Independent Living with Cooking Facilities for an Eligible individual or couple who meets one of the following situations:

1. 1. 

   Lives in their own household, as defined for Federal living arrangement A purposes, and has cooking and food storage facilities or is provided meals as part of the living arrangement;

2. 2. 

   Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care;

3. 3. 

   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;

4. 4. 

   Is a blind individual who lives in an independent living arrangement with or without cooking and food storage facilities; or

5. 5. 

   Lives in a private medical facility licensed by the State but not certified under Title XIX.

Non-medical Out-of-Home Care (NMOHC) applies when an individual or couple needs non-medical care or supervision in the following living arrangement situations:

CHILDREN (UNDER AGE 18)

1. a. 

   Blind child residing in a State licensed NMOHC facility; or

2. b. 

   Blind child residing in the home of a relative who is not a parent and not a legal guardian; or

3. c. 

   Disabled child residing in a State licensed NMOHC facility; or

4. d. 

   Disabled child residing in the home of a legal guardian who is not a relative; or

5. e. 

   Disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

6. f. 

   A blind or disabled child in a “certified family” home approved by a licensed home-finding agency (“certified family home placement”); or

ADULTS (AGE 18 AND OVER)

1. a. 

   Aged, blind or disabled individual or couple has been determined to be in FLA A and resides in the home of a relative, legal conservator or guardian; or

2. b. 

   Aged, blind, or disabled individual or couple is determined to be in FLA A and resides in a State licensed NMOHC facility.

For California optional supplement (OS) purposes, a relative is defined as a parent, child, silbling, half-sibling, parent's sibling, child's sibling, first cousin, or any person of the preceding generation denoted by the prefix “grand” or “great.”

Independent Living Without Cooking Facilities -- Aged or disabled individual or couple who is neither provided any meals, nor has access to adequate cooking or food storage facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C.

An individual or couple qualifies for OS C if any of the following situations exists:

1. 1. 

   Immediate living quarters do not have cooking and food storage facilities with which the individual or couple or another person (who is responsible for preparing their meals) can prepare meals on a daily basis.

2. 2. 

   Does not have access to adequate cooking and food storage facilities as part of the living arrangement (including cooking and food storage facilities which are outside the immediate living quarters) for the purpose of preparing meals or having them prepared on their behalf.

3. 3. 

   Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which they have access for preparation of meals.

4. 4. 

   Lives with friends or relatives in private living quarters in the same house or in separate living quarters (for example, “over the garage”) or in a similar situation and does not have access to the cooking and food storage facilities in the main residence for preparation of meals.

5. 5. 

   Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement with the facility is to purchase only shelter on a monthly basis).

“Adequate” cooking and food storage facilities exist when an individual or couple has access to:

• •

  Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.)

OR

• •

  Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner hotplates with temperature controls. (Hotplates without temperature controls that are used for warming food are not considered adequate cooking facilities.)

OR

• •

  Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at least one working burner on a stove or a one-burner hotplate with a temperature control.

Eligibility for OS C begins in the month the recipient applies for this supplement rate provided they have been without cooking and food storage facilities throughout the month.

If eligibility is based on temporary loss or non-functioning of an appliance, advise the individual of their responsibility to report immediately when the temporary condition has ceased. If the individual provides an expected date when the appliance will be replaced or repaired, diary the case for re-contact.

Eligibility for this supplementary payment ceases the month following the month in which meals are provided or adequate cooking and food storage facilities are available.

For a couple, comprised of an aged or disabled individual and a blind individual, whose living arrangement lacks adequate cooking and storage facilities, the couple is to receive the Supplemental Security Income and State Supplement Payment level for a blind or aged or disabled couple plus the restaurant meals allowance for the disabled member of the couple. Force payment in this living arrangement is required.

Living in the Household of Another -- Eligible individual or couple is living in the household of another and is receiving food and shelter from that individual. Most individuals or couples who are subject to a one-third reduction of their Federal SSI payments are eligible for OS D because the criteria for this supplement level are the same as for charging the one-third reduction. However, when the eligible individual or couple lives in the home of a relative (other than a spouse) and needs care and supervision, certification for non-medical out-of-home care (OS F) should be obtained from the county welfare office since this is the highest categorical supplement for which an individual or couple can qualify.

