H-6100, Exceptions to Reduced SSI Payment Standard

Revision 09-4; Effective December 1, 2009

SSI persons who enter a Medicaid long-term care facility can continue to receive their community-based SSI payment in the following situations:

• Section 1619 eligibility
  
  Disabled individuals with earnings greater than the SSI benefit rate can continue to receive SSI or Medicaid benefits or both under Section 1619 of the Social Security Act (Public Law 99-643, effective July 1, 1987). These individuals can receive the community-based SSI payment for two months after the month of entry to a Medicaid facility.
   
• Temporary institutionalization
  
  Effective July 1, 1988, Public Law 100-203 allows SSI persons who meet certain requirements to continue receiving their SSI benefits while they are temporarily confined to a medical facility.
  
  These continued benefits may be made for up to three months after the month of entry if:
  • the individual notifies the SSA that he expects to be in a medical facility for at least a full calendar month but for fewer than 90 days;
  • SSA receives a physician's certification within 10 days after the close of the month of admission. The physician certifies that the individual is likely to leave the facility no later than the 91st consecutive day after admission; and
  • SSA receives evidence within 10 days after the close of the month of admission that the individual needs to maintain and provide for the expenses of the home or living arrangement to which he may return.

In each situation, the SSI person is allowed to keep SSI benefits for the first two or three calendar months, respectively, after the month of entry. Neither law affects the SSI benefit for the month of entry. Because the Nursing Home Billing System generally does not consider the SSI benefit toward calculating the co-payment for months after the month of entry, do not process Form H1259, Correction of Applied Income, for these cases.