California

Nevada

Delaware

New Jersey

District Of Columbia

New York

Hawaii

Pennsylvania

Iowa

Rhode Island

Massachusetts

Utah

Michigan

Vermont

Montana

A

Independent Living with Cooking Facilities -- Eligible individual or couple who:

1. Lives in his/her 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; or

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. 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; or

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

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

B

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

CHILDREN (UNDER AGE 18)

1. Blind child residing in a State licensed NMOHC facility; or

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

3. Disabled child residing in a State licensed NMOHC facility; or

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

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

6. 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)

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

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

For California optional supplement purposes, a relative is defined as a parent, son, daughter, brother, sister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin, or any person of the preceding generation denoted by the prefix “grand” or “great.”

C

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

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

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

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. 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. 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. 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 SSI applicant's/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/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 applicant/recipient applies for this supplement rate provided he/she has been without cooking and food storage facilities throughout the month.

NOTE: For purposes of OS C, “throughout a month” does not mean the applicant/recipient must lack adequate cooking/food storage facilities from the very first moment of the month. He/she need only lack them from some time on the first day of the month.

If eligibility is based on temporary loss or nonfunctioning of an appliance, the individual should be advised of his/her responsibility to report immediately when the temporary condition has ceased. If the individual provides an expected date when the appliance will be replaced/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/disabled individual and a blind individual, whose living arrangement lacks adequate cooking and storage facilities, the couple is to receive the SSI/SSP level for a blind/aged or disabled couple plus the restaurant meals allowance for the disabled member of the couple. Force payment in this living arrangement is required.

D

Living in the Household of Another -- Eligible individual/couple is living in the household of another and is receiving food and shelter from that individual. Most individuals/couples who are subject to a 1/3 reduction of their Federal SSI payments (VTR) are eligible for OS D because the criteria for this supplement level are the same as for charging the VTR. However, when the eligible individual/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/couple can qualify.

E

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.

F

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 (SI 00835.200).

G

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 (SI 00835.200).

J

Residents of title XIX facilities.

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

Y

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

Z

No Supplement Cases -- Eligible individual or couple who is a patient:

1. In a medical facility where title XIX pays more than 50 percent of the costs; or

2. In a private medical facility which is not certified under title XIX and not licensed by the State.

Includes residents of publicly operated emergency shelters throughout a month.

NOTE: California is a concurrent category State and permits SSI recipients to receive the highest categorical supplement for which they can qualify.

A

A

Aged

637.00

233.00

870.00

Blind

637.00

298.00

935.00

Disabled

637.00

233.00

870.00

B

All

637.00

412.00

1049.00

C

Aged

637.00

317.00

954.00

Blind

637.00

0.00

637.00

Disabled

637.00

317.00

954.00

E

Disabled

637.00

119.00

756.00

Z

All

637.00

0.00

637.00

B

D

Aged

424.67¹

234.00

658.67

Blind

424.67¹

315.00

739.67

Disabled

424.67¹

234.00

658.67

F

All

424.67¹

407.00

831.67

G

Disabled

424.67¹

108.00

532.67

C

A

Blind

637.00

298.00

935.00

E

Disabled

637.00

119.00

756.00

D

J

All

30.00²

20.00

50.00

A

A

Aged/Aged

956.00

568.00

1524.00

Blind/Blind

956.00

795.00

1751.00

Disabled/Disabled

956.00

568.00

1524.00

Aged/Blind

956.00

710.00

1666.00

Aged/Disabled

956.00

568.00

1524.00

Blind/Disabled

956.00

710.00

1666.00

B

All

956.00

1142.00

2098.00

C

Aged/Aged

956.00

736.00

1692.00

Disabled/Disabled

956.00

736.00

1692.00

Aged/Disabled

956.00

736.00

1692.00

Z

All

956.00

0.00

956.00

B

D

Aged/Aged

637.34¹

595.66

1233.00

Blind/Blind

637.34¹

822.66

1460.00

Disabled/Disabled

637.34¹

595.66

1233.00

Aged/Blind

637.34¹

736.66

1374.00

Aged/Disabled

637.34¹

595.66

1233.00

Blind/Disabled

637.34¹

736.66

1374.00

F

All

637.34¹

1045.66

1683.00

D

J

All

60.00²

40.00

100.00

A

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.

