of State Supplementary Programs — Delaware (RTN 61 — 12/2015)

See SI 01415.010

(DE), Appendix I — Chart 31 (RTN 61 - 01/2015)
SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2015 -12/2016)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

     

In Own Household

A

Z

 

$733.00

$733.00

In Another's Hshld.

B

Z

 

$488.67

$488.67

In Parental Hshld.

C

Z

 

$733.00

$733.00

Medicaid Facility

D

Z

 

$ 30.00

$ 30.00

In Certified Residential Care Home

A

A

$140.00

$733.00

$873.00

COUPLES 1/

     

In Own Household

A

Z

 

$1100.00

$1100.00

In Another's Hshld.

B

Z

 

$ 733.34

$ 733.34

Medicaid Facility

D

Z

 

$ 60.00

$ 60.00

In Certified Residential Care Home

A

A

$448.00

$1100.00

$1,548.00

1/ For individuals/couples whose FCI precludes a Federal payment, the amounts in the "O/S Amount" column will vary depending on income. See SI 02005.001, which discusses situations of this kind.

* Effective March 1, 2003, "Residential Care Homes" include Adult Foster Care Homes, Adult Residential Care Facilities and Assisted Living Facilities. Eligibility for the state supplement is contingent upon receipt of the ADULT RESIDENTIAL CARE CERTIFICATION FORM, completed and signed by the proper authority.

       

(DE), Appendix I — Chart 30 (RTN 60 - 01/2014)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2014 — 12/2014)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

     

In Own Household

A

Z

 

$721.00

$721.00

In Another's Hshld.

B

Z

 

$480.67

$480.67

In Parental Hshld.

C

Z

 

$721.00

$721.00

Medicaid Facility

D

Z

 

$ 30.00

$ 30.00

In Certified Residential Care Home

A

A

$140.00

$721.00

$861.00

COUPLES 1/

     

In Own Household

A

Z

 

$1082.00

$1082.00

In Another's Hshld.

B

Z

 

$ 721.34

$ 721.34

Medicaid Facility

D

Z

 

$ 60.00

$ 60.00

In Certified Residential Care Home

A

A

$448.00

$1082.00

$1,530.00

1/ For individuals/couples whose FCI precludes a Federal payment, the amounts in the "O/S Amount" column will vary depending on income. See SI 02005.001, which discusses situations of this kind.

* Effective March 1, 2003, "Residential Care Homes" include Adult Foster Care Homes, Adult Residential Care Facilities and Assisted Living Facilities. Eligibility for the state supplement is contingent upon receipt of the ADULT RESIDENTIAL CARE CERTIFICATION FORM, completed and signed by the proper authority.

(DE), Appendix I — Chart 29 (RTN 59 - 01/2013)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2013 — 12/2013)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

     

In Own Household

A

Z

 

$710.00

$710.00

In Another's Hshld.

B

Z

 

$473.34

$473.34

In Parental Hshld.

C

Z

 

$710.00

$710.00

Medicaid Facility

D

Z

 

$ 30.00

$ 30.00

In Certified Residential Care Home

A

A

$140.00

$710.00

$850.00

COUPLES 1/

     

In Own Household

A

Z

 

$1066.00

$1066.00

In Another's Hshld.

B

Z

 

$ 710.67

$ 710.67

Medicaid Facility

D

Z

 

$ 60.00

$ 60.00

In Certified Residential Care Home

A

A

$448.00

$1048.00

$1,514.00

1/ For individuals/couples whose FCI precludes a Federal payment, the amounts in the "O/S Amount" column will vary depending on income. See SI 02005.001, which discusses situations of this kind.

* Effective March 1, 2003, "Residential Care Homes" include Adult Foster Care Homes, Adult Residential Care Facilities and Assisted Living Facilities. Eligibility for the state supplement is contingent upon receipt of the ADULT RESIDENTIAL CARE CERTIFICATION FORM, completed and signed by the proper authority.

(DE), Appendix I — Chart 29 (RTN 58- 11/2012)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2013 — 12/2013)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

     

In Own Household

A

Z

 

$698.00

$698.00

In Another's Hshld.

B

Z

 

$465.34

$465.34

In Parental Hshld.

C

Z

 

$698.00

$6980.00

Medicaid Facility

D

Z

 

$ 30.00

$ 30.00

In Certified Residential Care Home

A

A

$140.00

$698.00

$838.00

COUPLES 1/

     

In Own Household

A

Z

 

$1048.00

$1048.00

In Another's Hshld.

B

Z

 

$ 698.67

$ 698.67

Medicaid Facility

D

Z

 

$ 60.00

$ 60.00

In Certified Residential Care Home

A

A

$448.00

$1048.00

$1,496.00

1/ For individuals/couples whose FCI precludes a Federal payment, the amounts in the "O/S Amount" column will vary depending on income. See SI 02005.001, which discusses situations of this kind.

