Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Financial Criteria

12/01/2003

  • To be eligible for services through the personal care option, individuals must meet Medicaid's community income standard, which limits eligibility to those with incomes equal to the combined SSI/SSP benefit of $635.78 per month for an individual, of which $552 is the federal SSI benefit and $83.78 is the SSP. For couples, the income limit is $961.05. To be eligible for SSP an individual must be eligible for either SSI or some other federal benefit.6

  • Individuals may have no more than $2000 in assets; couples no more than $3,000.

  • SSI recipients who need at least 40 hours a month of assistance with activities of daily living are eligible for a larger state supplement of $179.77, for a total of $731.77. This amount can be used to pay for room and board in Community Based Residential Facilities. Prior to July 2000, this supplement--called the Exceptional Expense Supplement or SSI-E--was available only to individuals who lived in their own or another's home. Since that date, individuals who reside in (1) certified Residential Care Apartment Complexes, (2) Community Based Residential Facilities certified as consisting entirely of independent apartments, and (3) licensed or certified Adult Family Homes are also eligible for the enhanced supplement.

  • The state has a medically needy program for the aged, blind and disabled. The medically needy income standard is $591.67, with asset limits of $2000 for individuals and $3,000 for couples. The budget period for medical need is six months. The state provides the same medical coverage and services for the medically needy as it does for the categorically needy.7

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