Y

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

Z

No Supplement Cases -- All recipients who are not included in A or Y.

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

A

A

All

637.00

140.00

777.00

Z

All

637.00

0.00

637.00

B

Z

All

424.67¹

0.00

424.67

C

Z

All

637.00

0.00

637.00

D

Z

All

30.00²

0.00

30.00

A

A

All

956.00

448.00

1404.00

Z

All

956.00

0.00

956.00

B

Z

All

637.34¹

0.00

637.34

D

Z

All

60.00²

0.00

60.00

A

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.

B

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.

G

Residents of title XIX facilities.

Y

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

Z

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

A

A

All

637.00

485.00

1122.00

B

All

637.00

595.00

1232.00

B

Z

All

424.67¹

0.00

424.67

C

Z

All

637.00

0.00

637.00

D

G

All

30.00²

40.00

70.00

A

A

All

956.00

1288.00

2244.00

B

All

956.00

1508.00

2464.00

B

Z

All

637.34¹

0.00

637.34

D

G

All

60.00²

80.00

140.00

B

Living in a Community Care/Foster Care Home --

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

D

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

H

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.

I

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

Y

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

Z

No Supplement Cases -- Eligible individual (or couple) who is living in the household of another (see explanation in definition for optional supplement B) and an eligible individual (or couple) who is a patient in a private medical facility which is not certified under title XIX.

Also includes residents of publicly operated emergency shelters throughout a month.

A 

B

All

637.00

641.90

1278.90

H

All

637.00

641.90

1278.90

I

All

637.00

749.90

1386.90

B

Z

All

424.67¹

0.00

424.67

D

D

All

30.00²

20.00

50.00

 A

B

All

956.00

1601.80

2557.80

H

All

956.00

1601.80

2557.80

I

All

956.00

1817.80

2773.80

B

Z

All

637.34¹

0.00

637.34

D

D

All

60.00²

40.00

100.00

A

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)

B

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.

H

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 him or her, 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.

I

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.

G

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.

Y

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

Z

No Supplement Cases -- Residents of publicly operated emergency shelters throughout a month and aged and disabled recipients living in their own households or living in the households of others. No supplement also applies to all recipients living in medical facilities not certified under title XIX or all recipients whose Federal payments are reduced to $30/$60 due to living in a title XIX facility. In addition, aged and disabled recipients whose Federal payments are not reduced and who live in a title XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive a supplement.

NOTE: The State Department of Human Services administers three optional supplementation programs -- In-Home Health Related Care; Residential Care and Supplement for Medicare and Medicaid Eligibles.

