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.

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

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

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

Effective 1/1/88, the State elected Federal administration of an optional State supplementary payment to residents of title XIX facilities.

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

Independent Living – Eligible individual or couple who:

• •

  Lives in their own household as defined for Federal living arrangement A purposes. This includes living in a “half-way house,” which is a private non-medical facility with whom the State has a purchase or services agreement for the short term care of certain needy individuals; or

• •

  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

• •

  Is a blind or disabled child under age 18 (or age 21 if the individual qualifies as a “protected child”) living in the household of a parent or parents.

Optional supplement code A is the proper code to be used with an “intervening” Federal code A. (See SM 01301.535)

This State code is also used to supplement Section 1619 cases. This State living arrangement was terminated 12/31/2002.

Living in a Community Care/Foster Care Home -- Effective 1/03. 1.

1. a. 

   Persons eligible for SSI and who meet both of the following conditions:

   over age 18 and

2. b. 

   live in a State approved Community Care/Foster Care Home

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.

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

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

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 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. (See SM 01301.535)

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.

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.

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.

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.

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

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 is:

1. a. 

   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 will be considered living alone provided they do not use the residential kitchen facilities for preparing meals; or

2. b. 

   Living only with their eligible spouse; or

3. c. 

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

4. d. 

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

   NOTE: For purposes of SI 01415.037G.1. (See Code A, 1.a. through 1.d., 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 01415.037G.1. (See Code A, 1. or 2.) will be 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. (See SM 01301.535.)

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 01415.037G.1., Code A.4. 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).

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.

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.

Effective 7/1/87, 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.

Assisted Living -- Effective 7/1/94, 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 1/1/96. However, it has been restored, retroactively, to 1/1/97.

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.

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.

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.

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

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.)

Effective 1/1/88, the State elected Federal administration of an optional State supplementary payment to residents of title XIX facilities.

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

State-Certified Personal Care

State-Certified Residence in Group Home for Mentally Disabled

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

State-Certified Residence for Child and Adult Foster Care

State-Certified Transitional Living for Developmentally Disabled

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

Independent Living or Living in Parental Household -- Aged or blind eligible individual or couple who:

1. a. 

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

2. b. 

   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. c. 

   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. (See SM01301.535.)

Living in the Household of Another -- Aged or blind eligible individual or couple who is living in the household of another individual and receiving food and shelter from that individual. Aged or blind individuals or couples, who are subject to a one-third reduction 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.

Domiciliary Care -- Aged or blind eligible individual or couple who lives in a private non-medical facility or, as of 10/76, 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.

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

Licensed Residential Health Care Facilities and Certain Licensed Residential Facilities -- The State provides New Jersey field offices with lists of approved facilities. Mentally retarded individuals must be placed and supervised by either the State Department of Youth and Family Services or the State Division of Mental Retardation.

Living Alone or with Others -- Eligible individuals (including children) or eligible couples whose Federal living arrangements are A or C and who do not meet the requirements defined in other supplementation categories.

Therefore, effective 8/1/81, any eligible adult/couple who meets the requirement for a Federal code A will be 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 will automatically be entitled to optional supplement B.

This category includes, but is not limited to, those eligible adults/couples who are:

1. a. 

   Living physically alone; or

2. b. 

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

3. c. 

   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. (See SM 01301.535.)

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

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 will receive the same total payment as an eligible couple or an individual 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 will also qualify for the O/S - C rate.

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

Effective 9/1/88, the State elected Federal administration of an optional State supplementary payment to residents of title XIX facilities.

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

Living Alone -- Eligible individuals or eligible couples living physically alone, or living with only a foster child(ren), or a homemaker authorized by the local Department of Social Services (DSS), or a family care recipient(s) placed by the Office of Mental Health (OMH) or Office of Mental Retardation and Developmentally Disabled (OMRDD) or local DSS, or individuals living with others but paying a “flat fee for room and board,” or living with others but taking all their meals outside the dwelling unit, or living with others in a dwelling but separately preparing food, or having their food separately prepared for them.

Living with Others -- Individual/child/couple who resides in a dwelling with others and prepares food in common with at least one other person in the dwelling, or is a member of a religious community, or child in any living arrangement other than a family care home (Level I) or community residence (Level II) certified by OMRDD or OMH.