* Effective March 1, 2003, "Residential Care Homes" include Adult Foster Care Homes, Adult Residential Care Facilities and Assisted Living Facilities. Eligibility for the state supplement is contingent upon receipt of the ADULT RESIDENTIAL CARE CERTIFICATION FORM, completed and signed by the proper authority.

  

(DE), Appendix I — Chart 7 (RTN 56 - 12/2008)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2009-12/2009)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$674.00

$674.00

In Another's Hshld.

B

Z

449.34

449.34

In Parental Hshld.

C

Z

674.00

674.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

674.00

814.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$1011.00

$1011.00

In Another's Hshld.

B

Z

674.00

674.00

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

1011.00

1,459.00

1/ For individuals/couples whose FCI precludes a Federal payment, the amounts in the "O/S Amount" column will vary depending on income. See SI 02005.001, which discusses situations of this kind.

* Effective March 1, 2003, "Residential Care Homes" include Adult Foster Care Homes, Adult Residential Care Facilities and Assisted Living Facilities. Eligibility for the state supplement is contingent upon receipt of the ADULT RESIDENTIAL CARE CERTIFICATION FORM, completed and signed by the proper authority.

(DE), Appendix I Chart 27 (RTN 56 - 12/2007)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2008-12/2008)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$637.00

$637.00

In Another's Hshld.

B

Z

424.67

424.67

In Parental Hshld.

C

Z

637.00

637.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

637.00

777.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$956.00

$956.00

In Another's Hshld.

B

Z

637.34

637.34

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

956.00

1,404.00

(DE), Appendix I Chart 26 (RTN 52 - 12/2006)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2007-12/2007)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$623.00

$623.00

In Another's Hshld.

B

Z

415.34

415.34

In Parental Hshld.

C

Z

623.00

623.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

623.00

763.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$934.00

$934.00

In Another's Hshld.

B

Z

622.67

622.67

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

934.00

1,382.00

(DE), Appendix I — Chart 25 (RTN 51 - 1/2006)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2006-12/2006)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$603.00

$603.00

In Another's Hshld.

B

Z

402.00

402.00

In Parental Hshld.

C

Z

603.00

603.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

603.00

743.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$904.00

$904.00

In Another's Hshld.

B

Z

602.67

602.67

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

904.00

1,352.00

(DE), Appendix I — Chart 24 (RTN 49 - 1/2005)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2005-12/2005)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$579.00

$579.00

In Another's Hshld.

B

Z

386.00

386.00

In Parental Hshld.

C

Z

579.00

579.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

579.00

719.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$869.00

$869.00

In Another's Hshld.

B

Z

579.34

579.34

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

869.00

1,317.00

(DE), Appendix I — Chart 23 (RTN 47 - 1/2004)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2004 - 12/2004)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Amount

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$564.00

$564.00

In Another's Household

B

Z

$376.00

$376.00

In Parental Household

C

Z

$564.00

$564.00

Medicaid Facility

D

Z

$30.00

$30.00

In Certified Residential Care Home*

A

A

$140.00

$564.00

$704.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$846.00

$846.00

In Another's Household

B

Z

$564.00

$564.00

Medicaid Facility

D

Z

$60.00

$60.00

In Certified Residential Care Home*

A

A

$448.00

$846.00

$1,294.00

(DE), Appendix I — Chart 22 (RTN 46 - 1/2003)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2003 - 12/2003)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Amount

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$552.00

$552.00

In Another's Household

B

Z

$368.00

$368.00

In Parental Household

C

Z

$552.00

$552.00

Medicaid Facility

D

Z

$30.00

$30.00

In Certified Residential Care Home

A

A

$140.00

$552.00

$692.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$829.00

$829.00

In Another's Household

B

Z

$552.67

$552.67

Medicaid Facility

D

Z

$60.00

$60.00

In Certified Residential Care Home

A

A

$448.00

$829.00

$1,277.00

(DE), Appendix I — Chart 21 (RTN 45 - 1/2002)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2002 - 12/2002)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Amount

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$545.00

$545.00

In Another's Household

B

Z

$363.34

$363.34

In Parental Household

C

Z

$545.00

$545.00

Medicaid Facility

D

Z

$30.00

$30.00

In Certified Residential Care Home

A

A

$140.00

$545.00

$685.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$817.00

$817.00

In Another's Household

B

Z

$544.67

$544.67

Medicaid Facility

D

Z

$60.00

$60.00

In Certified Residential Care Home

A

A

$448.00

$817.00

$1,265.00

(DE), Appendix I — Chart 20 (RTN 44 - 1/2001)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/2001 - 12/2001)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Amount

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$530.00

$530.00

In Another's Household

B

Z

$353.34

$353.34

In Parental Household

C

Z

$530.00

$530.00

Medicaid Facility

D

Z

$30.00

$30.00

In Certified Residential Care Home

A

A

$140.00

$530.00

$670.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$796.00

$796.00

In Another's Household

B

Z

$530.67

$530.67

Medicaid Facility

D

Z

$60.00

$60.00

In Certified Residential Care Home

A

A

$448.00

$796.00

$1,244.00

(DE), Appendix I — Chart 19 (RTN 43 - 1/2000)

SUPPLEMENTATION CODING AND PAYMENT LEVEL (01/2000 - 12/2000)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Amount

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$512.00

$512.00

In Another's Household

B

Z

314.34

341.34

In Parental Household

C

Z

512.00

512.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

512.00

652.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$769.00

$769.00

In Another's Household

B

Z

512.67

512.67

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

769.00

1,217.00

(DE), Appendix I — Chart 18 (RTN 42 - 01/1999

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1999-12/1999)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$500.00

$500.00

In Another's Hshld.