A

A

Blind

637.00

22.00

659.00

C

Aged

637.00

325.00

962.00

Blind

637.00

347.00

984.00

Disabled

637.00

325.00

962.00

D

Aged

637.00

142.00

779.00

Blind

637.00

164.00

801.00

Disabled

637.00

142.00

779.00

Z

Aged

637.00

0.00

637.00

Disabled

637.00

0.00

637.00

B

B

Blind

424.67¹

22.00

446.67

H³

Aged

424.67¹

325.00

749.67

Blind

424.67¹

347.00

771.67

Disabled

424.67¹

325.00

749.67

I³

Aged

424.67¹

142.00

566.67

Disabled

424.67

142.00

566.67

Blind

424.67

164.00

588.67

Z

Aged

424.67¹

0.00

424.67

Disabled

424.67¹

0.00

424.67

C

A

Blind

637.00

22.00

659.00

C

Blind

637.00

347.00

984.00

Disabled

637.00

325.00

962.00

Z

Disabled

637.00

0.00

637.00

D

Z

All

30.00²

0.00

30.00

A

A

Blind/Blind

956.00

44.00

1000.00

Blind/Aged

956.00

22.00

978.00

Blind/Disabled

956.00

22.00

978.00

C

Aged/Aged

956.00

325.00

1281.00

Blind/Blind

956.00

369.00

1325.00

Disabled/Disabled

956.00

325.00

1281.00

Aged/Blind

956.00

347.00

1303.00

Aged/Disabled

956.00

325.00

1281.00

Blind/Disabled

956.00

347.00

1303.00

D

Aged/Aged

956.00

622.00

1578.00

Blind/Blind

956.00

666.00

1622.00

Disabled/Disabled

956.00

622.00

1578.00

Aged/Blind

956.00

644.00

1600.00

Aged/Disabled

956.00

622.00

1578.00

Blind/Disabled

956.00

644.00

1600.00

Z

Aged/Aged

956.00

0.00

956.00

Disabled/Disabled

956.00

0.00

956.00

Aged/Disabled

956.00

0.00

956.00

B

B

Blind/Blind

637.34¹

44.00

681.34

Blind/Aged

637.34¹

22.00

659.34

Blind/Disabled

637.34¹

22.00

659.34

H

Aged/Aged

637.34¹

325.00

962.34

Blind/Blind

637.34¹

369.00

1006.34

Disabled/Disabled

637.34¹

325.00

962.34

Aged/Blind

637.34¹

347.00

984.34

Aged/Disabled

637.34¹

325.00

962.34

Blind/Disabled

637.34¹

347.00

984.34

I

Aged/Aged

637.34¹

622.00

1259.34

Blind/Blind

637.34¹

666.00

1303.34

Disabled/Disabled

637.34¹

622.00

1259.34

Aged/Blind

637.34¹

644.00

1281.34

Aged/Disabled

637.34¹

622.00

1259.34

Blind/Disabled

637.34¹

644.00

1281.34

Z

Aged/Aged

637.34¹

0.00

637.34

Disabled/Disabled

637.34¹

0.00

637.34

Aged/Disabled

637.34¹

0.00

637.34

D

Z

All

60.00²

0.00

60.00

A

Full Cost-of-Living:

An individual who is in Federal living arrangement A is in State living arrangement A, if he/she is living in his/her own household¹ and is:

1. 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. Living only with his/her eligible spouse; or

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

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

NOTE: For purposes of 1 through 4, 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 he/she is 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 01415.040G.1. (See Code A, 1. or 2.) will be in State living arrangement A if he/she pays 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.)

B

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 01415.040G.1., Code A.4. 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. See SI 00520.011C.1.b, second and third bullets. 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 he/she is 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).

C

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.

E

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.

F

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. 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.

G

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.

Y

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

A

A

Aged

637.00

128.82

765.82

Blind

637.00

149.74

786.74

Disabled

637.00

114.39

751.39

B

Aged

637.00

39.26

676.26

Blind

637.00

149.74

786.74

Disabled

637.00

30.40

667.40

E

Aged

637.00

293.00

930.00

Blind

637.00

149.74

786.74

Disabled

637.00

293.00

930.00

G

Aged

637.00

454.00

1091.00

Blind

637.00

454.00

1091.00

Disabled

637.00

454.00

1091.00

B

C

Aged

424.67¹

104.36

529.03

Blind

424.67¹

362.07

786.74

Disabled

424.67¹

87.58

512.25

C

A

Blind

637.00

149.74

786.74

Disabled

637.00

114.39

751.39

B

Blind

637.00

149.74

786.74

Disabled

637.00

30.40

667.40

D

B²

Blind

30.00³

149.74

179.74

Disabled

30.00³

30.40

60.40

F

All

30.00³

42.80

72.80

A

A

Aged/Aged

956.00

201.72

1157.72

Blind/Blind

956.00

617.48

1573.48

Disabled/Disabled

956.00

180.06

1136.06

Aged/Blind

956.00

406.60

1365.60

Aged/Disabled

956.00

190.89

1146.89

Blind/Disabled

956.00

398.77

1354.77

B

Aged/Aged

956.00

201.72

1157.72

Blind/Blind

956.00

617.48

1573.48

Disabled/Disabled

956.00

180.06

1136.06

Aged/Blind

956.00

406.60

1365.60

Aged/Disabled

956.00

190.89

1146.89

Blind/Disabled

956.00

398.77

1354.77

E

Aged/Aged

956.00

904.00

1860.00

Blind/Blind

956.00

617.48

1573.48

Disabled/Disabled

956.00

904.00

1860.00

Aged/Blind

956.00

760.74

1716.74

Aged/Disabled

956.00

904.00

1860.00

Blind/Disabled

956.00

760.74

1716.74

G

All

956.00

681.00

1637.00

B

C

Aged/Aged

637.34¹

215.80

853.14

Blind/Blind

637.34¹

936.14

1573.48

Disabled/Disabled

637.34¹

194.18

831.52

Aged/Blind

637.34¹

575.97

1213.31

Aged/Disabled

637.34¹

204.99

842.33

Blind/Disabled

637.34¹

565.16

1202.50

D

F

All

60.00²

85.60

145.60

D

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.

