TN 28 (04-09)

SI 01415.041 Federally Administered Optional Supplementary Payment Programs for 01/09 Payment Levels

CITATIONS: Social Security Act as amended in 1973, Section 1616 ;Social Security Amendments of 1972, Section 301 ;Public Law 93-66, Section 212

A. Background

The following states are participating in the federally Administered Optional Supplementary Payment Programs:

State

Reference

California

SI 01415.041B

Delaware

SI 01415.041C

District Of Columbia

SI 01415.041D

Hawaii

SI 01415.041E

Iowa

SI 01415.041F

Massachusetts

SI 01415.041G

Michigan

SI 01415.041H

Montana

SI 01415.041I

Nevada

SI 01415.041J

New Jersey

SI 01415.041K

New York

SI 01415.041L

Pennsylvania

SI 01415.041M

Rhode Island

SI 01415.041N

Utah

SI 01415.041O

Vermont

SI 01415.041P

B. Description of supplements for California

1. Definitions of State living arrangement variations

Code

Definition

A

Independent Living with Cooking Facilities for an Eligible individual or couple who meets one of the following situations:

  1. Lives in their own household, as defined for Federal living arrangement A purposes, and has cooking and food storage facilities or is provided meals as part of the living arrangement;

  2. Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care;

  3. Is a blind child under age 18 living in the household of a parent, or parents, or is a disabled child age 18, or over who meets sharing criteria and is living in the household of a parent or parents;

  4. Is a blind individual who lives in an independent living arrangement with or without cooking and food storage facilities; or

  5. Lives in a private medical facility licensed by the State but not certified under Title XIX.

B

Non-medical Out-of-Home Care (NMOHC) applies when an individual or couple needs non-medical care or supervision in the following living arrangement situations:

CHILDREN (UNDER AGE 18)

  1. Blind child residing in a State licensed NMOHC facility; or

  2. Blind child residing in the home of a relative who is not a parent and not a legal guardian; or

  3. Disabled child residing in a State licensed NMOHC facility; or

  4. Disabled child residing in the home of a legal guardian who is not a relative; or

  5. Disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

  6. A blind or disabled child in a “certified family” home approved by a licensed home-finding agency (“certified family home placement”); or

ADULTS (AGE 18 AND OVER)

  1. Aged, blind or disabled individual or couple has been determined to be in FLA A and resides in the home of a relative, legal conservator or guardian; or

  2. Aged, blind, or disabled individual or couple is determined to be in FLA A and resides in a State licensed NMOHC facility.

For California optional supplement (OS) purposes, a relative is defined as a parent, son, daughter, brother, sister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin, or any person of the preceding generation denoted by the prefix “grand” or “great.”

C

Independent Living Without Cooking Facilities -- Aged or disabled individual or couple who is neither provided any meals, nor has access to adequate cooking or food storage facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C.

An individual or couple qualifies for OS C if any of the following situations exists:

  1. Immediate living quarters do not have cooking and food storage facilities with which the individual or couple or another person (who is responsible for preparing their meals) can prepare meals on a daily basis.

  2. Does not have access to adequate cooking and food storage facilities as part of the living arrangement (including cooking and food storage facilities which are outside the immediate living quarters) for the purpose of preparing meals or having them prepared on their behalf.

  3. Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which they have access for preparation of meals.

  4. Lives with friends or relatives in private living quarters in the same house or in separate living quarters (for example, “over the garage”) or in a similar situation and does not have access to the cooking and food storage facilities in the main residence for preparation of meals.

  5. Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement with the facility is to purchase only shelter on a monthly basis).

“Adequate” cooking and food storage facilities exist when an individual or couple has access to:

  • Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.)

OR

  • Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner hotplates with temperature controls. (Hotplates without temperature controls that are used for warming food are not considered adequate cooking facilities.)

OR

  • Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at least one working burner on a stove or a one-burner hotplate with a temperature control.

Eligibility for OS C begins in the month the recipient applies for this supplement rate provided they have been without cooking and food storage facilities throughout the month.

NOTE: For purposes of OS C, “throughout a month” does not mean the recipient must lack adequate cooking or food storage facilities from the very first moment of the month. The recipient need only lack them from some time on the first day of the month.

If eligibility is based on temporary loss or nonfunctioning of an appliance, advise the individual of their responsibility to report immediately when the temporary condition has ceased. If the individual provides an expected date when the appliance will be replaced or repaired, diary the case for re-contact.

Eligibility for this supplementary payment ceases the month following the month in which meals are provided or adequate cooking and food storage facilities are available.

 

For a couple, comprised of an aged or disabled individual and a blind individual, whose living arrangement lacks adequate cooking and storage facilities, the couple is to receive the Supplemental Security Income and State Supplement Payment level for a blind or aged or disabled couple plus the restaurant meals allowance for the disabled member of the couple. Force payment in this living arrangement is required.

D

Living in the Household of Another -- Eligible individual or couple is living in the household of another and is receiving food and shelter from that individual. Most individuals or couples who are subject to a one-third reduction of their Federal SSI payments are eligible for OS D because the criteria for this supplement level are the same as for charging the one-third reduction. However, when the eligible individual or couple lives in the home of a relative (other than a spouse) and needs care and supervision, certification for non-medical out-of-home care (OS F) should be obtained from the county welfare office since this is the highest categorical supplement for which an individual or couple can qualify.

E

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides with a parent or relative by blood or marriage.

NOTE: Only FLA A and C are compatible with OS E. If the VTR applies, see code G.

F

Non-medical Out-of-Home Care Living in the Household of Another -- Applies whenever an eligible individual or couple meets the criteria for the non-medical out-of-home care payment rate, and is determined to receive the Federal code B payment for living in the household of another. For the One-Third Reduction Provision see SI 00835.200.

G

Disabled Child Under Age 18 Living in the Household of Another -- Applies to a disabled (not blind) child under age 18, who resides with a parent or relative by blood or marriage, and is determined to receive the Federal code B payment for living in the household of another individual. For the One-Third Reduction Provision see SI 00835.200.

J

Residents of Title XIX facilities.

This State code is also used to supplement Section 1619 cases.

Y

Optional Supplementation Waived -- Individual is eligible for, but has waived their right to receive, an optional supplement.

Z

No Supplement Cases -- Eligible recipient who is a patient:

  1. In a medical facility where Title XIX pays more than 50 percent of the costs; or

  2. In a private medical facility which is not certified under Title XIX and not licensed by the State.

Includes residents of publicly operated emergency shelters throughout a month.

NOTE: California is a concurrent category State and permits SSI recipients to receive the highest categorical supplement for which they can qualify.

