California pays OSS A to an eligible individual/couple who:
lives in his/her own household, as defined for Federal living arrangement (FLA) A
purposes, and has cooking and food storage facilities (see SI SF01415.140 for definition of “cooking and food storage facilities”) or is provided meals as
part of the living arrangement; or
is a patient in a private medical facility certified for Title XIX and Title XIX does
not pay more than 50% of the patient's cost of care; or
effective July 1, 1983, is a patient in a private medical facility licensed as a skilled
nursing facility by the State but not certified for Title XIX; or
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, or
is a blind individual who lives in an independent living arrangement with or without
cooking and food storage facilities; or
effective December 1, 1996, is a child under age 18 in FLA D due to residence in a
private medical facility paid by private insurance. (See SI 00520.011C.)
IHSS Referral: Individuals who qualify for OSS A because they live in their own homes (i.e., either
home ownership or rental liability), and who need care and supervision, should be
referred to the county for In-Home Supportive Services (IHSS).
NOTE: Medicaid payments made under a Home or Community Based Services (HCBS) Medicaid waiver
(as defined by title XIX of the Social Security Act) usually do not result in imposing
the $30 payment limit, even if the Medicaid payment is over 50 % of the cost of care.
Room and board are generally not covered under an HCBS waiver.
The residents of a facility whose care is paid for under an HCBS waiver are FLA A
regardless of the percentage of their care being paid by Medicaid funds; OSS A applies.
For more information on waivers in these situations, see SI 00520.510D.
For information about an exception to this policy, see the second bullet of SI 00520.011C.4.
NOTE: Do not assume that an individual residing in a facility categorized as an Institution
for Mental Disease (IMD) is automatically eligible for FLA A and OSS A. Completion
of an SSA-8045 and contact with the facility to verify whether Medicaid is or is not
paying over 50% of the cost of care is always required. See SI
00520.011 for development of confinement in a medical treatment facility and SI SF01415.170 for state supplementation of FLA D.
Oliver Wood lives with and shares expenses with his brother. Mr. Wood's brother owns
the home in which they live. Mr. Wood is determined to be in FLA A because his contribution
for the household expenses exceeds his pro-rata share of the expenses. Mr. Wood is
eligible for OSS A because he is in an independent living arrangement and has access
to adequate cooking and food storage facilities.
Donovan Ojeda states he lives in a publicly operated community residence (POCR) designed
to serve no more than 16 residents and meals are provided. Since this residential
facility meets all the requirements set forth in SI 00520.500 (per the precedent established for this facility on the Seattle SSA-8045 Facility Determination site), the residents are not considered to be living in a public institution and
are, therefore, eligible for SSI payments based on FLA A and OSS A rates.
Sharon Lewis, a 17-year-old blind student, lives with her parents in their home. She
was determined to be in FLA C and is eligible for the OSS A rate because she is blind.
Consuelo Penrod lives in a licensed Developmentally Disabled Continuous Nursing Care
(DD-CNC) facility whose license has been voluntarily suspended while the facility
operates under a Home and Community Based Services (HCBS) waiver. Her living arrangement
is FLA A and OSS A while the waiver is in effect.
Li Nguyen, a 12-year-old child, is residing in a private hospital whose care is being
paid for by her parents’ private insurance. Her living arrangement is FLA D and OSS
is A while private insurance pays over 50% of the cost of care.