diff --git a/data/external/snapshots/income_resources_d4_v1/.gitattributes b/data/external/snapshots/income_resources_d4_v1/.gitattributes new file mode 100644 index 00000000..14519024 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/.gitattributes @@ -0,0 +1,3 @@ +# Pinned captures: store the bytes exactly as fetched, so their recorded +# SHA-256s hold on every checkout. +* -text diff --git a/data/external/snapshots/income_resources_d4_v1/capture_manifest.txt b/data/external/snapshots/income_resources_d4_v1/capture_manifest.txt new file mode 100644 index 00000000..4f45521b --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/capture_manifest.txt @@ -0,0 +1,119 @@ +# D4 part 1: plain-request captures and one reused SSA snapshot. +# Fields: retrieval_utc sha256 byte_size capture_file + +# ssa_manifest.txt +# Reused, not fetched: https://www.ssa.gov/policy/docs/statcomps/supplement/2025/4b.html +2026-07-27T13:02:54Z c228920ea9d53b1e323e5933b6d9f926e3c9b609d868b549fabc40118554b449 488165 ../ssa_level_anchors_vintage1/supplement2025_4b.html + +# poms_manifest.txt +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415000 +2026-10-24T12:40:56.922475Z 84ec0310b83249621ac7779bf0a0f642b708c410a979089e323c6c06dc1c3ff0 39925 poms_si_01415_index.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415031 +2026-10-24T12:42:11.374178Z 40e8cbdcae416ad1144e43b7c0616ee7974eb27d0d73881b5133e837964f6ebd 598744 poms_si_01415_1999.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415032 +2026-10-24T12:42:11.391443Z 1ae6f25b1da72404dd97cd32182586354addddf2eafc52016da7482658c46685 880615 poms_si_01415_2000.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415033 +2026-10-24T12:42:11.658843Z f5fe7a37407646e9bc91442728b4b32b90bbd056102b94922714849a7dc17da4 774357 poms_si_01415_2001.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415034 +2026-10-24T12:42:11.125515Z ac9696f1ebb477da04c90ac77c83af56b6c1c153743b078748f0588384d1315d 806798 poms_si_01415_2002.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415035 +2026-10-24T12:42:11.728143Z fccf7dfcec747561245e7ef9b6033e97956395aaaf03bbaaa39552484e443a9a 992291 poms_si_01415_2003.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415036 +2026-10-24T12:42:11.937059Z 349b9e1456c579cae132ea55138627021bdd97deda623ba5b4742d41e2c9eea4 828506 poms_si_01415_2004.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415037 +2026-10-24T12:42:11.935856Z c0efdc2042cc7ff12b3084e3336a0eeb5335f802d983d594f2f6e05269ad4deb 807378 poms_si_01415_2005.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415038 +2026-10-24T12:42:12.208030Z 360a7cf1dd586cffac45528787f206eaf432bbd9abdb080dad6e231107a0cde9 708104 poms_si_01415_2006.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415039 +2026-10-24T12:42:12.360739Z a9ed64e6a6506c68a8af84489125a655dde3af3117a6c3b2d68fae4018581bf6 705149 poms_si_01415_2007.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415040 +2026-10-24T12:42:12.528887Z 7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897 719631 poms_si_01415_2008.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415041 +2026-10-24T12:42:12.646711Z 824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09 835407 poms_si_01415_2009.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415042 +2026-10-24T12:42:12.721632Z 2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6 904168 poms_si_01415_2010.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415043 +2026-10-24T12:42:12.806612Z 2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9 787351 poms_si_01415_2011.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415044 +2026-10-24T12:42:13.034963Z 33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad 737833 poms_si_01415_2012.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415045 +2026-10-24T12:42:13.256070Z 7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214 658169 poms_si_01415_2013.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415046 +2026-10-24T12:42:13.258138Z 8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb 643731 poms_si_01415_2014.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415047 +2026-10-24T12:42:13.844544Z e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10 661201 poms_si_01415_2015.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415048 +2026-10-24T12:42:14.204710Z c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c 818951 poms_si_01415_2016.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415049 +2026-10-24T12:42:14.547525Z 3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65 635931 poms_si_01415_2017.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415050 +2026-10-24T12:42:14.663154Z c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e 655313 poms_si_01415_2018.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415051 +2026-10-24T12:42:14.908825Z 8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e 656129 poms_si_01415_2019.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415052 +2026-10-24T12:42:15.123773Z 090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310 659869 poms_si_01415_2020.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415053 +2026-10-24T12:42:15.720199Z 307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e 659833 poms_si_01415_2021.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415054 +2026-10-24T12:42:15.940151Z d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06 657723 poms_si_01415_2022.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415055 +2026-10-24T12:42:16.244889Z 761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119 659490 poms_si_01415_2023.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415056 +2026-10-24T12:42:16.105608Z a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0 606847 poms_si_01415_2024.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415057 +2026-10-24T12:42:16.902809Z 027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30 605487 poms_si_01415_2025.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0501415058 +2026-10-24T12:42:17.707028Z 0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1 532767 poms_si_01415_2026.html + +# coverage_manifest.txt +# URL https://secure.ssa.gov/poms.nsf/lnx/0301505000 +2026-10-24T12:41:26.961290Z fdc07d643ddf12867f5f205b69f2f263f7ae860fc2384c7549fbc926842b7b88 18436 poms_rs_01505_toc.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0301505042 +2026-10-24T12:46:23.938874Z b1f3b3c916cff0ec4a97958d062d21ec1f1ae4ed0a2a67d7f6ae134901960cf6 24780 poms_rs_0301505042.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0301505044 +2026-10-24T12:46:24.014005Z 54983d7e1719c0408542163b8c58ade88221127f09157ba958e049449e1e2012 27481 poms_rs_0301505044.html +# URL https://secure.ssa.gov/poms.nsf/lnx/1920001201 +2026-10-24T12:46:24.020978Z da4d3c8986a873700b7e6287995f7fcb4e94ac2dce945acdaab8ef8b598a5a88 26925 poms_sl_1920001201.html +# URL https://secure.ssa.gov/poms.nsf/lnx/1930001331 +2026-10-24T12:46:24.026434Z 88301a88d2b2dea7dc930638c59a14dcf5811bd83e6a06add5874565caf884f4 38827 poms_sl_1930001331.html +# URL https://secure.ssa.gov/poms.nsf/lnx/1930001347 +2026-10-24T12:46:24.213639Z f06dc121e076162f3aab7bdaece9177d6efd1050de67024c8bca026368afb155 38455 poms_sl_1930001347.html +# URL https://secure.ssa.gov/poms.nsf/lnx/1950001501 +2026-10-24T12:46:24.213956Z 375714297f63819fc408cf7110af8bec29fcec7733c1dbc19bab2e48b6062604 28428 poms_sl_1950001501.html +# URL https://secure.ssa.gov/poms.nsf/lnx/1950001510 +2026-10-24T12:46:24.254142Z 16eb3195b465303fff01c75caa044f123d23de16a9e9598b11fabf7f14b93578 29099 poms_sl_1950001510.html + +# pensions_manifest.txt +# URL https://www.federalreserve.gov/releases/z1/ +2026-10-24T12:41:10Z b62f9c27e66233a1a5004d9de9de810a92e5989a622295986fcd71e374624244 120825 fed_release.html +# URL https://www.dol.gov/agencies/ebsa/researchers/statistics/retirement-bulletins/private-pension-plan +2026-10-24T12:41:14Z c32608b14b81c54f0e5917a694f4b164d3ad8c96f33755efc7f28117c683b62b 103883 dol_landing.html +# URL https://www.irs.gov/statistics/soi-tax-stats-accumulation-and-distribution-of-individual-retirement-arrangements +2026-10-24T12:41:19Z e2955985c8c3a43b46120936441e020dd1a70f02269ab09d65397af10ce95051 172336 irs_landing.html +# URL https://www.federalreserve.gov/releases/z1/current/z1_table_mapping.csv +2026-10-24T12:43:07Z 2b1ebfb5ffc9f755ff36861ae6fa4c6cc802b814c6658f24b033b1aeb633f24f 9737 fed_mapping.csv +# URL https://www.federalreserve.gov/releases/z1/current/z1_csv_files.zip +2026-10-24T12:43:08Z b63af9755437df0fb88b7cf346f8f9eaeb22bf1aa2b5df1709334135c43de4b6 8336582 fed_tables.zip +# URL https://www.dol.gov/sites/dolgov/files/ebsa/researchers/statistics/retirement-bulletins/private-pension-plan-bulletins-abstract-2023.xlsx +2026-10-24T12:43:09Z cbb35a0f9d16749ed8184a913da1b457bceb6afbad627cb2ff01b0b8e7318eb3 434019 dol_bulletin_2023.xlsx +# URL https://www.irs.gov/pub/irs-soi/23in01ira.xlsx +2026-10-24T12:43:06Z 5716444ff8f28adddaf0737d82ada2cfce8591c60e222fa76767a229040f1ca5 11460 irs_2023_table_01.xlsx +# URL https://www.irs.gov/pub/irs-soi/23in02ira.xlsx +2026-10-24T12:43:08Z bfcf581ced743df4cc4c9786b8086b910082a2d258634a7a6ad8cc7cfd64fbf1 13686 irs_2023_table_02.xlsx +# URL https://www.irs.gov/pub/irs-soi/23in03ira.xlsx +2026-10-24T12:43:08Z d304678b39ddf277048def3b6f6b486899e0df8adeccc8383f47853e0ccf26e4 14542 irs_2023_table_03.xlsx +# URL https://www.irs.gov/pub/irs-soi/23in04ira.xlsx +2026-10-24T12:43:09Z 83a0da20618ecbdb76ea14ec18d3ad38a32389b8c18356eba45b8e302a70c068 13894 irs_2023_table_04.xlsx +# URL https://www.irs.gov/pub/irs-soi/23in05ira.xlsx +2026-10-24T12:43:09Z 17b02670eeb35dab5d3f8be6a26333d527993f8b22933fa77bb3a06f3c8ad143 11345 irs_2023_table_05.xlsx +# URL https://www.irs.gov/pub/irs-soi/23in06ira.xlsx +2026-10-24T12:43:10Z b526e4d4163172ed9992d16375cbf601b1c8b4d5bcf66f86e038c0e91c420418 11380 irs_2023_table_06.xlsx +# URL https://www.irs.gov/pub/irs-soi/23in07ira.xlsx +2026-10-24T12:43:10Z 1454c2cdfcc0d6df493fd6b5aea9f94d3d7bdfb237e36e5f0d321442e3752b99 12501 irs_2023_table_07.xlsx +# URL https://www.irs.gov/pub/irs-soi/23in08ira.xlsx +2026-10-24T12:43:11Z 92d505742b2f1bf489e358cd2b38d195cb680fca1f9ea86b5637856e8dd7dad8 14214 irs_2023_table_08.xlsx +# URL https://www.irs.gov/pub/irs-soi/23in09ira.xlsx +2026-10-24T12:43:11Z 1c9d544c0374f2c0347a5c3546415cf9252d52db55f56192505a0f83f4bc734a 12847 irs_2023_table_09.xlsx +# URL https://www.irs.gov/pub/irs-soi/23in10ira.xlsx +2026-10-24T12:43:12Z 9b1d412a608fe51128df846e7f626700e27bd06d2c95cad7afa1eb61c9298f16 13490 irs_2023_table_10.xlsx + diff --git a/data/external/snapshots/income_resources_d4_v1/coverage_manifest.txt b/data/external/snapshots/income_resources_d4_v1/coverage_manifest.txt new file mode 100644 index 00000000..2e26211c --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/coverage_manifest.txt @@ -0,0 +1,16 @@ +# URL https://secure.ssa.gov/poms.nsf/lnx/0301505000 +2026-10-24T12:41:26.961290Z fdc07d643ddf12867f5f205b69f2f263f7ae860fc2384c7549fbc926842b7b88 18436 poms_rs_01505_toc.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0301505042 +2026-10-24T12:46:23.938874Z b1f3b3c916cff0ec4a97958d062d21ec1f1ae4ed0a2a67d7f6ae134901960cf6 24780 poms_rs_0301505042.html +# URL https://secure.ssa.gov/poms.nsf/lnx/0301505044 +2026-10-24T12:46:24.014005Z 54983d7e1719c0408542163b8c58ade88221127f09157ba958e049449e1e2012 27481 poms_rs_0301505044.html +# URL https://secure.ssa.gov/poms.nsf/lnx/1920001201 +2026-10-24T12:46:24.020978Z da4d3c8986a873700b7e6287995f7fcb4e94ac2dce945acdaab8ef8b598a5a88 26925 poms_sl_1920001201.html +# URL https://secure.ssa.gov/poms.nsf/lnx/1930001331 +2026-10-24T12:46:24.026434Z 88301a88d2b2dea7dc930638c59a14dcf5811bd83e6a06add5874565caf884f4 38827 poms_sl_1930001331.html +# URL https://secure.ssa.gov/poms.nsf/lnx/1930001347 +2026-10-24T12:46:24.213639Z f06dc121e076162f3aab7bdaece9177d6efd1050de67024c8bca026368afb155 38455 poms_sl_1930001347.html +# URL https://secure.ssa.gov/poms.nsf/lnx/1950001501 +2026-10-24T12:46:24.213956Z 375714297f63819fc408cf7110af8bec29fcec7733c1dbc19bab2e48b6062604 28428 poms_sl_1950001501.html +# URL https://secure.ssa.gov/poms.nsf/lnx/1950001510 +2026-10-24T12:46:24.254142Z 16eb3195b465303fff01c75caa044f123d23de16a9e9598b11fabf7f14b93578 29099 poms_sl_1950001510.html diff --git a/data/external/snapshots/income_resources_d4_v1/coverage_registry.json b/data/external/snapshots/income_resources_d4_v1/coverage_registry.json new file mode 100644 index 00000000..58f96862 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/coverage_registry.json @@ -0,0 +1,230 @@ +[ + { + "identifier": "poms_rs_01505_000", + "publisher": "Social Security Administration", + "edition": "SSA - POMS: RS 01505.000 - Program Administration - Table of Contents - 03/07/2024", + "url": "https://secure.ssa.gov/poms.nsf/lnx/0301505000", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_rs_01505_toc.html", + "sha256": "fdc07d643ddf12867f5f205b69f2f263f7ae860fc2384c7549fbc926842b7b88", + "byte_size": 18436, + "retrieved_at": "2026-10-24T12:41:26.961290Z", + "units": [ + "cited_text" + ], + "years": [], + "geography": [ + "United States", + "states and local governments" + ], + "parser": "coverage_reference", + "role": "CE1 cited rules and CE3 classifier context; no observed coverage series", + "selector": { + "title": "RS 01505.000 Program Administration" + }, + "record_kind": "reference" + }, + { + "identifier": "poms_rs_01505_042", + "publisher": "Social Security Administration", + "edition": "SSA - POMS: RS 01505.042 - Procedures to Resolve General State and Local Coverage Issues - 11/30/2016", + "url": "https://secure.ssa.gov/poms.nsf/lnx/0301505042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_rs_0301505042.html", + "sha256": "b1f3b3c916cff0ec4a97958d062d21ec1f1ae4ed0a2a67d7f6ae134901960cf6", + "byte_size": 24780, + "retrieved_at": "2026-10-24T12:46:23.938874Z", + "units": [ + "cited_text" + ], + "years": [], + "geography": [ + "United States", + "states and local governments" + ], + "parser": "coverage_reference", + "role": "CE1 cited rules and CE3 classifier context; no observed coverage series", + "selector": { + "title": "RS 01505.042 Procedures to Resolve General State and Local Coverage Issues", + "sections": [ + "A. Tolerance rule for questionable coverage", + "B. Questions for development and documentation", + "C. Make a coverage determination and correct earnings" + ] + }, + "record_kind": "reference" + }, + { + "identifier": "poms_rs_01505_044", + "publisher": "Social Security Administration", + "edition": "SSA - POMS: RS 01505.044 - Directing Requests for Coverage and Wage Information on State and Local Government Employees - 04/15/2021", + "url": "https://secure.ssa.gov/poms.nsf/lnx/0301505044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_rs_0301505044.html", + "sha256": "54983d7e1719c0408542163b8c58ade88221127f09157ba958e049449e1e2012", + "byte_size": 27481, + "retrieved_at": "2026-10-24T12:46:24.014005Z", + "units": [ + "cited_text" + ], + "years": [], + "geography": [ + "United States", + "states and local governments" + ], + "parser": "coverage_reference", + "role": "CE1 cited rules and CE3 classifier context; no observed coverage series", + "selector": { + "title": "RS 01505.044 Directing Requests for Coverage and Wage Information on State and Local Government Employees", + "sections": [ + "A. Directing requests for information", + "B. How to obtain coverage and wage information" + ] + }, + "record_kind": "reference" + }, + { + "identifier": "poms_sl_20001_201", + "publisher": "Social Security Administration", + "edition": "SSA - POMS: SL 20001.201 - Introduction to Section 218 and State and Local Coverage - 05/05/2025", + "url": "https://secure.ssa.gov/poms.nsf/lnx/1920001201", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_sl_1920001201.html", + "sha256": "da4d3c8986a873700b7e6287995f7fcb4e94ac2dce945acdaab8ef8b598a5a88", + "byte_size": 26925, + "retrieved_at": "2026-10-24T12:46:24.020978Z", + "units": [ + "cited_text" + ], + "years": [], + "geography": [ + "United States", + "states and local governments" + ], + "parser": "coverage_reference", + "role": "CE1 cited rules and CE3 classifier context; no observed coverage series", + "selector": { + "title": "SL 20001.201 Introduction to Section 218 and State and Local Coverage", + "sections": [ + "A. Overview", + "B. Timeline" + ] + }, + "record_kind": "reference" + }, + { + "identifier": "poms_sl_30001_331", + "publisher": "Social Security Administration", + "edition": "SSA - POMS: SL 30001.331 - Divided-Vote Referendums - 11/16/2023", + "url": "https://secure.ssa.gov/poms.nsf/lnx/1930001331", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_sl_1930001331.html", + "sha256": "88301a88d2b2dea7dc930638c59a14dcf5811bd83e6a06add5874565caf884f4", + "byte_size": 38827, + "retrieved_at": "2026-10-24T12:46:24.026434Z", + "units": [ + "cited_text" + ], + "years": [], + "geography": [ + "United States", + "states and local governments" + ], + "parser": "coverage_reference", + "role": "CE1 cited rules and CE3 classifier context; no observed coverage series", + "selector": { + "title": "SL 30001.331 Divided-Vote Referendums", + "sections": [ + "A. Divided-vote referendum authority (Section 218(d)(6))", + "B. Referendum conditions", + "C. Certification form requirements", + "D. Employees eligible to vote", + "E. Employees not eligible to vote", + "F. Dividing the retirement system into separate \"deemed\" retirement systems following the referendum", + "G. Referendum time limitations" + ] + }, + "record_kind": "reference" + }, + { + "identifier": "poms_sl_30001_347", + "publisher": "Social Security Administration", + "edition": "SSA - POMS: SL 30001.347 - Providing Coverage for Police Officers and Firefighters - 01/29/2020", + "url": "https://secure.ssa.gov/poms.nsf/lnx/1930001347", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_sl_1930001347.html", + "sha256": "f06dc121e076162f3aab7bdaece9177d6efd1050de67024c8bca026368afb155", + "byte_size": 38455, + "retrieved_at": "2026-10-24T12:46:24.213639Z", + "units": [ + "cited_text" + ], + "years": [], + "geography": [ + "United States", + "states and local governments" + ], + "parser": "coverage_reference", + "role": "CE1 cited rules and CE3 classifier context; no observed coverage series", + "selector": { + "title": "SL 30001.347 Providing Coverage for Police Officers and Firefighters", + "sections": [ + "A. Covering police officer and firefighter positions as part of an absolute coverage group", + "B. Covering police officer and firefighter positions as a retirement system coverage group" + ] + }, + "record_kind": "reference" + }, + { + "identifier": "poms_sl_50001_501", + "publisher": "Social Security Administration", + "edition": "SSA - POMS: SL 50001.501 - Mandatory Social Security Coverage - 01/29/2020", + "url": "https://secure.ssa.gov/poms.nsf/lnx/1950001501", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_sl_1950001501.html", + "sha256": "375714297f63819fc408cf7110af8bec29fcec7733c1dbc19bab2e48b6062604", + "byte_size": 28428, + "retrieved_at": "2026-10-24T12:46:24.213956Z", + "units": [ + "cited_text" + ], + "years": [], + "geography": [ + "United States", + "states and local governments" + ], + "parser": "coverage_reference", + "role": "CE1 cited rules and CE3 classifier context; no observed coverage series", + "selector": { + "title": "SL 50001.501 Mandatory Social Security Coverage", + "sections": [ + "A. Mandatory Social Security coverage", + "B. Qualified Retirement System for purposes of mandatory coverage", + "C. Cessation of mandatory coverage for State and local government employees", + "D. Services not subject to mandatory Social Security coverage" + ] + }, + "record_kind": "reference" + }, + { + "identifier": "poms_sl_50001_510", + "publisher": "Social Security Administration", + "edition": "SSA - POMS: SL 50001.510 - Mandatory Medicare Coverage - 12/09/2003", + "url": "https://secure.ssa.gov/poms.nsf/lnx/1950001510", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_sl_1950001510.html", + "sha256": "16eb3195b465303fff01c75caa044f123d23de16a9e9598b11fabf7f14b93578", + "byte_size": 29099, + "retrieved_at": "2026-10-24T12:46:24.254142Z", + "units": [ + "cited_text" + ], + "years": [], + "geography": [ + "United States", + "states and local governments" + ], + "parser": "coverage_reference", + "role": "CE1 cited rules and CE3 classifier context; no observed coverage series", + "selector": { + "title": "SL 50001.510 Mandatory Medicare Coverage", + "sections": [ + "A. Continuing employment exception", + "B. Services not subject to mandatory Medicare coverage" + ] + }, + "record_kind": "reference" + } +] diff --git a/data/external/snapshots/income_resources_d4_v1/coverage_source_status.json b/data/external/snapshots/income_resources_d4_v1/coverage_source_status.json new file mode 100644 index 00000000..579e4a06 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/coverage_source_status.json @@ -0,0 +1,30 @@ +{ + "recorded_at": "2026-10-24T12:56:19.831588Z", + "request_times_retained": false, + "sources": [ + { + "url": "https://www.census.gov/programs-surveys/aspp/data.html", + "status": "SOURCE_BLOCKED", + "http_status": 403, + "detail": "Plain urllib request refused; no alternate headers, user agents or proxies used." + }, + { + "url": "https://www.census.gov/data/tables/2025/econ/aspp/aspp-historical-tables.html", + "status": "SOURCE_UNAVAILABLE", + "http_status": null, + "detail": "Initial plain request produced no capture; diagnostic response status was not retained. Census data portal independently returned HTTP 403. No further Census requests made." + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0301500000", + "status": "SOURCE_NOT_FOUND", + "http_status": 404, + "detail": "Guessed chapter index does not exist; substantive RS and SL sections captured from verified source links." + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0301507000", + "status": "SOURCE_UNAVAILABLE", + "http_status": null, + "detail": "Guessed section TOC produced no capture; diagnostic response status was not retained." + } + ] +} diff --git a/data/external/snapshots/income_resources_d4_v1/dol_bulletin_2023.xlsx b/data/external/snapshots/income_resources_d4_v1/dol_bulletin_2023.xlsx new file mode 100644 index 00000000..3ff5b04d Binary files /dev/null and b/data/external/snapshots/income_resources_d4_v1/dol_bulletin_2023.xlsx differ diff --git a/data/external/snapshots/income_resources_d4_v1/dol_landing.html b/data/external/snapshots/income_resources_d4_v1/dol_landing.html new file mode 100644 index 00000000..4f22a68a --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/dol_landing.html @@ -0,0 +1,1209 @@ + + + + + + + + + + + + + + + + + + + + + + + + + Private Pension Plan | U.S. Department of Labor + + + + + + + + + + + + + + + Skip to main content + + +
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+Private Pension Plan +

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Statistical summary of Form 5500 data on private pension plans including plan counts, participant counts, and financial totals (including assets by category, contributions, and benefits).