2. Coding and monthly payment levels

The coding and monthly payment levels for California effective 07/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Aged

674.00

176.00

850.00

 

 

Blind

674.00

239.00

913.00

 

 

Disabled

674.00

176.00

850.00

 

B

All

674.00

412.00

1,086.00

 

C

Aged

674.00

260.00

934.00

 

 

Blind

674.00

0.00

674.00

 

 

Disabled

674.00

260.00

934.00

 

E

Disabled

674.00

65.00

739.00

 

Z

All

674.00

0.00

674.00

B

D

Aged

449.341

194.18

643.52

 

 

Blind

449.341

273.32

722.66

 

 

Disabled

449.341

194.18

643.52

 

F

All

449.341

407.00

856.34

 

G

Disabled

449.341

71.08

520.42

C

A

Blind

674.00

239.00

913.00

 

E

Disabled

674.00

65.00

739.00

D

J

All

30.002

20.00

50.00

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Aged/Aged

1011.00

478.00

1489.00

 

 

Blind/Blind

1011.00

700.00

1711.00

 

 

Disabled/Disabled

1011.00

478.00

1489.00

 

 

Aged/Blind

1011.00

617.00

1628.00

 

 

Aged/Disabled

1011.00

478.00

1489.00

 

 

Blind/Disabled

1011.00

617.00

1628.00

 

B

All

1011.00

1161.00

2172.00

 

C

Aged/Aged

1011.00

646.00

1657.00

 

 

Disabled/Disabled

1011.00

646.00

1657.00

 

 

Aged/Disabled

1011.00

646.00

1657.00

 

Z

All

1011.00

0.00

1011.00

B

D

Aged/Aged

674.001

530.64

1204.64

 

 

Blind/Blind

674.001

752.42

1426.42

 

 

Disabled/Disabled

674.001

530.64

1204.64

 

 

Aged/Blind

674.001

668.40

1342.40

 

 

Aged/Disabled

674.001

530.64

1204.64

 

 

Blind/Disabled

674.001

668.40

1342.40

 

F

All

674.001

1045.66

1719.66

D

J

All

60.002

40.00

100.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

3. Coding and monthly payment levels

The coding and monthly payment levels for California effective 05/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Aged

674.00

196.00

870.00

 

 

Blind

674.00

261.00

935.00

 

 

Disabled

674.00

196.00

870.00

 

B

All

674.00

412.00

1,086.00

 

C

Aged

674.00

280.00

954.00

 

 

Blind

674.00

0.00

674.00

 

 

Disabled

674.00

280.00

954.00

 

E

Disabled

674.00

82.00

756.00

 

Z

All

674.00

0.00

674.00

B

D

Aged

449.341

209.33

658.67

 

 

Blind

449.341

290.33

739.67

 

 

Disabled

449.341

209.33

658.67

 

F

All

449.341

407.00

856.34

 

G

Disabled

449.341

83.33

532.67

C

A

Blind

674.00

261.00

935.00

 

E

Disabled

674.00

82.00

756.00

D

J

All

30.002

20.00

50.00

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Aged/Aged

1011.00

513.00

1524.00

 

 

Blind/Blind

1011.00

740.00

1751.00

 

 

Disabled/Disabled

1011.00

513.00

1524.00

 

 

Aged/Blind

1011.00

655.00

1666.00

 

 

Aged/Disabled

1011.00

513.00

1524.00

 

 

Blind/Disabled

1011.00

655.00

1666.00

 

B

All

1011.00

1161.00

2172.00

 

C

Aged/Aged

1011.00

681.00

1692.00

 

 

Disabled/Disabled

1011.00

681.00

1692.00

 

 

Aged/Disabled

1011.00

681.00

1692.00

 

Z

All

1011.00

0.00

1011.00

B

D

Aged/Aged

674.001

559.00

1233.00

 

 

Blind/Blind

674.001

786.00

1460.00

 

 

Disabled/Disabled

674.001

559.00

1233.00

 

 

Aged/Blind

674.001

700.00

1374.00

 

 

Aged/Disabled

674.001

559.00

1233.00

 

 

Blind/Disabled

674.001

700.00

1374.00

 

F

All

674.001

1045.66

1719.66

D

J

All

60.002

40.00

100.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

4. Coding and monthly payment levels

The coding and monthly payment levels for California effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Aged

674.00

233.00

907.00

 

 

Blind

674.00

298.00

972.00

 

 

Disabled

674.00

233.00

907.00

 

B

All

674.00

412.00

1,086.00

 

C

Aged

674.00

317.00

991.00

 

 

Blind

674.00

0.00

674.00

 

 

Disabled

674.00

317.00

991.00

 

E

Disabled

674.00

119.00

793.00

 

Z

All

674.00

0.00

674.00

B

D

Aged

449.341

234.00

633.34

 

 

Blind

449.341

315.00

764.34

 

 

Disabled

449.341

234.00

683.34

 

F

All

449.341

407.00

856.34

 

G

Disabled

449.341

108.00

557.34

C

A

Blind

674.00

298.00

972.00

 

E

Disabled

674.00

119.00

793.00

D

J

All

30.002

20.00

50.00

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Aged/Aged

1011.00

568.00

1579.00

 

 

Blind/Blind

1011.00

795.00

1806.00

 

 

Disabled/Disabled

1011.00

568.00

1579.00

 

 

Aged/Blind

1011.00

710.00

1721.00

 

 

Aged/Disabled

1011.00

568.00

1579.00

 

 

Blind/Disabled

1011.00

710.00

1721.00

 

B

All

1011.00

1161.00

2172.00

 

C

Aged/Aged

1011.00

736.00

1747.00

 

 

Disabled/Disabled

1011.00

736.00

1747.00

 

 

Aged/Disabled

1011.00

736.00

1747.00

 

Z

All

1011.00

0.00

1011.00

B

D

Aged/Aged

674.001

595.66

1269.66

 

 

Blind/Blind

674.001

822.66

1496.66

 

 

Disabled/Disabled

674.001

595.66

1269.66

 

 

Aged/Blind

674.001

736.66

1410.66

 

 

Aged/Disabled

674.001

595.66

1269.66

 

 

Blind/Disabled

674.001

736.66

1410.66

 

F

All

674.001

1045.66

1719.66

D

J

All

60.002

40.00

100.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

C. Description of supplements - Delaware

1. Definitions of State living arrangement variations

Code

Definition

A

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home -- Only living arrangement variation in Delaware and includes only those recipients who are certified by the State medical unit as residents of one of the above adult facilities.

Y

Optional Supplementation Waived -- Individual is eligible for, but has waived their right to receive, an optional supplement.

Z

No Supplement Cases -- All recipients who are not included in A or Y.

Optional supplementation code Z is the proper code to be used with an “intervening” Federal code A. For Optional State Supplement codes see SM 01301.535

2. Coding and monthly payment levels

The coding and monthly payments levels for Delaware effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total
Payment Levels

A

A

All

674.00

140.00

814.00

 

Z

All

674.00

0.00

674.00

B

Z

All

449.341

0.00

449.34

C

Z

All

674.00

0.00

674.00

D

Z

All

30.002

0.00

30.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

All

1011.00

448.00

1459.00

 

Z

All

1011.00

0.00

1011.00

B

Z

All

674.001

0.00

674.00

D

Z

All

60.002

0.00

60.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

D. Description of supplements - District of Columbia

1. Definitions of State living arrangement variations

Code

Definition

A

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by the District of Columbia, Department of Health, as residents of an adult foster care home with 50 or fewer residents.

B

Adult Foster Care Home with More than 50 Residents --Recipients who are certified by the District of Columbia, Department of Health, as residents of an adult foster care home with more than 50 residents.

