Appendix C: Reason Code Text for SSI/SSP Budgets

014 –Option A SSI/SSP Eligible

For the period of [*A01] to [*B01] you will receive $ [ *C01]. Effective [*D01], you will begin receiving $[*E01] once a month.

The Social Security Administration has notified the Pennsylvania Department of Public Welfare that you are eligible for Supplemental Security Income (SSI). As a result, you are eligible for the maximum State Supplementary Payment (SSP) and Medicaid. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).

You will receive a separate notice about your Medicaid eligibility.

Regulations: 55 Pa Code 299.1(a), 299.21 and 299.35

CAO Entries:

*A01 Begin date of One Time Issuance (OTI) period

*B01 End date of OTI period

*C01 OTI $ amount

Pre-populated by eCIS:

*D01 Begin date of ongoing SSP issuance

*E01 Monthly benefit

014 –Option B SSP-Only Eligible Notice – Manual Opening

For the period of [*A01] to [*B01] you will receive $ [*C01]. Effective [*D01], you will begin receiving $[*E01] once a month. You are eligible for Medicaid as of the SSP-eligibility begin date (earliest date shown above).

You are eligible for a State Supplementary Payment (SSP) because you are otherwise eligible for Supplemental Security (SSI), except for income. Your total countable monthly income is less than the combined Federal Benefit Rate (FBR) and the maximum SSP for your circumstances. Your total countable monthly earned, unearned and deemed income is [*F01]. This consists of your countable monthly earned income of *G01], unearned income of [*H01] and deemed income of [*J01] from your [*K01]. The FBR for your circumstances is [*L01] because you are: [*M01].

The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).The FBR plus the maximum SSP for your circumstances is $[*N01]. This income limit minus your total monthly countable income is your monthly SSP.

Regulations: 55 Pa Code 299.36(a)

CAO Entries:

*A01 Begin date of One Time Issuance (OTI) period

*B01 End date of OTI period

*C01 OTI $ amount

*F01 $ total countable monthly income

*G01 $ amount of countable earned income

*H01 $ amount of countable unearned income

*J01 $ amount of countable deemed income

*K01 Individual who is deeming the income, either 1) spouse or 2) parent(s)

*L01 Federal Benefit Rate (FBR)

*M01 Language text that explains the FBR. This will be one of four choices:
1) an individual living in your own home or apartment.
2) a member of an eligible couple living in your own home or apartment.
3) an individual living in the household of someone else who helps to pay food, clothing and shelter costs.
4) a member of an eligible couple living in the household of someone else who helps to pay food, clothing and shelter costs.

*N01 $ amount of FBR & SSP

Pre-populated by eCIS:

*D01 Begin date of ongoing benefit

*E01 Monthly benefit

014 –Option C SSP JAM/44 Ineligible: Excess Income

You are ineligible for a State Supplementary Payment (SSP) because your total countable monthly income is greater than the combined Federal Benefit Rate (FBR) and the maximum SSP for your circumstances. Your total countable monthly income earned, unearned and deemed income is $ [*A01]. This consists of your countable monthly earned income of $[ *B01], unearned income of $ [*C01] and deemed income of $ [*D01] from your [ *E01].

The FBR for your circumstances is $ [*F01] because you are
[*G01]
[*G02]

The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).The FBR plus the maximum SSP for your circumstances is $ [*H01], which is less than your total countable monthly income.

Regulation: 55 Pa Code 299.36(a)(2)(iv)

CAO Entries:

*A01 $ total countable monthly income

*B01 $ amount of countable earned income

*C01 $ amount of countable unearned income

*D01 $ amount of countable deemed income

*E01 Individual who is deeming the income, either 1) spouse or 2) parent(s)

*F01 Federal Benefit Rate (FBR)

*G01 Area of free text for worker explanation of recipient circumstances

*G02 Area of free text for worker explanation of recipient circumstances

*H01 $ amount of FBR + SSP

014 –Option D – SSP JAM/44 Ineligible: Excess Resources

You are ineligible for a State Supplementary Payment (SSP) because you have the following countable resources that exceed the SSP program limit of $2000 for an individual not living with a spouse or $3000 for an individual living with a spouse or for an eligible couple:

Amount Description

$ [*A01] - [*B01]

$ [*A02] - [*B02]

$ [*A03] - [*B03]

Regulation: 55 PA Code 299.36(a)(2)(iii)

CAO Entries:

*A01, *A02, *A03 $ amount of excess resources

*B01, *B02, *B03 text description of excess resources

014 –Option E – SSP-Only Ineligible: Non-Financial

You are ineligible for a State Supplementary Payment because:

[*A01] You are not aged (65 years of age or older) nor do you meet the criteria to be considered blind or disabled according to the Social Security Administration.