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+ + + + + + + + + + + + + + diff --git a/data/external/snapshots/income_resources_d4_v1/fed_mapping.csv b/data/external/snapshots/income_resources_d4_v1/fed_mapping.csv new file mode 100644 index 00000000..49ac5cbc --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/fed_mapping.csv @@ -0,0 +1,219 @@ +new,old,title +D3.g,D.1,Debt growth by sector +D3.s,D.3,Debt outstanding by sector +D3.t,D.2,Borrowing by sector +F0.t,F.8,Instrument discrepancies +F1.s,L.200,Monetary gold and special drawing rights (SDRs) +F1.t,F.200,Monetary gold and special drawing rights (SDRs) +F2.1.s,L.202,Interbank assets and liabilities +F2.1.t,F.202,Interbank assets and liabilities +F2.2.s,L.203,Checkable deposits and currency +F2.2.t,F.203,Checkable deposits and currency +F2.3.s,L.204,Time and savings deposits +F2.3.t,F.204,Time and savings deposits +F2.4.s,L.205,Other deposits +F2.4.t,F.205,Other deposits +F2.s,L.201,Currency and deposits +F2.t,F.201,Currency and deposits +F3.1.s,L.209,Open market paper +F3.1.t,F.209,Open market paper +F3.2.s,L.210,Treasury securities +F3.2.t,F.210,Treasury securities +F3.3.s,L.211,Agency- and GSE-backed securities +F3.3.t,F.211,Agency- and GSE-backed securities +F3.4.s,L.212,Municipal securities +F3.4.t,F.212,Municipal securities +F3.5.s,L.213,Corporate and foreign bonds +F3.5.t,F.213,Corporate and foreign bonds +F3.s,L.208,Debt securities +F3.t,F.208,Debt securities +F4.1.s,L.207,Federal funds and security repurchase agreements +F4.1.t,F.207,Federal funds and security repurchase agreements +F4.2.s,L.215,Depository institution loans not elsewhere classified +F4.2.t,F.215,Depository institution loans not elsewhere classified +F4.3.s,L.222,Consumer credit +F4.3.t,F.222,Consumer credit +F4.4.s,,Private credit loans +F4.4.t,,Private credit loans +F4.5.s,L.217,Total mortgages +F4.5.t,F.217,Total mortgages +F4.5a.s,L.218,One-to-four-family residential mortgages +F4.5a.t,F.218,One-to-four-family residential mortgages +F4.5b.s,L.219,Multifamily residential mortgages +F4.5b.t,F.219,Multifamily residential mortgages +F4.5c.s,L.220,Commercial mortgages +F4.5c.t,F.220,Commercial mortgages +F4.5d.s,L.221,Farm mortgages +F4.5d.t,F.221,Farm mortgages +F4.6.s,L.216,Other loans and advances +F4.6.t,F.216,Other loans and advances +F4.s,L.214,Loans +F4.t,F.214,Loans +F51.1.s,L.224,Corporate equities +F51.1.t,F.224,Corporate equities +F519.1.s,L.225.a,Direct investment equity +F519.1.t,F.225.a,Direct investment equity +F519.2.s,L.225.b,Miscellaneous other equity +F519.2.t,F.225.b,Miscellaneous other equity +F519.s,L.225,Other equity +F519.t,F.225,Other equity +F521.s,L.206,Money market fund shares +F521.t,F.206,Money market fund shares +F522.1.s,L.226,Mutual fund shares +F522.1.t,F.226,Mutual fund shares +F522.2.s,,Hedge fund shares +F522.2.t,,Hedge fund shares +F522.3.s,,Private debt fund shares +F522.3.t,,Private debt fund shares +F6.1.s,L.228,Life insurance reserves +F6.1.t,F.228,Life insurance reserves +F6.2.s,L.229,Pension entitlements +F6.2.t,F.229,Pension entitlements +F81.s,L.230,Trade credit +F81.t,F.230,Trade credit +F89.1.s,L.231,Taxes payable by businesses +F89.1.t,F.231,Taxes payable by businesses +F89.2.s,L.223,Direct investment intercompany debt +F89.2.t,F.223,Direct investment intercompany debt +F89.3.s,L.232,Total miscellaneous financial claims +F89.3.t,F.232,Total miscellaneous financial claims +F89.3a.s,L.233,Identified miscellaneous financial claims - part I +F89.3a.t,F.233,Identified miscellaneous financial claims - part I +F89.3b.s,L.234,Identified miscellaneous financial claims - part II +F89.3b.t,F.234,Identified miscellaneous financial claims - part II +F89.3c.s,L.235,Unidentified miscellaneous financial claims +F89.3c.t,F.235,Unidentified miscellaneous financial claims +M3.s,M.1.l,Financial accounts matrix--stocks +M3.s.c,M.1.l.c,Financial accounts matrix--stocks (coded) +M3.t,M.1.f,Financial accounts matrix--transactions +M3.t.c,M.1.f.c,Financial accounts matrix--transactions (coded) +S0.t,F.7,Sector discrepancies +S1.1.i.a,S.1.a,Total economy - current account +S1.1.i.q,S.1.q,Total economy - current account +S1.2.i.a,S.2.a,Selected aggregates for total economy and sectors +S1.2.i.q,S.2.q,Selected aggregates for total economy and sectors +S1.b,B.1,Derivation of U.S. net wealth +S11.1.b,B.103,Nonfinancial corporate business +S11.1.i.a,S.5.a,Nonfinancial corporate business +S11.1.i.q,S.5.q,Nonfinancial corporate business +S11.1.r,R.103,Nonfinancial corporate business +S11.1.s,L.103,Nonfinancial corporate business +S11.1.t,F.103,Nonfinancial corporate business +S11.2.b,B.104,Nonfinancial noncorporate business +S11.2.i.a,S.4.a,Nonfinancial noncorporate business +S11.2.i.q,S.4.q,Nonfinancial noncorporate business +S11.2.r,R.104,Nonfinancial noncorporate business +S11.2.s,L.104,Nonfinancial noncorporate business +S11.2.t,F.104,Nonfinancial noncorporate business +S11.s,L.102,Nonfinancial business +S11.t,F.102,Nonfinancial business +S12.i.a,S.6.a,Financial business +S12.i.q,S.6.q,Financial business +S12.s,L.108,Domestic financial sectors +S12.t,F.108,Domestic financial sectors +S121.i.a,S.61.a,Central bank +S121.s,L.109,Central bank +S121.t,F.109,Central bank +S122.1.s,L.111,U.S.-chartered depository institutions +S122.1.t,F.111,U.S.-chartered depository institutions +S122.2.s,L.112,Foreign banking offices in U.S. +S122.2.t,F.112,Foreign banking offices in U.S. +S122.3.s,L.113,Banks in U.S.-affiliated areas +S122.3.t,F.113,Banks in U.S.-affiliated areas +S122.4.s,L.114,Credit unions +S122.4.t,F.114,Credit unions +S122.i.a,S.62.a,Private depository institutions +S122.s,L.110,Private depository institutions +S122.t,F.110,Private depository institutions +S123.s,L.121,Money market funds +S123.t,F.121,Money market funds +S124.1.s,L.122,Mutual funds +S124.1.t,F.122,Mutual funds +S124.2.s,L.123,Closed-end funds +S124.2.t,F.123,Closed-end funds +S124.3.s,L.124,Exchange-traded funds +S124.3.t,F.124,Exchange-traded funds +S124.4.s,L.129,Mortgage real estate investment trusts (mortgage REITs) +S124.4.t,F.129,Mortgage real estate investment trusts (mortgage REITs) +S124.5.s,,Business development companies (BDCs) +S124.5.t,,Business development companies (BDCs) +S124.6.s,,Interval and tender offer funds +S124.6.t,,Interval and tender offer funds +S124.7.f.s,,Foreign hedge funds +S124.7.s,,Hedge funds +S124.7.t,,Hedge funds +S124.8.s,,Private debt funds +S124.8.t,,Private debt funds +S125s1.1.s,L.125,Government-sponsored enterprises (GSEs) +S125s1.1.t,F.125,Government-sponsored enterprises (GSEs) +S125s1.2.s,L.126,Agency- and GSE-backed mortgage pools +S125s1.2.t,F.126,Agency- and GSE-backed mortgage pools +S125s1.3.s,L.127,Issuers of asset-backed securities (ABS) +S125s1.3.t,F.127,Issuers of asset-backed securities (ABS) +S125s2.1.s,L.128,Finance companies +S125s2.1.t,F.128,Finance companies +S125s3.s,L.130,Security brokers and dealers +S125s3.t,F.130,Security brokers and dealers +S125s5.s,L.132.c,Central clearing counterparties (CCPs) +S127.1.s,L.131,Holding companies +S127.1.t,F.131,Holding companies +S127.2.s,L.132,Other financial business +S127.2.t,F.132,Other financial business +S128.i.a,S.63.a,Insurance companies +S1281.1.s,L.116.g,Life insurance companies: general accounts +S1281.1.t,F.116.g,Life insurance companies: general accounts +S1281.2.s,L.116.s,Life insurance companies: separate accounts +S1281.2.t,F.116.s,Life insurance companies: separate accounts +S1281.s,L.116,Life insurance companies +S1281.t,F.116,Life insurance companies +S1282.1.s,L.115,Property-casualty insurance companies +S1282.1.t,F.115,Property-casualty insurance companies +S129.1.s,L.118,Private pension funds +S129.1.t,F.118,Private pension funds +S129.2.s,L.119,Federal government employee pension funds +S129.2.t,F.119,Federal government employee pension funds +S129.3.s,L.120,State and local government employee pension funds +S129.3.t,F.120,State and local government employee pension funds +S129.i.a,S.64.a,Pension funds +S129.s,L.117,Private and public pension funds +S129.t,F.117,Private and public pension funds +S129s1.1.s,L.118.b,Private defined benefit pension funds +S129s1.1.t,F.118.b,Private defined benefit pension funds +S129s1.2.s,L.119.b,Federal government employee defined benefit pension funds +S129s1.2.t,F.119.b,Federal government employee defined benefit pension funds +S129s1.3.s,L.120.b,State and local government employee defined benefit pension funds +S129s1.3.t,F.120.b,State and local government employee defined benefit pension funds +S129s2.1.s,L.118.c,Private defined contribution pension funds +S129s2.1.t,F.118.c,Private defined contribution pension funds +S129s2.2.s,L.119.c,Federal government employee defined contribution pension funds +S129s2.2.t,F.119.c,Federal government employee defined contribution pension funds +S129s2.3.s,L.120.c,State and local government employee defined contribution pension funds +S129s2.3.t,F.120.c,State and local government employee defined contribution pension funds +S12R.i.a,S.65.a,Other financial business +S13.s,L.105,General government +S13.t,F.105,General government +S1311.i.a,S.7.a,Federal government +S1311.i.q,S.7.q,Federal government +S1311.s,L.106,Federal government +S1311.t,F.106,Federal government +S13M.i.a,S.8.a,State and local governments +S13M.i.q,S.8.q,State and local governments +S13M.s,L.107,State and local governments +S13M.t,F.107,State and local governments +S14.b,B.101.h,Balance sheet of households +S15.b,B.101.n,Balance sheet of nonprofit organizations +S1M.b,B.101,Households and nonprofit organizations +S1M.e.b,B.101.e,Balance sheet of households and nonprofit organizations with debt and equity holdings detail +S1M.i.a,S.3.a,Households and nonprofit institutions serving households +S1M.i.q,S.3.q,Households and nonprofit institutions serving households +S1M.r,R.101,Households and nonprofit organizations +S1M.s,L.101,Households and nonprofit organizations +S1M.t,F.101,Households and nonprofit organizations +S1P.s,L.6,Assets and liabilities of the personal sector +S1P.t,F.6,Derivation of measures of personal saving +S1S.s,L.100,Domestic nonfinancial sectors +S1S.t,F.100,Domestic nonfinancial sectors +S2.i.a,S.9.a,Rest of the world +S2.i.q,S.9.q,Rest of the world +S2.s,L.133,Rest of the world +S2.t,F.133,Rest of the world diff --git a/data/external/snapshots/income_resources_d4_v1/fed_release.html b/data/external/snapshots/income_resources_d4_v1/fed_release.html new file mode 100644 index 00000000..033593f5 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/fed_release.html @@ -0,0 +1,1749 @@ + + + + + + + + + + + + + + The Fed - Financial Accounts of the United States - Z.1 - Current Release + + + + + + + + + + + + + + + + Skip to main content + +
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An official website of the United States Government

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Current Release RSS Data Download XML | CSV | JSON

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During the week of November 9, the "Build Your Package" feature in the Data Download Program (DDP) will be removed in preparation for the eventual retirement of the DDP. Users can access data and expanded download options through the Federal Reserve Bank of St. Louis's Federal Reserve Economic Data (FRED). Learn more about the DDP and FRED partnership.

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+ Release Date: September 11, 2026 2026:Q2 Release +
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The Financial Accounts of the United States includes data on transactions and levels of financial assets and liabilities, by sector and financial instrument; full balance sheets, including net worth, for households and nonprofit organizations, nonfinancial corporate businesses, and nonfinancial noncorporate businesses; Integrated Macroeconomic Accounts; and additional supplemental detail.

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September 11, 2026 Release Tables: PDF | CSV

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Recent Developments

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Introductory Text

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Code Changes

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Z1 table mapping CSV

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HTML All | Summaries | Sectors | Instruments | Balance sheets | Supplementary | IMA

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Interactive Data Visualizations

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+ Household Balance Sheet Vertical bar chart showing two stacked data series and a line running horizontally along the first data series. View interactive | Accessible version | CSV +
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+ Changes in Net Worth Vertical bar chart showing three stacked data series and a line running horizontally along the first data series. View interactive | Accessible version | CSV +
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+ Nonfinancial Debt Area chart showing four stacked data series. View interactive | Accessible version | CSV +
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Announcements

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+ 2026:Q2 data now available for the Financial Accounts of the United States
+ 2026-09-11
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This release incorporates revisions, structural changes, and enhancements, including the incorporation of private credit lending vehicles, private credit loans, and hedge funds. Major changes are described in the "Release Highlights" section of the publication and are also in the online Financial Accounts Guide at www.federalreserve.gov/apps/fof/. The file structure of the Z.1 release consists of a single Z.1 PDF containing the Recent Developments summary, charts, and tables, the HTML tables corresponding to the Z.1 PDF, and a single set of compressed CSV files with accompanying data dictionary text files, also corresponding to the PDF. All data are available immediately for download through the Federal Reserve Data Download Program (DDP). The next Z.1 release will be Thursday, December 10, 2026, at 12:00 noon.

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Last Update: September 11, 2026
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SOI Tax Stats Accumulation and Distribution of Individual Retirement Arrangements

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Individual retirement arrangements

The Accumulation and Distribution of IRA's bulletin articles and related statistical tables provide detailed information about trends in the accumulation and distributions of IRAs by taxpayers. These annual statistics on types of IRA plans are based on information collected from matched samples of Form 1040, U.S Individual Income Tax Returns; Forms 5498, IRA Contribution Information; and Forms 1099-R, Distributions from Pensions, Annuities, Retirement or Profit-Sharing plans, IRAs, Insurance Contract, etc.

Important: Beginning with data for 2022, SOI introduced enhancements to improve the data’s overall quality as a new series of information.

Statistical tables

All tables are available as Microsoft Excel® files. A free Excel viewer is available for download, if needed.

IRA plans

Data presentedClassified byTax years
Table 1. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Type of PlanType of Plan2023 XLSX 2022 XLSX

Taxpayers with IRA plans

Data presentedClassified byTax years
Table 2. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Size of Adjusted Gross IncomeSize of Adjusted Gross Income2023 XLSX 2022 XLSX
Table 3. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Type of Plan and by Size of Adjusted Gross IncomeType of Plan and Size of Adjusted Gross Income2023 XLSX 2022 XLSX
Table 9. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Increasing Adjusted Gross Income (AGI) PercentileIncreasing Adjusted Gross Income (AGI) Percentile2023 XLSX 2022 XLSX
Table 10. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Type of Plan and by Increasing Adjusted Gross Income (AGI) PercentileType of Plan and Increasing Adjusted Gross Income (AGI) Percentile2023 XLSX 2022 XLSX
Table 7. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Filing Status and GenderFiling Status and Gender of Taxpayer2023 XLSX 2022 XLSX
Table 4. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Age of TaxpayerAge of Taxpayer2023 XLSX 2022 XLSX
Table 8. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Type of Plan and by Age of TaxpayerType of Plan and Age of Taxpayer2023 XLSX 2022 XLSX

Taxpayers with traditional IRA plans

Data presentedClassified byTax years
Table 5. Taxpayers with Traditional Individual Retirement Arrangement (IRA) Contributions, by Size of Contribution and Age of TaxpayerSize of Contribution and Age of Taxpayer2023 XLSX 2022 XLSX

Taxpayers with Roth IRA plans

Data presentedClassified byTax years
Table 6. Taxpayers with Roth Individual Retirement Arrangement (IRA) Contributions, by Size of Contributions and Age of TaxpayerSize of Contribution and Age of Taxpayer2023 XLSX 2022 XLSX

Confidence intervals

Data presentedTax years
Table 12023 XLSX 2022 XLSX
Table 22023 XLSX 2022 XLSX
Table 32023 XLSX 2022 XLSX
Table 42023 XLSX 2022 XLSX
Table 52023 XLSX 2022 XLSX
Table 62023 XLSX 2022 XLSX
Table 72023 XLSX 2022 XLSX
Table 82023 XLSX 2022 XLSX
Table 92023 XLSX 2022 XLSX
Table 102023 XLSX 2022 XLSX 

IRA plans 2000-2021

Data presentedClassified byTax years
Table 1. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Type of PlanType of Plan2021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX 2017 XLSX 2016 XLS 2015 XLS 2014 XLS 2013 XLS 2012 XLS 2011 XLS 2010 XLS 2009 XLS 2008 XLS 2007 XLS 2006 XLS 2005 XLS 2004 XLS 2002 XLS 2001 XLS 2000 XLS

Taxpayers with IRA plans 2000-2021

Data presentedClassified byTax years
Table 2. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Size of Adjusted Gross IncomeSize of Adjusted Gross Income2021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX 2017 XLSX 2016 XLS 2015 XLS 2014 XLS 2013 XLS 2012 XLS 2011 XLS 2010 XLS 2009 XLS 2008 XLS 2007 XLS 2006 XLS 2005 XLS 2004 XLS 2002 XLS 2001 XLS 2000 XLS
Table 3. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Type of Plan and by Size of Adjusted Gross IncomeType of Plan and Size of Adjusted Gross Income2021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX 2017 XLSX 2016 XLS 2015 XLS 2014 XLS 2013 XLS 2012 XLS 2011 XLS 2010 XLS 2009 XLS 2008 XLS 2007 XLS 2006 XLS 2005 XLS 2004 XLS 2002 XLS 2001 XLS 2000 XLS
Table 9. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Increasing Adjusted Gross Income (AGI) PercentileIncreasing Adjusted Gross Income (AGI) Percentile2021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX
Table 10. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Type of Plan and by Increasing Adjusted Gross Income (AGI) PercentileType of Plan and Increasing Adjusted Gross Income (AGI) Percentile2021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX
Table 7. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Filing Status and GenderFiling Status and Gender of Taxpayer2021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX 2017 XLSX 2016 XLS 2015 XLS 2014 XLS 2004 XLS 2002 XLS 2001 XLS 2000 XLS
Table 4. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Age of TaxpayerAge of Taxpayer2021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX 2017 XLSX 2016 XLS 2015 XLS 2014 XLS 2013 XLS 2012 XLS 2011 XLS 2010 XLS 2009 XLS 2008 XLS 2007 XLS 2006 XLS 2005 XLS 2004 XLS 2002 XLS 2001 XLS 2000 XLS
Table 8. Taxpayers with Individual Retirement Arrangement (IRA) Plans, by Type of Plan and by Age of TaxpayerType of Plan and Age of Taxpayer2021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX 2017 XLSX  

Taxpayers with traditional IRA plans 2000-2021

Data presentedClassified byTax years
Table 5. Taxpayers with Traditional Individual Retirement Arrangement (IRA) Contributions, by Size of Contribution and Age of TaxpayerSize of Contribution and Age of Taxpayer2021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX 2017 XLSX 2016 XLS 2015 XLS 2014 XLS 2013 XLS 2012 XLS 2011 XLS 2010 XLS 2009 XLS 2008 XLS 2007 XLS 2006 XLS 2005 XLS 2004 XLS

Taxpayers with Roth IRA plans 2000-2021

Data presentedClassified byTax years
Table 6. Taxpayers with Roth Individual Retirement Arrangement (IRA) Contributions, by Size of Contributions and Age of TaxpayerSize of Contribution and Age of Taxpayer2021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX 2017 XLSX 2016 XLS 2015 XLS 2014 XLS 2013 XLS 2012 XLS 2011 XLS 2010 XLS 2009 XLS 2008 XLS 2007 XLS 2006 XLS 2005 XLS 2004 XLS

Coefficients of variance 2000-2021

Table numberTax years
Table 12021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX
Table 22021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX
Table 32021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX
Table 42021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX
Table 52021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX
Table 62021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX
Table 72021 XLSX 2020 XLSX 2019 XLSX 2018 XLSX

Bulletin articles

All bulletin articles and papers are available as PDF files. A free Adobe® reader is available for download, if needed.