G

Residents of Title XIX facilities.

Y

Optional Supplementation Waived -- Individual is eligible for, but has waived their right to receive, an optional supplement.

Z

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

2. Coding and monthly payment levels

The coding and monthly payment levels for the District of Columbia effective 01/01/09 are shown in the following charts.

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

All

674.00

485.00

1159.00

 

B

All

674.00

595.00

1269.00

B

Z

All

449.341

0.00

449.34

C

Z

All

674.00

0.00

674.00

D

G

All

30.002

40.00

70.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement Code

Total Payment Levels

A

A

All

1011.00

1307.00

2318.00

 

B

All

1011.00

1527.00

2538.00

B

Z

All

674.001

0.00

674.00

D

G

All

60.002

80.00

140.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

E. Description of supplements - Hawaii

1. Definitions of State living arrangement variations

Code

Definition

B

Living in a Community Care or Foster Care Home --

Persons eligible for SSI and who are both over age 18 and live in a State approved Care or Foster Care Home.

D

Living in a Certified Medical Facility – Eligible individual living in a medical treatment facility where a substantial part (more than 50 percent) of the cost of care is paid under Title XIX.

H

Domiciliary Care I -- (Maximum of five residents) - Eligible individual (including a child) or couple living in a domiciliary care facility which provides varying levels of care and services. A domiciliary care facility is a private, non-medical facility established and maintained to provide personal care and services to aged, infirm, or handicapped persons. The State provides SSA with listings of these facilities.

I

Domiciliary Care II -- Same as H except care is provided for six or more residents.

Y

Optional Supplementation Waived -- Eligible for, but has waived their right to receive an optional supplement.

Z

No Supplement Cases -- Eligible recipient who is living in the household of another (see explanation in definition for optional supplement B) and an eligible recipient who is a patient in a private medical facility which is not certified under Title XIX.

Also includes residents of publicly operated emergency shelters throughout a month.

2. Coding and monthly payment levels

The coding and monthly payment levels for Hawaii effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

B

All

674.00

651.90

1325.90

 

H

All

674.00

651.90

1325.90

 

I

All

674.00

759.90

1433.90

B

Z

All

449.341

0.00

449.34

D

D

All

30.002

20.00

50.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

 A

B

All

1011.00

1640.80

2651.80

 

H

All

1011.00

1640.80

2651.80

 

I

All

1011.00

1856.80

2867.80

B

Z

All

674.001

0.00

674.00

D

D

All

60.002

40.00

100.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

F. Description of supplements - Iowa

1. Definitions of State living arrangement variations

Code

Definition

A

Living in Own Household (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, does not have an Essential Person (EP), and is not otherwise excepted from supplementation. Also included are blind recipients in Title XIX facilities where Medicaid pays 50 percent or less of the cost of care. Optional supplement code A is also compatible with Federal codes A and C.

Optional supplement code A is the proper code to be used with an “intervening” Federal code A. For State Supplement codes see SM 01301.535.

B

Living in the Household of Another (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household of another for Federal purposes, does not have an EP, and is not otherwise excepted from supplementation.

H

Living with a Dependent Person -- Eligible individual or each member of an eligible couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, child, or adult child living in the home with them, and who is financially dependent upon the eligible individual as defined by the State Department of Human Services.

The payment level for this variation is increased by $22 for each blind individual or blind member of a couple to reflect the categorical blind supplement.

I

Living in a Family Life or Boarding Home -- Eligible individual or each member of an eligible couple in Federal living arrangement A or B who resides in a family life home or boarding home licensed by the State Department of Health or certified by the State Department of Human Services.

G

Used to indicate that no supplement is payable to a recipient living in a Title XIX facility and Title XIX pays more than 50 percent of the cost of care; however, a Federal D living arrangement is not appropriate because the “throughout a month” requirement is not met at the time initial claims input is made.

Y

Optional Supplementation Waived -- Individual is eligible for, but has waived their right to receive, an optional supplement.

Z

No Supplement Cases -- Residents of publicly operated emergency shelters throughout a month and aged and disabled recipients living in their own households or living in the households of others. No supplement also applies to all recipients living in medical facilities not certified under Title XIX or all recipients whose Federal payments are reduced to $30 or $60 due to living in a Title XIX facility. In addition, aged and disabled recipients whose Federal payments are not reduced and who live in a Title XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive a supplement.

NOTE: The State Department of Human Services administers three optional supplementation programs -- In-Home Health Related Care; Residential Care and Supplement for Medicare and Medicaid Eligibles.

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest categorical supplement for which they can qualify.

Blind recipients (either individuals or member of a couple) whose records include an EP have a supplementary payment level that includes $22 for each individual in addition to the FBR and EP increment and must be force paid.

2. Coding and monthly payment levels

The coding and monthly payment levels for Iowa effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Blind

674.00

22.00

696.00

 

C

Aged

674.00

344.00

1018.00

 

 

Blind

674.00

366.00

1040.00

 

 

Disabled

674.00

344.00

1018.00

 

D

Aged

674.00

142.00

816.00

  

Blind

674.00

164.00

838.00

  

Disabled

674.00

142.00

816.00

 

Z

Aged

674.00

0.00

674.00

 

 

Disabled

674.00

0.00

674.00

B

B

Blind

449.341

22.00

471.34

 

H3

Aged

449.341

344.00

793.34

 

 

Blind

449.341

366.00

815.34

 

 

Disabled

449.341

344.00

793.34

 

I3

Aged

449.341

142.00

591.34

  

Disabled

449.34

142.00

591.34

  

Blind

449.34

164.00

613.34

 

Z

Aged

449.341

0.00

449.34

 

 

Disabled

449.341

0.00

449.34

C

A

Blind

674.00

22.00

696.00

 

C

Blind

674.00

366.00

1040.00

 

 

Disabled

674.00

344.00

1018.00

 

Z

Disabled

674.00

0.00

674.00

D

Z

All

30.002

0.00

30.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

NOTE:

State-administered programs: For Calendar Year 2009:

  • Individuals receiving “Residential Care” receive payment based on a per diem rate plus a monthly personal allowance.

  • Individuals receiving “In-Home Health Care” receive a payment based on actual cost of in-home health care plus basic Federal benefits.

  • Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 monthly payment.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total
Payment Levels

A

A

Blind/Blind

1011.00

44.00

1055.00

 

 

Blind/Aged

1011.00

22.00

1033.00

 

 

Blind/Disabled

1011.00

22.00

1033.00

 

C

Aged/Aged

1011.00

344.00

1355.00

 

 

Blind/Blind

1011.00

388.00

1399.00

 

 

Disabled/Disabled

1011.00

344.00

1355.00

 

 

Aged/Blind

1011.00

366.00

1377.00

 

 

Aged/Disabled

1011.00

344.00

1355.00

 

 

Blind/Disabled

1011.00

366.00

1377.00

 

D

Aged/Aged

1011.00

641.00

1652.00

  

Blind/Blind

1011.00

685.00

1696.00

  

Disabled/Disabled

1011.00

641.00

1652.00

  

Aged/Blind

1011.00

663.00

1674.00

  

Aged/Disabled

1011.00

641.00

1652.00

  

Blind/Disabled

1011.00

663.00

1674.00

 

Z

Aged/Aged

1011.00

0.00

1011.00

 

 

Disabled/Disabled

1011.00

0.00

1011.00

 

 

Aged/Disabled

1011.00

0.00

1011.00

B

B

Blind/Blind

674.001

44.00

718.00

 

 

Blind/Aged

674.001

22.00

696.00

 

 

Blind/Disabled

674.001

22.00

696.00

 

H

Aged/Aged

674.001

344.00

1018.00

 

 

Blind/Blind

674.001

388.00

1062.00

 

 

Disabled/Disabled

674.001

344.00

1018.00

 

 

Aged/Blind

674.001

366.00

1040.00

 

 

Aged/Disabled

674.001

344.00

1018.00

 

 

Blind/Disabled

674.001

366.00

1040.00

 

I

Aged/Aged

674.001

641.00

1315.00

  

Blind/Blind

674.001

685.00

1359.00

  

Disabled/Disabled

674.001

641.00

1315.00

  

Aged/Blind

674.001

663.00

1337.00

  

Aged/Disabled

674.001

641.00

1315.00

  

Blind/Disabled

674.001

663.00

1337.00

 

Z

Aged/Aged

674.001

0.00

674.00

 

 

Disabled/Disabled

674.001

0.00

674.00

 

 

Aged/Disabled

674.001

0.00

674.00

D

Z

All

60.002

0.00

60.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

NOTE:

State-administered programs: For Calendar Year 2009:

  • Individuals receiving “Residential Care” receive payment based on a per diem rate plus a monthly personal allowance.

  • Individuals receiving “In-Home Health Care” receive a payment based on actual cost of in-home health care plus basic Federal benefits. (Members of a couple are treated as individuals.)

  • Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 monthly payment.

G. Description of supplements - Massachusetts

  1. Definitions of State living arrangement variations

Code

Definition

A

Full Cost-of-Living:

An individual who is in Federal living arrangement A is in State living arrangement A, if they are living in their own household1 and meets one of the following:

  1. Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses which openly advertise to the public and which do not provide board, or who live in a hotel. Also, those who rent only rooms in private residences are considered living alone provided they do not use the residential kitchen facilities for preparing meals;

  2. Living only with their eligible spouse;

  3. Living with their eligible spouse and ineligible child or children 2 none of whom (children) receive public income maintenance payments;3 or

  4. Living only with their ineligible spouse or their ineligible child or children, none of whom (spouse and children) receive public income maintenance payments.

NOTE: For purposes of 1 through 4, foster children placed with anyone other than their parents are not considered to be living with the foster parent.

 

An individual who is in Federal living arrangement C is in State living arrangement A if none of the other people with whom they are living receive public income maintenance payments.

An individual who is in Federal living arrangement A or C and who does not meet the criteria contained in SI 01415.040G.1. (See Code A, 1 or 2 (in this chart)) is in State living arrangement A if they pay at least two-thirds of the household expenses. In making a determination as to whether the individual pays two-thirds or more of the expenses, use the method defined in SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible spouse's income (except any assistance based upon need) may be used to determine if the eligible person is paying two-thirds of the household expenses.

A person living in a public congregate housing development is in A. The State makes the determination that a public congregate housing development is eligible for listing. Optional supplement code A is the proper code to be used with an “intervening” Federal code A. For Optional State Supplement codes see SM 01301.535.

B

Shared Living Expenses -- An individual who is in Federal living arrangement A or C and who does not meet the criteria listed for State living arrangement A, E or G is in State living arrangement B. Also included in this living arrangement are transients, the homeless, and residents of public emergency shelters for the homeless (PESH).

Those residing in group-care facilities such as halfway houses, private medical facilities where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial boarding homes, or other facilities which do not meet the criteria for living arrangement E or public congregate housing defined in SI 01415.040G.1., Code A.4. This includes children under the age of 18 who are in Federal living arrangement D because a private health insurance policy or a combination of Medicaid and a private health insurance policy pays or is expected to pay over 50 percent of the cost of care for that month. For determination of applicability of $30 payment limit see second and third bullets in SI 00520.011C.1.b. Also included are individuals placed under the auspices of the State adult foster care program and residents of publicly operated emergency shelters throughout a month.

An individual living in a household where all members receive public income maintenance payments unless they are paying at least two-thirds of the household expenses (A).

An individual living in a mixed household -- i.e., a household where one or more other members receive a public income maintenance payment -- also is included unless the individual is paying at least two-thirds of the household expenses (A).

C

Living in the Household of Another -- Recipients determined under Federal rules to be living in the household of another and receiving support and maintenance which reduce the Federal benefit by one-third.

E

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or that portion in which they are living is licensed by and has a provider agreement with the State. Does not include residents of a Medicaid certified portion of a rest home.

F

Effective 07/01/87, the State elected Federal administration of this optional State supplementary payment to residents of Title XIX facilities where Medicaid pays more than 50 percent of the cost of care. This includes children under the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care for that month.

G

Assisted Living -- Effective 07/01/94, the State elected Federal administration of this variation. Includes an individual, certified by the State to be residing in an Assisted Living residence served by a certified Group Adult Foster Care provider, who is not receiving assistance under any other Federal or State rental assistance program, and who pays a fixed, non-separable fee for rent and supportive services, other than medically necessary services reimbursed by Medicaid. The State shall certify to SSA each individual who is eligible for this optional supplement living arrangement. This living arrangement was discontinued effective 01/01/96. However, it has been restored, retroactively, to 01/01/97.

Y

Optional Supplementation Waived -- Individual is eligible for, but has waived their right to receive, an optional supplement.

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive the highest categorical supplement for which they can qualify.

1For purposes of determining State living arrangements, a commercial boarding house, foster home, or halfway house is not considered the person's household.

2Use the SSI definition of child in, SI 00501.010.

3A public income maintenance payment is a payment from any of the following programs: Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), the Refugee Act of 1980, the Disaster Relief Act of 1974, general assistance programs of the Bureau of Indian Affairs, State or local government income maintenance programs that are based on need, or Department of Veterans Affairs benefits based on need.

1. Coding and monthly payments levels

The coding and monthly payment levels for Massachusetts effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Aged

674.00

128.82

802.82

 

 

Blind

674.00

149.74

823.74

 

 

Disabled

674.00

114.39

788.39

 

B

Aged

674.00

39.26

713.26

 

 

Blind

674.00

149.74

823.74

 

 

Disabled

674.00

30.40

704.40

 

E

Aged

674.00

293.00

967.00

 

 

Blind

674.00

149.74

823.74

 

 

Disabled

674.00

293.00

967.00

 

G

Aged

674.00

454.00

1128.00

 

 

Blind

674.00

454.00

1128.00

 

 

Disabled

674.00

454.00

1128.00

B

C

Aged

449.341

104.36

553.70

 

 

Blind

449.341

374.40

823.74

 

 

Disabled

449.341

87.58

536.92

C

A

Blind

674.00

149.74

823.74

 

 

Disabled

674.00

114.39

788.39

 

B

Blind

674.00

149.74

823.74

 

 

Disabled

674.00

30.40

704.40

D

B2

Blind

30.003

149.74

179.74

 

 

Disabled

30.003

30.40

60.40

 

F

All

30.003

42.80

72.80

1Not an FBR; the amount represents the FBR less VTR.

