If an individual gets Supplemental Security Income (SSI) benefits and is in either an LTC facility or a HCBS setting, the CAO must use one of the following categories for MA LTC payments: 55 Pa. Code § 299.1(a) 55 Pa. Code § 299.36 (e)
A—age 65 or older.
J—under age 65 and disabled according to Social Security Administration (SSA) requirements.
M—under age 65 and blind according to SSA requirements.
The CAO will use the SSI category only if the individual will continue to receive SSI benefits while receiving LTC services. The SSI payment can continue as long as one of the following conditions is met:
The individual is receiving HCBS.
The individual has no other income, or the individual’s countable income is less than the current SSI Personal Needs Allowance (PNA). The CAO will either contact the SSA or ask the individual or his representative to inform the SSA that he has entered an LTC facility and will be receiving Title XIX funds.
NOTE: An individual who is receiving SSI only and is admitted to an LTC facility can keep getting an SSI payment of $30 and a Supplement for Personal Needs (SPN) payment of $15. These payments should be used for the individual’s PNA of $45.
A doctor certifies that the individual’s stay in the LTC facility is not likely to last more than three months and that the individual must continue to pay shelter expenses in the community. The CAO will either contact the SSA or ask the individual or his representative to inform the SSA that he has entered an LTC facility and will be receiving Title XIX funds. The individual can receive federal and state SSI benefits for up to three months while living in the facility. During this three month period the individual does not need to pay anything toward the cost of care.
NOTE: The SSA must give the individual and the CAO written notice of any decision about the individual’s eligibility status. The CAO must create an alert to review the individual’s status at the end of the three months. The CAO must keep using the A, J, or M category until notified by the SSA that the individual’s SSI benefits have ended.
NOTE: See the Medical Assistance Eligibility Handbook, Chapter 387 for information about the SSI program.
Updated March 12, 2012, Replacing June 19, 2008