[*B01] You do not meet the requirements to be considered a qualified alien eligible to receive Supplemental Security Income (SSI) according to the Social Security Administration.

[*C01] Other [*C02]

Regulation: 55 Pa Code 299.21(a), 299.21(b)(1) and 299.36(a)

CAO Entries:

*A01, *B01, *C01 Manual entry of “X” if criteria are met or “N/A” if criteria are not met

*C02 If *C01 is an “X”, then CAO will enter an explanation of “other” reasons for non-financial eligibility

014 –Option F – JAM/44 Disc: No longer eligible due to excess income

You are no longer eligible for a State Supplementary Payment (SSP) because your total countable monthly income is greater than the combined Federal Benefit Rate (FBR) and the maximum SSP for your circumstances.

Your total countable monthly earned, unearned and deemed income is $[*A01]. This consists of your countable monthly earned income of $ [*B01], unearned income of $ [*C01] and deemed income of $ [*D01] from your [*E01]. The FBR for your circumstances is $[*F01] because you are [*G01].

The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person). The FBR plus the maximum SSP for your circumstances is $[*H01], which is less than your total countable monthly income.

You will receive a separate notice about your Medicaid eligibility.

Regulations: 55 Pa Code 299.36(a)(2)(iv)

CAO Entries:

*A01 $ total countable monthly income

*B01 $ amount of countable earned income

*C01 $ amount of countable unearned income

*D01 $ amount of countable deemed income

*E01 Individual who is deeming the income, either 1) spouse or 2) parent(s)

*F01 Federal Benefit Rate (FBR)

*G01 Language text that explains the FBR. This will be one of four choices:
1) an individual living in your own home or apartment.
2) a member of an eligible couple living in your own home or apartment.
3) an individual living in the household of someone else who helps to pay food, clothing and shelter costs.
4) a member of an eligible couple living in the household of someone else who helps to pay food, clothing and shelter costs.

*H01 $ amount of FBR + SSP

014 –Option G – JAM/44 Disc: Due to excess resources

You are no longer eligible for the State Supplementary Payment (SSP) because you have the following countable resources that exceed the SSP program limit of $2000 for an individual not living with a spouse or $3000 for an individual living with a spouse or for an eligible couple:

Amount Description

$ [*A01] - [*B01]

$ [*A02] - [*B02]

Regulation: 55 Pa Code 299.36(a)(2)(iii)

CAO Entries:

*A01, *A02 $ amount of excess resources

*B01, *B02 text description of excess resources

014 –Option H – JAM/44 Disc: Non-Financial Requirements

You are no longer eligible for a State Supplementary Payment (SSP) because:

[*A01] You do not meet the criteria to be considered blind or disabled according to the Social Security Administration. To be eligible for SSP, you must meet this criteria.

Other: [*B01]

------ [*B02]

Regulation: 55 Pa Code 299.36(a)&(b)

CAO Entries:

*A01 “X” if no one is disabled or blind

*B01 “X” if other reason

*B02 explanation of “other” reasons for ineligibility

014 –Option J – JAM/44 –CHAN – Increase Benefit due to Decreased Income

Your State Supplementary Payment (SSP) will increase as stated above because your total countable monthly income decreased. Your total countable monthly earned, unearned and deemed income is $ [*A01]. This consists of your countable monthly earned income of $ [*B01], unearned income of $ [*C01] and deemed income of $ [*D01] from your [*E01]. The Federal Benefit Rate (FBR) for your circumstances is $ [*F01] because you are

[*G01]

[*G02]

The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person)..