2State OS Code B applies to children under the age of 18 who are in Federal living arrangement D because of private health insurance payments.

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Aged/Aged

1011.00

201.72

1212.72

 

 

Blind/Blind

1011.00

636.48

1647.48

 

 

Disabled/Disabled

1011.00

180.06

1191.06

 

 

Aged/Blind

1011.00

419.10

1430.10

 

 

Aged/Disabled

1011.00

190.89

1201.89

 

 

Blind/Disabled

1011.00

408.27

1419.27

 

B

Aged/Aged

1011.00

201.72

1212.72

 

 

Blind/Blind

1011.00

636.48

1647.48

 

 

Disabled/Disabled

1011.00

180.06

1191.06

 

 

Aged/Blind

1011.00

419.10

1430.10

 

 

Aged/Disabled

1011.00

190.89

1201.89

 

 

Blind/Disabled

1011.00

408.27

1419.27

 

E

Aged/Aged

1011.00

923.00

1934.00

 

 

Blind/Blind

1011.00

636.48

1647.48

 

 

Disabled/Disabled

1011.00

923.00

1934.00

 

 

Aged/Blind

1011.00

779.74

1790.74

 

 

Aged/Disabled

1011.00

923.00

1934.00

 

 

Blind/Disabled

1011.00

779.74

1790.74

 

G

All

1011.00

681.00

1692.00

B

C

Aged/Aged

674.001

215.80

889.80

 

 

Blind/Blind

674.001

973.48

1647.48

 

 

Disabled/Disabled

674.001

194.18

868.18

 

 

Aged/Blind

674.001

594.64

1268.64

 

 

Aged/Disabled

674.001

204.99

878.99

 

 

Blind/Disabled

674.001

583.83

1257.83

D

F

All

60.002

85.60

145.60

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

H. Description of supplements - Michigan

1. Definitions of State living arrangement variations

Code

Definition

D

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide room, board, and supervision. The State provides a list of these facilities and certifies which recipients are residents requiring this level of care.

E

Personal Care -- Recipients residing in licensed non-medical facilities that provide general supervision, physical care, and assistance in carrying out the basic activities of daily living. The State provides a list of these facilities and certifies which recipients are residents requiring this level of care. Such care situations include, but are not limited to, licensed homes for the aged.

F

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The State provides SSA with a list of these facilities and certifies which recipients are residents requiring this level of care.

G

Independent Living with an EP -- Recipients with an EP, not living in the household of another. (Children under age 18 are excluded.)

H

Living in the Household of Another with an EP -- Recipients with an EP and living in the household of another for Federal purposes. (Children under age 18 are excluded.)

I

Effective 01/01/88, the State elected Federal administration of an optional State supplementary payment to residents of Title XIX facilities.

Y

Optional Supplementation Waived -- Individual is eligible for, but waived their right to receive, an optional supplement.

Z

No Supplement Cases -- Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the cost of care and recipients in medical facilities not certified under Title XIX.

2. Coding and monthly payment levels

The coding and monthly payment levels for Michigan effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

D

All

674.00

87.00

761.00

 

E

All

674.00

157.50

831.50

 

F

All

674.00

179.30

853.30

 

G

All

1012.002

14.00

1026.00

B

H

All

674.671

9.33

684.00

D

I

All

  30.003

7.00

37.00

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

2Not an FBR; the amount represents the FBR plus EP increment.

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement
Level

Total Payment Levels

A

D

All

1011.00

511.00

1522.00

 

E

All

1011.00

652.00

1663.00

 

F

All

1011.00

695.60

1706.60

 

G

All

1349.002

21.00

1370.00

B

H

All

899.34

14.00

913.34

D

I

All

60.003

14.00

74.00

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

2Not an FBR; the amount represents the FBR plus EP increment.

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

I. Description of supplements - Montana

1. Definitions of State living arrangement variations

Code

Definition

G

State-Certified Personal Care

H

State-Certified Residence in Group Home for Mentally Disabled

I

State-Certified Residence in Group Home for Physically or Developmentally Disabled

J

State-Certified Residence for Child and Adult Foster Care

K

State-Certified Transitional Living for Developmentally Disabled

Y

Optional Supplementation Waived -- Individual is eligible for, but has waived their right to receive, an optional supplement.

Z

No Supplement Cases -- Includes all individuals and couples not certified in State codes G, H, I, J, or K.

2. Coding and monthly payment levels

The coding and monthly payment levels for Montana effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

G

All

674.00

94.00

768.00

 

H

All

674.00

94.00

768.00

 

I

All

674.00

94.00

768.00

 

J

All

674.00

52.75

726.75

 

K

All

674.00

26.00

700.00

 

Z

All

674.00

0.00

674.00

B

Z

All

449.341

0.00

449.34

C

Z

All

674.00

0.00

674.00

D

Z

All

30.002

0.00

30.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

G

All

1011.00

193.00

1204.00

 

H

All

1011.00

193.00

1204.00

 

I

All

1011.00

193.00

1204.00

 

J

All

1011.00

110.50

1121.50

 

K

All

1011.00

57.00

1068.00

 

Z

All

1011.00

0.00

1011.00

B

Z

All

674.001

0.00

674.00

D

Z

All

60.002

0.00

60.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

J. Description of supplements - Nevada

1. Definitions of State living arrangement variations

Code

Definition

A

Independent Living or Living in Parental Household -- Aged or blind eligible recipient who meets one of the following situations:

  1. Lives in their own household as defined for Federal living arrangement A purposes;

  2. Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

  3. Is a blind child under age 18 (age 21 for individuals who qualify as a “protected child”) living in a parent's household.

Used with an “intervening” Federal code A. For Optional State Supplement codes see SM 01301.535.

B

Living in the Household of Another -- Aged or blind eligible recipient who is living in the household of another individual and receiving food and shelter from that individual. Aged or blind recipient who are subject to a one-third reduction (VTR) of their Federal SSI payment, are eligible for optional supplement B because the criteria for this supplement level are the same as for Federal code B.

C

Domiciliary Care -- Aged or blind eligible recipient who lives in a private non-medical facility or, a residential facility serving 16 or fewer persons, which provides personal care and services to aged, infirm, or handicapped adult persons who are unrelated to the proprietor.

These facilities are licensed or authorized to receive payment by the State. The State provides SSA with listings of these facilities.

Y

Optional Supplementation Waived -- Individual is eligible for, but has waived their right to receive, an optional supplement.

Z

No Supplement Cases -- No supplement cases include one of the following:

  1. Disabled eligible individual or disabled member of eligible couple;

  2. Eligible individual or member of eligible couple in a medical facility where Title XIX pays more than 50 percent of the cost;

  3. Eligible individual or member of eligible couple who is patient in a private medical facility which is not certified under Title XIX; or

  4. Residents of publicly operated emergency shelters throughout a month.

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest categorical supplement for which they can qualify.