Accumulation and distribution of individual retirement arrangements

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"header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 43 + ], + "effective_from": "2007-01-01", + "effective_to": null, + "parameter_effective_date_text": "Vermont effective 1/1/07.", + "date_options": {}, + "section_effective_from": "2007-12-20", + "section_effective_to": null, + "nominal_year": 2007, + "column_labels": [ + "FBR", + "State | Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415039", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2007.html", + "sha256": "a9ed64e6a6506c68a8af84489125a655dde3af3117a6c3b2d68fae4018581bf6", + "byte_size": 705149, + "retrieved_at": "2026-10-24T12:42:12.360739Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State 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"7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_california_individual_t02", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_california_couple_t03", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_delaware_individual_t05", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for Delaware effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_delaware_couple_t06", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for Delaware effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_district_of_columbia_individual_t08", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for the District of Columbia effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_district_of_columbia_couple_t09", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Code", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for the District of Columbia effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Code", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_hawaii_individual_t11", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Hawaii effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_hawaii_couple_t12", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Hawaii effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_iowa_individual_t14", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Iowa effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_iowa_couple_t15", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Iowa effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_massachusetts_individual_t17", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Massachusetts" + ], + "selector": { + "table_index": 17, + "state": "Massachusetts", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Massachusetts effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_massachusetts_couple_t18", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Massachusetts" + ], + "selector": { + "table_index": 18, + "state": "Massachusetts", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Massachusetts effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "published_identity_discrepancies": [ + "Massachusetts | couple | Federal code=A | State OS code=A | Category=Aged/Blind | source row=4", + "Massachusetts | couple | Federal code=A | State OS code=B | Category=Aged/Blind | source row=10" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_michigan_individual_t20", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 20, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Michigan effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_michigan_couple_t21", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 21, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Michigan effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_montana_individual_t23", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 23, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Montana effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_montana_couple_t24", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 24, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Montana effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_nevada_individual_t26", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 26, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Nevada effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_nevada_couple_t27", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 27, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Nevada effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_new_jersey_individual_t29", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 29, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for New Jersey effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_new_jersey_couple_t30", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 30, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for New Jersey effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_new_york_individual_t32", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 32, + "state": "New York", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for New York effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State | Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_new_york_couple_t33", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 33, + "state": "New York", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for New York effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State | Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_pennsylvania_individual_t35", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 35, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 34 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Pennsylvania effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_pennsylvania_couple_t36", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 36, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 34 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Pennsylvania effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_rhode_island_individual_t38", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 38, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 37 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Rhode Island effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_rhode_island_couple_t39", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 39, + "state": "Rhode Island", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 37 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Rhode Island effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_utah_individual_t41", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 41, + "state": "Utah", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Level" + ], + "definitions_table_indexes": [ + 40 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Utah effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Level" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_utah_couple_t42", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 42, + "state": "Utah", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 40 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Utah effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State | Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_vermont_individual_t44", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 44, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 43 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Vermont effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State | Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415040", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html", + "sha256": "7e193aea809385f19fd4f39bb47fce1b8ee1b4ad2532d0eae7c4868c73338897", + "byte_size": 719631, + "retrieved_at": "2026-10-24T12:42:12.528887Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2008_vermont_couple_t45", + "edition": "SI 01415.040: January 2008", + "years": [ + 2008 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 45, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 43 + ], + "effective_from": "2008-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Vermont effective 1/1/08 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2008-01-17", + "section_effective_to": null, + "nominal_year": 2008, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_california_individual_t02", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-07-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 07/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_california_couple_t03", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-07-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 07/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_california_individual_t04", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 4, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-05-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 05/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_california_couple_t05", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 5, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-05-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 05/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_california_individual_t06", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 6, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "published_identity_discrepancies": [ + "California | individual | Federal code=B | State OS code=D | Category=Aged | source row=10" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_california_couple_t07", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 7, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_delaware_individual_t09", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 9, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 8 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for Delaware effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_delaware_couple_t10", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 10, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 8 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for Delaware effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_district_of_columbia_individual_t12", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 12, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 11 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for the District of Columbia effective 01/01/09 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_district_of_columbia_couple_t13", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 13, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Code", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 11 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for the District of Columbia effective 01/01/09 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Code", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_hawaii_individual_t15", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 15, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 14 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Hawaii effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_hawaii_couple_t16", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 16, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 14 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Hawaii effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_iowa_individual_t18", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 18, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 17 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Iowa effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_iowa_couple_t19", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 19, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 17 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Iowa effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_massachusetts_individual_t21", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Massachusetts" + ], + "selector": { + "table_index": 21, + "state": "Massachusetts", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 20 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Massachusetts effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_massachusetts_couple_t22", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Massachusetts" + ], + "selector": { + "table_index": 22, + "state": "Massachusetts", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 20 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Massachusetts effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_michigan_individual_t24", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 24, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 23 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Michigan effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_michigan_couple_t25", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 25, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 23 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Michigan effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_montana_individual_t27", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 27, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 26 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Montana effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_montana_couple_t28", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 28, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 26 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Montana effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_nevada_individual_t30", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 30, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 29 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Nevada effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_nevada_couple_t31", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 31, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 29 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Nevada effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_new_jersey_individual_t33", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 33, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 32 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for New Jersey effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_new_jersey_couple_t34", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 34, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 32 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for New Jersey effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_new_york_individual_t36", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 36, + "state": "New York", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 35 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for New York effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State | Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_new_york_couple_t37", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 37, + "state": "New York", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 35 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for New York effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State | Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_pennsylvania_individual_t39", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 39, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 38 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Pennsylvania effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_pennsylvania_couple_t40", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 40, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 38 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Pennsylvania effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_rhode_island_individual_t42", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 42, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 41 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Rhode Island effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_rhode_island_couple_t43", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 43, + "state": "Rhode Island", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 41 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Rhode Island effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_utah_individual_t45", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 45, + "state": "Utah", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Level" + ], + "definitions_table_indexes": [ + 44 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Utah effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Level" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_utah_couple_t46", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 46, + "state": "Utah", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 44 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Utah effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State | Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_vermont_individual_t48", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 48, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 47 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Vermont effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State | Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415041", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html", + "sha256": "824a5175b58ff8ccacfc1d517d5b8247fccf8e8efda0a4f1dbab277e347afd09", + "byte_size": 835407, + "retrieved_at": "2026-10-24T12:42:12.646711Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2009_vermont_couple_t49", + "edition": "SI 01415.041: January 2009", + "years": [ + 2009 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 49, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 47 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Vermont effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2009-08-07", + "section_effective_to": null, + "nominal_year": 2009, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_california_individual_t02", + "edition": "SI 01415.042: January 2010", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-11-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 11 /01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_california_couple_t03", + "edition": "SI 01415.042: January 2010", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-11-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 11 /01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_california_individual_t04", + "edition": "SI 01415.042: January 2010", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 4, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Leve l", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-07-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 07/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Leve l", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_california_couple_t05", + "edition": "SI 01415.042: January 2010", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 5, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-07-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 07/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_california_individual_t06", + "edition": "SI 01415.042: January 2010", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 6, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-05-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 05/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_california_couple_t07", + "edition": "SI 01415.042: January 2010", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 7, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-05-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 05/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_california_individual_t08", + "edition": "SI 01415.042: January 2010", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 8, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "published_identity_discrepancies": [ + "California | individual | Federal code=B | State OS code=D | Category=Aged | source row=10" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_california_couple_t09", + "edition": "SI 01415.042: January 2010", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 9, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California effective 01/01/09 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_delaware_individual_t11", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 11, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for Delaware effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_delaware_couple_t12", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 12, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for Delaware effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_district_of_columbia_individual_t14", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 14, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for the District of Columbia effective 01/01/10 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_district_of_columbia_couple_t15", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 15, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Code", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for the District of Columbia effective 01/01/10 are shown in the following charts.", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Code", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_hawaii_individual_t17", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 17, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Hawaii effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_hawaii_couple_t18", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 18, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Hawaii effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_iowa_individual_t20", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 20, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Iowa effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_iowa_couple_t21", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 21, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Iowa effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_massachusetts_individual_t23", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Massachusetts" + ], + "selector": { + "table_index": 23, + "state": "Massachusetts", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Massachusetts effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_massachusetts_couple_t24", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Massachusetts" + ], + "selector": { + "table_index": 24, + "state": "Massachusetts", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Massachusetts effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_michigan_individual_t26", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 26, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Michigan effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_michigan_couple_t27", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 27, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Michigan effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_montana_individual_t29", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 29, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Montana effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_montana_couple_t30", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 30, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Montana effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_nevada_individual_t32", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 32, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Nevada effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_nevada_couple_t33", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 33, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Nevada effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_new_jersey_individual_t35", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 35, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 34 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for New Jersey effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_new_jersey_couple_t36", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 36, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 34 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for New Jersey effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_new_york_individual_t38", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 38, + "state": "New York", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 37 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for New York effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_new_york_couple_t39", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 39, + "state": "New York", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 37 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for New York effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_pennsylvania_individual_t41", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 41, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 40 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Pennsylvania effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_pennsylvania_couple_t42", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 42, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 40 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Pennsylvania effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_rhode_island_individual_t44", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 44, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 43 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Rhode Island effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_rhode_island_couple_t45", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 45, + "state": "Rhode Island", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 43 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Rhode Island effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_utah_individual_t47", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 47, + "state": "Utah", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Level" + ], + "definitions_table_indexes": [ + 46 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Utah effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Level" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_utah_couple_t48", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 48, + "state": "Utah", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 46 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Utah effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_vermont_individual_t50", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 50, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 49 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Vermont effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415042", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html", + "sha256": "2c4aba069d26a0cb0b9d97ec141df66a767bcd48af2ea925f4f4886a58c16ba6", + "byte_size": 904168, + "retrieved_at": "2026-10-24T12:42:12.721632Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2010_vermont_couple_t51", + "edition": "SI 01415.042: January 2010", + "years": [ + 2010 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 51, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 49 + ], + "effective_from": "2010-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Vermont effective 01/01/10 are shown in the following charts:", + "date_options": {}, + "section_effective_from": "2011-01-07", + "section_effective_to": null, + "nominal_year": 2010, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_california_individual_t02", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2011-07-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California, effective 07/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_california_couple_t03", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2011-07-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for California, effective 07/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_california_individual_t04", + "edition": "SI 01415.043: January 2011", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 4, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-11-01", + "effective_to": "2011-06-30", + "parameter_effective_date_text": "The coding and monthly payment levels for California, effective from 11/01/09 to 06/30/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_california_couple_t05", + "edition": "SI 01415.043: January 2011", + "years": [ + 2009 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 5, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2009-11-01", + "effective_to": "2011-06-30", + "parameter_effective_date_text": "The coding and monthly payment levels for California, effective from 11/01/09 to 06/30/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_delaware_individual_t07", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 7, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 6 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for Delaware, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_delaware_couple_t08", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 8, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 6 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for Delaware, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_district_of_columbia_individual_t10", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 10, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 9 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for the District of Columbia, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_district_of_columbia_couple_t11", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 11, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Code", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 9 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for the District of Columbia, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Code", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_hawaii_individual_t13", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 13, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 12 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Hawaii, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_hawaii_couple_t14", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 14, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 12 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Hawaii, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_iowa_individual_t16", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 16, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 15 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Iowa, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_iowa_couple_t17", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 17, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 15 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Iowa, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_massachusetts_individual_t19", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Massachusetts" + ], + "selector": { + "table_index": 19, + "state": "Massachusetts", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 18 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Massachusetts, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_massachusetts_couple_t20", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Massachusetts" + ], + "selector": { + "table_index": 20, + "state": "Massachusetts", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 18 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Massachusetts, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_michigan_individual_t22", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 22, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 21 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Michigan, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_michigan_couple_t23", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 23, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 21 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Michigan, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_montana_individual_t25", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 25, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 24 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Montana, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_montana_couple_t26", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 26, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 24 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Montana, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_nevada_individual_t28", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 28, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 27 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Nevada, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_nevada_couple_t29", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 29, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 27 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Nevada, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_new_jersey_individual_t31", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 31, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 30 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for New Jersey, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_new_jersey_couple_t32", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 32, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 30 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payments levels for New Jersey, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_new_york_individual_t34", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 34, + "state": "New York", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for New York, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_new_york_couple_t35", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 35, + "state": "New York", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for New York, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_pennsylvania_individual_t37", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 37, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 36 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Pennsylvania, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_pennsylvania_couple_t38", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 38, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 36 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Pennsylvania, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_rhode_island_individual_t40", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 40, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 39 + ], + "effective_from": "2011-10-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Rhode Island, effective 10/01/11, are in the following chart:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_rhode_island_individual_t41", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 41, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 39 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Rhode Island, effective 01/01/11, are in the following chart:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_utah_individual_t43", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 43, + "state": "Utah", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Level" + ], + "definitions_table_indexes": [ + 42 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Utah, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Level" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_utah_couple_t44", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 44, + "state": "Utah", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 42 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Utah, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_vermont_individual_t46", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 46, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 45 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Vermont, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415043", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html", + "sha256": "2a679781c018297ec66a1e83e131f4d8bfaee7874880ef92119958f375607de9", + "byte_size": 787351, + "retrieved_at": "2026-10-24T12:42:12.806612Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2011_vermont_couple_t47", + "edition": "SI 01415.043: January 2011", + "years": [ + 2011 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 47, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 45 + ], + "effective_from": "2011-01-01", + "effective_to": null, + "parameter_effective_date_text": "The coding and monthly payment levels for Vermont, effective 01/01/11, are in the following charts:", + "date_options": {}, + "section_effective_from": "2013-01-28", + "section_effective_to": null, + "nominal_year": 2011, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_california_individual_t02", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective 01/01/2012.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_california_couple_t03", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective 01/01/2012.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_delaware_individual_t05", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_delaware_couple_t06", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_district_of_columbia_individual_t08", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_district_of_columbia_couple_t09", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Code", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Code", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_hawaii_individual_t11", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_hawaii_couple_t12", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_iowa_individual_t14", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_iowa_couple_t15", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "published_identity_discrepancies": [ + "Iowa | couple | Federal code=B | State OS code=Z | Category=Aged/Disabled | source row=30" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_massachusetts_individual_t17", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Massachusetts" + ], + "selector": { + "table_index": 17, + "state": "Massachusetts", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Massachusetts effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_massachusetts_couple_t18", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Massachusetts" + ], + "selector": { + "table_index": 18, + "state": "Massachusetts", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Massachusetts effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_michigan_individual_t20", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 20, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_michigan_couple_t21", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 21, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_montana_individual_t23", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 23, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_montana_couple_t24", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 24, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_nevada_individual_t26", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 26, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_nevada_couple_t27", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 27, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_new_jersey_individual_t29", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 29, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_new_jersey_couple_t30", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 30, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_new_york_individual_t32", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 32, + "state": "New York", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for New York effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_new_york_couple_t33", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 33, + "state": "New York", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for New York effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_pennsylvania_individual_t35", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 35, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 34 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_pennsylvania_couple_t36", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 36, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 34 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_rhode_island_individual_t38", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 38, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 37 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_utah_individual_t40", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 40, + "state": "Utah", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Level" + ], + "definitions_table_indexes": [ + 39 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Utah effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Level" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_utah_couple_t41", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 41, + "state": "Utah", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 39 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Utah effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415044", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html", + "sha256": "33c9efd56bb3327589ba15043f000d498617809ccfae0d706ffc59c5fbdf07ad", + "byte_size": 737833, + "retrieved_at": "2026-10-24T12:42:13.034963Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2012_vermont_individual_t43", + "edition": "SI 01415.044: January 2012", + "years": [ + 2012 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 43, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 42 + ], + "effective_from": "2012-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment 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+ "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective 01/01/12.", + "date_options": {}, + "section_effective_from": "2012-08-06", + "section_effective_to": null, + "nominal_year": 2012, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_california_individual_t02", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective 01/01/2013.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_california_couple_t03", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective 01/01/2013.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_delaware_individual_t05", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_delaware_couple_t06", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_district_of_columbia_individual_t08", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_district_of_columbia_couple_t09", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS 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input: federally administered State supplements", + "identifier": "poms_si_01415_2013_hawaii_individual_t11", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_hawaii_couple_t12", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_iowa_individual_t14", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_iowa_couple_t15", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "published_identity_discrepancies": [ + "Iowa | couple | Federal code=B | State OS code=Z | Category=Aged/Disabled | source row=36" + ], + "column_labels": [ + "FBR", + "State 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"effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_michigan_couple_t18", + "edition": "SI 01415.045: January 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"column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_montana_couple_t21", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": 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"2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_new_jersey_individual_t26", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered 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"section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_new_york_couple_t30", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 30, + "state": "New York", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for New York effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally 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"data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_pennsylvania_couple_t33", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 33, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_rhode_island_individual_t35", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 35, + "state": "Rhode 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"units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_utah_individual_t37", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 37, + "state": "Utah", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Level" + ], + "definitions_table_indexes": [ + 36 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Utah effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Level" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_utah_couple_t38", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Utah" + ], + "selector": { + "table_index": 38, + "state": "Utah", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 36 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Utah effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2013_vermont_individual_t40", + "edition": "SI 01415.045: January 2013", + "years": [ + 2013 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 40, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 39 + ], + "effective_from": "2013-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective 01/01/13.", + "date_options": {}, + "section_effective_from": "2013-09-24", + "section_effective_to": null, + "nominal_year": 2013, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415045", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html", + "sha256": "7e4851edbe7c61c36018e3ea4c6e75b53c749c8c05ae09eeca2ef495442a9214", + "byte_size": 658169, + "retrieved_at": "2026-10-24T12:42:13.256070Z", + "publisher": "Social Security 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"url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_california_individual_t02", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective 01/01/2014.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_california_couple_t03", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective 01/01/2014.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_delaware_individual_t05", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_delaware_couple_t06", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_district_of_columbia_individual_t08", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": 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01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Code", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_hawaii_individual_t11", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 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"data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_iowa_individual_t14", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_iowa_couple_t15", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 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"data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_michigan_couple_t18", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_montana_individual_t20", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_montana_couple_t21", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_nevada_individual_t23", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_nevada_couple_t24", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_new_jersey_individual_t26", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_new_jersey_couple_t27", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels", + "" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels", + "Unlabelled amount column 7" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_new_york_individual_t29", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 29, + "state": "New York", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for New York effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_new_york_couple_t30", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "New York" + ], + "selector": { + "table_index": 30, + "state": "New York", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for New York effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_pennsylvania_individual_t32", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 32, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_pennsylvania_couple_t33", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 33, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_rhode_island_individual_t35", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 35, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 34 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_vermont_individual_t37", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 37, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 36 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "published_identity_discrepancies": [ + "Vermont | individual | Federal code=A | State OS code=B | Category=All (Restricted to Chittenden County) | source row=2" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415046", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html", + "sha256": "8b1d7421519574a7829196348f68d31bdfe1ae187585e05fc3ef3761e1cf20cb", + "byte_size": 643731, + "retrieved_at": "2026-10-24T12:42:13.258138Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2014_vermont_couple_t38", + "edition": "SI 01415.046: January 2014", + "years": [ + 2014 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 38, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 36 + ], + "effective_from": "2014-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective 01/01/14.", + "date_options": {}, + "section_effective_from": "2014-05-14", + "section_effective_to": null, + "nominal_year": 2014, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_california_individual_t02", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective 01/01/2015.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_california_couple_t03", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective 01/01/2015.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_delaware_individual_t05", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_delaware_couple_t06", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_district_of_columbia_individual_t08", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_district_of_columbia_couple_t09", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Code", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Code", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_hawaii_individual_t11", + "edition": "SI 01415.047: January 2015", + "years": [ 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"retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_hawaii_couple_t12", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_iowa_individual_t14", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_iowa_couple_t15", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_michigan_individual_t17", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_michigan_couple_t18", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": 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"2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_nevada_individual_t23", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State 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"units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_nevada_couple_t24", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_new_jersey_individual_t26", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_new_jersey_couple_t27", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_pennsylvania_individual_t29", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_pennsylvania_couple_t30", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_rhode_island_individual_t32", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_vermont_individual_t34", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415047", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html", + "sha256": "e82bcaf9e199b86e4f8990b361383520997a41959762d352efdc5c195b9a9b10", + "byte_size": 661201, + "retrieved_at": "2026-10-24T12:42:13.844544Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2015_vermont_couple_t35", + "edition": "SI 01415.047: January 2015", + "years": [ + 2015 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective 01/01/15.", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2015, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_california_individual_t02", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_california_couple_t03", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_delaware_individual_t05", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_delaware_couple_t06", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_district_of_columbia_individual_t08", + "edition": "SI 01415.048: January 2016", + "years": [ + 2016 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2016-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2016:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_district_of_columbia_couple_t09", + "edition": "SI 01415.048: January 2016", + "years": [ + 2016 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Code", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2016-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2016:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Code", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_hawaii_individual_t11", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_hawaii_couple_t12", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_iowa_individual_t14", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_iowa_couple_t15", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_michigan_individual_t17", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_michigan_couple_t18", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_montana_individual_t20", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_montana_couple_t21", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_nevada_individual_t23", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "published_identity_discrepancies": [ + "Nevada | individual | Federal code=B | State OS code=B | Category=Blind | source row=7" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_nevada_couple_t24", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_new_jersey_individual_t26", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_new_jersey_couple_t27", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_pennsylvania_individual_t29", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_pennsylvania_couple_t30", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_rhode_island_individual_t32", + "edition": "SI 01415.048: January 2016", + "years": [ + 2016 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2016-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2016:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_vermont_individual_t34", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415048", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html", + "sha256": "c78f026fa6db579398bc34046011d747aab4e9a51321c31d9667481ea4393b4c", + "byte_size": 818951, + "retrieved_at": "2026-10-24T12:42:14.204710Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2016_vermont_couple_t35", + "edition": "SI 01415.048: January 2016", + "years": [ + 2015 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2015-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2015:", + "date_options": {}, + "section_effective_from": "2024-08-09", + "section_effective_to": null, + "nominal_year": 2016, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_california_individual_t02", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_california_couple_t03", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_delaware_individual_t05", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_delaware_couple_t06", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_district_of_columbia_individual_t08", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_district_of_columbia_couple_t09", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_hawaii_individual_t11", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_hawaii_couple_t12", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_iowa_individual_t14", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_iowa_couple_t15", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_michigan_individual_t17", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "published_identity_discrepancies": [ + "Michigan | individual | Federal code=B | State OS code=H | Category=All | source row=5" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_michigan_couple_t18", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_montana_individual_t20", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_montana_couple_t21", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_nevada_individual_t23", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_nevada_couple_t24", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_new_jersey_individual_t26", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_new_jersey_couple_t27", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_pennsylvania_individual_t29", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_pennsylvania_couple_t30", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_rhode_island_individual_t32", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_vermont_individual_t34", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415049", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html", + "sha256": "3263e3bb8b5d77767672e935a0f263a57691adb6c091136c29cc2c5856bcdb65", + "byte_size": 635931, + "retrieved_at": "2026-10-24T12:42:14.547525Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2017_vermont_couple_t35", + "edition": "SI 01415.049: January 2017", + "years": [ + 2017 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2017-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2017:", + "date_options": {}, + "section_effective_from": "2024-08-08", + "section_effective_to": null, + "nominal_year": 2017, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_california_individual_t02", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_california_couple_t03", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_delaware_individual_t05", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_delaware_couple_t06", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_district_of_columbia_individual_t08", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_district_of_columbia_couple_t09", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_hawaii_individual_t11", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_hawaii_couple_t12", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_iowa_individual_t14", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_iowa_couple_t15", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_michigan_individual_t17", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_michigan_couple_t18", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_montana_individual_t20", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_montana_couple_t21", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_nevada_individual_t23", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_nevada_couple_t24", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_new_jersey_individual_t26", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_new_jersey_couple_t27", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_pennsylvania_individual_t29", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_pennsylvania_couple_t30", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_rhode_island_individual_t32", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_vermont_individual_t34", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415050", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html", + "sha256": "c63ecdac5e1727a6160ae2e039cdeb89f6c3601aeaa9e43733d87de06fe7626e", + "byte_size": 655313, + "retrieved_at": "2026-10-24T12:42:14.663154Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2018_vermont_couple_t35", + "edition": "SI 01415.050: January 2018", + "years": [ + 2018 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2018-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2018:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2018, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_california_individual_t02", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_california_couple_t03", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "published_identity_discrepancies": [ + "California | couple | Federal code=A | State OS code=A | Category=Aged/Disabled | source row=5" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_delaware_individual_t05", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_delaware_couple_t06", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "published_identity_discrepancies": [ + "Delaware | couple | Federal code=B | State OS code=Z | Category=All | source row=3" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_district_of_columbia_individual_t08", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_district_of_columbia_couple_t09", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_hawaii_individual_t11", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_hawaii_couple_t12", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_iowa_individual_t14", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_iowa_couple_t15", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_michigan_individual_t17", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_michigan_couple_t18", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_montana_individual_t20", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_montana_couple_t21", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_nevada_individual_t23", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_nevada_couple_t24", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_new_jersey_individual_t26", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_new_jersey_couple_t27", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_pennsylvania_individual_t29", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_pennsylvania_couple_t30", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "published_identity_discrepancies": [ + "Pennsylvania | couple | Federal code=B | State OS code=D | Category=All | source row=5" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_rhode_island_individual_t32", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_vermont_individual_t34", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415051", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html", + "sha256": "8e6e5ee861cb303c743805added3c0b99833747c76cf34a067769bdf9d7f3e9e", + "byte_size": 656129, + "retrieved_at": "2026-10-24T12:42:14.908825Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2019_vermont_couple_t35", + "edition": "SI 01415.051: January 2019", + "years": [ + 2019 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2019-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2019:", + "date_options": {}, + "section_effective_from": "2024-08-13", + "section_effective_to": null, + "nominal_year": 2019, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_california_individual_t02", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_california_couple_t03", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_delaware_individual_t05", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_delaware_couple_t06", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_district_of_columbia_individual_t08", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_district_of_columbia_couple_t09", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_hawaii_individual_t11", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_hawaii_couple_t12", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_iowa_individual_t14", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_iowa_couple_t15", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_michigan_individual_t17", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_michigan_couple_t18", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_montana_individual_t20", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_montana_couple_t21", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_nevada_individual_t23", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_nevada_couple_t24", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_new_jersey_individual_t26", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_new_jersey_couple_t27", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_pennsylvania_individual_t29", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_pennsylvania_couple_t30", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_rhode_island_individual_t32", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_vermont_individual_t34", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415052", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html", + "sha256": "090fb421a468c89f44cb98fc505d614e08433b3d4c1300dfc11ce4cbe4edd310", + "byte_size": 659869, + "retrieved_at": "2026-10-24T12:42:15.123773Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2020_vermont_couple_t35", + "edition": "SI 01415.052: January 2020", + "years": [ + 2020 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2020-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2020:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2020, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_california_individual_t02", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_california_couple_t03", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_delaware_individual_t05", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_delaware_couple_t06", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_district_of_columbia_individual_t08", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_district_of_columbia_couple_t09", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_hawaii_individual_t11", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_hawaii_couple_t12", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_iowa_individual_t14", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_iowa_couple_t15", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_michigan_individual_t17", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_michigan_couple_t18", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_montana_individual_t20", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_montana_couple_t21", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_nevada_individual_t23", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_nevada_couple_t24", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "published_identity_discrepancies": [ + "Nevada | couple | Federal code=A | State OS code=A | Category=Aged/ Disabled | source row=4" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_new_jersey_individual_t26", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_new_jersey_couple_t27", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_pennsylvania_individual_t29", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_pennsylvania_couple_t30", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_rhode_island_individual_t32", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_vermont_individual_t34", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415053", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html", + "sha256": "307c3c72b105bf15380ed7967317e9c671510b4c9ee29e81e5f9f6e996d24a2e", + "byte_size": 659833, + "retrieved_at": "2026-10-24T12:42:15.720199Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2021_vermont_couple_t35", + "edition": "SI 01415.053: January 2021", + "years": [ + 2021 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2021-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2021:", + "date_options": {}, + "section_effective_from": "2024-08-19", + "section_effective_to": null, + "nominal_year": 2021, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_california_individual_t02", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_california_couple_t03", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_delaware_individual_t05", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_delaware_couple_t06", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_district_of_columbia_individual_t08", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_district_of_columbia_couple_t09", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_hawaii_individual_t11", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_hawaii_couple_t12", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "unresolved_numeric_cells": [ + { + "row_key": "Hawaii | couple | Federal code=A | State OS code=Z | Category=All | source row=4", + "column_key": "FBR", + "options": { + "literal_punctuation": "unparseable", + "possible_group_separator": "requires_source_confirmation" + } + } + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_iowa_individual_t14", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_iowa_couple_t15", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "published_identity_discrepancies": [ + "Iowa | couple | Federal code=B | State OS code=B | Category=Blind/Aged | source row=20", + "Iowa | couple | Federal code=B | State OS code=B | Category=Blind/Disabled | source row=21" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_michigan_individual_t17", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_michigan_couple_t18", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_montana_individual_t20", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_montana_couple_t21", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_nevada_individual_t23", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_nevada_couple_t24", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_new_jersey_individual_t26", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_new_jersey_couple_t27", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_pennsylvania_individual_t29", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_pennsylvania_couple_t30", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_rhode_island_individual_t32", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_vermont_individual_t34", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415054", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html", + "sha256": "d23620a981907eeba17d1ce4a2bbc976b6a32b06390565b633cb7f6f1c73fd06", + "byte_size": 657723, + "retrieved_at": "2026-10-24T12:42:15.940151Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2022_vermont_couple_t35", + "edition": "SI 01415.054: January 2022", + "years": [ + 2022 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2022-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2022:", + "date_options": {}, + "section_effective_from": "2024-08-12", + "section_effective_to": null, + "nominal_year": 2022, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_california_individual_t02", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "published_identity_discrepancies": [ + "California | individual | Federal code=B | State OS code=G | Category=Disabled | source row=13" + ], + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_california_couple_t03", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "published_identity_discrepancies": [ + "California | couple | Federal code=A | State OS code=B | Category=All | source row=7" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_delaware_individual_t05", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_delaware_couple_t06", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_district_of_columbia_individual_t08", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_district_of_columbia_couple_t09", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_hawaii_individual_t11", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_hawaii_couple_t12", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "unresolved_numeric_cells": [ + { + "row_key": "Hawaii | couple | Federal code=A | State OS code=Z | Category=All | source row=4", + "column_key": "FBR", + "options": { + "literal_punctuation": "unparseable", + "possible_group_separator": "requires_source_confirmation" + } + } + ], + "published_identity_discrepancies": [ + "Hawaii | couple | Federal code=A | State OS code=B | Category=All | source row=1", + "Hawaii | couple | Federal code=A | State OS code=H | Category=All | source row=2" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_iowa_individual_t14", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "published_identity_discrepancies": [ + "Iowa | individual | Federal code=B | State OS code=I | Category=Blind | source row=15" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_iowa_couple_t15", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_michigan_individual_t17", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_michigan_couple_t18", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "published_identity_discrepancies": [ + "Michigan | couple | Federal code=B | State OS code=H | Category=All | source row=5" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_montana_individual_t20", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_montana_couple_t21", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_nevada_individual_t23", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_nevada_couple_t24", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_new_jersey_individual_t26", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "published_identity_discrepancies": [ + "New Jersey | individual | Federal code=A | State OS code=C | Category=w/EP | source row=4" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_new_jersey_couple_t27", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_pennsylvania_individual_t29", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_pennsylvania_couple_t30", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_rhode_island_individual_t32", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_vermont_individual_t34", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415055", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html", + "sha256": "761d61eacb5aa68fc58c0be69761912c78cc4106eec901d923b4a8f454929119", + "byte_size": 659490, + "retrieved_at": "2026-10-24T12:42:16.244889Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2023_vermont_couple_t35", + "edition": "SI 01415.055: January 2023", + "years": [ + 2023 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2023-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2023:", + "date_options": {}, + "section_effective_from": "2024-08-15", + "section_effective_to": null, + "nominal_year": 2023, + "published_identity_discrepancies": [ + "Vermont | couple | Federal code=A | State OS code=G | Category=All | source row=4" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_california_individual_t02", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_california_couple_t03", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_delaware_individual_t05", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_delaware_couple_t06", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_district_of_columbia_individual_t08", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_district_of_columbia_couple_t09", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_hawaii_individual_t11", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_hawaii_couple_t12", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_iowa_individual_t14", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_iowa_couple_t15", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_michigan_individual_t17", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_michigan_couple_t18", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_montana_individual_t20", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_montana_couple_t21", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_nevada_individual_t23", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_nevada_couple_t24", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_new_jersey_individual_t26", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_new_jersey_couple_t27", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_pennsylvania_individual_t29", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_pennsylvania_couple_t30", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_rhode_island_individual_t32", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_vermont_individual_t34", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415056", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html", + "sha256": "a05465e94f25c1978a79657b32fc17c0877d2580ab4571186c0546300aa3cec0", + "byte_size": 606847, + "retrieved_at": "2026-10-24T12:42:16.105608Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2024_vermont_couple_t35", + "edition": "SI 01415.056: January 2024", + "years": [ + 2024 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-08-26", + "section_effective_to": null, + "nominal_year": 2024, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_california_individual_t02", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_california_couple_t03", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_delaware_individual_t05", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_delaware_couple_t06", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_district_of_columbia_individual_t08", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_district_of_columbia_couple_t09", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_hawaii_individual_t11", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_hawaii_couple_t12", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_iowa_individual_t14", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_iowa_couple_t15", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_michigan_individual_t17", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_michigan_couple_t18", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_montana_individual_t20", + "edition": "SI 01415.057: January 2025", + "years": [ + 2024 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_montana_couple_t21", + "edition": "SI 01415.057: January 2025", + "years": [ + 2024 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2024-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2024:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_nevada_individual_t23", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_nevada_couple_t24", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_new_jersey_individual_t26", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_new_jersey_couple_t27", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_pennsylvania_individual_t29", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_pennsylvania_couple_t30", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_rhode_island_individual_t32", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_vermont_individual_t34", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415057", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html", + "sha256": "027971da9bf7e7e393d8f676d6c049da45a2b7f3ff525870bd11925a0db55c30", + "byte_size": 605487, + "retrieved_at": "2026-10-24T12:42:16.902809Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2025_vermont_couple_t35", + "edition": "SI 01415.057: January 2025", + "years": [ + 2025 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2025-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2025:", + "date_options": {}, + "section_effective_from": "2024-12-23", + "section_effective_to": null, + "nominal_year": 2025, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_california_individual_t02", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 2, + "state": "California", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "Federal Benefit Rate (FBR)", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_california_couple_t03", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "California" + ], + "selector": { + "table_index": 3, + "state": "California", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 1 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for California effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_delaware_individual_t05", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 5, + "state": "Delaware", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_delaware_couple_t06", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Delaware" + ], + "selector": { + "table_index": 6, + "state": "Delaware", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 4 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for Delaware effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_district_of_columbia_individual_t08", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 8, + "state": "District of Columbia", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_district_of_columbia_couple_t09", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "District of Columbia" + ], + "selector": { + "table_index": 9, + "state": "District of Columbia", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 7 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for the District of Columbia effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_hawaii_individual_t11", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 11, + "state": "Hawaii", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_hawaii_couple_t12", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Hawaii" + ], + "selector": { + "table_index": 12, + "state": "Hawaii", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 10 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Hawaii effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_iowa_individual_t14", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 14, + "state": "Iowa", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_iowa_couple_t15", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Iowa" + ], + "selector": { + "table_index": 15, + "state": "Iowa", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 13 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Iowa effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "published_identity_discrepancies": [ + "Iowa | couple | Federal code=B | State OS code=H | Category=Aged/Disabled | source row=26" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_michigan_individual_t17", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 17, + "state": "Michigan", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_michigan_couple_t18", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Michigan" + ], + "selector": { + "table_index": 18, + "state": "Michigan", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 16 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Michigan effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_montana_individual_t20", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 20, + "state": "Montana", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_montana_couple_t21", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Montana" + ], + "selector": { + "table_index": 21, + "state": "Montana", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 19 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Montana effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_nevada_individual_t23", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 23, + "state": "Nevada", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_nevada_couple_t24", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Nevada" + ], + "selector": { + "table_index": 24, + "state": "Nevada", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 22 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Nevada effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_new_jersey_individual_t26", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 26, + "state": "New Jersey", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_new_jersey_couple_t27", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "New Jersey" + ], + "selector": { + "table_index": 27, + "state": "New Jersey", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 25 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payments levels for New Jersey effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_pennsylvania_individual_t29", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 29, + "state": "Pennsylvania", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_pennsylvania_couple_t30", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Pennsylvania" + ], + "selector": { + "table_index": 30, + "state": "Pennsylvania", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 28 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Pennsylvania effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_rhode_island_individual_t32", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Rhode Island" + ], + "selector": { + "table_index": 32, + "state": "Rhode Island", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 31 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Rhode Island effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_vermont_individual_t34", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 34, + "state": "Vermont", + "claimant_type": "individual", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + }, + { + "url": "https://secure.ssa.gov/poms.nsf/lnx/0501415058", + "capture_file": "data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html", + "sha256": "0366a7c952da8025f51aef7d6c25d13f885b0ff4080e6c9525e7877ea344aaa1", + "byte_size": 532767, + "retrieved_at": "2026-10-24T12:42:17.707028Z", + "publisher": "Social Security Administration", + "units": [ + "USD per month" + ], + "parser": "poms", + "role": "SSI2 worked-example input: federally administered State supplements", + "identifier": "poms_si_01415_2026_vermont_couple_t35", + "edition": "SI 01415.058: January 2026", + "years": [ + 2026 + ], + "geography": [ + "Vermont" + ], + "selector": { + "table_index": 35, + "state": "Vermont", + "claimant_type": "couple", + "header_labels": [ + "Federal Code", + "State OS Code", + "Category", + "FBR", + "State Supplement Level", + "Total Payment Levels" + ], + "definitions_table_indexes": [ + 33 + ], + "effective_from": "2026-01-01", + "effective_to": null, + "parameter_effective_date_text": "The following charts display the coding and monthly payment levels for Vermont effective January 1, 2026:", + "date_options": {}, + "section_effective_from": "2026-08-28", + "section_effective_to": null, + "nominal_year": 2026, + "published_identity_discrepancies": [ + "Vermont | couple | Federal code=B | State OS code=E | Category=All | source row=6" + ], + "column_labels": [ + "FBR", + "State Supplement Level", + "Total Payment Levels" + ] + } + } +] diff --git a/data/external/snapshots/income_resources_d4_v1/poms_rs_01505_toc.html b/data/external/snapshots/income_resources_d4_v1/poms_rs_01505_toc.html new file mode 100644 index 00000000..075ab9c4 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_rs_01505_toc.html @@ -0,0 +1,302 @@ + + +SSA - POMS: RS 01505.000 - Program Administration - Table of Contents - 03/07/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

RS 01505.000 Program Administration

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Subchapter Table of Contents
Section Latest
Transmittal
RS 01505.031Deferred Compensation Plan for Employees of State and Local GovernmentsTN 24 11-09
RS 01505.032Employer Pick-Up PlansTN 24 11-09
RS 01505.035Wage Evidence for State and Local Government EmployeesTN 24 11-09
RS 01505.042Procedures to Resolve General State and Local Coverage IssuesTN 39 03-24
RS 01505.044Directing Requests for Coverage and Wage Information on State and Local Government + Employees + TN 28 04-21
+ +
+ +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0301505000
RS 01505.000 - Program Administration - Table of Contents - 03/07/2024
+Batch run: 03/07/2024
+Rev:03/07/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_rs_0301505042.html b/data/external/snapshots/income_resources_d4_v1/poms_rs_0301505042.html new file mode 100644 index 00000000..5fef7542 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_rs_0301505042.html @@ -0,0 +1,460 @@ + + +SSA - POMS: RS 01505.042 - Procedures to Resolve General State and Local Coverage Issues - 11/30/2016 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 39 (03-24)

+

RS 01505.042 Procedures to Resolve General State and Local Coverage Issues +

+ + +
+
+

A. Tolerance rule for questionable coverage +

+
+
+

Do not develop a claims case if the primary insurance amount (PIA) is not $1 or more.

