Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. State Supplemental Payments (SSPs)


Many states supplement the basic SSI payment and pair these supplementary payments with automatic Medicaid eligibility. This combination of benefits enables beneficiaries to obtain the services they need in a range of community settings.

The maximum monthly Federal SSI benefit ($674 in 2010) is assumed to be minimally sufficient to enable recipients to pay for a basic level of ordinary living expenses (food, shelter, clothing). Many states have elected to spend state-only funds to supplement the basic SSI benefit in circumstances where they have determined that rate to be insufficient to cover living expenses necessary for minimally adequate living standards. These state supplements are state-determined and vary widely.17 Some individuals have too much income to qualify for SSI but may qualify for an SSP benefit only. States can elect to make such persons automatically eligible for Medicaid, just as they can for SSI beneficiaries.

State Supplemental Payments

  • States can supplement the basic SSI payment.

  • States can pay across-the-board SSPs to all elderly persons or persons with disabilities in the state, or they can target them to persons in supported living settings.

  • States can provide Medicaid to people receiving an SSP who are not eligible for SSI.

Few states provide across-the-board state supplements to SSI. Most target them specifically to persons who are unable to live independently but do not need an institutional level of care. The state supplement can be used to help pay for services provided in residential care settings such as foster care, group homes, assisted living, and other settings defined by the state. Services in these settings can vary widely--consisting of as little as housekeeping or general supervision, to various levels of assistance with activities of daily living.

Automatic Medicaid eligibility for state supplement beneficiaries provides an additional measure of assistance in paying for needed medical services. States have broad flexibility with respect to not only the level of SSP support but also the kinds of settings to be supported, quality standards, and oversight. States can pay SSPs for as many different types of supported living settings as they wish.

How a State Supplemental Payment Might Work

In the year 2010, the Federal SSI monthly benefit rate is $674 for an individual. Assume a state sets its supplemental benefit at $200 (making the SSP benefit $874). Then,

  • a person receiving Federal SSI would receive an additional SSP of $200 per month.
  • a person with countable income of $774--from, say, Social Security or a pension--would have $80 ($100 minus $20 disregard) too much income to qualify for SSI, but would still qualify for a $100 SSP benefit, and at the state’s option, for Medicaid.

As with many other Medicaid options, the option states have to provide Medicaid to SSP beneficiaries not eligible for SSI is subject to certain conditions. The SSP must be based on need, and the state must pay the SSP on a regular basis to anyone in the supported living setting to which the SSP applies who, but for income, would qualify for SSI. There is no rule obligating the state to establish such settings throughout the state. If the particular type of living setting supported by a state’s SSP happens to exist only in limited areas of a state, the state is permitted to pay SSPs just to persons in those settings.

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