2. Coding and monthly payment levels

The coding and monthly payment levels for Nevada effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Aged

674.00

36.40

710.40

 

 

Blind

674.00

109.30

783.30

 

C

Aged

674.00

391.00

1065.00

 

 

Blind

674.00

391.00

1065.00

 

Z

Disabled

674.00

0.00

674.00

B

B

Aged

449.341

24.27

473.61

 

 

Blind

449.341

213.96

663.30

 

Z

Disabled

449.341

0.00

449.34

C

A

Blind

674.00

109.30

783.30

 

Z

Disabled

674.00

0.00

674.00

D

Z

All

30.002

0.00

30.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement Level

Total Payment Levels

A

A

Aged/Aged

1011.00

74.46

1085.46

 

 

Blind/Blind

1011.00

374.60

1385.60

 

 

Aged/Blind

1011.00

224.53

1235.53

 

 

Aged/Disabled

1011.00

37.23

1048.23

 

 

Blind/Disabled

1011.00

187.30

1198.30

 

C

Aged/Aged

1011.00

881.00

1892.00

 

 

Blind/Blind

1011.00

881.00

1892.00

 

 

Aged/Blind

1011.00

881.00

1892.00

 

 

Aged/Disabled

1011.00

440.50

1451.50

 

 

Blind/Disabled

1011.00

440.50

1451.50

 

Z

Disabled

1011.00

0.00

1011.00

B

B

Aged/Aged

674.001

49.64

723.64

 

 

Blind/Blind

674.001

531.94

1205.94

 

 

Aged/Blind

674.001

290.79

964.79

 

 

Aged/Disabled

674.001

24.82

698.82

 

 

Blind/Disabled

674.001

265.97

939.97

 

Z

Disabled

674.001

0.00

674.00

D

Z

All

60.002

0.00

60.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

K. Description of supplements - New Jersey (NJ)

1. Definitions of State living arrangement variations

Code

Definition

A

Congregate Care - Eligible recipient in Federal living arrangement (FLA) A. The living arrangement includes the following: Recipients in residential facilities who are under the supervision of the Department of Human Services: Children and adults under the supervision of or placed by the NJ Department of Human Services’ Division of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS) who are in residential facilities (both in and outside of NJ); and Recipients in Assisted Living Residences and in Comprehensive Personal Care Homes (CPCH) licensed by the Department of Health and Senior Services.

B

Living Alone or with Others -- Eligible recipients whose Federal living arrangements are A or C and do not meet the requirements defined in other supplementation categories.

Therefore, any eligible recipient who meets the requirement for a Federal code A is in optional supplement B unless residing in a residential health care facility or living alone with an ineligible spouse.

Likewise, any child meeting the criteria for a Federal code C is automatically entitled to optional supplement B.

This category includes, but is not limited to, those eligible recipients who are in one of the following situations:

  1. Living physically alone;

  2. Living with others in a private dwelling, but meeting some criteria for Federal living arrangement A; or

  3. Living in the Transitional Residency Program when the placement is through the Division of Mental Health and Hospitals, Department of Human Services.

Optional supplement code B is the proper code to be used with an “intervening” Federal code A. For State Supplement codes see SM 01301.535.

This State code is also used to supplement Section 1619 cases.

C

Living Alone with an Ineligible Spouse -- Used when an individual lives with their ineligible spouse and there are no other persons who are part of the household. An ineligible spouse for State supplementation purposes is determined by using Federal criteria; i.e., a spouse, either by marriage or holding out who is either not eligible for SSI or who chooses not to apply. The State uses this category to ensure that an individual with an ineligible spouse receives the same total payment as an eligible recipient with an EP. Once other persons, even minor children, are present in the household, this supplementary payment variation cannot exist. However, it is possible that a claimant and their ineligible spouse live with others and allege that they are a separate “household” by virtue of the fact that they eat their meals out or have separate purchase and preparation of food. In this instance, an optional supplement C is permissible as long as no other person is in their “household.” There is no couple counterpart in this category.

Parent(s) with minor children are always considered to be in the same household and therefore the presence of minor children in the household of an ineligible spouse would result in optional supplement B.

A transient individual who co-exists only with an ineligible spouse also qualifies for the Optional Supplement (OS) - C rate.

D

Living in the Household of Another -- Persons who are “living in the household of another” for Federal purposes.

I

Licensed Residential Health Care Facilities -- Attached to a nursing home; Assisted Living Residence; CPCH; or “free standing”. Prior to 01/01/06 residents of these facilities were paid at the OS “A” rate.

Authorization to make this payment is based on the recipient's residence at a facility listed in the New Jersey Congregate Care Directory .

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. Residents of the Assisted Living Resident (ALR) or CPCH section of a multipurpose facility are paid at the OS “A” rate. Nursing home residents are living arrangement (D/G) if Medicaid pays more than 50 percent of the cost of care.

G

Effective 09/01/88, the State elected Federal administration of an optional State supplementary payment to residents of Title XIX facilities.

Y

Optional Supplementation Waived -- Individual is eligible for, but has waived their right to receive, an optional supplement.

Z

No Supplement Cases – Recipients in licensed medical facilities where Medicaid is paying less than 50 percent of the cost of care, recipients in publicly operated community residences having 16 or less residents, and residents of publicly operated emergency shelters throughout a month.

It also includes cases that were FLA D prior to 01/1988 or effective 12/01/96 children under age 18 residing in certain public or private facilities receiving payment for their care under any health insurance policy issued by a private provider. For determination of applicability of $30 payment limit see SI 00520.011.

2. Coding and monthly payment levels

The coding and monthly payments levels for New Jersey effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement
Level

Total Payment Levels

A

A

All

674.00

150.05

824.05

 

B

All

674.00

31.25

705.25

 

C

Individual

674.00

344.36

1018.36

 

 

w/EP

1012.002

25.36

1037.36

 

I

All

674.00

210.05

884.05

 

Z

All

674.00

0.00

674.00

B

D

All

449.341

44.31

493.65

C

B

All

674.00

31.25

705.25

D

G

All

30.003

10.00

40.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents the FBR plus EP increment.

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement
Level

Total Payment Levels

A

A

All

1011.00

599.36

1610.36

 

B

All

1011.00

25.36

1036.36

 

I

All

1011.00

719.36

1730.36

 

Z

All

1011.00

  0.00

1011.00

B

D

All

674.001

93.09

767.09

D

G

All

60.002

20.00

80.00

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

L. Description of supplements - New York

1. Definitions of State living arrangement variations

Code

Definition

A

Living Alone - Eligible recipient who meet one of the following situations:

  1. Live physically alone;

  2. Pay a fixed, pre-established flat fee for both room and board in a commercial establishment;

  3. Lives with others but takes all meals outside the dwelling;

  4. Live with others but separately prepares or has someone separately prepare their food. Occasional preparation of meals in common does not preclude a finding of separate preparation;

  5. Receive a fixed, pre-established flat fee for room and board from all others in the dwelling;

  6. Live with only a foster child, or a homemaker authorized by the local department of social services (DSS), or a family care recipient placed by: the Office of Mental Health (OMH) or Office of Mental Retardation and Developmentally Disabilities (OMRDD) or local DSS; or

  7. Have no permanent living arrangement (i.e., transient or street person) and is not with a spouse or a child for whom they have primary responsibility.

