TN 24 (12-94)

NL 00804.155 Marriage/Federal Living Arrangements

1160. Situation Where Used:

Recipient's marital status changed during initial period of eligibility. (This paragraph may be used more than once on the same notice.)

(You) (1) married (2) .

(1)Choice 1 - are
 Choice 2 - are not
 Choice 3 - were
 Choice 4 - were not
 Choice 5 - is
 Choice 6 - is not
 Choice 7 - was
 Choice 8 - was not
(3)Choice 1 - for (Month/Year)
 Choice 2 - for (Month/Year) through (Month/Year)
 Choice 3 - for (Month/Year) on

1165. Situation Where Used:

IC and PE: Used to show periods of FLA-C or D.

(1) (2) living (3) (4) (5)

(1)Choice 1 - (You)
 Choice 2 - (Your) spouse
 Choice 3 - (You) and (your) spouse
(2)Choice 1 -are
 Choice 2 -were
 Choice 3 -is
 Choice 4 -was
(3)Choice 1 -with (your) spouse
 Choice 2 -Null
(4)Choice 1 - in (your) parents' household
 Choice 2 -in a hospital or other institution and more than half the cost of (your) care is provided by Medicaid
 Choice 3 -in a hospital or other institution and more than half the cost of your care was provided by Medicaid
 Choice 4 -in a hospital or other institution and more than half the cost of the care is provided by Medicaid
((5)Choice 1 -for (month/year)
 Choice 2 -for (month/year) through (month/year)
 Choice 3 -for (month/year) on

2160. Situation Where Used:

Individual and/or spouse changes Federal living arrangement and is paid for living in own household for month of change, even though not living in own household for the entire month of change.

(1) (2) not living (3) (4) or (5) (6) for the full month of (7) .

(1)Choice 1 - (You)
 Choice 4 - (Your) spouse
(2)Choice 1 -are
 Choice 2 -is
 Choice 3 -were
 Choice 4 -was
(3)Choice 1 -with (your) spouse
 Choice 2 -Null
(4)Choice 1 -in the household of someone else and receiving support and maintenance
 Choice 2 -in a hospital or other institution and more than half the cost of care was provided by Medicaid
 Choice 3 - in a hospital or other institution and more than half the cost of care is provided by Medicaid
(5)Choice 1 -with (your) spouse
 Choice 2 -Null
(6)Choice 1 -in the household of someone else and receiving support and maintenance
 Choice 2 -in a hospital or other institution and more than half the cost of care was provided by Medicaid
 Choice 3 -in a hospital or other institution and more than half the cost of care is provided by Medicaid
(7)(Month/Year)  

2161. Situation Where Used:

PE: When a recipient moves from FLA-B to FLA-A.

(Your) SSI payment has been changed because (you) are no longer receiving free food and shelter while living in someone else's home or apartment.

2162. Situation Where Used:

PE: When a recipient moves from FLA-C or D to FLA-A.

(You) are no longer living in (1) .

(1)Choice 1 - (your) parents' household
 Choice 2 -a hospital or other institution where more than half of the cost of the care was provided by Medicaid

 

MANUAL PARAGRAPHS

FLAM01. Situation Where Used:

Individual is considered to be married because of “holding out” for one or more months of the period of initial eligibility.

For Supplemental Security Income eligibility purposes, it has been determined that (1) (your) spouse and that (2) were living together (3) .

(1)Choice 1 - (Name of Spouse) is
 Choice 2 - (Name of Spouse) was
(2)Choice 1 - you
 Choice 2 - they
(3)Choice 1 - for (Month/Year)
 Choice 2 - for (Month/Year) through (Month/Year)
 Choice 3 - for (Month/Year) on

FLAM02. Situation Where Used:

Use this language for manual notices for recipients in LA-D. This includes situations where the $30.00 payment limit is imposed because of a transfer of resources.

(Your) SSI for (1) is based on the following facts:

  • (2) (3) living in a medical care facility, like a hospital or nursing home, for a full month;

    and

  • (4)

(1)Choice 1 -month/year
 Choice 2 -month/year through month/year
 Choice 3 -month/year on
(2)Choice 1 - (You)
 Choice 2 - (Your) spouse
 Choice 3 - (You) and (your) spouse
(3)Choice 1 -are
 Choice 2 -were
 Choice 3 -is
 Choice 4 - was
(4)Choice 1 -Medicaid pays for or would usually pay for more than half the cost of the care.
 Choice 2 -Medicaid paid for or would usually have paid for more than half the cost of the care.

FLAM03. Situation Where Used:

When this paragraph is automated it will replace 2162. Currently, use this paragraph instead of 2162 when preparing manual notices.

(1) (2) no longer living in a medical care facility, like a hospital or nursing home, where (3)

(1)Choice 1 - (You)
 Choice 4 - (Your) spouse
 Choice 7 - (You) and (your) spouse
(2)Choice 1 -are
 Choice 2 -were
 Choice 3 -is