The FBR plus the maximum SSP for your circumstances is $ [*H01].

$ [*J01] minus $ [*K01] is your monthly SSP.

There is no change to your eligibility for Medicaid.

Regulations: 55 Pa Code 299.36(a)(2)(iv)

CAO Entries:

*A01 $ total countable monthly income

*B01 $ amount of countable earned income

*C01 $ amount of countable unearned income

*D01 $ amount of countable deemed income

*E01 Individual who is deeming the income, either 1) spouse or 2) parent(s)

*F01 Federal Benefit Rate (FBR)

*G01 Area of free text for worker explanation of recipient circumstances

*G02 Area of free text for worker explanation of recipient circumstances

*H01 $ amount of FBR + SSP

014 –Option K – JAM/44 REDU: Reduce Benefits due to Increased Income

Your State Supplementary Payment (SSP) will decrease as stated above because your total countable monthly income increased. Your total countable monthly earned, unearned and deemed income is $[*A01]. This consists of your countable monthly earned income of $ [*B01], unearned income of $ [*C01] and deemed income of $[*D01] from your [*E01]. The Federal Benefit Rate (FBR) for your circumstances is $ [*F01] because you are

[*G01]

[*G02]

The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).

The FBR plus the maximum SSP for your circumstances is $ [*H01]. $ [*J01] minus $ *[K01] is your monthly SSP.

There is no change to your eligibility for Medicaid.

Regulations: 55 Pa Code 299.36(a)(2)(iv)

CAO Entries:

*A01 $ total countable monthly income

*B01 $ amount of countable earned income

*C01 $ amount of countable unearned income

*D01 $ amount of countable deemed income

*E01 Individual who is deeming the income, either 1) spouse or 2) parent(s)

*F01 Federal Benefit Rate (FBR)

*G01 Area of free text for worker explanation of recipient circumstances

*G02 Area of free text for worker explanation of recipient circumstances

*H01 $ amount of FBR + SSP

*J01 $ FBR + SSP

*K01 $ total countable monthly income

014 –Option L SSI/SSP – SUSP: SSI Discontinued by SS

You are no longer eligible for the State Supplementary Payment (SSP) because you are no longer eligible for Supplemental Security Income (SSI). If your notice from the Social Security Administration (SSA) indicated that you are ineligible for SSI due to excess income, we have determined, using the countable income the SSA reported to us, that your total countable monthly income exceeds the combined total of the current SSI Federal Benefit Rate (FBR) plus the maximum SSP for your circumstances. If you live independently in your own home or apartment, the FBR for an individual is $721 and the FBR for an eligible couple is $1,082 ($541 per person). If you live in the household of someone else who helps to pay food, clothing or shelter expenses, the FBR is $480.67 for an individual and $721.34. for an eligible couple ($360.67 per person). The FBR is not affected if your spouse who is living with you provides these items or if you are a minor child living with a parent or parents who provide these items. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).

You will receive separate notification of any change to your medical benefits.

Regulations: 55 Pa Code 299.21

014 –Option M – JAM/44 INEL: NCE Retro Eligibility Period

You received Supplementary Security Income (SSI) for the period from [*A01] to [*B01] and were eligible to receive the maximum State Supplementary Payment (SSP) for the same time period. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person). You are eligible for $ [*C01], the maximum SSP times the number of full months in the time period from [*D01] to [*E01}.

Regulations: 55 Pa Code 299.21 and 299.36(c)

CAO Entries:

*A01 Begin date of Non-continuous eligibility (NCE) period

*B01 End date of NCE period

Pre-populated by eCIS:

*A01 OTI $ amount

*B01 Begin date of NCE period

*C01 End date of NCE period

014 –Option N – JAM/44 CHAN: Reinstate Suspended Benefit

Your State Supplementary Payment has been reinstated. There is no change to your benefit amount or your eligibility for Medicaid.