B

Living with Others - Recipient who meets one of the following situations:

  1. Resides in a dwelling with others and prepares food in common with at least one other person in the dwelling.

    NOTE: An individual living with an ineligible spouse must be considered living with others despite any separate preparation. The same is true if a recipient lives with a child for whom they have primary responsibility (except if the child is a foster child)

  2. Is a child who does not meet the criteria for OSS C or OSS D (below);

  3. Lives in a religious community and room and board are provided in full or in part by the religious community; or

  4. Has no permanent living arrangement (i.e., transient or street person), but is with an ineligible spouse or child for whom they have primary responsibility.

C

Congregate Care Level I

  1. Recipient is placed in a family type home certified by New York State (NYS) Office of Children and Family Services and supervised by a local DSS.

  2. Recipient is placed in a family care home certified by OMH or OMRDD.

D

Congregate Care Level II – Payable to an eligible recipient who is a resident of a licensed Level II care facility. These consist of facilities, which provide supportive living environments and include: Residences for Adults certified by the NYS Department of Health; Privately operated facilities certified by the NYS OMH; Privately-operated facilities certified by the NYS OMH and OMRDD; and Privately-operated facilities certified by OASAS.

E

Congregate Care Level III -- Enhanced Residential Care

Payable to an eligible recipient who is a resident of a licensed level 3 care facility which includes: Adult Homes and Enriched Housing programs certified by the NYS Department of Health or Schools for the Mentally Retarded certified by the NYS Office of Mental Retardation and Developmental Disabilities. Schools for the Mentally Retarded usually meet the basic Federal definition of institution and consist of residential facilities that provide academic, vocational, recreational and social skills programs. Although sometimes called schools, they often do not meet the Federal definition of schools.

NOTE - A child residing in a Level III facility cannot receive OSS E; they receive OSS B.

F

Living in the Household of Another -- Payable to recipients who are FLA B.

G

Effective 01/01/88, the State elected Federal administration of an optional State supplementary payment to residents of Title XIX facilities. Federal administration was terminated effective 09/30/03. State began administering this payment 10/01/03.

Y

Optional Supplementation Waived -- Individual is eligible for, but has waived their right to receive, an optional supplement.

Z

No Supplement Cases – Includes Eligible recipient in FLA A or D who meet one of the following:

  1. Is in a licensed medical facility where Medicaid is paying less than 50 percent of the cost of care;

  2. Is in a publicly operated community residence which serves 16 or fewer residents;

  3. Is in a publicly operated emergency shelter (PESH);

  4. Qualifies under the special provision in SI 00520.130 (1619 eligible goes into medical institution);

  5. Effective 10/01/03 eligible recipient in FLA D and also cases that were FLA D prior to January 1988; or

  6. Effective 12/01/96, children under age 18 residing in certain public or private facilities receiving payment for their care under any health insurance policy issued by a private provider. For determination of applicability of $30 payment limit see SI 00520.011).

2. Coding and monthly payment levels

The coding and monthly payment levels for New York effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State

Supplement Level

Total Payment Levels

A,C

A

All

674.00

87.00

761.00

 

B

All

674.00

23.00

697.00

 

C

NY City and selected counties1

674.00

266.48

940.48

 

 

All other counties

674.00

228.48

902.48

 

D

NY City and selected counties1

674.00

435.00

1109.00

 

 

All other counties

674.00

405.00

1079.00

 

E

NY City and selected counties1

674.00

694.00

1368.00

 

 

All other counties

674.00

694.00

1368.00

 

Z

All

674.00

  0.00

674.00

B

F

All

449.342

23.00

472.34

D

Z

All

30.003

0.004

30.00

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, Suffolk, and Westchester counties effective 01/01/07.

2Not an FBR; the amount represents the FBR less VTR.

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State

Supplement Level

Total Payment Levels

A,C

A

All

1011.00

104.00

1115.00

 

B

All

1011.00

46.00

1057.00

 

C

NY City and selected counties1

1011.00

869.96

1880.96

 

 

All other counties

1011.00

793.96

1804.96

 

D

NY City and selected counties1

1011.00

1207.00

2218.00

 

 

All other counties

1011.00

1147.00

2158.00

 

E

NY City and selected counties1

1011.00

1725.00

2736.00

 

 

All other counties

1011.00

1725.00

2736.00

 

Z

All

1011.00

0.00

1011.00

B

F

All

674.002

46.00

720.00

D

Z

All

60.003

0.004

60.00

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, Suffolk, and Westchester counties effective 01/01/07.

2Not an FBR; the amount represents the FBR less VTR.

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

M. Description of supplements - Pennsylvania

1. Definitions of State living arrangement variations

Code

Definition

C

Living with an EP -- Recipients who are not living in the household of another or in a foster care home for adults and who have one or more EP’s as defined under the Federal rules.

D

Living in the Household of Another with an EP -- Recipients who live in the household of another and have one or more EP’s as defined under the Federal rules.

G

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified by the State to be residing in non-medical residential care facilities.

H

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified by the State to be residing in non-medical residential care facilities.

Y

Optional Supplementation Waived -- Individual is eligible for, but waived their right to receive, an optional supplement.

Z

No Supplement Cases -- Includes all recipients who are residing in a medical facility in which Title XIX is paying more than 50 percent of the cost of care and recipients in FLA-A or FLA-B who receive a State-administered supplement.

2. Coding and monthly payment levels

The coding and monthly payment levels for Pennsylvania effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement
Level

Total Payment Levels

A

Z

All

674.00

0.00

674.00

 

C

All

1012.001

43.70

1055.70

 

G

All

674.00

434.30

1108.30

 

H

All

674.00

439.30

1113.30

B

Z

All

449.342

0.00

449.34

 

D

All

674.673

43.70

718.37

C

Z

All

674.00

0.00

674.00

D

Z

All

30.004

0.00

30.00

1Not an FBR; the amount represents the FBR plus EP increment.

2Not an FBR; the amount represents the FBR less VTR.

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

4Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement
Level

Total Payment Levels

A

A

All

1011.00

0.00

1011.00

 

C

All

1349.001

68.05

1417.05

 

G

All

1011.00

947.40

1958.40

 

H

All

1011.00

957.40

1968.40

B

B

All

674.002

0.00

674.00

 

D

All

899.34

68.05

967.39

D

Z

All

60.004

0.00

60.00

1Not an FBR; the amount represents the FBR plus EP increment.

2Not an FBR; the amount represents the FBR less VTR.

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

4Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

N. Description of supplements - Rhode Island

1. Definitions of State living arrangement variations

Definitions of State Living Arrangement Variations are as follows:

Code

Definition

A

Independent Living -- Recipients who are in Federal codes A and C, except for individuals residing in a residential care or assisted living facility who are certified as eligible for State Code D. This includes children under the age of 18 who are in Federal living arrangement D because a private health insurance policy or a combination of Medicaid and a private health insurance policy pays or is expected to pay over 50 percent of the cost of care for that month. For determination of applicability of $30 payment limit see second and third bullets in SI 00520.011C.1.b.