E

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.

F

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.

G

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

H

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.)

I

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

Y

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

Z

No Supplement Cases -- Recipients in title XIX facilities where Medicaid pays more than 50 percent of the cost of care and recipients in medical facilities not certified under title XIX.

A

D

All

637.00

87.00

724.00

E

All

637.00

157.50

794.50

F

All

637.00

179.30

816.30

G

All

956.00²

14.00

970.00

B

H

All

637.34¹

9.33

646.67

D

I

All

 30.00³

7.00

37.00

A

D

All

956.00

492.00

1448.00

E

All

956.00

633.00

1589.00

F

All

956.00

676.60

1632.60

G

All

1275.00²

21.00

1296.00

B

H

All

850.00

14.00

864.00

D

I

All

60.00³

14.00

74.00

G

State-Certified Personal Care

H

State-Certified Residence in Group Home for Mentally Disabled

I

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

J

State-Certified Residence for Child and Adult Foster Care

K

State-Certified Transitional Living for Developmentally Disabled

Y

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

Z

No Supplement Cases -- Includes all individuals and couples not certified in State codes G, H, I, J, or K.

A

G

All

637.00

94.00

731.00

H

All

637.00

94.00

731.00

I

All

637.00

94.00

731.00

J

All

637.00

52.75

689.75

K

All

637.00

26.00

663.00

Z

All

637.00

0.00

637.00

B

Z

All

424.67¹

0.00

424.67

C

Z

All

637.00

0.00

637.00

D

Z

All

30.00²

0.00

30.00

A

G

All

956.00

193.00

1149.00

H

All

956.00

193.00

1149.00

I

All

956.00

193.00

1149.00

J

All

956.00

110.50

1066.50

K

All

956.00

57.00

1013.00

Z

All

956.00

0.00

956.00

B

Z

All

637.34¹

0.00

637.34

D

Z

All

60.00²

0.00

60.00

A

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

1. Lives in his/her own household as defined for Federal living arrangement A purposes; or

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. 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.)

B

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.

C

Domiciliary Care -- Aged or blind eligible individual or couple 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.

Y

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

Z

No Supplement Cases -- No supplement cases include:

1. Disabled eligible individuals or disabled members of eligible couples; or

2. Eligible individuals or members of eligible couples in a medical facility where title XIX pays more than 50 percent of the cost; or

3. Eligible individuals or members of eligible couples who are patients in a private medical facility which is not certified under title XIX; or

4. Residents of publicly operated emergency shelters throughout a month.

A

A

Aged

637.00

36.40

673.40

Blind

637.00

109.30

746.30

C

Aged

637.00

391.00

1028.00

Blind

637.00

391.00

1028.00

Z

Disabled

637.00

0.00

637.00

B

B

Aged

424.67¹

24.27

448.94

Blind

424.67¹

213.96

638.63

Z

Disabled

424.67¹

0.00

424.67

C

A

Blind

637.00

109.30

746.30

Z

Disabled

637.00

0.00

637.00

D

Z

All

30.00²

0.00

30.00

A

A

Aged/Aged

956.00

74.46

1030.46

Blind/Blind

956.00

374.60

1330.60

Aged/Blind

956.00

224.53

1180.53

Aged/Disabled

956.00

37.23

993.23

Blind/Disabled

956.00

187.30

1143.30

C

Aged/Aged

956.00

881.00

1837.00

Blind/Blind

956.00

881.00

1837.00

Aged/Blind

956.00

881.00

1837.00

Aged/Disabled

956.00

440.50

1396.50

Blind/Disabled

956.00

440.50

1396.50

Z

Disabled

956.00

0.00

956.00

B

B

Aged/Aged

637.34¹

49.64

686.98

Blind/Blind

637.34¹

531.94

1169.28

Aged/Blind

637.34¹

290.79

928.13

Aged/Disabled

637.34¹

24.82

662.16

Blind/Disabled

637.34¹

265.97

903.31

Z

Disabled

637.34¹

0.00

637.34

D

Z

All

60.00²

0.00

60.00

A

Congregate Care - Eligible individual/child/couple 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 and/or placement 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 licensed by the Department of Health and Senior Services.