Regulations: 55 Pa Code 299.1(a) & 299.21

014 –Option P – JAM/00 CHAN to JAM/44 - REDU: SSI Disc SSP Decreased

The Social Security Administration has notified us that you are no longer eligible for Supplemental Security Income (SSI) because your countable income increased and exceeds the Federal Benefit Rate (FBR) for your circumstances. As a result you are no longer eligible for the maximum State Supplementary Payment (SSP). You continue to be eligible for an SSP because you are

otherwise eligible for SSI and your countable income is less than the combined FBR and the maximum SSP for your circumstances. Your SSP will decrease as stated above because your total countable monthly income increased.

Your total countable monthly earned, unearned and deemed income is $ [*A01]. This consists of your countable monthly earned income of $ [*B01], unearned income of $ [*C01] and deemed income of $ [*D01] from your [*E01]. The FBR for your circumstances is $ [*F01] because you are {*G01]. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person). The FBR plus the maximum SSP for your circumstances is $ [*H01]. $ [*J01] minus $ [*K01] is your monthly SSP. There is no change to your eligibility for Medicaid.

Regulations: 55 Pa Code 299.21 & 299.36(a)(2)(iv)

042 – Option 5 – JAM/44 INEL: Failure to Provide Verification at Application

You are ineligible for a State Supplementary Payment (SSP) because:

You failed to provide verification of the following:

[*A01]

[*A02]

If you provide the verification, your eligibility for the SSP will be determined.

Regulation: 55 Pa Code 299.36(a)(2)(vii)

CAO Entries:

*A01, *A02 text descriptions of verifications not provided

052 –Option D – JAM/44 DISC: No Longer Residing in PA

You are no longer residing in Pennsylvania. Therefore you are no longer eligible for Pennsylvania's State Supplementary Payment or Medicaid through the Pennsylvania Department of Public Welfare.

Regulations: 55 Pa Code 299.36(a)(2)(i) and 148.3

090 – Option B – JAM/44 STOP: Death of Payee

Due to the recipient's death, the State Supplementary Payment and Medicaid benefits will stop.

Regulations: 55 PA Code 133.4(c)

093 – Option 6 – JAM/44 CHAN/REDU: Couple to Single/Single to Couple

Your circumstances have changed:
1) from an individual to a member of an eligible couple or
2) from a member of an eligible couple to an individual.

This requires a change to your State Supplementary Payment (SSP). Your total countable monthly earned, unearned and deemed income used to make this change is $ [*A01]. This consists of your countable monthly earned income of $ [*B01], unearned income of $ [*C01] and deemed income of $ [*[D01] from your[ *E01. The Federal Benefit Rate (FBR) for your circumstances is $ [*F01] because you are:

[*G01]

[*G02]

The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).

The FBR plus the maximum SSP for your circumstances is $ [*H01]. $ [*J01] minus $ [*K01] is your monthly SSP.

Regulations: 55 Pa Code 299.36(a)(2)(iv)

CAO Entries:

*A01 $ total countable monthly income

*B01 $ amount of countable earned income

*C01 $ amount of countable unearned income

*D01 $ amount of countable deemed income

*E01 Individual who is deeming the income, either 1) spouse or 2) parent(s)

*F01 Federal Benefit Rate (FBR)

*G01 Area of free text for worker explanation of recipient circumstances

*G02 Area of free text for worker explanation of recipient circumstances

*H01 $ amount of FBR + SSP

*J01 $ FBR + SSP

*K01 $ total countable monthly income

099 – Option D – Inter-County Transfer of JAM/PSC ≠ 45,46,60, 62

If a recipient makes a permanent move to another Pennsylvania county and continues to be eligible for the State Supplementary Payment (SSP) and Medicaid, then the SSP is continued at the new address in the new county. You reported moving from [*A01] County to [*B01] County. You will stop receiving the SSP and Medicaid in this county on [*C01]. You will start receiving the SSP and Medicaid in your new county of residence beginning [*D01]. This change does not affect the amount of your SSP.

If you have any questions contact the County Assistance Office at the telephone number listed below.