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides with a parent or relative by blood or marriage.

NOTE: Only FLA A and C are compatible with OS E. If the VTR applies, see code G.

Non-medical Out-of-Home Care Living in the Household of Another -- Applies whenever an eligible individual or couple meets the criteria for the non-medical out-of-home care payment rate, and is determined to receive the Federal code B payment for living in the household of another. For the One-Third Reduction Provision see SI 00835.200.

Disabled Child Under Age 18 Living in the Household of Another -- Applies to a disabled (not blind) child under age 18, who resides with a parent or relative by blood or marriage, and is determined to receive the Federal code B payment for living in the household of another individual. For the One-Third Reduction Provision see SI 00835.200.

Residents of Title XIX facilities.

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

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

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 have 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 Health, 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 Health, as residents of an adult foster care home with more than 50 residents.

Residents of Title XIX facilities.

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

Living in a Community Care or Foster Care Home --

Persons eligible for SSI and who are both over age 18 and live in a State approved Care or Foster Care Home.

Living in a Certified Medical Facility – Eligible individual living in a medical treatment facility where a substantial part (more than 50 percent) of the cost of care is paid under Title XIX.

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 have 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 Essential Person (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. For State Supplement codes 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 have waived their right to receive, an optional supplement.

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 01/01/88, 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 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 recipient who meets one of the following situations:

1. 1. 

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

2. 2. 

   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. 3. 

   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. For Optional State Supplement codes see SM 01301.535.

Living in the Household of Another -- Aged or blind eligible recipient who is living in the household of another individual and receiving food and shelter from that individual. Aged or blind recipient who are subject to a one-third reduction (VTR) 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 recipient who lives in a private non-medical facility or, 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 have waived their right to receive, an optional supplement.

Congregate Care - Eligible recipient in Federal living arrangement (FLA) A. The living arrangement includes the following: Recipients in residential facilities who are under the supervision of the Department of Human Services: Children and adults under the supervision of or placed by the NJ Department of Human Services’ Division of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS) who are in residential facilities (both in and outside of NJ); and Recipients in Assisted Living Residences and in Comprehensive Personal Care Homes (CPCH) licensed by the Department of Health and Senior Services.

Living Alone or with Others -- Eligible recipients whose Federal living arrangements are A or C and do not meet the requirements defined in other supplementation categories.

Therefore, any eligible recipient who meets the requirement for a Federal code A is 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 is automatically entitled to optional supplement B.

This category includes, but is not limited to, those eligible recipients who are in one of the following situations:

1. 1. 

   Living physically alone;

2. 2. 

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

3. 3. 

   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. For State Supplement codes 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 receives the same total payment as an eligible recipient 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 also qualifies for the Optional Supplement (OS) - C rate.

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

Licensed Residential Health Care Facilities -- Attached to a nursing home; Assisted Living Residence; CPCH; or “free standing”. Prior to 01/01/06 residents of these facilities were paid at the OS “A” rate.

Authorization to make this payment is based on the recipient's residence at a facility listed in the New Jersey Congregate Care Directory .

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. Residents of the Assisted Living Resident (ALR) or CPCH section of a multipurpose facility are paid at the OS “A” rate. Nursing home residents are living arrangement (D/G) if Medicaid pays more than 50 percent of the cost of care.

Effective 09/01/88, 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 have waived their right to receive, an optional supplement.

Living Alone - Eligible recipient who meet one of the following situations:

1. 1. 

   Live physically alone;

2. 2. 

   Pay a fixed, pre-established flat fee for both room and board in a commercial establishment;

3. 3. 

   Lives with others but takes all meals outside the dwelling;

4. 4. 

   Live with others but separately prepares or has someone separately prepare their food. Occasional preparation of meals in common does not preclude a finding of separate preparation;

5. 5. 

   Receive a fixed, pre-established flat fee for room and board from all others in the dwelling;

6. 6. 

   Live with only a foster child, or a homemaker authorized by the local department of social services (DSS), or a family care recipient placed by: the Office of Mental Health (OMH) or Office of Mental Retardation and Developmentally Disabilities (OMRDD) or local DSS; or

7. 7. 

