Program Operations Manual System (POMS)
HI 00815.015 Loss of a Supplemental Security Income (SSI) Payment to an Individual in a Title XIX (Medicaid) Institution
The Supplemental Security Income (SSI) payment amount may change if a beneficiary, who is otherwise eligible for SSI, is in a hospital, skilled nursing facility, intermediate care facility or nursing home which receives funds from Title XIX (Medicaid) for that person.
If Medicaid is paying more than 50 percent of the cost of services provided to the beneficiary, the maximum Federal payment is reduced to $30 a month. This reduction occurs whether the institution is public, nonprofit, or private. If the beneficiary has countable income, his payment will be reduced below $30. A beneficiary with $30 or more of countable income will be ineligible because of excess income. Since there is a $20 disregard of income from any source, a beneficiary receiving a Social Security benefit of $50 or more will not receive an SSI payment.
When sources other than Medicaid are paying more than 50 percent of the cost on behalf of an institutionalized beneficiary, the SSI payment amount depends on whether the institution is public or private. A beneficiary who is in a public institution is ineligible for any SSI payments, even if he or she has no other income. The basic standard is used to compute SSI payments for beneficiaries in private institutions.
Any changes in the SSI payment amount or eligibility do not take place until after the beneficiary has been in an institution throughout a calendar month. This means that a person entering an institution, for example, on January 15th will receive his former payment amount for February. Any reduction will be effective with the March 1st check. The beneficiary will be overpaid for February. The case will be alerted for Social Security office development of the overpayment; i.e., either recovery action or waiver.
If a State has included Title XIX Medical Assistance Only (MAO) in its Buy-in agreement, the system will continue a beneficiary on the Buy-in if he loses SSI or a federally administered State supplement and the Federal living arrangement (FLA) code changes to “D” (living in a Title XIX institution). An FLA-D applies to an individual who lives in a public or private medical institution throughout a month and Medicaid is paying more than 50 percent of the cost of the individual’s care. The Third Party System (TPS) will convert the billing item from Federal jurisdiction to State jurisdiction. The State should verify continuing eligibility for this type of case.
|To Link to this section - Use this URL: |
HI 00815.015 - Loss of a Supplemental Security Income (SSI) Payment to an Individual in a Title XIX (Medicaid) Institution - 06/01/2015
Batch run: 06/01/2015