[*E01]

[*F01]

[*G01] , PA [*H01]

Phone: [*J01]

Regulations: 55 Pa Code 299.31

CAO Entries:

*A01 Name of losing county

*B01 Name of gaining county

*C01 End date of SSP in losing county

*D01 Begin date of SSP in gaining county

Pre-populated by eCIS:

*E01 Gaining county name

*F01 Gaining county address

*G01 Gaining county city

*H01 Gaining county zip code

*J01 Gaining county telephone number

414 – Option A – SSI/SSP Eligible

For the period of [*A01] to [*B01] you will receive $ [ *C01]. Effective [*D01], you will begin receiving $

[*E01] once a month.

The Social Security Administration has notified the Pennsylvania Department of Public Welfare that you are eligible for Supplemental Security Income (SSI). As a result, you are eligible for the maximum State Supplementary Payment (SSP) and Medicaid. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).

You will receive a separate notice about your Medicaid eligibility.

Regulations: 55 Pa Code 299.1(a), 299.21 and 299.35

Pre-populated by eCIS:

*A01 Begin date of One Time Issuance (OTI) period

*B01 End date of OTI period

*C01 OTI $ amount

*D01 Begin date of ongoing SSP issuance

*E01 Monthly benefit

414 – Option B – SSI/SSP DISC(SUSP): SSI Discontinued by SSA

You are no longer eligible for the State Supplementary Payment (SSP) because you are no longer eligible for Supplemental Security Income (SSI). If your notice from the Social Security Administration (SSA) indicated that you are ineligible for SSI due to excess income, we have determined, using the

countable income the SSA reported to us, that your total countable monthly income exceeds the combined total of the current SSI Federal Benefit Rate (FBR) plus the maximum SSP for your circumstances. If you live independently in your own home or apartment, the FBR for an individual is $721 and the FBR for an eligible couple is $1,082 ($541 per person). If you live in the household of someone else who helps to pay food, clothing or shelter expenses the FBR is $480.67 for an individual and $721.34 for an eligible couple ($360.67 per person). The FBR is not affected if your spouse who is living with you provides these items or if you are a minor child living with a parent or parents who provide these items. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person). You will receive separate notification of any change to your medical benefits.

Regulations: 55 Pa Code 299.21

414 – Option C – SSI/SSP CHAN: (Reinstate Suspended Benefit)

The Social Security Administration has notified us that you are eligible for Supplemental Security Income. As a result, you are eligible for the maximum State Supplementary Payment (SSP) for your circumstances. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person). There is no change to your eligibility for Medicaid.

Regulations: 55 Pa Code 299.1(a) & 299.21

414 – Option D – SSI/SSP CHAN: Benefit Increase/Decrease: Couple/Single

We received notification from the Social Security Administration that your circumstances have changed:
1) from an individual to a member of an eligible couple or
2) from a member of an eligible couple to an individual.

This requires a change to your maximum State Supplementary Payment (SSP).

The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).

Regulation: 55 Pa Code 299.35

414 – Option E – JAM/46 CHAN: DPW Starts SSP – PSC to 00,31,32,33,35,36,37,64

The Social Security Administration (SSA) has notified the Pennsylvania Department of Public Welfare (DPW) that you are no longer eligible for the State Supplementary Payment (SSP) administered by the SSA. Because you continue to be eligible for Supplemental Security Income (SSI), you are

eligible for the maximum State Supplementary Payment (SSP) administered by DPW. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person).

There is no change to your Medicaid eligibility.

Regulations: 55 Pa Code 299.1(c)(2)(i) & (c)(3)

414 – Option F – JAM/00,31,32,33,35,36,37,44,64 STOP: Recipient to DC/PC

The Social Security Administration (SSA) has notified the Pennsylvania Department of Public Welfare (DPW) that you moved to a domiciliary care or personal care facility. Therefore, your State Supplementary Payment (SSP) will no longer be issued through DPW. Your continued eligibility for the SSP will be determined by the SSA. SSA will notify you regarding your SSP benefit and issue the payment.

There is no change to your Medicaid eligibility.

Regulations: 55 Pa Code 299.1(c)(2)

414 – Option G – SSI/SSP CHAN: NH to Community JAM/00,31,32,33,35,36,37,64

The Social Security Administration notified The Department of Public Welfare (DPW) that you are no longer receiving a Supplemental Security Income (SSI) benefit based on living in a medical care facility where Medicaid pays a substantial portion (more than 50 percent) of the cost of your care.