B

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, 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. Living physically alone; or

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

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. (See SM 01301.535.)

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

C

Living Alone with an Ineligible Spouse -- Used when an individual lives with his/her 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 his/her 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.

D

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

I

Licensed Residential Health Care Facilities -- Attached to a nursing home; Assisted Living Residence; Comprehensive Personal Care Home; or “free standing”. Prior to January 1, 2006 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 ALR or CPCH section of a multipurpose facility are paid at the OS “A” rate. Nursing home residents are D/G if Medicaid pays more than 50% of the cost of care.

G

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

Y

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

Z

No Supplement Cases -- Individuals and couples in licensed medical facilities where Medicaid is paying less than 50 percent of the cost of care, individuals and couples in publicly operated community residences having 16 or less residents, and residents of publicly operated emergency shelters throughout a month.

It also includes cases that were FLA D prior to January 1988 or effective 12/1/96 children under age 18 residing in certain public or private facilities receiving payment for their care under any health insurance policy issued by a private provider (SI 00520.011).

A

A

All

637.00

150.05

787.05

B

All

637.00

31.25

668.25

C

Individual

637.00

344.36

981.36

w/EP

956.00

25.36

981.36

I

All

637.00

210.05

847.05

Z

All

637.00

0.00

637.00

B

D

All

424.67¹

44.31

468.98

C

B

All

637.00

31.25

668.25

D

G

All

30.00³

10.00

40.00

A

A

All

956.00

599.36

1555.36

B

All

956.00

25.36

981.36

I

All

956.00

719.36

1675.36

Z

All

956.00

  0.00

956.00

B

D

All

637.34¹

93.09

730.43

D

G

All

60.00²

20.00

80.00

A

Living Alone -- Eligible individuals or eligible couples who:

1. Live physically alone.

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

3. Lives with others but takes all meals outside the dwelling.

4. Live with others but separately prepares or has someone separately prepare his/her food. Occasional preparation of meals in common will not preclude a finding of separate preparation.

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

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.

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.

B

Living with Others -- Individual/child/couple who:

1. 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 an individual/couple lives with a child for whom he/she has primary responsibility (except if the child is a foster child).

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

3. Lives in a religious community and room and/or board are provided in full or in part by the religious community.

4. 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.

C

Congregate Care Level I –

1. Individual/couple/child has been placed in a family type home certified by NYS Office of Children and Family Services and supervised by a local DSS.

2. Individual/couple/child has been placed in a family care home certified by OMH/OMRDD.

D

Congregate Care Level II – Payable to an eligible individual/couple/child who is a resident of a licensed level 2 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.

E

Congregate Care Level III -- Enhanced Residential Care

Payable to an eligible individual/couple 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.

NOTE - A child residing in a Level 3 facility cannot receive OSS E; he/she will receive OSS B.

F

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

G

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.

Y

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

Z

No Supplement Cases – Includes Eligible individual/couple in FLA A or B who:

1. Is in a licensed medical facility where Medicaid is paying less than 50% of the cost of care; or

2. Is in a publicly operated community residence which serves 16 or fewer residents; or

3. Is in a publicly operated emergency shelter (PESH); or

4. Qualifies under the special provision in SI 00520.130 (1619 eligible goes into medical institution).

5. Effective 10/1/03 eligible individual/couple in FLA D and also cases that were FLA D prior to January 1988.

6. Effective 12/1/96, children under age 18 residing in certain public or private facilities receiving payment for their care under any health insurance policy issued by a private provider (SI 00520.011).

