H-6000, Co-Payment for SSI Cases

Revision 22-1; Effective March 1, 2022

Under SSI policy, a person is eligible for the full standard payment amount in the month of entry to a Medicaid certified long-term care facility. Before entry to the Medicaid facility, the person must have been living in a non-institutional setting or in a private institution where Medicaid made no substantial payments for any part of that month. For any future month the person continues to live in the facility throughout the month, HHSC uses the reduced SSI payment standard.

An SSI recipient who lives in an approved Medicaid long-term care facility remains eligible for SSI if their countable income does not exceed the SSI reduced standard payment amount.

The Social Security Administration (SSA) determines eligibility for these recipients and HHSC staff determine the copayment amount.

Determine the co-payment for SSI recipients based on the SSI payment amount the person is entitled to and not the actual SSl payment received. SSA will recoup any erroneous payments.

Note: The reduced SSI payment standard is $30.

The reduced SSI payment standard applies to all future months if the person continues to live in the Medicaid long-term care facility throughout the month. A person is entitled to the reduced SSI payment standard for the month of entry into a Medicaid long-term care facility only if:

  • the person was living in a public institution or in a Medicaid medical treatment facility for every day of the month before the date of admission to the long-term care facility; or
  • Medicaid was paying more than half of the person’s cost of care.

Note: HHSC supplements the reduced SSI payment standard by $30 per month so that SSI recipients also have a $60 personal needs allowance.

A couple may be eligible under the full SSI payment standard for a couple during the month one or both spouses enter a Medicaid medical treatment facility in which Medicaid is expected to make substantial payments.

If only one spouse enters a facility and remains there throughout the subsequent month(s), SSA separates the payments for the subsequent month(s) to reflect the living arrangements of each spouse. If both spouses enter the Medicaid medical facility and Medicaid makes substantial payments for each spouse, SSA lowers the SSI payment standard to the reduced standard for a couple ($60) for the months after the month of entry.

Through SSI monitoring, determine if an SSI recipient has other income. Calculate the co-payment and notify Provider Claim Services.

The following amounts are the SSI federal benefit rate for the periods shown:

Time Period Individual Couple
Jan. 1, 2022 to present $841.00 $1,261.00
Jan. 1, 2021 to Dec. 31, 2021 $794.00 $1,191.00
Jan. 1, 2020 to Dec. 31, 2020 $783.00 $1,175.00
Jan. 1, 2019 to Dec. 31, 2019 $771.00 $1,157.00
Jan. 1, 2018 to Dec. 31, 2018 $750.00 $1,125.00
Jan. 1, 2017 to Dec. 31, 2017 $735.00 $1,103.00
Jan. 1, 2016 to Dec. 31, 2016 $733.00 $1,100.00
Jan. 1, 2015 to Dec. 31, 2015 $733.00 $1,100.00
Jan. 1, 2014 to Dec. 31, 2014 $721.00 $1,082.00
Jan. 1, 2013 to Dec. 31, 2013 $710.00 $1,066.00
Jan. 1, 2012 to Dec. 31, 2012 $698.00 $1,048.00
Jan. 1, 2011 to Dec. 31, 2011 $674.00 $1,011.00
Jan. 1, 2010 to Dec. 31, 2010 $674.00 $1,011.00
Jan. 1, 2009 to Dec. 31, 2009 $674.00 $1,011.00
Jan. 1, 2008 to Dec. 31, 2008 $637.00 $956.00
Jan. 1, 2007 to Dec. 31, 2007 $623.00 $934.00
Jan. 1, 2005 to Dec. 31, 2005 $579.00 $869.00
Jan.1, 2004 to Dec. 31, 2004 $564.00 $846.00
Jan.1, 2003 to Dec. 31, 2003 $552.00 $829.00
Jan.1, 2002 to Dec. 31, 2002 $545.00 $817.00
Jan.1, 2001 to Dec. 31, 2001 $531.00 $796.00
Jan.1, 2000 to Dec. 31, 2000 $512.00 $769.00
Jan.1, 1999 to Dec. 31, 1999 $500.00 $751.00
Jan.1, 1998 to Dec. 31, 1998 $494.00 $741.00
Jan.1, 1997 to Dec. 31, 1997 $484.00 $726.00
Jan.1, 1996 to Dec. 31, 1996 $470.00 $705.00
Jan.1, 1995 to Dec. 31, 1995 $458.00 $687.00
Jan.1, 1994 to Dec. 31, 1994 $446.00 $669.00
Jan.1, 1993 to Dec. 31, 1993 $434.00 $652.00
Jan.1, 1992 to Dec. 31, 1992 $422.00 $633.00
Jan.1, 1991 to Dec. 31, 1991 $407.00 $610.00
Jan.1, 1990 to Dec. 31, 1990 $386.00 $579.00
Jan.1, 1989 to Dec. 31, 1989 $368.00 $553.00
Jan.1, 1988 to Dec. 31, 1988 $354.00 $532.00
Jan.1, 1987 to Dec. 31, 1987 $340.00 $510.00
Jan.1, 1986 to Dec. 31, 1986 $336.00 $504.00
Jan.1, 1985 to Dec. 31, 1985 $325.00 $488.00
Jan.1, 1984 to Dec. 31, 1984 $314.00 $472.00
July 1, 1983 to Dec. 31, 1983 $304.30 $456.40
July 1, 1982 to June 30, 1983 $284.30 $426.40
July 1, 1981 to June 30, 1982 $264.70 $397.00
July 1, 1980 to June 30, 1981 $238.00 $357.00
July 1, 1979 to June 30, 1980 $208.20 $312.30
July 1, 1978 to June 30, 1979 $189.40 $284.10
July 1, 1977 to June 30, 1978 $177.80 $266.70
July 1, 1976 to June 30, 1977 $167.80 $251.80
July 1, 1975 to June 30, 1976 $157.70 $236.60
July 1, 1974 to June 30, 1975 $146.00 $219.00
Jan. 1, 1974 to June 30, 1974 $140.00 $210.00

From Jan.1, 1974, to June 30, 1988, the reduced SSI standard payment amount was $25 for a person and $50 for a couple.