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a.
State supplementary payments may be suspended in months during which an individual's
Federal payment limit is $30 (effective July 1, 1988) due to their stay in a title
XIX facility. Upon discharge from the institution, the individual may again receive
federally administered MMSS payments based on the MIL or, if higher, a federally administered
OSS.
NOTE: (1) MMSS payments are not suspended if the individual was converted in December 1973
while residing in a Medicaid facility. (2) The benefits described in section 1619
of the act and sections 1611(e)(1)E and 1611(e)(1)G of the act do not apply to the
above discussions about title XIX institutions.
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b.
When only one member of an eligible couple resides in a title XIX facility, MMSS computations
follow the Federal rule that each member of the couple is treated as an individual.
See SI 02005.030C. for Federal and OSS computations under RMA.
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c.
Follow these steps to compute the MMSS payment for this couple:
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•
Establish separate MIL's for each couple member. Follow the procedures in SI 02005.082D.6.
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•
Compute the MMSS payment for the noninstitutionalized member, and the MMSS payment
for the institutionalized member if they was converted in FLA-D, independently.
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•
From the individual MIL(s) subtract the total of the individual's Federal SSI benefit
and Randy's own income.
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d.
EXAMPLE: One Member of an Eligible Couple Resides in a Title XIX Facility — Other
Member in Own Household
Randy and Laura were converted in the same State as eligible individuals in their
own households. Randy's MIL was established as $450 based on a December 1973 GA of
$410 and SCI of $40. Lauras' MIL was established as $300 based the December 1973 GA
of $260 and SCI of $40. Their State of conversion does not elect to maintain supplementary
payment levels for passalong purposes. They married in 1975. Their December 1973 incomes
and grant amounts were combined to form new MIL's based on couple status.
MIL Computation:
$410 |
Randy's December 1973 GA |
260 |
Lauras' December 1973 GA |
40 |
Randy's December 1973 SCI |
+40 |
Lauras' December 1973 SCI |
$750 |
$750 divided by 2 = $375 MIL for each couple member.
In September 1990 Laura enters a nursing home and Medicaid covers the entire cost
of theircare. For every month that Laura remains subject to the $30 payment limit,
the MMSS payments are suspended.
Randy remains in their own household. Randy continues to receive the $55 company pension
of which $40 was countable under the State plan. In October 1990 Randy begins receiving
a monthly payment of $10 from a sibling. (Randy's State plan would not have counted
the $10 had it been received in December 1973 because of the State's unearned income
exclusion.)
October 1990: This is the first month throughout which Laura is residing in the title
XIX facility. Compute Randy's payment as an individual.
Step (1): The MMSS Eligibility Test
$450 |
MIL in October (the original individual MIL) |
-341 |
Federal eligibility amount ($55 pension +$10 from sister - $20 general exclusion =
$45 FCI. $386 FBR - $45 October FCI = $341)
|
$109 |
- 40 |
SCI for October |
$ 69 |
Randy is MMSS eligible |
Step (2): The MMSS Payment Computation
$450 |
MIL in October (the original individual MIL) |
-351 |
Federal payment amount ($55 pension - $20 general exclusion = $35 FCI. $386 FBR -
$35 August FCI = $351)
|
$ 99 |
- 40 |
SCI for October |
$ 59 |
MMSS Payment for October |