Recipients residing in a public emergency shelter for the homeless and those who are eligible for Section 1619 are included in this category.

B

Living in the Household of Another -- Recipients who are living in the household of another and receiving support and maintenance in-kind. This variation applies only when the one-third reduction to the Federal benefit is applied.

D

Residential Care or Assisted Living -- This category applies to individuals only.

E

The State elected Federal Administration of an optional State Supplementary payment to residents of Title XIX Facilities (Effective 03/01/91). This includes children under the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care for that month.

Y

Optional Supplementation Waived -- Individual is eligible for, but waived their right to receive, an optional supplement.

2. Coding and monthly payment levels

The coding and monthly payment levels for Rhode Island effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement
Level

Total Payment Levels

A

A1

All

674.00

39.92

713.92

 

D

All

674.00

538.00

1212.00

B

B1

All

449.342

51.92

501.26

C

A1

All

674.00

39.92

713.92

D

A3

Children Private Insurance

30.004

39.92

69.92

 

E

All

30.004

20.00

50.00

1Code is systems generated from the Federal code.

2Not an FBR; the amount represents the FBR less VTR.

3State OS Code A applies to children under the age of 18 who are in Federal living arrangement D because of private health insurance payments.

4Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement
Level

Total Payment Levels

A

A1

All

1011.00

79.38

1090.38

B

B1

All

674.002

97.30

771.30

D

E

All

60.003

40.00

100.00

1Code is systems generated from the Federal code.

2Not an FBR; the amount represents the FBR less VTR.

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

O. Description of supplements - Utah

1. Definitions of State living arrangement variations

Code

Definition

A

Living Alone or With Others -- This variation includes recipients who are in Federal codes A and C.

B

Living in the Household of Another -- Recipients with no EP who are “living in the household of another” for Federal purposes. (Children under age 18 are included in this living arrangement variation.)

Z

No Supplement Cases -- No supplement cases include all recipients who are not included in A or B.

2. Coding and monthly payment levels

The coding and monthly payment levels for Utah effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State
Supplement
Level

Total Payment Level

A,C

Z

All

674.00

0.00

674.00

B

B

All

449.342

3.13

452.47

D

Z

All

30.001

0.00

30.00

1Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

2Not an FBR, the amount represents the FBR less VTR.

b. Couple

Federal Code

State OS Code

Category

FBR

State

Supplement
Level

Total Payment Levels

A,C

A

All

1011.00

4.60

1015.60

B

B

All

674.002

9.73

683.73

D

Z

All

60.001

0.00

60.00

1Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

2Not an FBR, the amount represents the FBR less VTR.

P. Description of supplements - Vermont

1. Definitions of State living arrangement variations

Definitions of State Living Arrangement Variations

Code

Definition

A

Independent Living (except Chittenden County) – Recipients not living in the household of another and not in a residential or custodial care situation. This includes a child who is living with a parent and recipients residing in a private Title XIX facility where Medicaid is not paying more than 50 percent of the cost of care. It includes children under the age of 18 who are in Federal living arrangement D because a private health insurance policy or a combination of Medicaid and a private health insurance policy pays or is expected to pay over 50 percent of the cost of care for that month. For determination of applicability of $30 payment limit see second and third bullets in SI 00520.011C.1.b.

A recipient residing in a publicly operated emergency shelter throughout a month.

B

Independent Living in Chittenden County -- Same as Code A above except restricted to residents of Chittenden County.

C

Licensed Residential Care Home or Assisted Living Residence with Assistive Community Care Services (Level III) -- Recipients residing in Level III facilities identified by the State. Refer to the Vermont Community Care Facilities (OS C and G) list on BOSNET to determine if a residence meets the requirements for Optional Supplement C.

E

Living in the Household of Another -- Recipients living in the household of another and receiving support and maintenance (subject to the Federal one-third reduction provisions).

G

Licensed Residential Care Home or Therapeutic Community Residence (Level IV) -- Recipients residing in Level IV facilities identified by the State. Refer to the Vermont Community Care Facilities (OS C and G) list on BOSNET to determine if a residence meets the requirements for Optional Supplement G.

H

Custodial Care: Family Home -- Recipients living in another's home in such a manner that the recipient is paying room and board and is receiving one or more of the services outlined under the custodial care definition. The recipient must also receive the room and board and custodial care in the home in which they reside. In order to qualify as a home under this arrangement, these services must not be provided to more than two persons and must be provided by a resident of the home.

In some cases the Vermont Department of Disabilities, Aging, and Independent Living (DAIL) has established outplacement programs meeting the definition of living arrangement (L/A) H. To qualify these programs must meet the requirements stated above.

Custodial care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under normal circumstances, occasional tray service (tray service two-three times a week) which may include supervision for the recipient's protection. Supervision for the recipient's protection deals primarily with protection services for retarded and emotionally disturbed individuals. A person who receives one or more of these personal services is receiving custodial care.

I

Effective 07/01/87, the State elected Federal administration of an optional State supplementary payment to residents in Title XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care for that month.

Y

Optional Supplementation Waived -- Individual is eligible for, but has waived their right to receive, an optional supplement.

2. Coding and monthly payment levels

The coding and monthly payment levels for Vermont effective 01/01/09 are shown in the following charts:

a. Individual

Federal Code

State OS Code

Category

FBR

State

Supplement
Level

Total Payment Levels

A

A

All (Except Chittenden County)

674.00

52.04

726.04

 

B

All (Restricted to Chittenden County)

674.00

52.04

726.04

 

C

All

674.00

48.38

722.38

 

G

All

674.00

223.94

897.94

 

H

All

674.00

98.69

772.69

B

E

All

449.341

39.30

488.64

C

A

All (Except Chittenden County)

674.00

52.04

726.04

 

B

All (Restricted to Chittenden County)

674.00

52.04

726.04

D

A or B2

Children Private Insurance

30.003

52.04

82.04

 

I

All

30.003

17.66

47.66

1Not an FBR; the amount represents the FBR less VTR.

2State OS Code A or B applies to children under the age of 18 who are in Federal living arrangement D because of private health insurance payments.

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

b. Couple

Federal Code

State OS Code

Category

FBR

State
Supplement
Level

Total Payment Levels

A

A

All (Except Chittenden County

1011.00

98.88

1109.88

 

B

All (Restricted to Chittenden County

1011.00

98.88

1109.88

 

C

All

1011.00

96.77

1107.77

 

G

All

1011.00

562.06

1573.06

 

H

All

1011.00

332.82

1343.82

B

E

All

674.001

48.31

722.31

D

I

All

60.002

35.33

95.33

1Not an FBR; the amount represents the FBR less VTR.

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415041
SI 01415.041 - Federally Administered Optional Supplementary Payment Programs for 01/09 Payment Levels - 08/07/2009
Batch run: 08/13/2009
Rev:08/07/2009