Because you continue to be eligible for SSI, you are eligible for the maximum State Supplementary Payment (SSP) issued through DPW. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).

There is no change to your Medicaid eligibility.

Regulations: 55 Pa Code 299.21 & 299.22

414 – Option H – SSI/SSP CHAN: DOM/PC (60,62) to JAM (00,31,32,33,35,64)

You are no longer living in a domiciliary care or personal care facility. As a result, the Social Security Administration will no longer administer your State Supplementary Payment (SSP). Because you continue to be eligible for Supplemental Security Income (SSI), you are eligible for the maximum SSP, administered by the Department of Public Welfare. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).

There is no change to your Medicaid eligibility.

Regulations: 55 Pa Code 299.21, 299.22 and 299.35

414 – Option J – SSP DISC: Community to Nursing Home

You are no longer eligible for the State Supplementary Payment because we have been notified by the Social Security Administration that you are residing in a medical care facility where Medicaid pays a substantial portion (more than 50 percent) of the cost for your care.

You will receive a separate notice if there is any change to your eligibility for Medicaid.

Regulations: 55 Pa Code 299.21 (b)(3)

414 – Option K – SSP CHAN: Increase the SSP Payment (PSC 44 to 00)

The Social Security Administration has notified Pennsylvania that you are eligible for Supplemental Security Income (SSI). As a result, you are eligible for the maximum State Supplementary Payment (SSP) for your circumstances. The maximum SSP for an individual is $22.10. The maximum SSP for a couple in which both are eligible for SSI is $33.30 ($16.65 per person). If you are living with someone who is not your spouse and you do not pay your fair share of the household expenses such as food and rent, the maximum SSP is $25.53 for an individual and $38.44 for a couple in which both are eligible for SSI ($19.22 per person).

There is no change to your eligibility for Medicaid.

Regulations: 55 Pa Code 299.21

451 – Option 3 – SSP SUSP: EBT Benefit Return

You have not used your ACCESS card to withdraw cash benefits from your State Supplementary Payment (SSP) account in the past 180 days. As a result, your SSP was returned to the Department of Public Welfare. Contact your caseworker to re-issue your benefit that was returned.

Regulations: 55 PA Code 299.1(a) and 299.21

451 – Option 4 – SSI SUSP: Check Return (US Mail)

A recent State Supplementary Payment (SSP) check has been returned to us. Contact your caseworker to re-issue your benefit that was returned.

Regulations: 55 PA Code 299.1(a) and 299.21

464 – Option 2 – SSI/SSP STOP: Move Out of State

The Social Security Administration has notified us that you are no longer residing in Pennsylvania. As a result, you are no longer eligible for Pennsylvania's State Supplementary Payment.

Regulations: 55 Pa Code 299.35

490 – Option 2 – JAM ≠ 44 – STOP: Death of Payee

Due to death, the State Supplementary Payment and Medicaid benefits have been stopped.

Regulations: 55 PA Code 133.4(c)

414 – Option 2 – SSP: REDU – Living Arrangement Change: PSC 64 to 00

The Social Security Administration notified the Department of Public Welfare that your living arrangements have changed. You now pay your fair share of the household expenses such as rent and utility bills and are considered as living independently.

Your State Supplementary Payment (SSP) went down because the maximum SSP for an individual living independently is $22.10. The state maximum SSP for a couple living independently in which both individuals are eligible for SSP is $33.30 ($16.65 per person).

Regulations: 55 PA Code 299.37

414 – Option 3 – SSP: REDU-INCREASE Benefit: Living Arrangement Change: PSC 00 to 64

The Social Security Administration notified the Department of Public Welfare that your living arrangements have changed. You now live in the household of someone else, not your spouse, and you do not pay your fair share of the household living expenses such as rent and utility bills.

Your State Supplementary Payment (SSP) went up because the maximum payment for an individual with your living arrangements is $25.53. The state maximum SSP for a couple with your living arrangements in which both individuals are eligible for SSP is $38.44 ($19.22 per person).

Regulations: 55 PA Code 299.37

Reissued December 2, 2013, replacing December 21, 2012