B

Z

333.34

333.34

In Parental Hshld.

C

Z

500.00

500.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

500.00

640.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$751.00

$751.00

In Another's Hshld.

B

Z

500.00

500.00

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

751.00

1199.00

(DE), Appendix I — Chart 17 (RTN 40 - 02/1998)

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1998-12/1998)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$494.00

$494.00

In Another's Hshld.

B

Z

329.34

329.34

In Parental Hshld.

C

Z

494.00

494.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

494.00

634.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$741.00

$741.00

In Another's Hshld.

B

Z

494.00

494.00

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

741.00

1189.00

(DE), Appendix I — Chart 16

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1997-12/1997)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$484.00

$484.00

In Another's Hshld.

B

Z

322.67

322.67

In Parental Hshld.

C

Z

484.00

484.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

484.00

624.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$726.00

$726.00

In Another's Hshld.

B

Z

484.00

484.00

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

726.00

1,174.00

(DE), Appendix I — Chart 15

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1996-12/1996)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$470.00

$470.00

In Another's Hshld.

B

Z

313.34

313.34

In Parental Hshld.

C

Z

470.00

470.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

470.00

610.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$705.00

$705.00

In Another's Hshld.

B

Z

470.00

470.00

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

705.00

1,153.00

(DE), Appendix I — Chart 14

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1995-12/1995)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$458.00

$458.00

In Another's Hshld.

B

Z

305.34

305.34

In Parental Hshld.

C

Z

458.00

458.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

458.00

598.00

COUPLES 1/

 

 

 

 

 

In Own Household

A

Z

$687.00

$687.00

In Another's Hshld.

B

Z

458.00

458.00

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

687.00

1,135.00

(DE), Appendix I — Chart 13

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1994-12/1994)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

In Own Household

 

 

 

 

 

No EP

A

C

$15.00

$446.00

$461.00

1 EP

A

E

15.00

669.00

684.00

In Certified Adult

A

A

147.20

446.00

593.20

Foster Care Home

A

B

257.20

446.00

703.20

In Another's Hshld.

 

 

 

 

 

No EP

B

D

15.00

297.34

312.34

1 EP

B

F

15.00

446.00

461.00

In Parental Hshld.

C

C

15.00

446.00

461.00

Medicaid Facility

D

G

40.00

30.00

70.00

COUPLES 1/

In Own Household

 

 

 

 

 

No EP

A

C

$ 30.00

$669.00

$699.00

1 EP

A

E

30.00

892.00

922.00

In Certified Adult

A

A

517.40

669.00

1,186.40

Foster Care Home

A

B

737.40

669.00

1,406.40

In Another's Hshld.

 

 

 

 

 

No EP

B

D

30.00

446.00

476.00

1 EP

B

F

30.00

594.67

624.67

Medicaid Facility

D

G

80.00

60.00

140.00

(DE), Appendix I — Chart 12

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1993-12/1993)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$434.00

$434.00

In Another's Hshld.

B

Z

289.34

289.34

In Parental Hshld.

C

Z

434.00

434.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

434.00

574.00

COUPLES 2/

 

 

 

 

 

In Own Household

A

Z

$652.00

$652.00

In Another's Hshld.

B

Z

434.67

434.67

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

652.00

1,100.00

(DE), Appendix I — Chart 11

SUPPLEMENTATION CODING AND PAYMENT LEVELS (01/1992 - 12/1992)

Living Arrangement

L/A Code

O/S Code

O/S Amount

Federal Payment Amount

Total Payment Level

INDIVIDUALS 1/

 

 

 

 

 

In Own Household

A

Z

$422.00

$422.00

In Another's Hshld.

B

Z

281.34

281.34

In Parental Hshld.

C

Z

422.00

422.00

Medicaid Facility

D

Z

30.00

30.00

In Certified Residential Care Home

A

A

$140.00

422.00

562.00

COUPLES 2/

 

 

 

 

 

In Own Household

A

Z

$633.00

$633.00

In Another's Hshld.

B

Z

422.00

422.00

Medicaid Facility

D

Z

60.00

60.00

In Certified Residential Care Home

A

A

$448.00

633.00

1,081.00


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415008PHI
SI PHI01415.008 - Administration of State Supplementary Programs -- Delaware (RTN 61 -- 12/2015) - 11/23/2015
Batch run: 11/23/2015
Rev:11/23/2015