+
+
+ +
+
+

B. Questions for development and documentation +

+
+
+

You need to document the following:

+
    +
  • +
    +
    •
    +
    +

    Is the claimant an employee?

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    What is the identity of the employing entity?

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is the employing entity included in the Agreements?

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Which Agreement or modification covers the service of the position?

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    What is the legal status of the employing unit, e.g., a governmental or proprietary + function? +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is there an optional or required exclusion that applies?

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is the employee's position under a State or local retirement system?

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    What is the retirement system status of the claimant (member, ineligible, or optional)?

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    What date was the position first placed under the retirement system (or systems)?

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Did the claimant vote for or against coverage in a coverage referendum? Was the claimant + given additional opportunity for such coverage and so elected? +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Was there a break in the claimant’s service and or a break in retirement system membership?

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Was the claimant in an employment relationship on the date of controlling retroactive + coverage? +

    + +
    +
    +
  • +
+
+
+ +
+
+

C. Make a coverage determination and correct earnings +

+
+
+

Correct reporting errors using the instructions in RS 01405.000. +

+

If there is not sufficient space on the Earnings Modernization Item Correction (ICOR) + screens to document your determination or if you determine there is no need to adjust + the earnings record, prepare a special determination using the Form SSA-553 (Special Determination). +

+

Include in your documentation:

+
    +
  • +
    +
    •
    +
    +

    modification number;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    questionnaires;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    statements of the facts;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    copies of records; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    all other pertinent information.

    + +
    +
    +
  • +
+

Send a copy of the determination or a memorandum to the regional office.

+

 

+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0301505042
RS 01505.042 - Procedures to Resolve General State and Local Coverage Issues - 11/30/2016
+Batch run: 05/27/2025
+Rev:11/30/2016
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_rs_0301505044.html b/data/external/snapshots/income_resources_d4_v1/poms_rs_0301505044.html new file mode 100644 index 00000000..eccf98a6 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_rs_0301505044.html @@ -0,0 +1,484 @@ + + +SSA - POMS: RS 01505.044 - Directing Requests for Coverage and Wage Information on State and Local Government Employees - 04/15/2021 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 28 (04-21)

+

RS 01505.044 Directing Requests for Coverage and Wage Information on State and Local Government + Employees +

+ + +
+
+

A. Directing requests for information +

+
+
+

We are responsible to accurately respond to requests for coverage and wage information. + Follow the instructions in this section for requests made directly to the field office + (FO) and regional office (RO). +

+
+
+

1. FO +

+
+
+

Direct requests for coverage and wage information according to arrangements made with + your State Social Security Administrator. +

+
+
+
+
+

2. RO +

+
+
+

Establish direct contact with the State Social Security Administrator.

+
+
+
+
+ +
+
+

B. How to obtain coverage and wage information +

+
+
+

Follow the instructions in this section when you contact other sources for coverage + and wage information. +

+
+
+

1. FOs to employers +

+
+
+

Contact employers directly unless special procedures provide other contact routes. + Follow special procedures for your state in the regional office Program Operations + Manual System (POMS) instructions. +

+
+
+
+
+

2. FOs to RO +

+
+
+

Request the RO to obtain coverage or wage information, use form SSA-562-U3 (Request for Assistance Certification) if:

+
    +
  1. +
    +
    a. 
    +
    +

    The state does not want local reporting officials contacted;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Employment was for the State (unless other arrangements are in effect for a particular + unit of state government); +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Employment was for a governmental entity in another state (send the request to the + RO servicing that state); +

    + +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    The local reporting official cannot resolve your question ;

    + +
    +
    +
  8. +
  9. +
    +
    e. 
    +
    +

    Your question involves state law provisions; or

    + +
    +
    +
  10. +
  11. +
    +
    f. 
    +
    +

    You want the views of the state official.

    + +
    +
    +
  12. +
+

Show the reason for the request on the SSA-562-U3 and include all development information + obtained such as questionnaires, statements, and references to statutes. +

+

To correct the earnings record (E/R), send the necessary adjustment forms to the RO + completed to the extent possible and signed by the FO representative who prepared + them. +

+
+
+
+
+

3. RO +

+
+
+

Review FO referrals.

+
    +
  • +
    +
    •
    +
    +

    Examine the request and determine the appropriate action to take;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Notify the requesting FO of precedent determination that resolves the question;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Resolve disagreements between us and the State; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Return materials, except for correction forms, to the FO after you approve the determination.

    + +
    +
    +
  • +
+
+
+
+
+

4. Processing center (PC) or Office of Earnings and International Operations (OEIO) +

+
+
+

Send routine requests for additional information or development to the resident FO.

+
    +
  • +
    +
    •
    +
    +

    Direct all requests for additional development on a substantive issue of coverage + or wages to the RO, with a copy to the resident FO. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The RO determines whether the FO requests the information directly from the State + or from the local reporting official by the resident FO. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The resident FO or RO obtains the requested information, or documents the unavailability + of the evidence, and returns the material to the PC or OEIO. +

    + +
    +
    +
  • +
+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0301505044
RS 01505.044 - Directing Requests for Coverage and Wage Information on State and Local Government Employees - 04/15/2021
+Batch run: 04/15/2021
+Rev:04/15/2021
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_1999.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_1999.html new file mode 100644 index 00000000..f5ee0054 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_1999.html @@ -0,0 +1,15899 @@ + + +SSA - POMS: SI 01415.031 - Federally Administered Optional Supplementary Payment Programs — January 1999 Payment Levels - 03/20/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 64 (03-24)

+

SI 01415.031 Federally Administered Optional Supplementary Payment Programs — January 1999 Payment + Levels +

+ + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CALIFORNIANEVADA
DELAWARENEW JERSEY
DISTRICT OF COLUMBIANEW YORK
HAWAIIPENNSYLVANIA
IOWARHODE ISLAND
MASSACHUSETTSUTAH
MICHIGANVERMONT
MONTANAWASHINGTON
+
+

CALIFORNIA

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Independent Living with Cooking Facilities — Eligible individual or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement “A” purposes, and has cooking and food storage facilities or is provided meals as part + of the living arrangement; or +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent or parents or is + a disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; or +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or +

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective July 1, 1983, lives in a private medical facility licensed by the State + but not certified under title XIX. (An optional supplement “A” payment based on the new instructions is payable retroactively to July 1, 1983.) +

    + +
    +
    +
  10. +
+ +
+

B

+ +
+

Nonmedical Out-of-Home Care (NMOHC) — Applies when an individual/couple needs nonmedical + care or supervision in the following living arrangement situations: +

+ +

CHILDREN (UNDER AGE 18)

+ +
    +
  1. +
    +
    1. 
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Effective October 1, 1979, disabled child residing in the home of a legal guardian + who is not a relative; or +

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective January 1, 1984, disabled child residing in the home of a relative who is + not a parent ( Major v. McMahon decision, reopening a prior decision to pay OS B under this definition may be retroactive + to January 1, 1984; or +

    + +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding agency (“certified family home placement”); or

    + +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    For periods prior to July 1, 1983 only, a blind or disabled child placed in any home + or State licensed NMOHC facility as the result of a court order; or +

    + +

    ADULTS (AGE 18 AND OVER)

    + +
    +
    +
  14. +
  15. +
    +
    8. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or +

    + +
    +
    +
  16. +
  17. +
    +
    9. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in a State licensed NMOHC facility. +

    + +
    +
    +
  18. +
+ +

For California optional supplement purposes, a relative is defined as a parent, son, + daughter, brother, sister, half-brother, half-sister, uncle, aunt, niece, nephew, + first cousin, or any person of the preceding generation denoted by the prefix “grand” or “great.” +

+ +
+

C

+ +
+

Independent Living Without Cooking Facilities — Aged or disabled individual/couple + who is neither provided any meals nor has access to adequate cooking/food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C. +

+ +
    +
  1. +
    +
    1. 
    +
    +

    An individual/couple qualifies for OS C if any of the following situations exists:

    + +
      +
    1. +
      +
      a. 
      +
      +

      Immediate living quarters do not have cooking and food storage facilities with which + the individual/couple or another person (who is responsible for preparing the individual's/couple's + meals) can prepare meals on a daily basis. +

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf. +

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals. +

      + +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage” ) or in a similar situation and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals. +

      + +
      +
      +
    8. +
    9. +
      +
      e. 
      +
      +

      Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the SSI applicant's/recipient's arrangement with the facility + is to purchase only shelter on a monthly basis). +

      + +
      +
      +
    10. +
    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    “Adequate” cooking and food storage facilities exist when an

    individual/couple has access to: +

    + +
      +
    1. +
      +
      a. 
      +
      +

      Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.) +

      + +

      OR

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls which + are used for warming food are not considered adequate cooking facilities.) +

      + +

      OR

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature control. +

      + +
      +
      +
    6. +
    + +
    +
    +
  4. +
+ +
​ +
    +
  1. +
    +
    3. 
    +
    +

    Eligibility for OS C begins in the month the applicant/recipient applies for this + supplement rate provided he/she has been without cooking and food storage facilities + throughout the month. +

    + +
    +
    +

    For purposes of OS C, “throughout a month” does not mean the applicant/recipient must lack adequate cooking/food storage facilities from + the very first moment of the month. They need only lack them from some time on the + first day of the month. +

    + +
    +
    + +
    +
    +
  2. +
  3. +
    +
    4. 
    +
    +

    If eligibility is based on temporary loss or nonfunctioning of an appliance, the individual + should be advised of Their responsibility to report immediately when the temporary + condition has ceased. If the individual provides an expected date when the appliance + will be replaced/repaired, diary the case for recontact. +

    + +
    +
    +
  4. +
  5. +
    +
    5. 
    +
    +

    Eligibility for this supplement payment ceases the month following the month in which + meals are provided or adequate cooking and food storage facilities are available. +

    + +
    +
    +
  6. +
  7. +
    +
    6. 
    +
    +

    For a couple, comprised of an aged/disabled individual and a blind individual, whose + living arrangement lacks adequate cooking and storage facilities, the couple is to + receive the SSI/SSP level for a blind/aged or disabled couple plus the restaurant + meals allowance for the disabled member of the couple. Force payment in this living + arrangement is required. +

    + +
    +
    +
  8. +
+ +
+

D

+ +
+

Living in the Household of Another — Eligible individual/couple is living in the household + of another and is receiving food and shelter from that individual. Most individuals/couples who are subject to a 1/3 reduction + of their Federal SSI payments (VTR) are eligible for OS D because the criteria for + this supplement level are the same as for charging the VTR. However, when the eligible + individual/couple lives in the home of a relative (other than a spouse) and needs + care and supervision, certification for nonmedical out-of-home care (OS F) should + be obtained from the county welfare office since this is the highest categorical supplement + for which an individual/couple can qualify. +

+ +
+

E

+ +
+

Disabled Child Under Age 18 — Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage. (Until September 30, 1979, a disabled + child under age 18 living with a legal guardian also fell into this category.) +

+ +
+
+

Effective February 1, 1982, only FLA A and C are compatible with OS E. If the VTR + applies, see SI 01415.031G.

+ +
+
+ +
+

F

+ +
+

Nonmedical Out-of-Home Care Living in the Household of Another — Effective February + 1, 1982. Applies whenever an eligible individual or couple meets the criteria for + the nonmedical out-of-home care payment rate, and is determined to receive the Federal + B payment for living in the household of another (SI 00835.200). +

+ +
+

G

+ +
+

Disabled Child Under Age 18 Living in the Household of Another — Effective February + 1, 1982. Applies to a disabled (not blind) child under age 18, who resides with a + parent or relative by blood or marriage, and is determined to receive the Federal B payment for living in the household of another + individual (SI 00835.200). +

+ +
+

J

+ +
+

Effective July 1, 1987, the State elected Federal adminstration of an optional State + supplementary payment to residents of title XIX facilities. +

+ +

This State code is also used to supplement section 1619 cases.

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Eligible individual or couple who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX and not licensed + by the State (effective July 1, 1983). (Prior to July 1, 1983, the facility could + have been licensed by the State but not certified under title XIX.) +

    + +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+

California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. +

+ +
+
+ +
+
+
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

California

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
Aged +

500.00

+ +
+

176.00

+ +
+

676.00

+ +
​​Blind +

500.00

+ +
+

232.00

+ +
+

732.00

+ +
​​Disabled +

500.00

+ +
+

176.00

+ +
+

676.00

+ +
​ +

B

+ +
All +

500.00

+ +
+

327.00

+ +
+

827.00

+ +
​ +

C

+ +
Aged +

500.00

+ +
+

247.00

+ +
+

747.00

+ +
​​Disabled +

500.00

+ +
+

247.00

+ +
+

747.00

+ +
​ +

E

+ +
Disabled +

500.00

+ +
+

79.00

+ +
+

579.00

+ +
​ +

Z

+ +
All +

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

B

+ +
+

D

+ +
Aged +

333.34 1

+ +
+

183.66

+ +
+

517.00

+ +
​​Blind +

333.34 1

+ +
+

251.66

+ +
+

585.00

+ +
​​Disabled +

333.34 1

+ +
+

183.66

+ +
+

517.00

+ +
​ +

F

+ +
All +

333.34 1

+ +
+

329.66

+ +
+

663.00

+ +
​ +

G

+ +
Disabled +

333.34 1

+ +
+

77.66

+ +
+

411.00

+ +
+

C

+ +
+

A

+ +
Blind +

500.00

+ +
+

232.00

+ +
+

732.00

+ +
​ +

E

+ +
Disabled +

500.00

+ +
+

79.00

+ +
+

579.00

+ +
+

D

+ +
+

J

+ +
All +

30.00 2

+ +
+

13.00

+ +
+

43.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
Aged/Aged +

751.00

+ +
+

450.00

+ +
+

1,201.00

+ +
​​Blind/Blind +

751.00

+ +
+

640.00

+ +
+

1,391.00

+ +
​​Disabled/Disabled +

751.00

+ +
+

450.00

+ +
+

1,201.00

+ +
​​ +

Aged/Blind

+ +
+

751.00

+ +
+

569.00

+ +
+

1,320.00

+ +
​​Aged/Disabled +

751.00

+ +
+

450.00

+ +
+

1,201.00

+ +
​​Blind/Disabled +

751.00

+ +
+

569.00

+ +
+

1,320.00

+ +
​ +

B

+ +
All +

751.00

+ +
+

903.00

+ +
+

1,654.00

+ +
​ +

C

+ +
Aged/Aged +

751.00

+ +
+

592.00

+ +
+

1,343.00

+ +
​​Disabled/Disabled +

751.00

+ +
+

592.00

+ +
+

1,343.00

+ +
​​Aged/Disabled +

751.00

+ +
+

592.00

+ +
+

1,343.00

+ +
​ +

Z

+ +
+

All

+ +
+

751.00

+ +
+

0.00

+ +
+

751.00

+ +
+

B

+ +
+

D

+ +
Aged/Aged +

500.67 1

+ +
+

482.33

+ +
+

983.00

+ +
​​Blind/Blind +

500.67 1

+ +
+

673.33

+ +
+

1,174.00

+ +
​​Disabled/Disabled +

500.67 1

+ +
+

482.33

+ +
+

983.00

+ +
​​Aged/Blind +

500.67 1

+ +
+

601.33

+ +
+

1,102.00

+ +
​​Aged/Disabled +

500.67 1

+ +
+

482.33

+ +
+

983.00

+ +
​​Blind/Disabled +

500.67 1

+ +
+

601.33

+ +
+

1,102.00

+ +
​ +

F

+ +
All +

500.67 1

+ +
+

863.33

+ +
+

1,364.00

+ +
+

D

+ +
+

J

+ +
All +

60.00 2

+ +
+

26.00

+ +
+

86.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

DELAWARE

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
AAdult Residential Care Facility — Only living arrangement variation in Delaware and + includes only those recipients who are certified by the State medical unit as residents + of an adult care facility. +
YOptional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +
ZNo Supplement Cases — All recipients who are not included in A or Y.
​Optional supplementation code Z is the proper code to be used with an “intervening” Federal A code. (See SM 01301.535.)
+
+
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

Delaware

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

500.00

+ +
+

140.00

+ +
+

640.00

+ +
​ +

Z

+ +
+

All

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

333.34 1

+ +
+

0.00

+ +
+

333.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.00 2

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

751.00

+ +
+

448.00

+ +
+

1,199.00

+ +
​ +

Z

+ +
+

All

+ +
+

751.00

+ +
+

0.00

+ +
+

751.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

500.67 1

+ +
+

0.00

+ +
+

500.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.00 2

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +

DISTRICT OF COLUMBIA

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
AAdult Foster Care Home with 50 or Fewer Residents —Recipients who are certified by + the District of Columbia, Department of Human Services, as residents of an adult foster + care home with 50 or fewer residents. +
BAdult Foster Care Home with More than 50 Residents — Recipients who are certified + by the District of Columbia, Department of Human Services, as residents of an adult + foster care home with more than 50 residents. +
GEffective January 1, 1988, the State elected Federal administration of an optional + State supplementary payment to residents of title XIX facilities. +
YOptional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +
ZNo Supplement Cases — All recipients who are not included in A, B, G, or Y.
+
+
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

District of Columbia

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

500.00

+ +
+

307.00

+ +
+

807.00

+ +
​ +

B

+ +
+

All

+ +
+

500.00

+ +
+

417.00

+ +
+

917.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

333.34

+ +
+

0.00

+ +
+

333.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.00 2

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

751.00

+ +
+

863.00

+ +
+

1,614.00

+ +
​ +

B

+ +
+

All

+ +
+

751.00

+ +
+

1083.00

+ +
+

1,834.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

500.67 1

+ +
+

0.00

+ +
+

500.67

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.00 2

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective August 1, 1998 Retroactive to January 1, 1999

District of Columbia

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

494.00

+ +
+

297.00

+ +
+

791.00

+ +
​ +

B

+ +
+

All

+ +
+

494.00

+ +
+

407.00

+ +
+

901.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

329.34 1

+ +
+

0.00

+ +
+

329.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

494.00

+ +
+

0.00

+ +
+

494.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.00 2

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

741.00

+ +
+

841.00

+ +
+

1582.00

+ +
​ +

B

+ +
+

All

+ +
+

741.00

+ +
+

1061.00

+ +
+

1802.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

494.00 1

+ +
+

0.00

+ +
+

494.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.00 2

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

HAWAII

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Independent Living — Eligible individual or couple who:

+ +
    +
  • +
    +
    •
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes. + This includes living in a “half-way house,” which is a private nonmedical facility with whom the State has a purchase or services + agreement for the short term care of certain needy individuals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a blind or disabled child under age 18 (or age 21 if the individual qualifies as + a “protected child”) living in the household of a parent or parents. +

    + +
    +
    +
  • +
+ +
  +

Optional supplement code A is the proper code to be used with an “intervening” Federal A code. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another — Effective July 1, 1983, a supplement is no longer + payable because the combined Federal/State supplementary payment level established + by the State is lower than the FBR. +

+ +
+

H

+ +
+

Domiciliary Care I — (Maximum of five residents) - Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, nonmedical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary Care II — Same as H except care is provided for six or more residents.

+ +
+

Y

+ +
+

Optional Supplementation Waived — Eligible for, but has waived his/her right to receive, + an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Eligible individual (or couple) who is living in the household + of another (see explanation in definition for optional supplement B) and an eligible + individual (or couple) who is a patient: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX.

    + +
    +
    +
  4. +
+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

Hawaii

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

500.00

+ +
+

4.90

+ +
+

504.90

+ +
​ +

H

+ +
+

All

+ +
+

500.00

+ +
+

521.90

+ +
+

1,021.90

+ +
​ +

I

+ +
+

All

+ +
+

500.00

+ +
+

629.90

+ +
+

1,129.90

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

333.34 1

+ +
+

0.00

+ +
+

333.34

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

500.00

+ +
+

4.90

+ +
+

504.90

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.00 2

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

751.00

+ +
+

8.80

+ +
+

759.80

+ +
​ +

H

+ +
+

All

+ +
+

751.00

+ +
+

1,292.80

+ +
+

2,043.80

+ +
​ +

I

+ +
+

All

+ +
+

751.00

+ +
+

1,508.80

+ +
+

2,259.80

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

500.67 1

+ +
+

0.00

+ +
+

500.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.00 2

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +

IOWA

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
ALiving in Own Household (Blind Only) — Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, does not have + an EP, and is not otherwise excepted from supplementation. Also included are blind recipients in title XIX facilities where Medicaid pays 50 percent or less of the + cost of care. Optional supplement code A is also compatible with Federal codes A and + C. +
​Optional supplement code A is the proper code to be used with an “intervening” Federal A code. (See SM 01301.535.)
BLiving in the Household of Another (Blind Only) — Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +
C/HLiving with a Dependent Person — Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services. +
​The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement. +
D/ILiving in a Family Life or Boarding Home — Eligible individual or each member of an + eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services. +
GUsed to indicate that no supplement is payable to a recipient living in a title XIX + facility and title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement is not met at the time initial claims input is made. +
YOptional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +
ZNo Supplement Cases — Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under title XIX or all recipients whose Federal payments + are reduced to $30/$60 due to living in a title XIX facility. In addition, aged and + disabled recipients whose Federal payments are not reduced and who live in a title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement. +
​NOTE: The State Department of Human Services administers two optional supplementation programs + — In-Home Health Related Care and Residential Care. +
+
+
+
+

Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+ +

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the Federal FBR and EP increment and must be force paid. +

+ +

 

+ +
+
+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

Iowa

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
Blind +

500.00

+ +
+

22.00

+ +
+

522.00

+ +
​ +

C

+ +
Aged +

500.00

+ +
+

251.00

+ +
+

751.00

+ +
​​Blind +

500.00

+ +
+

273.00

+ +
+

773.00

+ +
​​Disabled +

500.00

+ +
+

251.00

+ +
+

751.00

+ +
​ +

D

+ +
All +

500.00

+ +
+

62.20

+ +
+

562.20

+ +
​ +

G

+ +
All +

500.00

+ +
+

0.00

+ +
+

500.00

+ +
​ +

Z

+ +
Aged +

500.00

+ +
+

0.00

+ +
+

500.00

+ +
​​Disabled +

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

B

+ +
+

B

+ +
Blind +

333.34 1

+ +
+

22.00

+ +
+

355.34

+ +
​ +

H 3

+ +
Aged +

333.34 1

+ +
+

251.00

+ +
+

584.34

+ +
​​Blind +

333.34 1

+ +
+

273.00

+ +
+

606.34

+ +
​​Disabled +

333.34 1

+ +
+

251.00

+ +
+

584.34

+ +
​ +

I 3

+ +
All +

333.34 1

+ +
+

62.20

+ +
+

395.54

+ +
​ +

Z

+ +
Aged +

333.34 1

+ +
+

0.00

+ +
+

333.34

+ +
​​Disabled +

333.34 1

+ +
+

0.00

+ +
+

333.34

+ +
+

C

+ +
+

A

+ +
Blind +

500.00

+ +
+

22.00

+ +
+

522.00

+ +
​ +

C

+ +
Blind +

500.00

+ +
+

273.00

+ +
+

773.00

+ +
​​Disabled +

500.00

+ +
+

251.00

+ +
+

751.00

+ +
​ +

Z

+ +
Disabled +

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

D

+ +
+

Z

+ +
All +

30.00 2

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

3 Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible + with the RMA policy computation process.