Congregate Care Level I -- Family type homes and family care homes. Family type homes are facilities operated for the purpose of providing long-term residential care for adults and are certified by the New York State DSS and supervised by local departments of social services. Family care homes are private households that provide care for mentally disabled persons.

Congregate Care Level II -- Residential facilities for adults and certain children with mental disabilities.

Congregate Care Level III -- Privately operated non-medical residential facilities. Although Level III facilities are often called schools, these facilities may not meet the Federal definition of school. Operated for the purpose of providing treatment, training and education for mentally retarded or developmentally disabled individuals, these facilities are certified by OMRDD in accordance with State regulations.

Living in the Household of Another -- Same as Federal definition. The State supplement payment for the individual/child/couple whose Federal benefit rate is subject to the one-third reduction is the “living with others” rate but for systems purposes is coded F.

Effective 1/1/88, the State elected Federal administration of an optional State supplementary payment to residents of title XIX facilities. Federal administration was terminated effective 9/30/03. State began administering this payment 10/1/03.

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

Living Alone -- Recipients in private medical facilities (nursing homes, hospitals, intermediate care facilities) where title XIX is not paying more than 50 percent of the cost of care, residents of publicly operated emergency shelters throughout a month, and all other individuals and couples in Federal codes A and C not meeting the definition of another variation.

Used with an “intervening” Federal code A. (See SM 01301.535.)

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

Living in the Household of Another -- Recipients who do not have an EP and who live in the household of another and receive support and maintenance for Federal purposes.

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; i.e., Public Law 93-66.

Living in the Household of Another with an EP --Recipients who live in the household of another and who have one or more EP’s as defined under the Federal rules; i.e., Public Law 93-66.

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.

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 (Effective 7/1/89).

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

Independent Living -- Recipients who are in Federal codes A and C, except for individuals residing in a residential care/assisted living facility who have been certified as eligible for State Code D.

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

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.

Residential Care/Assisted Living (Effective 10/1/98). (Formerly Shelter Care from 10/01/90 – 9/30/98.) This category applies to individuals only.

The State elected Federal Administration of an optional State Supplementary payment to residents of Title XIX Facilities (Effective 3/1/91).

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

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.)

Independent Living (except Chittenden County) -- Recipients not living in the household of another, not in a custodial care situation, and not otherwise excepted from supplementation. 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.

Effective 5/1/83, an individual or eligible couple residing in a publicly operated emergency shelter throughout a month.

Optional supplement code A is the proper code to be used with an “intervening” Federal code A (except Chittenden County).

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

Effective 5/1/83, an individual or eligible couple residing in a publicly operated emergency shelter throughout a month.

Optional supplement code B is the proper code to be used with an “intervening” Federal code A (Chittenden County only). (See SM 01301.535.)

Assistive Community Care Level III: Recipients living in facilities identified by the State.

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), and not otherwise excepted from supplementation.

Custodial Care: Licensed Community Care Home -- Recipients living in Level IV Community Homes identified by the State.

Custodial Care: Family Home -- Recipients living in another's home in such a manner that the individual or couple is paying room and board and is receiving one or more of the services outlined under the custodial care definition. The individual or couple 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.

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 2-3 times a week) and/or 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.

The change in this arrangement is effective for initial claims filed on or after 1/1/84. For redeterminations the change is effective with the month after the month in which the first redetermination on or after 1/1/84, is initiated.

This arrangement does not cover:

• •

  Institutional Living -- Regardless of whether custodial care is needed in addition to the medical, training, rehabilitation, educational or similar services as the primary function of the institution.

• •

  A person whose Federal living arrangement is based on home ownership or rental liability. (A flat fee for room and board per SI 00835.120B. is not considered as rental liability for this arrangement.)

• •

  A child under age 18 not placed by a Vermont Community Mental Health Agency or the Vermont Department of Mental Health.

• •

  Custodial care or supervision provided by a spouse (as defined by Federal regulations).

• •

  Any home or boarding arrangement which does not meet the Federal SSI definition of independent living, Federal Code A.

Effective 7/1/87, the State elected Federal administration of an optional State supplementary payment to residents in title XIX facilities.