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SSI and Institutionalized Persons

Posted on:11/21/2011
Institutionalized persons may be eligible for SSI payments. Payment standards and eligibility criteria for institutionalized persons vary by type of institution. Residents of medical institutions may receive SSI payments under certain conditions.


The Social Security Administration reduces payments for persons if Medicaid pays more than half the cost of their care. The usual reason for the reduction is that a patient living in a medical facility needs less income than someone in the community because Medicaid is paying the bulk of ordinary living expenses.

 

If Medicaid pays less than 50 percent, a patient may be entitled to the full federal payment regardless of whether Medicare, private insurance, or the patient pays the portion of the cost not reimbursed by Medicaid.

 

SSI payments are made to residents of domiciliary care facilities or boarding homes, or to persons residing under similar supervised living arrangements. Unlike skilled nursing and intermediate care facilities, these facilities do not provide ongoing medical care. Instead, they provide the residents with general supervision, room and board, personal care, and other services. Medicaid reimbursement is not available for the non-medical services the residents receive, but frequently it can be obtained for their medical care.

 

Residents of public domiciliary care or other public residential homes are ineligible for standard federal SSI payments if the facility has more than sixteen beds. If it has sixteen or fewer beds or if it is privately owned, the residents may qualify for the standard SSI payment. Further, the states can elect to supplement the federal payment. Many states have special provisions for those receiving domiciliary care; some vary the supplement by type of facility because of cost differentials in meeting resident needs; others pay more for persons in licensed than unlicensed facilities.
  
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