+ +
+
+

State-administered programs: For Calendar Year 1999 -

+ +
    +
  1. +
    +
    (1) 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate plus a monthly personal allowance. The proposed + per diem rate for calendar year 1999 is $17.05 to $23.83. The proposed personal allowance + is $71.00. +

    + +
    +
    +
  2. +
  3. +
    +
    (2) 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost of in-home health care plus basic Federal + benefits. The proposed maximum payment for care in in-home related care is $458.20. +

    + +
    +
    +
  4. +
+ +
+
+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
Blind/Blind +

751.00

+ +
+

44.00

+ +
+

795.00

+ +
​​Blind/Aged +

751.00

+ +
+

22.00

+ +
+

773.00

+ +
​​Blind/Disabled +

751.00

+ +
+

22.00

+ +
+

773.00

+ +
​ +

C

+ +
Aged/Aged +

751.00

+ +
+

251.00

+ +
+

1002.00

+ +
​​Blind/Blind +

751.00

+ +
+

295.00

+ +
+

1046.00

+ +
​​Disabled/Disabled +

751.00

+ +
+

251.00

+ +
+

1002.00

+ +
​​Aged/Blind +

751.00

+ +
+

273.00

+ +
+

1024.00

+ +
​​Aged/Disabled +

751.00

+ +
+

251.00

+ +
+

1002.00

+ +
​​Blind/Disabled +

751.00

+ +
+

273.00

+ +
+

1024.00

+ +
​ +

D

+ +
All +

751.00

+ +
+

413.40

+ +
+

1164.40

+ +
​ +

G

+ +
All +

751.00

+ +
+

0.00

+ +
+

751.00

+ +
​ +

Z

+ +
Aged/Aged +

751.00

+ +
+

0.00

+ +
+

751.00

+ +
​​Disabled/Disabled +

751.00

+ +
+

0.00

+ +
+

751.00

+ +
​​Aged/Disabled +

751.00

+ +
+

0.00

+ +
+

751.00

+ +
+

B

+ +
+

B

+ +
Blind/Blind +

500.67 1

+ +
+

44.00

+ +
+

544.67

+ +
​​Blind/Aged +

500.67 1

+ +
+

22.00

+ +
+

522.67

+ +
​​Blind/Disabled +

500.67 1

+ +
+

22.00

+ +
+

522.67

+ +
​ +

H3

+ +
Aged/Aged +

500.67 1

+ +
+

251.00

+ +
+

751.67

+ +
​​Blind/Blind +

500.67 1

+ +
+

295.00

+ +
+

795.67

+ +
​​Disabled/Disabled +

500.67 1

+ +
+

251.00

+ +
+

751.67

+ +
​​Aged/Blind +

500.67 1

+ +
+

273.00

+ +
+

773.67

+ +
​​Aged/Disabled +

500.67 1

+ +
+

251.00

+ +
+

751.67

+ +
​​Blind/Disabled +

500.67 1

+ +
+

273.00

+ +
+

773.67

+ +
​ +

I 3

+ +
All +

500.67 1

+ +
+

413.40

+ +
+

914.07

+ +
​ +

Z

+ +
Aged/Aged +

500.67 1

+ +
+

0.00

+ +
+

500.67

+ +
​​Disabled/Disabled +

500.67 1

+ +
+

0.00

+ +
+

500.67

+ +
​​Aged/Disabled +

500.67 1

+ +
+

0.00

+ +
+

500.67

+ +
+

D

+ +
+

Z

+ +
All +

60.00 2

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

3 Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible + with the RMA policy computation process.

+ +
+
+

State-administered programs: For Calendar Year 1999 -

+ +
    +
  1. +
    +
    (1) 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate plus a monthly personal allowance. The proposed + per diem rate for calendar year 1999 is $17.05 to $23.83. The proposed personal allowance + is $71.00. +

    + +
    +
    +
  2. +
  3. +
    +
    (2) 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost of in-home health care plus basic Federal + benefits. The proposed maximum payment for care in in-home related care is $458.20. + (Members of a couple are treated as individuals.) +

    + +
    +
    +
  4. +
+ +

MASSACHUSETTS

+ +

Definitions of State Living Arrangement Variations

+ +
+
+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Full Cost-of-Living:

+ +
    +
  1. +
    +
    1. 
    +
    +

    An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and are: +

    + +
      +
    1. +
      +
      a. 
      +
      +

      Living alone — Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences will be considered + living alone provided they do not use the residential kitchen facilities for preparation + of meals; or +

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Living only with their eligible spouse; or

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Living with their eligible spouse and ineligible child/children 2 none of whom (children) receive public income maintenance

      payments; 3 or +

      + +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Living only with their ineligible spouse and/or their ineligible child/children, none + of whom (spouse and children) receive public income maintenance payments. +

      + +
      +
      +
    8. +
    + +
    +
    +

    NOTE: For purposes of a. through d. above, foster children placed with anyone other than + their parents are not considered to be living with the foster parent. +

    + +
    +
    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom he/she is living receive public income maintenance + payments. +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in 1. or 2. above will be in State living arrangement A if he/she + pays at least two-thirds of the household expenses. In making a determination as to + whether the individual pays two-thirds or more of the expenses, use the method defined + in

    SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses. +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. +

    + +

    Optional supplement code A is the proper code to be used with an “intervening” Federal A code. (See SM 01301.535.)

    + +
    +
    +
  8. +
+ +
BShared Living Expenses — An individual who is in Federal living arrangement A or C + and who does not meet the criteria listed for State living arrangement A or E is in + State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH). +
​Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined above. Also included are individuals placed + under the auspices of the State adult foster care program and residents of publicly + operated emergency shelters throughout a month. +
​An individual living in a household where all members receive public income maintenance + payments unless they are paying at least two-thirds of the household expenses (A). +
​An individual living in a mixed household — i.e., a household where one or more other + members receive a public income maintenance payment — also is included unless the + individual is paying at least two-thirds of the household expenses (A). +
CLiving in the Household of Another — Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third. +
ELicensed Rest Home — Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home. +
FEffective July 1, 1987, the State elected Federal administration of an optional State + supplementary payment to residents of title XIX facilities. +
GAssisted Living — Effective July 1, 1994, the State elected Federal administration + of their variation. Includes an individual, certified by the State to be residing + in an Assisted Living residence served by a certified Group Adult Foster Care provider, + who is not receiving assistance under any other Federal or State rental assistance + program, and who pays a fixed, non-separable fee for rent and supportive services, + other than medically necessary services reimbursed by Medicaid. The State shall certify + to SSA each individual who is eligible for this optional supplement living arrangement. + This living arrangement was discontinued effective January 1, 1996. However, it has + been restored, retroactively, to January 1, 1997. +
YOptional Supplementation Waived — Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +
ZNo Supplement Cases — Recipients in a title XIX facility where Medicaid pays more + than 50 percent of the cost. +
+
+
+

Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. +

+ +
+
+ +
+
+

1 For purposes of determining State living arrangements, a commercial boarding house, + foster home, or halfway house is not considered the person's household.

+ +

2 Use the SSI definition of child, SI 00501.400.

+ +

3 A public income maintenance payment is a payment from any of the following programs: + Aid to Families with Dependent Children (AFDC), SSI, the Refugee Act of 1980, the + Disaster Relief Act of 1974, general assistance programs of the Bureau of Indian Affairs, + State or local government income maintenance programs that are based on need, or Veterans' + Administration benefits based on need.

+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

Massachusetts

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
State OS

Code +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
Aged +

500.00

+ +
+

128.82

+ +
+

628.82

+ +
​​Blind +

500.00

+ +
+

149.74

+ +
+

649.74

+ +
​​Disabled +

500.00

+ +
+

114.39

+ +
+

614.39

+ +
​ +

B

+ +
Aged +

500.00

+ +
+

39.26

+ +
+

539.26

+ +
​​Blind +

500.00

+ +
+

149.74

+ +
+

649.74

+ +
​​Disabled +

500.00

+ +
+

30.40

+ +
+

530.40

+ +
​ +

E

+ +
Aged +

500.00

+ +
+

293.00

+ +
+

793.00

+ +
​​Blind +

500.00

+ +
+

149.74

+ +
+

649.74

+ +
​​Disabled +

500.00

+ +
+

293.00

+ +
+

793.00

+ +
​ +

G

+ +
Aged +

500.00

+ +
+

454.00

+ +
+

954.00

+ +
​​Blind +

500.00

+ +
+

454.00

+ +
+

954.00

+ +
​​Disabled +

500.00

+ +
+

454.00

+ +
+

954.00

+ +
+

B

+ +
+

C

+ +
Aged +

333.34 1

+ +
+

104.36

+ +
+

437.70

+ +
​​Blind +

333.34 1

+ +
+

316.40

+ +
+

649.74

+ +
​​Disabled +

333.34 1

+ +
+

87.58

+ +
+

420.92

+ +
+

C

+ +
+

A

+ +
Blind +

500.00

+ +
+

149.74

+ +
+

649.74

+ +
​​Disabled +

500.00

+ +
+

114.39

+ +
+

614.39

+ +
​ +

B

+ +
Blind +

500.00

+ +
+

149.74

+ +
+

649.74

+ +
​​Disabled +

500.00

+ +
+

30.40

+ +
+

530.40

+ +
+

D

+ +
+

F

+ +
All +

30.00 2

+ +
+

35.00

+ +
+

65.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
Aged/Aged +

751.00

+ +
+

201.72

+ +
+

952.72

+ +
​​Blind/Blind +

751.00

+ +
+

548.48

+ +
+

1,299.48

+ +
​​Disabled/Disabled +

751.00

+ +
+

180.06

+ +
+

931.06

+ +
​​Aged/Blind +

751.00

+ +
+

375.10

+ +
+

1,126.10

+ +
​​Aged/Disabled +

751.00

+ +
+

190.89

+ +
+

941.89

+ +
​​Blind/Disabled +

751.00

+ +
+

364.27

+ +
+

1,115.27

+ +
​ +

B

+ +
Aged/Aged +

751.00

+ +
+

201.72

+ +
+

952.72

+ +
​​Blind/Blind +

751.00

+ +
+

548.48

+ +
+

1,299.48

+ +
​​Disabled/Disabled +

751.00

+ +
+

180.06

+ +
+

931.06

+ +
​​Aged/Blind +

751.00

+ +
+

375.10

+ +
+

1,126.10

+ +
​​Aged/Disabled +

751.00

+ +
+

190.89

+ +
+

941.89

+ +
​​Blind/Disabled +

751.00

+ +
+

364.27

+ +
+

1,115.27

+ +
​ +

E

+ +
Aged/Aged +

751.00

+ +
+

835.00

+ +
+

1,586.00

+ +
​​Blind/Blind +

751.00

+ +
+

548.48

+ +
+

1,299.48

+ +
​​Disabled/Disabled +

751.00

+ +
+

835.00

+ +
+

1,586.00

+ +
​​Aged/Blind +

751.00

+ +
+

691.74

+ +
+

1,442.74

+ +
​​Aged/Disabled +

751.00

+ +
+

835.00

+ +
+

1,586.00

+ +
​​Blind/Disabled +

751.00

+ +
+

691.74

+ +
+

1,442.74

+ +
​ +

G

+ +
Aged/Aged +

751.00

+ +
+

681.00

+ +
+

1,432.00

+ +
​​Blind/Blind +

751.00

+ +
+

681.00

+ +
+

1,432.00

+ +
​​Disabled/Disabled +

751.00

+ +
+

681.00

+ +
+

1,432.00

+ +
​​Aged/Blind +

751.00

+ +
+

681.00

+ +
+

1,432.00

+ +
​​Aged/Disabled +

751.00

+ +
+

681.00

+ +
+

1,432.00

+ +
​​Blind/Disabled +

751.00

+ +
+

681.00

+ +
+

1,432.00

+ +
+

B

+ +
+

C

+ +
Aged/Aged +

500.67 1

+ +
+

215.80

+ +
+

716.47

+ +
​​Blind/Blind +

500.67 1

+ +
+

798.81

+ +
+

1,299.48

+ +
​​Disabled/Disabled +

500.67 1

+ +
+

194.18

+ +
+

694.85

+ +
​​Aged/Blind +

500.67 1

+ +
+

507.31

+ +
+

1007.98

+ +
​​Aged/Disabled +

500.67 1

+ +
+

204.99

+ +
+

705.66

+ +
​​Blind/Disabled +

500.67 1

+ +
+

496.50

+ +
+

997.17

+ +
+

D

+ +
+

F

+ +
All +

60.00 2

+ +
+

70.00

+ +
+

130.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +

 

+ +

MICHIGAN

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
DDomiciliary Care — Recipients residing in licensed nonmedical facilities which provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care. +
EPersonal Care — Recipients residing in licensed nonmedical facilities which provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to licensed homes for the aged. +
FHome for the Aged — Recipients residing in a nonmedical facility for the aged. The + State provides SSA with a list of these facilities and certified which recipients + are residents requiring this level of care. +
GIndependent Living with an EP — Recipients with an EP, not living in the household + of another. (Children under 18 are excluded.) +
HLiving in the Household of Another with an EP —Recipients with an EP and living in + the household of another for Federal purposes. (Children under 18 are excluded.) +
IEffective January 1, 1988, the State elected Federal administration of an optional + State supplementary payment to residents of title XIX facilities. +
YOptional Supplementation Waived — Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +
ZNo Supplement Cases — Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under title XIX. +
+
+

 

+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

Michigan

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

500.00

+ +
+

87.00

+ +
+

587.00

+ +
​ +

E

+ +
+

All

+ +
+

500.00

+ +
+

157.50

+ +
+

657.50

+ +
​ +

F

+ +
+

All

+ +
+

500.00

+ +
+

179.30

+ +
+

679.30

+ +
​ +

G

+ +
+

All

+ +
+

750.00 2

+ +
+

14.00

+ +
+

764.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

500.00 1

+ +
+

9.33

+ +
+

509.33

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.00 3

+ +
+

7.00

+ +
+

37.00

+ +
+
+

1 Not an FBR; the amount represents the FBR plus EP increment less VTR.

+ +

2 Not an FBR; the amount represents the FBR plus EP increment.

+ +

3 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

751.00

+ +
+

423.00

+ +
+

1,174.00

+ +
​ +

E

+ +
+

All

+ +
+

751.00

+ +
+

564.00

+ +
+

1,315.00

+ +
​ +

F

+ +
+

All

+ +
+

751.00

+ +
+

607.60

+ +
+

1,358.60

+ +
​ +

G

+ +
+

All

+ +
+

1001.00 2

+ +
+

21.00

+ +
+

1,022.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

667.34 1

+ +
+

14.00

+ +
+

681.34

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.00 3

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1 Not an FBR; the amount represents the FBR plus EP increment less VTR.

+ +

2 Not an FBR; the amount represents the FBR plus EP increment.

+ +

3 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +

MONTANA

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
GState-Certified Personal Care
HState-Certified Residence in Community Home for Mentally Disabled
IState-Certified Residence in Community Home for Physically or Developmentally Disabled
JState-Certified Residence for Child and Adult Foster Care
KState-Certified Semi-Independent Care
YOptional Supplementation Waived — Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +
ZNo Supplement Cases — Includes all individuals and couples not certified in State + codes G, H, I, J, or K. +
+
+
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

Montana

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

500.00

+ +
+

94.00

+ +
+

594.00

+ +
​ +

H

+ +
+

All

+ +
+

500.00

+ +
+

94.00

+ +
+

594.00

+ +
​ +

I

+ +
+

All

+ +
+

500.00

+ +
+

94.00

+ +
+

594.00

+ +
​ +

J

+ +
+

All

+ +
+

500.00

+ +
+

52.75

+ +
+

552.75

+ +
​ +

K

+ +
+

All

+ +
+

500.00

+ +
+

26.00

+ +
+

526.00

+ +
​ +

Z

+ +
+

All

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

333.34 1

+ +
+

0.00

+ +
+

333.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.00 2

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

751.00

+ +
+

193.00

+ +
+

944.00

+ +
​ +

H

+ +
+

All

+ +
+

751.00

+ +
+

193.00

+ +
+

944.00

+ +
​ +

I

+ +
+

All

+ +
+

751.00

+ +
+

193.00

+ +
+

944.00

+ +
​ +

J

+ +
+

All

+ +
+

751.00

+ +
+

110.50

+ +
+

861.50

+ +
​ +

K

+ +
+

All

+ +
+

751.00

+ +
+

57.00

+ +
+

808.00

+ +
​ +

Z

+ +
+

All

+ +
+

751.00

+ +
+

0.00

+ +
+

751.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

500.67 1

+ +
+

0.00

+ +
+

500.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.00 2

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +

NEVADA

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Independent Living or Living in Parental Household — Aged or blind eligible individual + or couple who: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in his/her own household as defined for Federal living arrangement A purposes; + or +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected child”) living in a parent's household.

    + +
    +
    +
  6. +
+ +

Used with an “intervening” Federal A code. (See SM 01301.535.)

+ +
BLiving in the Household of Another — Aged or blind eligible individual or couple who + is living in the household of another individual and receiving food and shelter from that individual. Aged or blind individuals or couples, who are subject + to a one-third reduction of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B. +
CDomiciliary Care — Aged or blind eligible individual or couple who lives in a private + nonmedical facility or, as of October 1976, a residential facility serving 16 or fewer + persons, which provides personal care and services to aged, infirm, or handicapped + adult persons who are unrelated to the proprietor. +
​These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities. +
YOptional Supplementation Waived — Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +
ZNo Supplement Cases — No supplement cases include:
 ​
  +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individuals or disabled members of eligible couples; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individuals or members of eligible couples in a medical facility where title + XIX pays more than 50 percent of the cost; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individuals or members of eligible couples who are patients in a private + medical facility which is not certified under title XIX; or +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    + +
    +
    +
  8. +
+ +
+
+
+
+

Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+ +

 

+ +
+
+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

Nevada

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
Aged +

500.00

+ +
+

36.40

+ +
+

536.40

+ +
​​Blind +

500.00

+ +
+

109.30

+ +
+

609.30

+ +
​ +

C

+ +
Aged +

500.00

+ +
+

329.66

+ +
+

829.66

+ +
​​Blind +

500.00

+ +
+

329.66

+ +
+

829.66

+ +
​ +

Z

+ +
Disabled +

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

B

+ +
+

B

+ +
Aged +

333.34 1

+ +
+

24.27

+ +
+

357.61

+ +
​​Blind +

333.34 1

+ +
+

213.96

+ +
+

547.30

+ +
​ +

Z

+ +
Disabled +

333.34 1

+ +
+

0.00

+ +
+

333.34

+ +
+

C

+ +
+

A

+ +
Blind +

500.00

+ +
+

109.30

+ +
+

609.30

+ +
​ +

Z

+ +
Disabled +

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

D

+ +
+

Z

+ +
All +

30.00 2

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
Aged/Aged +

751.00

+ +
+

74.46

+ +
+

825.46

+ +
​​Blind/Blind +

751.00

+ +
+

374.60

+ +
+

1,125.60

+ +
​​Aged/Blind +

751.00

+ +
+

224.53

+ +
+

975.53

+ +
​​Aged/Disabled +

751.00

+ +
+

37.23

+ +
+

788.23

+ +
​​Blind/Disabled +

751.00

+ +
+

187.30

+ +
+

938.30

+ +
​ +

C

+ +
Aged/Aged +

751.00

+ +
+

829.98

+ +
+

1,580.98

+ +
​​Blind/Blind +

751.00

+ +
+

829.98

+ +
+

1,580.98

+ +
​​Aged/Blind +

751.00

+ +
+

829.98

+ +
+

1,580.98

+ +
​​Aged/Disabled +

751.00

+ +
+

414.99

+ +
+

1,165.99

+ +
​​Blind/Disabled +

751.00

+ +
+

414.99

+ +
+

1,165.99

+ +
​ +

Z

+ +
Disabled +

751.00

+ +
+

0.00

+ +
+

751.00

+ +
+

B

+ +
+

B

+ +
Aged/Aged +

500.67 1

+ +
+

49.64

+ +
+

550.31

+ +
​​Blind/Blind +

500.67 1

+ +
+

531.94

+ +
+

1,032.61

+ +
​​Aged/Blind +

500.67 1

+ +
+

290.79

+ +
+

791.46

+ +
​​Aged/Disabled +

500.67 1

+ +
+

24.82

+ +
+

525.49

+ +
​​Blind/Disabled +

500.67 1

+ +
+

265.97

+ +
+

766.64

+ +
​ +

Z

+ +
Disabled +

500.67 1

+ +
+

0.00

+ +
+

500.67

+ +
+

D

+ +
+

Z

+ +
All +

60.00 2

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +

 

+ +

NEW JERSEY

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
ALicensed Residential Health Care Facilities and Certain Licensed Residential Facilities + — The State provides New Jersey District Offices with lists of approved facilities. + Mentally retarded individuals must be placed and supervised by either the State Department + of Youth and Family Services or the State Division of Mental Retardation. +
BLiving Alone or with Others — Eligible individuals (including children) or eligible + couples whose Federal living arrangements are A or C and who do not meet the requirements + defined in other supplementation categories. +
​Therefore, effective August 1, 1981, any eligible adult/couple who meets the requirement + for a Federal A will be in optional supplement B unless residing in a residential + health care facility or living alone with an ineligible spouse. +
  +

Likewise, any child meeting the criteria for a Federal code C will automatically be + entitled to optional supplement B. +

+ +

This category includes, but is not limited to, those eligible adults/couples who are:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or +

    + +
    +
    +
  4. +
+ +
  +
    +
  1. +
    +
    3. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services +

    + +
    +
    +
  2. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal A code. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

C

+ +
+

Living Alone with an Ineligible Spouse — Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse will receive the same total payment as an eligible + couple or an individual with an EP. Once other persons, even minor children, are present + in the household, this supplementary payment variation cannot exist. However, it is + possible that a claimant and their ineligible spouse live with others and allege that + they are a separate “household” by virtue of the fact that they eat their meals out or have separate purchase and + preparation of food. In this instance, an optional supplement C is permissible as + long as no other person is in their “household.” There is no couple counterpart in this category. +

+ +
​Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B. +
​A transient individual who co-exists only with an ineligible spouse will also qualify + for the O/S - C rate. +
DLiving in the Household of Another — Persons who are “living in the household of another” for Federal purposes.
GEffective September 1, 1988, the State elected Federal administration of an optional + State supplementary payment to residents of title XIX facilities. +
YOptional Supplementation Waived — Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +
ZNo Supplement Cases — Individuals and couples in licensed medical facilities where + Medicaid is paying more than 50 percent of the cost of care, individuals and couples + in publicly operated community residences having 16 or less residents, and residents + of publicly operated emergency shelters throughout a month. +
+
+

 

+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

New Jersey

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
All +

500.00

+ +
+

150.05

+ +
+

650.05

+ +
​ +

B

+ +
All +

500.00

+ +
+

31.25

+ +
+

531.25

+ +
​ +

C

+ +
Individual +

500.00

+ +
+

276.36

+ +
+

776.36

+ +
​​w/EP +

750.00 2

+ +
+

26.36

+ +
+

776.36

+ +
​ +

Z

+ +
All +

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

B

+ +
+

D

+ +
All +

333.34 1

+ +
+

44.31

+ +
+

377.65

+ +
+

C

+ +
+

B

+ +
All +

500.00

+ +
+

31.25

+ +
+

531.25

+ +
+

D

+ +
+

G

+ +
All +

30.00 3

+ +
+

10.00

+ +
+

40.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents the FBR plus EP increment.

+ +

3 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
All +

751.00

+ +
+

530.36

+ +
+

1,281.36

+ +
​ +

B

+ +
All +

751.00

+ +
+

25.36

+ +
+

776.36

+ +
​ +

Z

+ +
All +

751.00

+ +
+

0.00

+ +
+

751.00

+ +
+

B

+ +
+

D

+ +
All +

500.67 1

+ +
+

93.09

+ +
+

593.76

+ +
+

D

+ +
+

G

+ +
All +

60.00 2

+ +
+

20.00

+ +
+

80.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +

 

+ +

NEW YORK

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
ALiving Alone — Eligible individuals or eligible couples living physically alone, or + living with only a foster child(ren), or a homemaker authorized by the local Department + of Social Services (DSS), or a family care recipient(s) placed by the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabled (OMRDD) + or local DSS, or individuals living with others but paying a “flat fee for room and board,” or living with others but taking all their meals outside the dwelling unit, or living + with others in a dwelling but separately preparing food, or having their food separately + prepared for them. +
BLiving with Others — Individual/child/couple who resides in a dwelling with others + and prepares food in common with at least one other person in the dwelling, or is + a member of a religious community, or child in any living arrangement other than a + family care home (Level I) or community residence (Level II) certified by OMRDD or + OMH. +
CCongregate Care Level I — Family type homes and family care homes. Family type homes + are facilities operated for the purpose of providing long-term residential care for + adults and are certified by the New York State DSS and supervised by local departments + of social services. Family care homes are private households which provide care for + mentally disabled persons. +
DCongregate Care Level II — Residential facilities for adults and certain children + with mental disabilities. +
ECongregate Care Level III — Privately operated non-medical residential facilities. + Although Level III facilities are often called schools, these facilities may not meet + the Federal definition of school. Operated for the purpose of providing treatment, + training and education for mentally retarded or developmentally disabled individuals, + these facilities are certified by OMRDD in accordance with State regulations. +
FLiving in the Household of Another — Same as Federal definition. The State supplement + payment for the individual/child/couple whose Federal benefit rate is subject to the + one-third reduction is the “living with others” rate but for systems purposes is coded F. +
GEffective January 1, 1988, the State elected Federal administration of an optional + State supplementary payment to residents of title XIX facilities. +
YOptional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +
ZNo Supplement Cases — Recipients in licensed medical facilities where Medicaid is + paying more than 50 percent of the cost of care, recipients in publicly operated community + residences which serve 16 or fewer residents, and residents of publicly operated emergency + shelters throughout a month. +
+
+

 

+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

New York

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A, C

+ +
+

A

+ +
All +

500.00

+ +
+

87.00

+ +
+

587.00

+ +
​ +

B

+ +
All +

500.00

+ +
+

23.00

+ +
+

523.00

+ +
​ +

C

+ +
NY City +

500.00

+ +
+

266.48

+ +
+

766.48

+ +
​​Nassau County4 +

500.00

+ +
+

266.48

+ +
+

766.48

+ +
​​All other counties +

500.00

+ +
+

228.48

+ +
+

728.48

+ +
​ +

D

+ +
NY City +

500.00

+ +
+

435.00

+ +
+

935.00

+ +
​​Nassau County4 +

500.00

+ +
+

435.00

+ +
+

935.00

+ +
​​All other counties +

500.00

+ +
+

405.00

+ +
+

905.00

+ +
​ +

E

+ +
NY City +

500.00

+ +
+

482.96

+ +
+

982.96

+ +
​​Nassau County4 +

500.00

+ +
+

458.96

+ +
+

958.96

+ +
​​All other counties +

500.00

+ +
+

458.96

+ +
+

958.96

+ +
​ +

Z

+ +
All +

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

B

+ +
+

F

+ +
All +

333.34 1

+ +
+

23.00

+ +
+

356.34

+ +
+

D

+ +
+

G

+ +
All +

30.00 2

+ +
+

5.00 3

+ +
+

35.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

3 New York administers a supplement of $20 to some recipients in a title XIX institution. +

+ +

4 Includes and applies to: Nassau, Suffolk, and Westchester counties effective 7/1/85.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A, C

+ +
+

A

+ +
All +

751.00

+ +
+

104.00

+ +
+

855.00

+ +
​ +

B

+ +
All +

751.00

+ +
+

46.00

+ +
+

797.00

+ +
​ +

C

+ +
NY City +

751.00

+ +
+

781.96

+ +
+

1,532.96

+ +
​​Nassau County4 +

751.00

+ +
+

781.96

+ +
+

1,532.96

+ +
​​All other counties +

751.00

+ +
+

705.96

+ +
+

1,456.96

+ +
​ +

D

+ +
NY City +

751.00

+ +
+

1,119.00

+ +
+

1,870.00

+ +
​​Nassau County4 +

751.00

+ +
+

1,119.00

+ +
+

1,870.00

+ +
​​All other counties +

751.00

+ +
+

1,059.00

+ +
+

1,810.00

+ +
​ +

E

+ +
NY City +

751.00

+ +
+

1,214.92

+ +
+

1,965.92

+ +
​​Nassau County4 +

751.00

+ +
+

1,166.92

+ +
+

1,917.92

+ +
​​All other counties +

751.00

+ +
+

1,166.92

+ +
+

1,917.92

+ +
​ +

Z

+ +
All +

751.00

+ +
+

0.00

+ +
+

751.00

+ +
+

B

+ +
+

F

+ +
All +

500.67 1

+ +
+

46.00

+ +
+

546.67

+ +
+

D

+ +
+

G

+ +
All +

60.00 2

+ +
+

10.003

+ +
+

70.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

3 New York administers a supplement of $40 to recipients in a title XIX institution. +

+ +

4 Includes and applies to: Nassau, Suffolk and Westchester counties effective 7/1/85.

+ +

 

+ +

PENNSYLVANIA

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
ALiving Alone — Recipients in private medical facilities (nursing homes, hospitals, + intermediate care facilities) where title XIX is not paying more than 50 percent of the cost of care, residents of publicly operated emergency + shelters throughout a month, and all other individuals and couples in Federal codes + A and C not meeting the definition of another variation. +
​Used with an “intervening” Federal A code. (See SM 01301.535.)
​This State code is also used to supplement Section 1619 cases.
BLiving in the Household of Another — Recipients who do not have an EP and who live + in the household of another and receive support and maintenance for Federal purposes. +
CLiving with an EP — Recipients who are not living in the household of another or in + a foster care home for adults and who have one or more EP's as defined under the Federal + rules; i.e., Public Law 93-66. +
DLiving in the Household of Another with an EP —Recipients who live in the household + of another and who have one or more EP's as defined under the Federal rules; i.e., + Public Law 93-66. +
GLiving in a Domiciliary Care Facility — Adult persons (18 and over) certified by the + State to be residing in nonmedical residential care facilities. +
HLiving in a Personal Care Boarding Home — Adult Persons (18 and Over) certified by + the State to be residing in nonmedical residential care facilities (Effective 07/01/89). +
YOptional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +
ZNo Supplement Cases — Includes all recipients who are residing in a medical facility + in which title XIX is paying more than 50 percent of the cost of care. +
+
+
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

Pennsylvania

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

500.00

+ +
+

27.40

+ +
+

527.40

+ +
​ +

C

+ +
+

All

+ +
+

750.00 3

+ +
+

43.70

+ +
+

793.70

+ +
​ +

G

+ +
+

All

+ +
+

500.00

+ +
+

329.30

+ +
+

829.30

+ +
​ +

H

+ +
+

All

+ +
+

500.00

+ +
+

334.30

+ +
+

834.30

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

333.34 1

+ +
+

27.40

+ +
+

360.74

+ +
​ +

D

+ +
+

All

+ +
+

500.00 2

+ +
+

43.70

+ +
+

543.70

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

500.00

+ +
+

27.40

+ +
+

527.40

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.00 4

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents the FBR plus EP increment less VTR.