   Have no permanent living arrangement (i.e., transient or street person) and is not with a spouse or a child for whom they have primary responsibility.

Living with Others - Recipient who meets one of the following situations:

1. a. 

   Resides in a dwelling with others and prepares food in common with at least one other person in the dwelling.

   NOTE: An individual living with an ineligible spouse must be considered living with others despite any separate preparation. The same is true if a recipient lives with a child for whom they have primary responsibility (except if the child is a foster child)

2. b. 

   Is a child who does not meet the criteria for OSS C or OSS D (below);

3. c. 

   Lives in a religious community and room and board are provided in full or in part by the religious community; or

4. d. 

   Has no permanent living arrangement (i.e., transient or street person), but is with an ineligible spouse or child for whom they have primary responsibility.

Congregate Care Level I

1. 1. 

   Recipient is placed in a family type home certified by New York State (NYS) Office of Children and Family Services and supervised by a local DSS.

2. 2. 

   Recipient is placed in a family care home certified by OMH or OMRDD.

Congregate Care Level II – Payable to an eligible recipient who is a resident of a licensed Level II care facility. These consist of facilities, which provide supportive living environments and include: Residences for Adults certified by the NYS Department of Health; Privately operated facilities certified by the NYS OMH; Privately-operated facilities certified by the NYS OMH and OMRDD; and Privately-operated facilities certified by OASAS.

Congregate Care Level III -- Enhanced Residential Care

Payable to an eligible recipient who is a resident of a licensed level 3 care facility which includes: Adult Homes and Enriched Housing programs certified by the NYS Department of Health or Schools for the Mentally Retarded certified by the NYS Office of Mental Retardation and Developmental Disabilities. Schools for the Mentally Retarded usually meet the basic Federal definition of institution and consist of residential facilities that provide academic, vocational, recreational and social skills programs. Although sometimes called schools, they often do not meet the Federal definition of schools.

Living in the Household of Another -- Payable to recipients who are FLA B.

Effective 01/01/88, the State elected Federal administration of an optional State supplementary payment to residents of Title XIX facilities. Federal administration was terminated effective 09/30/03. State began administering this payment 10/01/03.

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

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.

Living in the Household of Another with an EP -- Recipients who live in the household of another and have one or more EP’s as defined under the Federal rules.

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.

Optional Supplementation Waived -- Individual is eligible for, but 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 or assisted living facility who are certified as eligible for State Code D. This includes children under the age of 18 who are in Federal living arrangement D because a private health insurance policy or a combination of Medicaid and a private health insurance policy pays or is expected to pay over 50 percent of the cost of care for that month. For determination of applicability of $30 payment limit see second and third bullets in SI 00520.011C.1.b.

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 or Assisted Living -- This category applies to individuals only.

The State elected Federal Administration of an optional State Supplementary payment to residents of Title XIX Facilities (Effective 03/01/91). This includes children under the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care for that month.

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 and not in a residential or custodial care situation. This 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. It includes children under the age of 18 who are in Federal living arrangement D because a private health insurance policy or a combination of Medicaid and a private health insurance policy pays or is expected to pay over 50 percent of the cost of care for that month. For determination of applicability of $30 payment limit see second and third bullets in SI 00520.011C.1.b.

A recipient residing in a publicly operated emergency shelter throughout a month.

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

Licensed Residential Care Home or Assisted Living Residence with Assistive Community Care Services (Level III) -- Recipients residing in Level III facilities identified by the State. Refer to the Vermont Community Care Facilities (OS C and G) list on BOSNET to determine if a residence meets the requirements for Optional Supplement C.

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).

Licensed Residential Care Home or Therapeutic Community Residence (Level IV) -- Recipients residing in Level IV facilities identified by the State. Refer to the Vermont Community Care Facilities (OS C and G) list on BOSNET to determine if a residence meets the requirements for Optional Supplement G.

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

In some cases the Vermont Department of Disabilities, Aging, and Independent Living (DAIL) has established outplacement programs meeting the definition of living arrangement (L/A) H. To qualify these programs must meet the requirements stated above.

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 two-three times a week) which may include 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.

Effective 07/01/87, the State elected Federal administration of an optional State supplementary payment to residents in Title XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care for that month.