A,C

A

All

637.00

87.00

724.00

B

All

637.00

23.00

660.00

C

NY City and selected counties¹

637.00

266.48

903.48

All other counties

637.00

228.48

865.48

D

NY City and selected counties¹

637.00

435.00

1072.00

All other counties

637.00

405.00

1042.00

E

NY City and selected counties¹

637.00

656.00

1293.00

All other counties

637.00

656.00

1293.00

Z

All

637.00

  0.00

637.00

B

F

All

424.67²

23.00

447.67

D

G

All

30.00³

0.00⁴

30.00

A,C

A

All

956.00

104.00

1060.00

B

All

956.00

46.00

1002.00

C

NY City and selected counties¹

956.00

850.96

1806.96

All other counties

956.00

774.96

1730.96

D

NY City and selected counties¹

956.00

1188.00

2144.00

All other counties

956.00

1128.00

2084.00

E

NY City and selected counties¹

956.00

1630.00

2586.00

All other counties

956.00

1630.00

2586.00

Z

All

956.00

0.00

956.00

B

F

All

637.34²

46.00

683.34

D

G

All

60.00³

0.00⁴

60.00

C

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.

D

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.

G

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.

H

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.

Y

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

Z

No Supplement Cases -- Includes all recipients who are residing in a medical facility in which title XIX is paying more than 50 percent of the cost of care and recipients in FLA-A or FLA-B who receive a State-administered supplement.

A

Z

All

637.00

0.00

637.00

C

All

956.00¹

43.70

999.70

G

All

637.00

434.30

1071.30

H

All

637.00

439.30

1076.30

B

Z

All

424.67²

0.00

424.67

D

All

637.34³

43.70

681.04

C

Z

All

637.00

0.00

637.00

D

Z

All

30.00⁴

0.00

30.00

A

A

All

956.00

0.00

956.00

C

All

1275.00¹

68.05

1343.05

G

All

956.00

947.40

1903.40

H

All

956.00

957.40

1913.40

B

B

All

637.34²

0.00

637.34

D

All

850.00

68.05

918.05

D

Z

All

60.00⁴

0.00

60.00

A

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. 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. See SI 00520.011C.1.b., second and third bullets.

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

B

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.

D

Residential Care/Assisted Living -- This category applies to individuals only.

E

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

Y

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

A

A¹

All

637.00

57.35

694.35

D

All

637.00

575.00

1212.00

B

B¹

All

424.67²

69.94

494.61

C

A¹

All

637.00

57.35

694.35

D

A³

Children Private Insurance

30.00⁴

57.35

87.35

E

All

30.00⁴

20.00

50.00

A

A¹

All

956.00

108.50

1064.50

B

B¹

All

637.34²

128.50

765.84

D

E

All

60.00³

40.00

100.00

A

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

B

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.)

Z

No Supplement Cases -- No supplement cases include all recipients who are not included in A or B.

A,C

Z

All

637.00

0.00

637.00

B

B

All

424.67²

3.13

427.80

D

Z

All

30.00¹

0.00

30.00

A,C

A

All

956.00

4.60

960.60

B

B

All

637.34²

9.73

647.07

D

Z

All

60.00¹

0.00

60.00

A

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. See SI 00520.011C.1.b., second and third bullets.

An individual or eligible couple residing in a publicly operated emergency shelter throughout a month.

B

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

C

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.

E

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).

G

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.

H

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 he/she (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 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 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.

I

Effective 7/1/87, 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.

Y

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

A

A

All (Except Chittenden County)

637.00

52.04

689.04

B

All (Restricted to Chittenden County)

637.00

52.04

689.04

C

All

637.00

48.38

685.38

G

All

637.00

223.94

860.94

H

All

637.00

98.69

735.69

B

E

All

424.67¹

39.30

463.97

C

A

All (Except Chittenden County)

637.00

52.04

689.04

B

All (Restricted to Chittenden County)

637.00

52.04

689.04

D

A or B²

Children Private Insurance

30.00³

52.04

82.04

I

All

30.00³

17.66

47.66

A

A

All (Except Chittenden County

956.00

98.88

1054.88

B

All (Restricted to Chittenden County

956.00

98.88

1054.88

C

All

956.00

96.77

1052.77

G

All

956.00

562.06

1518.06

H

All

956.00

332.82

1288.82

B

E

All

637.34¹

48.31

685.65

D

I

All

60.00²

35.33

95.33