+ +

3 Not an FBR; the amount represents the FBR plus EP increment.

+ +

4 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

751.00

+ +
+

43.70

+ +
+

794.70

+ +
​ +

C

+ +
+

All

+ +
+

1001.00 3

+ +
+

68.05

+ +
+

1,069.05

+ +
​ +

G

+ +
+

All

+ +
+

751.00

+ +
+

737.40

+ +
+

1,488.40

+ +
​ +

H

+ +
+

All

+ +
+

751.00

+ +
+

747.40

+ +
+

1,498.40

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

500.67 1

+ +
+

43.70

+ +
+

544.37

+ +
​ +

D

+ +
+

All

+ +
+

750.67 2

+ +
+

68.05

+ +
+

818.72

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.00 4

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents the FBR plus EP increment less VTR.

+ +

3 Not an FBR; the amount represents the FBR plus EP increment.

+ +

4 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +

 

+ +

RHODE ISLAND

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
ALiving Alone — Recipients who are in Federal codes A and C.
​Used to supplement Section 1619 cases.
BLiving in the Household of Another — Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied. +
DLiving in a Shelter Care Facility (Effective 10/01/90). Revised to: Residential Care/Assisted + Living - Adult Individuals Only (Effective 10/01/98). +
EThe State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 03/01/91). +
YOptional Supplementation Waived — Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +
ZNo Supplement Cases — Residents of publicly operated emergency shelters throughout + a month and recipients who are subject to the $30 per month SSI payment limit because + they are inpatients in medical facilities receiving more than 50 percent of the cost + of care from the State's Medicaid program. +
+
+
+

CODING AND MONTHLY PAYMENT LEVELS

Effective July 1, 1999

Rhode Island

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A 1

+ +
+

All

+ +
+

500.00

+ +
+

64.35

+ +
+

564.35

+ +
​ +

D

+ +
+

All

+ +
+

500.00

+ +
+

582.00

+ +
+

1082.00

+ +
+

B

+ +
+

B 1

+ +
+

All

+ +
+

333.34 2

+ +
+

74.60

+ +
+

407.94

+ +
+

C

+ +
+

A 1

+ +
+

All

+ +
+

500.00

+ +
+

64.35

+ +
+

564.35

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

30.00 3

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1 Code is systems generated from the Federal code.

+ +

2 Not an FBR; the amount represents the FBR less VTR.

+ +

3 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A 1

+ +
+

All

+ +
+

751.00

+ +
+

120.50

+ +
+

871.50

+ +
+

B

+ +
+

B 1

+ +
+

All

+ +
+

500.67 2

+ +
+

136.50

+ +
+

637.17

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

60.00 3

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1 Code is systems generated from the Federal code.

+ +

2 Not an FBR; the amount represents the FBR less VTR.

+ +

3 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +

 

+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

Rhode Island

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A 1

+ +
+

All

+ +
+

500.00

+ +
+

64.35

+ +
+

564.35

+ +
​ +

D

+ +
+

All

+ +
+

500.00

+ +
+

582.00

+ +
+

1082.00

+ +
+

B

+ +
+

B 1

+ +
+

All

+ +
+

333.34 2

+ +
+

74.60

+ +
+

407.94

+ +
+

C

+ +
+

A 1

+ +
+

All

+ +
+

500.00

+ +
+

64.35

+ +
+

564.35

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

30.00 3

+ +
+

10.00

+ +
+

40.00

+ +
+
+

1 Code is systems generated from the Federal code.

+ +

2 Not an FBR; the amount represents the FBR less VTR.

+ +

3 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A 1

+ +
+

All

+ +
+

751.00

+ +
+

120.50

+ +
+

871.50

+ +
+

B

+ +
+

B 1

+ +
+

All

+ +
+

500.67 2

+ +
+

136.50

+ +
+

637.17

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

60.00 3

+ +
+

20.00

+ +
+

80.00

+ +
+
+

1 Code is systems generated from the Federal code.

+ +

2 Not an FBR; the amount represents the FBR less VTR.

+ +

3 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +

 

+ +

UTAH

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
ALiving Alone or With Others — This variation includes recipients who are in Federal + codes A and C. +
BLiving in the Household of Another — Recipients with no EP who are “living in the household of another” for Federal purposes. (Children under 18 are included in this living arrangement + variation.) +
ZNo Supplement Cases — No supplement cases include all recipients who are not included + in A or B. +
+
+
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

UTAH

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A,C

+ +
+

Z

+ +
+

All

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

333.34 2

+ +
+

3.13

+ +
+

336.47

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.00 1

+ +
+

None

+ +
+

30.00

+ +
+
+

1 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

2 Not an FBR, the amount represents the FBR less VTR.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A,C

+ +
+

A

+ +
+

All

+ +
+

751.00

+ +
+

4.60

+ +
+

755.60

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

500.67 2

+ +
+

9.73

+ +
+

510.40

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.00 1

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

2 Not an FBR, the amount represents the FBR less VTR.

+ +

 

+ +

VERMONT

+ +

 

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
AIndependent Living (except Chittenden County) — Recipients not living in the household + of another, not in a custodial care situation, and not otherwise excepted from supplementation. + Includes a child who is living with a parent and recipients residing in a private + title XIX facility where Medicaid is not paying more than 50 percent of the cost of + care. +
​Effective May 1, 1983, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +
​Optional supplement code A is the proper code to be used with an “intervening” Federal A code (except Chittenden County).
BIndependent Living in Chittenden County — Same as A above except restricted to residents + of Chittenden County. +
​Effective May 1, 1983, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +
​Optional supplement code B is the proper code to be used with an “intervening” Federal A code (Chittenden County only). (See SM 01301.535.)
CLevel III assistive community care: Recipients living in Level III facilities identified + by the State. (Effective July 1, 1999) +
ELiving in the Household of Another — Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions), and not otherwise excepted from supplementation. +
FCustodial Care: Licensed Home with Limited Nursing Care —

Recipients living in Level III Community Homes identified by the State. State administration + effective July 1, 1999. +
GCustodial Care: Licensed Community Care Home — Recipients living in Level IV Community + Homes identified by the State. +
HCustodial Care: Family Home — Recipients living in another's home in such a manner + that the individual or couple is paying room and board and is receiving one or more + of the services outlined under the custodial care definition. The individual or couple + must also receive the room and board and custodial care in the home in which they + reside. In order to qualify as a home under this arrangement, these services must + not be provided to more than two persons and must be provided by a resident of the + home. +
​In addition to the above individuals, the Vermont Community Mental Health Agency and + Department of Mental Health have established outplacement programs which provide a + family home setting to no more than two persons in need of custodial care or supervision. + The individuals placed in this setting are eligible for this arrangement only if a + third party resides with the individual and provides the custodial care. +
​Custodial care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service 2-3 times a week) and/or + supervision for the recipients's protection. Supervision for the recipient's protection + deals primarily with protection services for retarded and emotionally disturbed individuals. + A person who receives one or more of these personal services is receiving custodial + care. +
​The change in this arrangement is effective for initial claims filed on or after January + 1, 1984. For redeterminations the change is effective with the month after the month + in which the first redetermination on or after January 1, 1984, is initiated. +
  +

This arrangement does not cover:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Institutional Living — Regardless of whether custodial care is needed in addition + to the medical, training, rehabilitation, educational or similar services as the primary + function of the institution. +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    A person whose Federal living arrangement is based on home ownership or rental liability. + (A flat fee for room and board per SI 00835.120B. is not considered as rental liability for this arrangement.) +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    A child under l8 years of age not placed by a Vermont Community Mental Health Agency + or the Vermont Department of Mental Health. +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Custodial care or supervision provided by a spouse (as defined by Federal regulations).

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Any home or boarding arrangement which does not meet the Federal (SSI) definition + of independent living, Federal code A. +

    + +
    +
    +
  10. +
+ +
IEffective July 1, 1987, the State elected Federal administration of an optional State + supplementary payment to residents in title XIX facilities. +
YOptional Supplementation Waived — Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +
ZNo Supplement Cases — Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of the care. +
+
+

 

+ +
+
+

When a person has a room in one facility/household and receives board or custodial + care in another facility/household, the custodial rate (F, G, or H) is based on the + facility/household where the person sleeps. +

+ +

 

+ +
+
+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective September 1, 1999

Vermont

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
All (Except Chittenden

County) +
+

500.00

+ +
+

57.66

+ +
+

557.66

+ +
​ +

B

+ +
All (Restricted to Chittenden County) +

500.00

+ +
+

57.66

+ +
+

557.66

+ +
​ +

C 3

+ +
+

All

+ +
+

500.00

+ +
+

47.25

+ +
+

547.25

+ +
​ +

F 4

+ +
+

All

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
​ +

G

+ +
+

All

+ +
+

500.00

+ +
+

218.69

+ +
+

718.69

+ +
​ +

H

+ +
+

All

+ +
+

500.00

+ +
+

96.38

+ +
+

596.38

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

333.34 1

+ +
+

38.38

+ +
+

371.72

+ +
+

C

+ +
+

A

+ +
All (Except Chittenden

County) +
+

500.00

+ +
+

57.66

+ +
+

557.66

+ +
​ +

B

+ +
All (Restricted to

Chittenden County) +
+

500.00

+ +
+

57.66

+ +
+

557.66

+ +
+

D

+ +
+

I

+ +
All +

30.00 2

+ +
+

17.25

+ +
+

47.25

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

3 New State living arrangement effective July 1, 1999.

+ +

4 State administration effective July 1, 1999.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
All (Except Chittenden County) +

751.00

+ +
+

108.28

+ +
+

859.28

+ +
​ +

B

+ +
All (Restricted to Chittenden County) +

751.00

+ +
+

108.28

+ +
+

859.28

+ +
​ +

C 3

+ +
+

All

+ +
+

751.00

+ +
+

94.50

+ +
+

845.50

+ +
​ +

F 4

+ +
+

All

+ +
+

751.00

+ +
+

0.00

+ +
+

751.00

+ +
​ +

G

+ +
+

All

+ +
+

751.00

+ +
+

548.89

+ +
+

1,299.89

+ +
​ +

H

+ +
+

All

+ +
+

751.00

+ +
+

325.02

+ +
+

1,076.02

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

500.67 1

+ +
+

47.18

+ +
+

547.85

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.00 2

+ +
+

34.50

+ +
+

94.50

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

3 New State living arrangement effective July 1, 1999.

+ +

4 State administration effective July 1, 1999.

+ +

 

+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective July 1, 1999

Vermont

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
All (Except Chittenden County) +

500.00

+ +
+

54.91

+ +
+

554.91

+ +
​ +

B

+ +
All (Restricted to Chittenden County) +

500.00

+ +
+

54.91

+ +
+

554.91

+ +
​ +

C 3

+ +
+

All

+ +
+

500.00

+ +
+

45.00

+ +
+

545.00

+ +
​ +

F 4

+ +
+

All

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
​ +

G

+ +
+

All

+ +
+

500.00

+ +
+

208.28

+ +
+

708.28

+ +
​ +

H

+ +
+

All

+ +
+

500.00

+ +
+

91.79

+ +
+

591.79

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

333.34 1

+ +
+

36.55

+ +
+

369.89

+ +
+

C

+ +
+

A

+ +
All (Except Chittenden

County) +
+

500.00

+ +
+

54.91

+ +
+

554.91

+ +
​ +

B

+ +
All (Restricted to

Chittenden County) +
+

500.00

+ +
+

54.91

+ +
+

554.91

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.00 2

+ +
+

15.00

+ +
+

45.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

3 New State living arrangement effective July 1, 1999.

+ +

4 State administration effective July 1, 1999.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

751.00

+ +
+

103.12

+ +
+

854.12

+ +
​ +

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

751.00

+ +
+

103.12

+ +
+

854.12

+ +
​ +

C3

+ +
+

All

+ +
+

751.00

+ +
+

90.00

+ +
+

841.00

+ +
​ +

F4

+ +
+

All

+ +
+

751.00

+ +
+

0.00

+ +
+

751.00

+ +
​ +

G

+ +
+

All

+ +
+

751.00

+ +
+

522.75

+ +
+

1,273.75

+ +
​ +

H

+ +
+

All

+ +
+

751.00

+ +
+

309.54

+ +
+

1,060.54

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

500.671

+ +
+

44.93

+ +
+

545.60

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

30.00

+ +
+

90.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ +

3 New State living arrangement effective July 1, 1999.

+ +

4 State administration effective July 1, 1999.

+ +

 

+ +

WASHINGTON

+ +

Definitions of State Living Arrangement Variations

+ +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Living Alone — Recipients who are “living in own household” under title XVI. If an eligible individual/couple is determined to be living in own + household (Federal living arrangement A) for title XVI, the eligible individual /couple + will usually be in a living alone arrangement for State supplementation purposes. +

+ +

This variation includes:

+ +
    +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples living in private households, whether they + are renting, buying, own their home, or have an interest in the home (e.g., a life + estate). The household may be in a house, room, college dormitory, apartment, hotel, + motel, etc. +

    + +
    +
    +
  • +
+ +
  +
    +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples living in board and room situations. This + includes commercial, benevolent, religious, or fraternal board and room accommodations. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples residing in homes approved as congregate + care facilities (group homes). +

    + +
    +
    +
  • +
+ +
  +
    +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples residing in publicly operated community-based + residences of 16 or fewer beds. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individuals and eligible couples residing in adult family homes. Adult family + homes are homes that provide board, room, laundry. They may also provide necessary + supervision, personal and social services, and, when appropriate, a minimum of nursing + care, and are approved for payment and licensed by the State Department of Social + and Health Services. +

    + +
    +
    +
  • +
+ +
  +
    +
  • +
    +
    •
    +
    +

    An eligible individual living with an ineligible spouse when natural, step, adoptive + or foster children under age 18 whose needs are included in determining an AFDC grant + are residing in the same household. In these cases we assume that the ineligible spouse's + income has been considered in determining the AFDC payment unless the couple is living + in a holding-out relationship. (Where the holding-out spouse has income, the local + Department of Social and Health Services office must be contacted to determine whether + that income has been considered in an AFDC payment.) This variation does not include + an eligible individual living with an ineligible spouse and grandchildren under age + 18 whose needs are included in determining an AFDC grant. +

    + +
    +
    +
  • +
+ +
  +
    +
  • +
    +
    •
    +
    +

    A child in a Federal code A or C living arrangement.

    + +
    +
    +
  • +
+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal A code. (See SM 01301.535.)

+ +

Exceptions

+ +

Optional supplement A is not paid when:

+ +
    +
  1. +
    +
    a. 
    +
    +

    An individual is living in a medical care facility throughout an entire calendar month;

    + +
    +
    +
  2. +
+ +
  +
    +
  1. +
    +
    b. 
    +
    +

    An eligible individual has more than one EP;

    + +
    +
    +
  2. +
  3. +
    +
    c. 
    +
    +

    An eligible couple has one or more EP's; and

    + +
    +
    +
  4. +
  5. +
    +
    d. 
    +
    +

    An eligible individual or couple is residing in a public emergency shelter for the + homeless (effective 5/83). +

    + +
    +
    +
  6. +
+ +
+

B

+ +
+

Living Alone with an Ineligible Spouse — Eligible individual who is the head of the + household and who lives alone as described in A above and is living with an ineligible + spouse. An ineligible spouse is a spouse who has either not applied for SSI benefits, + has been denied or terminated, or has withdrawn their application. It is not material + whether the ineligible spouse is aged, blind, or disabled. An ineligible spouse includes: +

+ +
    +
  • +
    +
    •
    +
    +

    Legally married and common law spouses;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “Holding-out” spouses;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Alien spouses not lawfully admitted to the U.S., and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Refugee spouses receiving payments.

    + +
    +
    +
  • +
+ +
  +
    +
  • +
    +
     
    +
    +
    +
    +

    NOTE: Refugee payments are not deemable to the eligible individual. +

    + +
    +
    + +
    +
    +
  • +
+ +

In determining whether an ineligible spouse is a member of the household for the purpose + of paying the optional supplement B to the eligible individual, use the same rules + for making Federal determinations. If an eligible individual marries, or a separated + spouse returns home, the ineligible spouse supplement is paid beginning with the month + after the month of the arrival of the ineligible spouse in the household. +

+ +
  +

Exceptions

+ +

Optional supplement B is not paid when: (1) an individual with an ineligible spouse + also has child(ren) under the age of 18 whose needs are considered in determining + an AFDC grant. Rather, the optional supplement A is paid. This is true whether or + not the ineligible spouse is actually included on the AFDC grant; (2) an eligible + individual resides in a public emergency shelter for the homeless (effective 5/83). + In this case, use optional supplementation code Z. +

+ +
CLiving in the Household of Another — Applies to most cases which meet the Federal + definition of living in the household of another (Federal code B). +
​Exceptions
​Not paid when: (1) an individual lives in the household of another with more than + one EP; or (2) a couple lives in the household of another with one or more EP's. In + both of these cases the optional supplementation code is Z. +
FLiving in the Household of Another with an Ineligible Spouse — Individuals living + in the household of another (Federal code B) who have an ineligible spouse or an EP. +
​Exceptions
​Individuals with more than one EP are not eligible for an optional supplement.
GLiving with an Essential Person — Applies to an eligible individual who is the head + of the household and who lives alone as described in A above and was converted from + the December 1973 State rolls with an EP who has continued to live in the household. + The system will pay the optional supplement for an EP. If an eligible individual has + more than one EP use optional supplementation code Z. +
HLiving in the Household of Another with an EP — Applies to individuals living in the + household of another who have an EP. Individuals with more than one EP are not eligible + for an optional supplement. +
YOptional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +
ZNo Supplement Cases — The following groups are ineligible for a federally administered + optional supplement: +
  +
    +
  • +
    +
    •
    +
    +

    An individual with more than one EP.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A couple with one or more EP's.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals residing in a medical facility throughout a month, regardless of whether + private or public, or if Medicaid is involved in reimbursement for the cost of the + care. (If only one member of an eligible couple is in a medical facility, determine + the optional supplement variation that applies to the other member separately.) The + term “medical facility” includes hospitals, nursing homes, and extended care facilities, but does not include + boarding schools, congregate care facilities, and half-way houses. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Residents of publicly operated emergency shelters throughout a month, effective May + 1983. +

    + +
    +
    +
  • +
+ +
+
+

 

+ +
+

CODING AND MONTHLY PAYMENT LEVELS

Effective January 1, 1999

Washington

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
State OS

Code +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
AAKing, Kitsap, Pierce,

Snohomish, Thurston

Counties +
500.0027.00527.00
​​All other counties500.006.55506.55
​BKing, Kitsap, Pierce,

Snohomish, Thurston

Counties +
500.00167.20667.20
​​All other counties500.00137.25637.25
​GIndividual with one EP

King, Kitsap, Pierce,

Snohomish, Thurston

Counties +
750.0021.00771.00
​​Individual with one

EP

All other counties +
750.000.00750.00
​ZAll500.0030.00500.00
BCAll333.3414.81338.15
​FIndividual w/Ineligible Spouse333.341102.76436.10
​HIndividual living with

one EP +
500.0025.30505.30
​ZIndividual living with more than one EP333.3430.00333.34
CAKing, Kitsap, Pierce,

Snohomish, Thurston

Counties +
500.0027.00527.00
​​All other counties500.006.55506.55
DZAll30.0050.00430.00
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Not an FBR; the amount represents the FBR plus EP increment less VTR.

+ +

3 Plus increment for each EP, if appropriate.

+ +

4 Individuals/each member of a couple with income of $45.00 or less will receive a + $11.62 State-administered supplement. Individuals/each member of a couple with income + making them ineligible for SSI payments will be allowed to keep $36.62/month for personal + expenses.

+ +

5 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+ +
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
State OS

Code +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total

Payment

Levels +

+ +
AAKing, Kitsap, Pierce,

Snohomish,

Thurston

Counties +
751.0021.00772.00
​​All other counties751.000.00751.00
​ZAll751.0020.00751.00
BCAll500.6715.30505.97
​ZAll500.6720.00500.67
DZAll60.0040.00360.00
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+ +

2 Plus increment for each EP, if appropriate.

+ +

3 Individuals/each member of a couple with income of $45.00 or less will each receive + a $11.62 State-administered supplement. Individuals/each member of a couple with income + making them ineligible for SSI payments will be allowed to keep $36.62/month for personal + expenses.

+ +

4 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415031
SI 01415.031 - Federally Administered Optional Supplementary Payment Programs — January 1999 Payment Levels - 03/20/2024
+Batch run: 02/19/2025
+Rev:03/20/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2000.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2000.html new file mode 100644 index 00000000..8588d4a0 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2000.html @@ -0,0 +1,18224 @@ + + +SSA - POMS: SI 01415.032 - Federally Administered Optional Supplementary Payment Programs — 1/00 Payment Levels - 03/21/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 65 (03-24)

+

SI 01415.032 Federally Administered Optional Supplementary Payment Programs — 1/00 Payment Levels +

+ + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

CALIFORNIA

+ +
+

NEVADA

+ +
+

DELAWARE

+ +
+

NEW JERSEY

+ +
+

DISTRICT OF COLUMBIA

+ +
+

NEW YORK

+ +
+

HAWAII

+ +
+

PENNSYLVANIA

+ +
+

IOWA

+ +
+

RHODE ISLAND

+ +
+

MASSACHUSETTS

+ +
+

UTAH

+ +
+

MICHIGAN

+ +
+

VERMONT

+ +
+

MONTANA

+ +
+

WASHINGTON

+ +
+
+
+
+

A. CALIFORNIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living with Cooking Facilities — Eligible individual or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and has cooking and food storage facilities or is provided meals as part of the living + arrangement; or +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent or parents or is + a disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; or +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or +

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 7/1/83, lives in a private medical facility licensed by the State but not + certified under title XIX. (An optional supplementary A payment based on the new instructions + is payable retroactively to 7/1/83.) +

    + +
    +
    +
  10. +
+ +
+

B

+ +
+

Nonmedical Out-of-Home Care (NMOHC) - Applies when an individual/couple needs nonmedical + care or supervision in the following living arrangement situations: +

+ +

CHILDREN (UNDER AGE 18)

+ +
    +
  1. +
    +
    1. 
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Effective 10/1/79, disabled child residing in the home of a legal guardian who is + not a relative; or +

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 1/1/84, disabled child residing in the home of a relative who is not a parent + (Major v. McMahon decision), reopening a prior decision to pay OS B under this definition may be retroactive + to 1/1/84; or +

    + +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or +

    + +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    For periods prior to 7/1/83 only, a blind or disabled child placed in any home or + State licensed NMOHC facility as the result of a court order; or +

    + +
    +
    +
  14. +
+ +
​ +

ADULTS (AGE 18 AND OVER)

+ +
    +
  1. +
    +
    8. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or +

    + +
    +
    +
  2. +
  3. +
    +
    9. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in a State licensed NMOHC facility. +

    + +
    +
    +
  4. +
+ +

For California optional supplement purposes, a relative is defined as a parent, son, + daughter, brother, sister, half-brother, half-sister, uncle, aunt, niece, nephew, + first cousin, or any person of the preceding generation denoted by the prefix “grand” + or “great.” +

+ +
+

C

+ +
+

Independent Living Without Cooking Facilities — Aged or disabled individual/couple + who is neither provided any meals nor has access to adequate cooking/food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C. +

+ +
    +
  1. +
    +
    1. 
    +
    +

    An individual/couple qualifies for OS C if any of the following situations exists:

    + +
      +
    1. +
      +
      a. 
      +
      +

      Immediate living quarters do not have cooking and food storage facilities with which + the individual/couple or another person (who is responsible for preparing the individual's/couple's + meals) can prepare meals on a daily basis. +

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf. +

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals. +

      + +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for + preparation of meals. +

      + +
      +
      +
    8. +
    9. +
      +
      e. 
      +
      +

      Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the SSI applicant's/recipient's arrangement with the facility + is to purchase only shelter on a monthly basis). +

      + +
      +
      +
    10. +
    + +
    +
    +
  2. +
+ +
​ +
    +
  1. +
    +
    2. 
    +
    +

    “Adequate” cooking and food storage facilities exist when an individual /couple has + access to: +

    + +
      +
    1. +
      +
      a. 
      +
      +

      Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.) +

      + +

      OR

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls which + are used for warming food are not considered adequate cooking facilities.) +

      + +

      OR

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove or a one-burner hotplate with a temperature control. +

      + +
      +
      +
    6. +
    + +
    +
    +
  2. +
  3. +
    +
    3. 
    +
    +

    Eligibility for OS C begins in the month the applicant/recipient applies for this + supplement rate provided he/she has been without cooking and food storage facilities + throughout the month. +

    + +
    +
    +

    NOTE : For purposes of OS C, “throughout a month” does not mean the applicant/recipient must lack adequate cooking/food storage facilities from + the very first moment of the month. They need only lack them from some time on the + first day of the month. +

    + +
    +
    + +
    +
    +
  4. +
+ +
+
    +
  1. +
    +
    4. 
    +
    +

    If eligibility is based on temporary loss or nonfunctioning of an appliance, the individual + should be advised of their responsibility to report immediately when the temporary + condition has ceased. If the individual provides an expected date when the appliance + will be replaced/repaired, diary the case for recontact. +

    + +
    +
    +
  2. +
  3. +
    +
    5. 
    +
    +

    Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available. +

    + +
    +
    +
  4. +
  5. +
    +
    6. 
    +
    +

    For a couple, comprised of an aged/disabled individual and a blind individual, whose + living arrangement lacks adequate cooking and storage facilities, the couple is to + receive the SSI/SSP level for a blind/aged or disabled couple plus the restaurant + meals allowance for the disabled member of the couple. Force payment in this living + arrangement is required. +

    + +
    +
    +
  6. +
+ +
+

D

+ +
+

Living in the Household of Another — Eligible individual/couple is living in the household + of another and is receiving food and shelter from that individual. Most individuals/couples who are subject to a 1/3 reduction + of their Federal SSI payments (VTR) are eligible for OS D because the criteria for + this supplement level are the same as for charging the VTR. However, when the eligible + individual/couple lives in the home of a relative (other than a spouse) and needs + care and supervision, certification for nonmedical out-of-home care (OS F) should + be obtained from the county welfare office since this is the highest categorical supplement + for which an individual/couple can qualify. +

+ +
+

E

+ +
+

Disabled Child under Age 18 — Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage. (Until 9/30/79, a disabled child under + age 18 living with a legal guardian also fell into this category.) +

+ +
+
+

NOTE: Effective 2/1/82, only FLA A and C are compatible with OS E. If the VTR applies, + see G below. +

+ +
+
+ +
+

F

+ +
+

Nonmedical Out-of-Home Care Living in the Household of Another —Effective 2/1/82. + Applies whenever an eligible individual or couple meets the criteria for the nonmedical + out-of-home care payment rate, and is determined to receive the Federal code B payment + for living in the household of another (SI 00835.200). +

+ +
+

G

+ +
+

Disabled Child under Age 18 Living in the Household of Another —Effective 2/1/82. + Applies to a disabled (not blind) child under age 18, who resides with a parent or + relative by blood or marriage, and is determined to receive the Federal code B payment for living in the household of + another individual (SI 00835.200). +

+ +
+

J

+ +
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Eligible individual or couple who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX and not licensed + by the State (effective 7/1/83). (Prior to 7/1/83, the facility could have been licensed + by the State but not certified under title XIX.) +

    + +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+

NOTE: California is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. +

+ +
+
+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

California Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

512.00

+ +
+

180.00

+ +
+

692.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

512.00

+ +
+

237.00

+ +
+

749.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

180.00

+ +
+

692.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

512.00

+ +
+

335.00

+ +
+

847.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

512.00

+ +
+

253.00

+ +
+

765.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

512.00

+ +
+

237.00

+ +
+

749.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

253.00

+ +
+

765.00

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

512.00

+ +
+

81.00

+ +
+

593.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

341.341

+ +
+

187.66

+ +
+

529.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

341.341

+ +
+

257.66

+ +
+

599.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

341.341

+ +
+

187.66

+ +
+

529.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

341.341

+ +
+

337.66

+ +
+

679.00

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

341.341

+ +
+

79.66

+ +
+

421.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

512.00

+ +
+

237.00

+ +
+

749.00

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

512.00

+ +
+

81.00

+ +
+

593.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

14.00

+ +
+

44.00

+ +
+
+

1 rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

 

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

769.00

+ +
+

460.00

+ +
+

1,229.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

769.00

+ +
+

655.00

+ +
+

1,424.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

769.00

+ +
+

460.00

+ +
+

1,229.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

769.00

+ +
+

582.00

+ +
+

1,351.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

769.00

+ +
+

460.00

+ +
+

1,229.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

769.00

+ +
+

582.00

+ +
+

1,351.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

769.00

+ +
+

925.00

+ +
+

1,694.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

769.00

+ +
+

606.00

+ +
+

1,375.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

769.00

+ +
+

606.00

+ +
+

1,375.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

769.00

+ +
+

606.00

+ +
+

1,375.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

512.671

+ +
+

493.33

+ +
+

1006.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

512.671

+ +
+

689.33

+ +
+

1,202.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

512.671

+ +
+

493.33

+ +
+

1006.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

512.671

+ +
+

615.33

+ +
+

1,128.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

512.671

+ +
+

493.33

+ +
+

1006.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

512.671

+ +
+

615.33

+ +
+

1,128.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

512.671

+ +
+

883.33

+ +
+

1,396.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

28.00

+ +
+

88.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

B. DELAWARE +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult Residential Care Facility — Only living arrangement variation in Delaware and + includes only those recipients who are certified by the State medical unit as residents + of an adult care facility. +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — All recipients who are not included in A or Y.

+ +

Optional supplementation code Z is the proper code to be used with an “intervening” + Federal code A. (See SM 01301.535.) +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Delaware Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

512.00

+ +
+

140.00

+ +
+

652.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

341.341

+ +
+

0.00

+ +
+

341.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A +

+ +
+

A

+ +
+

All

+ +
+

769.00

+ +
+

448.00

+ +
+

1,217.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

512.671

+ +
+

0.00

+ +
+

512.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

C. DISTRICT OF COLUMBIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult Foster Care Home with 50 or Fewer Residents —Recipients who are certified by + the District of Columbia, Department of Human Services, as residents of an adult foster + care home with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult Foster Care Home with More than 50 Residents —Recipients who are certified by + the District of Columbia, Department of Human Services, as residents of an adult foster + care home with more than 50 residents. +

+ +
+

G

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — All recipients who are not included in A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

District of Columbia Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A +

+ +
+

A

+ +
+

All

+ +
+

512.00

+ +
+

370.00

+ +
+

819.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

512.00

+ +
+

417.00

+ +
+

929.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

341.341

+ +
+

0.00

+ +
+

341.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A +

+ +
+

A

+ +
+

All

+ +
+

769.00

+ +
+

869.00

+ +
+

1,638.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

769.00

+ +
+

1,089.00

+ +
+

1,858.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

512.671

+ +
+

0.00

+ +
+

512.67

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

D. HAWAII +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living — Eligible individual or couple who:

+ +
    +
  • +
    +
    •
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes. + This includes living in a “half-way house,” which is a private nonmedical facility + with whom the State has a purchase or services agreement for the short term care of + certain needy individuals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a blind or disabled child under age 18 (or age 21 if the individual qualifies as + a “protected child”) living in the household of a parent or parents. +

    + +
    +
    +
  • +
+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another — Effective 7/1/83, a supplement is no longer payable + because the combined Federal/State supplementary payment level established by the + State is lower than the FBR. +

+ +
+

H

+ +
+

Domiciliary Care I — (Maximum of five residents) - Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, nonmedical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary Care II — Same as H except care is provided for six or more residents.

+ +
+

Y

+ +
+

Optional Supplementation Waived — Eligible for, but has waived his/her right to receive + an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Eligible individual (or couple) who is living in the household + of another (see explanation in definition for optional supplement B) and an eligible + individual (or couple) who is a patient: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX.

    + +
    +
    +
  4. +
+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Hawaii Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

All

+ +
+

512.00

+ +
+

4.90

+ +
+

516.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

512.00

+ +
+

521.90

+ +
+

1033.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

512.00

+ +
+

629.90

+ +
+

1141.90

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

341.341

+ +
+

0.00

+ +
+

341.34

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

512.00

+ +
+

4.90

+ +
+

516.90

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

All

+ +
+

769.00

+ +
+

8.80

+ +
+

777.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

769.00

+ +
+

1298.80

+ +
+

2067.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

769.00

+ +
+

1514.80

+ +
+

2283.80

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

512.671

+ +
+

0.00

+ +
+

512.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

E. IOWA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in Own Household (Blind Only) — Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, does not have + an essential (EP), and is not otherwise excepted from supplementation. Also included + are blind recipients in title XIX facilities where Medicaid pays 50 percent or less of the + cost of care. Optional supplement code A is also compatible with Federal codes A and + C. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +
+

B

+ +
+

Living in the Household of Another (Blind Only) — Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C/H

+ +
+

Living with a Dependent Person — Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with him/her, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services. +

+ +

The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D/I

+ +
+

Living in a Family Life or Boarding Home — Eligible individual or each member of an + eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services. +

+ +
+

G

+ +
+

Used to indicate that no supplement is payable to a recipient living in a title XIX + facility and title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made. +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under title XIX or all recipients whose Federal payments + are reduced to $30/$60 due to living in a title XIX facility. In addition, aged and + disabled recipients whose Federal payments are not reduced and who live in a title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement. +

+ +

NOTE: The State Department of Human Services administers two optional supplementary programs + -- In-Home Health Related Care and Residential Care. +

+ +
+
+

Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Iowa Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A +

+ +
+

A

+ +
+

Blind

+ +
+

512.00

+ +
+

22.00

+ +
+

534.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

512.00

+ +
+

257.00

+ +
+

769.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

512.00

+ +
+

279.00

+ +
+

791.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

257.00

+ +
+

769.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

512.00

+ +
+

62.20

+ +
+

574.20

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

 

+ +
+

Z

+ +
+

Aged

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

341.341

+ +
+

22.00

+ +
+

363.34

+ +
+

 

+ +
+

H3

+ +
+

Aged

+ +
+

341.341

+ +
+

257.00

+ +
+

598.34

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

341.341

+ +
+

279.00

+ +
+

620.34

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

341.341

+ +
+

257.00

+ +
+

598.34

+ +
+

 

+ +
+

I3

+ +
+

All

+ +
+

341.341

+ +
+

62.20

+ +
+

403.54

+ +
+

 

+ +
+

Z

+ +
+

Aged

+ +
+

341.341

+ +
+

0.00

+ +
+

341.34

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

341.341

+ +
+

0.00

+ +
+

341.34

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

512.00

+ +
+

22.00

+ +
+

534.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

512.00

+ +
+

279.00

+ +
+

791.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

257.00

+ +
+

769.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

3 Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible + with the RMA policy computation process. +

+

State-administered programs: For Calendar Year 2000 -

+
    +
  1. +
    +
    (1) 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 1999 is $17.05 + to $23.83. The calendar year 1999 personal allowance is $71.00. Rates for calendar + year 2000 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    (2) 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 1999 for care in in-home related care is $458.20. The payment rate for calendar + year 2000 was not available for inclusion in this publication. +

    + +
    +
    +
  4. +
+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

Blind/Blind

+ +
+

769.00

+ +
+

44.00

+ +
+

813.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

769.00

+ +
+

22.00

+ +
+

791.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

769.00

+ +
+

22.00

+ +
+

791.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

769.00

+ +
+

257.00

+ +
+

1026.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

769.00

+ +
+

301.00

+ +
+

1070.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

769.00

+ +
+

257.00

+ +
+

1026.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

769.00

+ +
+

279.00

+ +
+

1048.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

769.00

+ +
+

257.00

+ +
+

1026.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

769.00

+ +
+

279.00

+ +
+

1048.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

769.00

+ +
+

399.40

+ +
+

1168.40

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

512.671

+ +
+

44.00

+ +
+

556.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

512.671

+ +
+

22.00

+ +
+

534.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

512.671

+ +
+

22.00

+ +
+

534.67

+ +
+

 

+ +
+

H3

+ +
+

Aged/Aged

+ +
+

512.671

+ +
+

257.00

+ +
+

769.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

512.671

+ +
+

301.00

+ +
+

813.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

512.671

+ +
+

257.00

+ +
+

769.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

512.671

+ +
+

279.00

+ +
+

791.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

512.671

+ +
+

257.00

+ +
+

769.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

512.671

+ +
+

279.00

+ +
+

791.67

+ +
+

 

+ +
+

I3

+ +
+

All

+ +
+

512.671

+ +
+

399.40

+ +
+

912.07

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

512.671

+ +
+

0.00

+ +
+

512.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

512.671

+ +
+

0.00

+ +
+

512.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

512.671

+ +
+

0.00

+ +
+

512.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3 Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible + with the RMA policy computation process.

+
+
+

NOTE: +

+ +
+
+

State-administered programs: For Calendar Year 2000 -

+
    +
  1. +
    +
    (1) 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 1999 is $17.05 + to $23.83. The calendar year 1999 personal allowance is $71.00. Rates for calendar + year 2000 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    (2) 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 1999 for care in-home related care is $458.20. The payment rate for calendar + year 2000 was not available for inclusion in this publication. (Members of a couple + are treated as individuals.) +

    + +
    +
    +
  4. +
+
+
+
+
+ +
+
+

F. MASSACHUSETTS +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Full Cost-of-Living:

+ +
    +
  1. +
    +
    1. 
    +
    +

    An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and are: +

    + +
      +
    1. +
      +
      a. 
      +
      +

      Living alone — Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences will be considered + living alone provided they do not use the residential kitchen facilities for preparing + meals; or +

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Living only with their eligible spouse; or

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Living with their eligible spouse and ineligible child/children 2 none of whom (children) receive public income maintenance payments3; or +

      + +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Living only with their ineligible spouse and/or their ineligible child/children, none + of whom (spouse and children) receive public income maintenance payments. +

      + +
      +
      +

      NOTE : For purposes of a. through d. above, foster children placed with anyone other than + their parents are not considered to be living with the foster parent. +

      + +
      +
      + +
      +
      +
    8. +
    + +
    +
    +
  2. +
+ +
+
    +
  1. +
    +
    2. 
    +
    +

    An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments. +

    + +
    +
    +
  2. +
  3. +
    +
    3. 
    +
    +

    An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in 1. or 2. above will be in State living arrangement A if they + pay at least two-thirds of the household expenses. In making a determination as to + whether the individual pays two-thirds or more of the expenses, use the method defined + in SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses. +

    + +
    +
    +
  4. +
+ +

A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +
+

B

+ +
+

Shared Living Expenses — An individual who is in Federal living arrangement A or C + and who does not meet the criteria listed for State living arrangement A, E or G is + in State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH). +

+ +
+

 

+ +
+

Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined above. Also included are individuals placed + under the auspices of the State adult foster care program and residents of publicly + operated emergency shelters throughout a month. +

+ +

An individual living in a household where all members receive public income maintenance + payments unless they are paying at least two-thirds of the household expenses (A). +

+ +

An individual living in a mixed household — i.e., a household where one or more other + members receive a public income maintenance payment —also is included unless the individual + is paying at least two-thirds of the household expenses (A). +

+ +
+

C

+ +
+

Living in the Household of Another — Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third. +

+ +
+

E

+ +
+

Licensed Rest Home — Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home. +

+ +
+

F

+ +
+

Effective 7/1/87, the State elected Federal administration of this optional State + supplementary payment to residents of title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Assisted Living — Effective 7/1/94, the State elected Federal administration of this + variation. Includes an individual, certified by the State to be residing in an Assisted + Living residence served by a certified Group Adult Foster Care provider, who is not + receiving assistance under any other Federal or State rental assistance program, and + who pays a fixed, non-separable fee for rent and supportive services, other than medically + necessary services reimbursed by Medicaid. The State shall certify to SSA each individual + who is eligible for this optional supplement living arrangement. This living arrangement + was discontinued effective 1/1/96. However, it has been restored, retroactively, to + 1/1/97. +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+
+

Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. +

+

1For purposes of determining State living arrangements, a commercial boarding house, + foster home, or halfway house is not considered the person's household.

+

2Use the SSI definition of child, SI 00501.400.

+

3A public income maintenance payment is a payment from any of the following programs: + Aid to Families with Dependent Children (AFDC), SSI, the Refugee Act of 1980, the + Disaster Relief Act of 1974, general assistance programs of the Bureau of Indian + Affairs, State or local government income maintenance programs that are based on + need, or Department of Veterans Affairs benefits based on need.

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Massachusetts Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

512.00

+ +
+

128.82

+ +
+

640.82

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

512.00

+ +
+

149.74

+ +
+

661.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

114.39

+ +
+

626.39

+ +
+

 

+ +
+

B

+ +
+

Aged

+ +
+

512.00

+ +
+

39.26

+ +
+

551.26

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

512.00

+ +
+

149.74

+ +
+

661.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

30.40

+ +
+

542.40

+ +
+

 

+ +
+

E

+ +
+

Aged

+ +
+

512.00

+ +
+

293.00

+ +
+

805.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

512.00

+ +
+

149.74

+ +
+

661.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

293.00

+ +
+

805.00

+ +
+

 

+ +
+

G

+ +
+

Aged

+ +
+

512.00

+ +
+

454.00

+ +
+

966.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

512.00

+ +
+

454.00

+ +
+

966.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

454.00

+ +
+

966.00

+ +
+

B

+ +
+

C

+ +
+

Aged

+ +
+

341.341

+ +
+

104.36

+ +
+

445.70

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

341.341

+ +
+

320.40

+ +
+

661.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

341.341

+ +
+

87.58

+ +
+

428.92

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

512.00

+ +
+

149.74

+ +
+

661.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

114.39

+ +
+

626.39

+ +
+

 

+ +
+

B

+ +
+

Blind

+ +
+

512.00

+ +
+

149.74

+ +
+

661.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

512.00

+ +
+

30.40

+ +
+

542.40

+ +
+

D

+ +
+

F

+ +
+

All

+ +
+

30.002

+ +
+

35.00

+ +
+

65.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A +

+ +
+

A

+ +
+

Aged/Aged

+ +
+

769.00

+ +
+

201.72

+ +
+

970.72

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

769.00

+ +
+

554.48

+ +
+

1323.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

769.00

+ +
+

180.06

+ +
+

949.06

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

769.00

+ +
+

378.10

+ +
+

1147.10

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

769.00

+ +
+

190.89

+ +
+

959.89

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

769.00

+ +
+

367.27

+ +
+

1136.27

+ +
+

 

+ +
+

B

+ +
+

Aged/Aged

+ +
+

769.00

+ +
+

201.72

+ +
+

970.72

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

769.00

+ +
+

554.48

+ +
+

1323.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

769.00

+ +
+

180.06

+ +
+

949.06

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

769.00

+ +
+

378.10

+ +
+

1147.10

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

769.00

+ +
+

190.89

+ +
+

959.89

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

769.00

+ +
+

367.27

+ +
+

1136.27

+ +
+

 

+ +
+

E

+ +
+

Aged/Aged

+ +
+

769.00

+ +
+

841.00

+ +
+

1610.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

769.00

+ +
+

554.48

+ +
+

1323.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

769.00

+ +
+

841.00

+ +
+

1610.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

769.00

+ +
+

697.74

+ +
+

1466.74

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

769.00

+ +
+

841.00

+ +
+

1610.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

769.00

+ +
+

697.74

+ +
+

1466.74

+ +
+

 

+ +
+

G

+ +
+

Aged/Aged

+ +
+

769.00

+ +
+

681.00

+ +
+

1450.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

769.00

+ +
+

681.00

+ +
+

1450.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

769.00

+ +
+

681.00

+ +
+

1450.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

769.00

+ +
+

681.00

+ +
+

1450.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

769.00

+ +
+

681.00

+ +
+

1450.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

769.00

+ +
+

681.00

+ +
+

1450.00

+ +
+

B

+ +
+

C

+ +
+

Aged/Aged

+ +
+

512.671

+ +
+

215.80

+ +
+

728.47

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

512.671

+ +
+

810.80

+ +
+

1323.47

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

512.671

+ +
+

194.18

+ +
+

706.85

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

512.671

+ +
+

513.30

+ +
+

1025.97

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

512.671

+ +
+

204.99

+ +
+

717.66

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

512.671

+ +
+

502.49

+ +
+

1015.16

+ +
+

D

+ +
+

F

+ +
+

All

+ +
+

 60.002

+ +
+

70.00

+ +
+

130.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

G. MICHIGAN +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D +

+ +
+

Domiciliary Care — Recipients residing in licensed nonmedical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal Care — Recipients residing in licensed nonmedical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the Aged — Recipients residing in a nonmedical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care. +

+ +
+

G

+ +
+

Independent Living with an EP — Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.) +

+ +
+

H

+ +
+

Living in the Household of Another with an EP —Recipients with an EP and living in + the household of another for Federal purposes. (Children under age 18 are excluded.) +

+ +
+

I

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under title XIX. +

+ +
+
+

 

+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+
+

Michigan Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

D

+ +
+

All

+ +
+

512.00

+ +
+

87.00

+ +
+

599.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

512.00

+ +
+

157.50

+ +
+

669.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

512.00

+ +
+

179.30

+ +
+

691.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

769.002

+ +
+

14.00

+ +
+

783.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

512.671

+ +
+

9.33

+ +
+

522.00

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 30.003

+ +
+

7.00

+ +
+

37.00

+ +
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

 

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

D

+ +
+

All

+ +
+

769.00

+ +
+

429.00

+ +
+

1198.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

769.00

+ +
+

570.00

+ +
+

1339.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

769.00

+ +
+

613.60

+ +
+

1382.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1026.002

+ +
+

21.00

+ +
+

1047.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

684.001

+ +
+

14.00

+ +
+

698.00

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 60.003

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

 

+
+
+
+
+ +
+
+

H. MONTANA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-Certified Personal Care

+ +
+

H

+ +
+

State-Certified Residence in Community Home for Mentally Disabled

+ +
+

I

+ +
+

State-Certified Residence in Community Home for Physically or Developmentally Disabled

+ +
+

J

+ +
+

State-Certified Residence for Child and Adult Foster Care

+ +
+

K

+ +
+

State-Certified Semi-Independent Care

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Includes all individuals and couples not certified in State + codes G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Montana Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

G

+ +
+

All

+ +
+

512.00

+ +
+

94.00

+ +
+

606.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

512.00

+ +
+

94.00

+ +
+

606.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

512.00

+ +
+

94.00

+ +
+

606.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

512.00

+ +
+

52.75

+ +
+

564.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

512.00

+ +
+

26.00

+ +
+

538.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

341.341

+ +
+

0.00

+ +
+

341.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

G

+ +
+

All

+ +
+

769.00

+ +
+

193.00

+ +
+

962.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

769.00

+ +
+

193.00

+ +
+

962.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

769.00

+ +
+

193.00

+ +
+

962.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

769.00

+ +
+

110.50

+ +
+

879.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

769.00

+ +
+

57.00

+ +
+

826.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

512.671

+ +
+

0.00

+ +
+

512.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

I. NEVADA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living or Living in Parental Household — Aged or blind eligible individual + or couple who: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes; + or +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. (See SM 01301.535.)

+ +
+

B

+ +
+

Living in the Household of Another — Aged or blind eligible individual or couple who + is living in the household of another individual and receiving food and shelter from that individual. Aged or blind individuals or couples, who are subject + to a one-third reduction of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B. +

+ +
+

C

+ +
+

Domiciliary Care — Aged or blind eligible individual or couple who lives in a private + nonmedical facility or, as of 10/76, a residential facility serving 16 or fewer persons, + which provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — No supplement cases include:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individuals or disabled members of eligible couples; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individuals or members of eligible couples in a medical facility where title + XIX pays more than 50 percent of the cost; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individuals or members of eligible couples who are patients in a private + medical facility which is not certified under title XIX; or +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    + +
    +
    +
  8. +
+ +
+
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Nevada Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

Aged

+ +
+

512.00

+ +
+

36.40

+ +
+

548.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

512.00

+ +
+

109.30

+ +
+

621.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

512.00

+ +
+

350.00

+ +
+

862.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

512.00

+ +
+

350.00

+ +
+

862.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

341.341

+ +
+

24.27

+ +
+

365.61

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

341.341

+ +
+

213.96

+ +
+

555.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

341.341

+ +
+

0.00

+ +
+

341.34

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

512.00

+ +
+

109.30

+ +
+

621.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

Aged/Aged

+ +
+

769.00

+ +
+

74.46

+ +
+

843.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

769.00

+ +
+

374.60

+ +
+

1143.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

769.00

+ +
+

224.53

+ +
+

993.53

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

769.00

+ +
+

37.23

+ +
+

806.23

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

769.00

+ +
+

187.30

+ +
+

956.30

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

769.00

+ +
+

881.00

+ +
+

1650.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

769.00

+ +
+

881.00

+ +
+

1650.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

769.00

+ +
+

881.00

+ +
+

1650.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

769.00

+ +
+

440.50

+ +
+

1209.50

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

769.00

+ +
+

440.50

+ +
+

1209.50

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

512.671

+ +
+

49.64

+ +
+

562.31

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

512.671

+ +
+

531.94

+ +
+

1044.61

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

512.671

+ +
+

290.79

+ +
+

803.46

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

512.671

+ +
+

24.82

+ +
+

537.49

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

512.671

+ +
+

265.97

+ +
+

778.64

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

512.671

+ +
+

0.00

+ +
+

512.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

J. NEW JERSEY +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Licensed Residential Health Care Facilities and Certain Licensed Residential Facilities + — The State provides New Jersey field offices with lists of approved facilities. Mentally + retarded individuals must be placed and supervised by either the State Department + of Youth and Family Services or the State Division of Mental Retardation. +

+ +
+

B

+ +
+

Living Alone or with Others — Eligible individuals (including children) or eligible + couples whose Federal living arrangements are A or C and who do not meet the requirements + defined in other supplementation categories. +

+ +

Therefore, effective 8/1/81, any eligible adult/couple who meets the requirement for + a Federal code A will be in optional supplement B unless residing in a residential + health care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code C will automatically be + entitled to optional supplement B. +

+ +

This category includes, but is not limited to, those eligible adults/couples who are:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

C

+ +
+

Living Alone with an Ineligible Spouse — Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse will receive the same total payment as an eligible + couple or an individual with an EP. Once other persons, even minor children, are present + in the household, this supplementary payment variation cannot exist. However, it is + possible that a claimant and their ineligible spouse live with others and allege that + they are a separate “household” by virtue of the fact that they eat their meals out + or have separate purchase and preparation of food. In this instance, an optional supplement + C is permissible as long as no other person is in their “household.” There is no couple + counterpart in this category. +

+ +

Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B. +

+ +

A transient individual who co-exists only with an ineligible spouse will also qualify + for the O/S - C rate. +

+ +
+

D

+ +
+

Living in the Household of Another — Persons who are “living in the household of another” + for Federal purposes. +

+ +
+

G

+ +
+

Effective 9/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Individuals and couples in licensed medical facilities where + Medicaid is paying more than 50 percent of the cost of care, individuals and couples + in publicly operated community residences having 16 or less residents, and residents + of publicly operated emergency shelters throughout a month. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

New Jersey Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

All

+ +
+

512.00

+ +
+

150.05

+ +
+

662.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

512.00

+ +
+

31.25

+ +
+

543.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

512.00

+ +
+

282.36

+ +
+

794.36

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

769.002

+ +
+

25.36

+ +
+

794.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

341.341

+ +
+

44.31

+ +
+

385.65

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

512.00

+ +
+

31.25

+ +
+

543.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 30.003

+ +
+

10.00

+ +
+

40.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

All

+ +
+

769.00

+ +
+

536.36

+ +
+

1305.36

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

769.00

+ +
+

25.36

+ +
+

794.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

512.671

+ +
+

93.09

+ +
+

605.76

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 60.002

+ +
+

20.00

+ +
+

80.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

K. NEW YORK +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone — Eligible individuals or eligible couples living physically alone, or + living with only a foster child(ren), or a homemaker authorized by the local Department + of Social Services (DSS), or a family care recipient(s) placed by the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabled (OMRDD) + or local DSS, or individuals living with others but paying a “flat fee for room and + board,” or living with others but taking all their meals outside the dwelling unit, + or living with others in a dwelling but separately preparing food, or having their + food separately prepared for them. +

+ +
+

B

+ +
+

Living with Others — Individual/child/couple who resides in a dwelling with others + and prepares food in common with at least one other person in the dwelling, or is + a member of a religious community, or child in any living arrangement other than a + family care home (Level I) or community residence (Level II) certified by OMRDD or + OMH. +

+ +
+

C

+ +
+

Congregate Care Level I — Family type homes and family care homes. Family type homes + are facilities operated for the purpose of providing long-term residential care for + adults and are certified by the New York State DSS and supervised by local departments + of social services. Family care homes are private households which provide care for + mentally disabled persons. +

+ +
+

D

+ +
+

Congregate Care Level II — Residential facilities for adults and certain children + with mental disabilities. +

+ +
+

E

+ +
+

Congregate Care Level III — Privately operated nonmedical residential facilities. + Although Level III facilities are often called schools, these facilities may not meet + the Federal definition of school. Operated for the purpose of providing treatment, + training and education for mentally retarded or developmentally disabled individuals, + these facilities are certified by OMRDD in accordance with State regulations. +

+ +
+

F

+ +
+

Living in the Household of Another — Same as Federal definition. The State supplementary + payment for the individual/child/couple whose Federal benefit rate is subject to the + one-third reduction is the “living with others” rate but for systems purposes is coded + F. +

+ +
+

G

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Recipients in licensed medical facilities where Medicaid is + paying more than 50 percent of the cost of care, recipients in publicly operated community + residences which serve 16 or fewer residents, and residents of publicly operated emergency + shelters throughout a month. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

New York Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A,C +

+ +
+

A

+ +
+

All

+ +
+

512.00

+ +
+

87.00

+ +
+

599.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

512.00

+ +
+

23.00

+ +
+

535.00

+ +
+

 

+ +
+

C

+ +
+

NY City

+ +
+

512.00

+ +
+

266.48

+ +
+

778.48

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

512.00

+ +
+

266.48

+ +
+

778.48

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

512.00

+ +
+

228.48

+ +
+

740.48

+ +
+

 

+ +
+

D

+ +
+

NY City

+ +
+

512.00

+ +
+

435.00

+ +
+

947.00

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

512.00

+ +
+

435.00

+ +
+

947.00

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

512.00

+ +
+

405.00

+ +
+

917.00

+ +
+

 

+ +
+

E

+ +
+

NY City

+ +
+

512.00

+ +
+

482.96

+ +
+

994.96

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

512.00

+ +
+

458.96

+ +
+

970.96

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

512.00

+ +
+

458.96

+ +
+

970.96

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

B

+ +
+

F

+ +
+

All

+ +
+

341.341

+ +
+

23.00

+ +
+

364.34

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 30.002

+ +
+

5.003

+ +
+

35.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3New York administers a supplement of $20 to some recipients in a title XIX institution. +

+

4Includes and applies to: Nassau, Rockland, Suffolk, and Westchester counties.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A,C +

+ +
+

A

+ +
+

All

+ +
+

769.00

+ +
+

104.00

+ +
+

873.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

769.00

+ +
+

46.00

+ +
+

815.00

+ +
+

 

+ +
+

C

+ +
+

NY City

+ +
+

769.00

+ +
+

787.96

+ +
+

1556.96

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

769.00

+ +
+

787.96

+ +
+

1556.96

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

769.00

+ +
+

711.96

+ +
+

1480.96

+ +
+

 

+ +
+

D

+ +
+

NY City

+ +
+

769.00

+ +
+

1125.00

+ +
+

1894.00

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

769.00

+ +
+

1125.00

+ +
+

1894.00

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

769.00

+ +
+

1065.00

+ +
+

1834.00

+ +
+

 

+ +
+

E

+ +
+

NY City

+ +
+

769.00

+ +
+

1220.92

+ +
+

1989.92

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

769.00

+ +
+

1172.92

+ +
+

1941.92

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

769.00

+ +
+

1172.92

+ +
+

1941.92

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

B

+ +
+

F

+ +
+

All

+ +
+

512.671

+ +
+

46.00

+ +
+

558.67

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

10.003

+ +
+

70.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3New York administers a supplement of $20 to some recipients in a title XIX institution. +

+

4Includes and applies to: Nassau, Rockland, Suffolk, and Westchester counties.

+

 

+
+
+
+
+ +
+
+

L. PENNSYLVANIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone — Recipients in private medical facilities (nursing homes, hospitals, + intermediate care facilities) where title XIX is not paying more than 50 percent of the cost of care, residents of publicly operated emergency + shelters throughout a month, and all other individuals and couples in Federal codes + A and C not meeting the definition of another variation. +

+ +

Used with an “intervening” Federal code A. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another — Recipients who do not have an EP and who live + in the household of another and receive support and maintenance for Federal purposes. +

+ +
+

C

+ +
+

Living with an EP — Recipients who are not living in the household of another or in + a foster care home for adults and who have one or more Ips as defined under the Federal + rules; i.e., Public Law 93-66. +

+ +
+

D

+ +
+

Living in the Household of Another with an EP —Recipients who live in the household + of another and who have one or more EPs as defined under the Federal rules; i.e., + Public Law 93-66. +

+ +
+

G

+ +
+

Living in a Domiciliary Care Facility — Adult persons (age 18 and over) certified + by the State to be residing in nonmedical residential care facilities. +

+ +
+

H

+ +
+

Living in a Personal Care Boarding Home — Adult Persons (age 18 and over) certified + by the State to be residing in nonmedical residential care facilities (Effective 7/1/89). +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Includes all recipients who are residing in a medical facility + in which title XIX is paying more than 50 percent of the cost of care. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+
+

Pennsylvania Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

All

+ +
+

512.00

+ +
+

27.40

+ +
+

539.40

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

769.003

+ +
+

43.70

+ +
+

812.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

512.00

+ +
+

329.30

+ +
+

841.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

512.00

+ +
+

334.30

+ +
+

846.30

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

341.341

+ +
+

27.40

+ +
+

368.74

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

512.002

+ +
+

43.70

+ +
+

555.70

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

512.00

+ +
+

27.40

+ +
+

539.40

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

 

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

All

+ +
+

  769.00

+ +
+

43.70

+ +
+

812.70

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1026.003

+ +
+

68.05

+ +
+

1094.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

  769.00

+ +
+

737.40

+ +
+

1506.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

  769.00

+ +
+

747.40

+ +
+

1516.40

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

  512.671

+ +
+

43.70

+ +
+

556.37

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

684.002

+ +
+

68.05

+ +
+

752.05

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

M. RHODE ISLAND +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone — Recipients who are in Federal codes A and C.

+ +

Used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied. +

+ +
+

D

+ +
+

Living in a Shelter Care Facility (Effective 10/1/90). Revised to: Residential Care/Assisted + Living - Adult Individuals Only (Effective 10/1/98). +

+ +
+

E

+ +
+

The State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 3/1/91). +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Residents of publicly operated emergency shelters throughout + a month and recipients who are subject to the $30-per-month SSI payment limit because + they are inpatients in medical facilities receiving more than 50 percent of the cost + of care from the State's Medicaid program. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Rhode Island Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A1

+ +
+

All

+ +
+

512.00

+ +
+

64.35

+ +
+

576.35

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

512.00

+ +
+

582.00

+ +
+

1094.00

+ +
+

B

+ +
+

B1

+ +
+

All

+ +
+

341.342

+ +
+

74.60

+ +
+

415.94

+ +
+

C

+ +
+

A1

+ +
+

All

+ +
+

512.00

+ +
+

64.35

+ +
+

576.35

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

 30.003

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

 

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A1

+ +
+

All

+ +
+

769.00

+ +
+

120.50

+ +
+

889.50

+ +
+

B

+ +
+

B1

+ +
+

All

+ +
+

512.672

+ +
+

136.50

+ +
+

649.17

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

 60.003

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

N. UTAH +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone or With Others — This variation includes recipients who are in Federal + codes A and C. +

+ +
+

B

+ +
+

Living in the Household of Another — Recipients with no EP who are “living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.) +

+ +
+

Z

+ +
+

No Supplement Cases — No supplement cases include all recipients who are not included + in A or B. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Utah Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A,C

+ +
+

Z

+ +
+

All

+ +
+

512.00

+ +
+

0.00

+ +
+

512.00

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

341.342

+ +
+

3.13

+ +
+

344.47

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

2Not an FBR; the amount represents the FBR less VTR.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A,C +

+ +
+

A

+ +
+

All

+ +
+

769.00

+ +
+

4.60

+ +
+

773.60

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

512.672

+ +
+

9.73

+ +
+

522.40

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

2 Not an FBR; the amount represents the FBR less VTR.

+

 

+
+
+
+
+ +
+
+

O. VERMONT +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Independent Living (except Chittenden County) — Recipients not living in the household + of another, not in a custodial care situation, and not otherwise excepted from supplementation. + Includes a child who is living with a parent and recipients residing in a private + title XIX facility where Medicaid is not paying more than 50 percent of the cost of + care. +

+ +

Effective 5/1/83, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A (except Chittenden County). +

+ +
+

B

+ +
+

Independent Living in Chittenden County — Same as A above except restricted to residents + of Chittenden County. +

+ +

Effective 5/1/83, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +

+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A (Chittenden County only). (See SM 01301.535.) +

+ +
+

C

+ +
+

Assistive Community Care Level III: Recipients living in facilities identified by + the State. +

+ +
+

E

+ +
+

Living in the Household of Another — Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions), and not otherwise excepted from supplementation. +

+ +
+

F

+ +
+

Custodial Care: Licensed Home with Limited Nursing Care —Recipients living in Level + III Community Homes identified by the State. State administration effective 7/1/99. +

+ +
+

G

+ +
+

Custodial Care: Licensed Community Care Home — Recipients living in Level IV Community + Homes identified by the State. +

+ +
+

H

+ +
+

Custodial Care: Family Home — Recipients living in another's home in such a manner + that the individual or couple is paying room and board and is receiving one or more + of the services outlined under the custodial care definition. The individual or couple + must also receive the room and board and custodial care in the home in which they + reside. In order to qualify as a home under this arrangement, these services must + not be provided to more than two persons and must be provided by a resident of the + home. +

+ +

In addition to the above individuals, the Vermont Community Mental Health Agency and + Department of Mental Health have established outplacement programs which provide a + family home setting to no more than two persons in need of custodial care or supervision. + The individuals placed in this setting are eligible for this arrangement only if a + third party resides with the individual and provides the custodial care. +

+ +

Custodial care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service 2-3 times a week) and/or + supervision for the recipient's protection. Supervision for the recipient's protection + deals primarily with protection services for retarded and emotionally disturbed individuals. + A person who receives one or more of these personal services is receiving custodial + care. +

+ +

The change in this arrangement is effective for initial claims filed on or after 1/1/84. + For redeterminations the change is effective with the month after the month in which + the first redetermination on or after 1/1/84, is initiated. +

+ +

This arrangement does not cover:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Institutional Living — Regardless of whether custodial care is needed in addition + to the medical, training, rehabilitation, educational or similar services as the primary + function of the institution. +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    A person whose Federal living arrangement is based on home ownership or rental liability. + (A flat fee for room and board per SI 00835.120B. is not considered as rental liability for this arrangement.) +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    A child under age 18 not placed by a Vermont Community Mental Health Agency or the + Vermont Department of Mental Health. +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Custodial care or supervision provided by a spouse (as defined by Federal regulations).

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Any home or boarding arrangement which does not meet the Federal SSI definition of + independent living, Federal code A. +

    + +
    +
    +
  10. +
+ +
+

I

+ +
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents in title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of the care. +

+ +
+
+

NOTE: When a person has a room in one facility/household and receives board or custodial + care in another facility/household, the custodial rate (C, G, or H) is based on the + facility/household where the person sleeps. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Vermont Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

512.00

+ +
+

57.66

+ +
+

569.66

+ +
​ +

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

512.00

+ +
+

57.66

+ +
+

569.66

+ +
​ +

C

+ +
+

All

+ +
+

512.00

+ +
+

47.25

+ +
+

559.25

+ +
​ +

G

+ +
+

All

+ +
+

512.00

+ +
+

218.69

+ +
+

730.69

+ +
​ +

H

+ +
+

All

+ +
+

512.00

+ +
+

96.38

+ +
+

608.38

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

341.341

+ +
+

38.38

+ +
+

379.72

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

512.00

+ +
+

57.66

+ +
+

569.66

+ +
​ +

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

512.00

+ +
+

57.66

+ +
+

569.66

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 30.002

+ +
+

17.25

+ +
+

47.25

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

769.00

+ +
+

108.28

+ +
+

877.28

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

769.00

+ +
+

108.28

+ +
+

877.28

+ +
​ +

C

+ +
+

All

+ +
+

769.00

+ +
+

94.50

+ +
+

863.50

+ +
​ +

G

+ +
+

All

+ +
+

769.00

+ +
+

548.89

+ +
+

1317.89

+ +
​ +

H

+ +
+

All

+ +
+

769.00

+ +
+

325.02

+ +
+

1094.02

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

512.671

+ +
+

47.18

+ +
+

559.85

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 60.002

+ +
+

34.50

+ +
+

94.50

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

3. Coding and Monthly Payment Levels +

+
+
+
+

Vermont Effective 9/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

512.00

+ +
+

59.04

+ +
+

571.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

512.00

+ +
+

59.04

+ +
+

571.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

512.00

+ +
+

48.38

+ +
+

560.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

512.00

+ +
+

223.94

+ +
+

735.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

512.00

+ +
+

98.69

+ +
+

610.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

341.341

+ +
+

39.30

+ +
+

380.64

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

512.00

+ +
+

59.04

+ +
+

571.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

512.00

+ +
+

59.04

+ +
+

571.04

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 30.002

+ +
+

17.66

+ +
+

47.66

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

769.00

+ +
+

110.88

+ +
+

879.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

769.00

+ +
+

110.88

+ +
+

879.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

769.00

+ +
+

96.77

+ +
+

865.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

769.00

+ +
+

562.06

+ +
+

1331.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

769.00

+ +
+

332.82

+ +
+

1101.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

512.671

+ +
+

48.31

+ +
+

560.98

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 60.002

+ +
+

35.33

+ +
+

95.33

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

P. WASHINGTON +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone — Recipients who are “living in own household” under title XVI. If an + eligible individual/couple is determined to be living in own household (Federal living + arrangement A) for title XVI, the eligible individual/couple will usually be in a + living alone arrangement for State supplementation purposes. +

+ +

This variation includes:

+ +
    +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples living in private households, whether they + are renting, buying, own their home, or have an interest in the home (e.g., a life + estate). The household may be in a house, room, college dormitory, apartment, hotel, + motel, etc. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples living in board and room situations. This + includes commercial, benevolent, religious, or fraternal board and room accommodations. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples residing in homes approved as congregate + care facilities (group homes). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples residing in publicly operated community-based + residences of 16 or fewer beds. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individuals and eligible couples residing in adult family homes. Adult family + homes are homes that provide board, room, and laundry. They may also provide necessary + supervision, personal and social services, and, when appropriate, a minimum of nursing + care, and are approved for payment and licensed by the State Department of Social + and Health Services. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    An eligible individual living with an ineligible spouse when natural, step, adoptive + or foster children under age 18 whose needs are included in determining an AFDC grant + are residing in the same household. In these cases we assume that the ineligible spouse's + income has been considered in determining the AFDC payment unless the couple is living + in a holding-out relationship. (Where the holding-out spouse has income, the local + Department of Social and Health Services office must be contacted to determine whether + that income has been considered in an AFDC payment.) This variation does not include + an eligible individual living with an ineligible spouse and grandchildren under age + 18 whose needs are included in determining an AFDC grant. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A child in a Federal code A or C living arrangement.

    + +
    +
    +
  • +
+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + A code. (See SM 01301.535.) +

+ +

Exceptions

+ +

Optional supplement A is not paid when:

+ +
    +
  1. +
    +
    a. 
    +
    +

    An individual is living in a medical care facility throughout an entire calendar month;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    An eligible individual has more than one EP;

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    An eligible couple has one or more EPs; and

    + +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    An eligible individual or couple is residing in a public emergency shelter for the + homeless (effective 5/83). +

    + +
    +
    +
  8. +
+ +
+

B

+ +
+

Living Alone with an Ineligible Spouse — Eligible individual who is the head of the + household and who lives alone as described in A above and is living with an ineligible + spouse. An ineligible spouse is a spouse who has either not applied for SSI benefits, + has been denied or terminated, or has withdrawn his/her application. It is not material + whether the ineligible spouse is aged, blind, or disabled. An ineligible spouse includes: +

+ +
    +
  • +
    +
    •
    +
    +

    Legally married and common-law spouses;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “Holding-out” spouses;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Alien spouses not lawfully admitted to the U.S.; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Refugee spouses receiving payments.

    + +

    NOTE: Refugee payments are not deemable to the eligible individual. +

    + +
    +
    +
  • +
+ +

In determining whether an ineligible spouse is a member of the household for the purpose + of paying the optional supplement B to the eligible individual, use the same rules + for making Federal determinations. If an eligible individual marries, or a separated + spouse returns home, the ineligible spouse supplement is paid beginning with the month + after the month of the arrival of the ineligible spouse in the household. +

+ +

Exceptions

+ +

Optional supplement B is not paid when: (1) an individual with an ineligible spouse + also has child(ren) under age 18 whose needs are considered in determining an AFDC + grant. Rather, the optional supplement A is paid. This is true whether or not the + ineligible spouse is actually included on the AFDC grant; (2) an eligible individual + resides in a public emergency shelter for the homeless (effective 5/83). In this case, + use optional supplementation code Z. +

+ +
+

C

+ +
+

Living in the Household of Another — Applies to most cases which meet the Federal + definition of living in the household of another (Federal code B). +

+ +

Exceptions

+ +

Not paid when: (1) an individual lives in the household of another with more than + one EP; or (2) a couple lives in the household of another with one or more EPs. In + both of these cases the optional supplementation code is Z. +

+ +
+

F

+ +
+

Living in the Household of Another with an Ineligible Spouse — Individuals living + in the household of another (Federal code B) who have an ineligible spouse or an EP. +

+ +

Exception

+ +

Individuals with more than one EP are not eligible for an optional supplement.

+ +
+

G

+ +
+

Living with an EP — Applies to an eligible individual who is the head of the household + and who lives alone as described in A above and was converted from the 12/73 State + rolls with an EP who has continued to live in the household. The system will pay the + optional supplement for an EP. If an eligible individual has more than one EP use + optional supplementation code Z. +

+ +
+

H

+ +
+

Living in the Household of Another with an EP — Applies to individuals living in the + household of another who have an EP. Individuals with more than one EP are not eligible + for an optional supplement. +

+ +
+

Y

+ +
+

Optional Supplementation Waived — Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases — The following groups are ineligible for a federally administered + optional supplement: +

+ +
    +
  • +
    +
    •
    +
    +

    An individual with more than one EP.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A couple with one or more EPs.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals residing in a medical facility throughout a month, regardless of whether + private or public, or if Medicaid is involved in reimbursement for the cost of the + care. (If only one member of an eligible couple is in a medical facility, determine + the optional supplement variation that applies to the other member separately.) The + term “medical facility” includes hospitals, nursing homes, and extended care facilities, + but does not include boarding schools, congregate care facilities, and half-way houses. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Residents of publicly operated emergency shelters throughout a month, effective 5/83.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Washington Effective 1/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

A

+ +

 

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +
+

512.00

+ +
+

27.00

+ +
+

539.00

+ +
+

All other counties

+ +
+

512.00

+ +
+

6.55

+ +
+

518.55

+ +
+

B

+ +

 

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +
+

512.00

+ +
+

167.20

+ +
+

679.20

+ +
+

All other counties

+ +
+

512.00

+ +
+

137.25

+ +
+

649.25

+ +
+

G

+ +

 

+ +
+

Individual with one EP King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +
+

769.00

+ +
+

21.00

+ +
+

790.00

+ +
+

Individual with one EP All other counties

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

Z

+ +
+

All

+ +
+

512.003

+ +
+

0.00

+ +
+

512.00

+ +
+

B

+ +

 

+ +

 

+ +

 

+ +
+

C

+ +
+

All

+ +
+

341.341

+ +
+

4.81

+ +
+

346.15

+ +
+

F

+ +
+

Individual w/Ineligible Spouse

+ +
+

341.341

+ +
+

102.76

+ +
+

444.10

+ +
+

H

+ +
+

Individual living with one EP

+ +
+

512.002

+ +
+

5.30

+ +
+

517.30

+ +
+

Z

+ +
+

Individual living with more than one EP

+ +
+

341.343

+ +
+

0.00

+ +
+

341.34

+ +
+

C

+ +

 

+ +
+

A

+ +

 

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +
+

512.00

+ +
+

27.00

+ +
+

539.00

+ +
+

All other counties

+ +
+

512.00

+ +
+

6.55

+ +
+

518.55

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.005

+ +
+

0.004

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

3Plus increment for each EP, if appropriate.

+

4Individuals/each member of a couple with income of $45.00 or less will receive a + $11.62 State-administered supplement. Individuals/each member of a couple with income + making them ineligible for SSI payments will be allowed to keep $36.62 a month for + personal expenses.

+

5Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +

 

+ +

 

+ +
+

A

+ +

 

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +
+

769.00

+ +
+

21.00

+ +
+

790.00

+ +
+

All other counties

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

Z

+ +
+

All

+ +
+

769.002

+ +
+

0.00

+ +
+

769.00

+ +
+

B

+ +

 

+ +
+

C

+ +
+

All

+ +
+

512.671

+ +
+

5.30

+ +
+

517.97

+ +
+

Z

+ +
+

All

+ +
+

512.672

+ +
+

0.00

+ +
+

512.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.004

+ +
+

0.003

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Plus increment for each EP, if appropriate.

+

3 Individuals/each member of a couple with income of $45.00 or less will each receive + a $11.62 State-administered supplement. Individuals/each member of a couple with + income making them ineligible for SSI payments will be allowed to keep $36.62 a month + for personal expenses.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution

+
+
+
+
+

3. Coding and Monthly Payment Levels +

+
+
+
+

Washington Effective 11/1/00

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +
+

512.00

+ +

 

+ +
+

22.90

+ +
+

534.90

+ +
+

All other counties

+ +
+

512.00

+ +
+

2.45

+ +
+

514.45

+ +
+

B

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

All other counties

+ +
+

512.00

+ +

 

+ +

512.00

+ +
+

167.20

+ +

 

+ +

137.25

+ +
+

679.20

+ +

 

+ +

649.25

+ +
+

G

+ +
+

Individual with one EP King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

Individual with one EP All other Counties

+ +
+

769.00

+ +

 

+ +

769.00

+ +

 

+ +
+

21.00

+ +

 

+ +

 

+ +

0.00

+ +
+

790.00

+ +

 

+ +

 

+ +

769.00

+ +
+

Z

+ +
+

All

+ +
+

512.001

+ +
+

0.00

+ +
+

512.00

+ +
+

B

+ +

 

+ +

 

+ +

 

+ +
+

C

+ +
+

All

+ +
+

341.342

+ +
+

4.81

+ +
+

346.15

+ +
+

F

+ +
+

Individual with Ineligible Spouse

+ +
+

341.342

+ +
+

102.76

+ +
+

444.10

+ +
+

H

+ +
+

Individual living with one EP

+ +
+

512.003

+ +
+

5.30

+ +
+

517.30

+ +
+

Z

+ +
+

Individual living with more than one EP

+ +
+

341.341

+ +
+

0.00

+ +
+

341.34

+ +
+

C

+ +

 

+ +
+

A

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +
+

512.00

+ +
+

27.00

+ +
+

539.00

+ +
+

 

+ +
+

All other counties

+ +
+

512.00

+ +
+

6.55

+ +
+

518.55

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.005

+ +
+

0.004

+ +
+

30.00

+ +
+
+

1Plus increment for each EP, if appropriate.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XVI institution.

+

5Individuals/each member of a couple with income of $45.00 or less will receive a + $11.62 State administered supplement. Individuals/each member of a couple with income + making them ineligible for SSI payments will be allowed to keep $36.62 a month for + personal expenses.

+
+
+
+
+

4. Coding and Monthly Payment Levels +

+
+
+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal

Code +

+ +
+

State OS

Code +

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment

Levels +

+ +
+

A +

+ +

 

+ +

 

+ +
+

A

+ +

 

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +
+

769.00

+ +
+

21.00

+ +
+

790.00

+ +
+

All other counties

+ +
+

769.00

+ +
+

0.00

+ +
+

769.00

+ +
+

Z

+ +
+

All

+ +
+

769.002

+ +
+

0.00

+ +
+

769.00

+ +
+

B

+ +

 

+ +
+

C

+ +
+

All

+ +
+

512.671

+ +
+

5.30

+ +
+

517.97

+ +
+

Z

+ +
+

All

+ +
+

512.672

+ +
+

0.00

+ +
+

512.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.003

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Plus increment for each EP, if appropriate.

+

3 Individuals/each member of a couple with income of $45.00 or less will each receive + a $11.62 State-administered supplement. Individuals/each member of a couple with + income making them ineligible for SSI payments will be allowed to keep $36.62 a month + for personal expenses.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415032
SI 01415.032 - Federally Administered Optional Supplementary Payment Programs — 1/00 Payment Levels - 03/21/2024
+Batch run: 02/19/2025
+Rev:03/21/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2001.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2001.html new file mode 100644 index 00000000..3598bac3 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2001.html @@ -0,0 +1,15941 @@ + + +SSA - POMS: SI 01415.033 - Federally Administered Optional Supplementary Payment Programs – 1/01 Payment Levels - 07/19/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 67 (07-24)

+

SI 01415.033 Federally Administered Optional Supplementary Payment Programs – 1/01 Payment Levels +

+ + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

CALIFORNIA

+ +
+

NEVADA

+ +
+

DELAWARE

+ +
+

NEW JERSEY

+ +
+

DISTRICT OF COLUMBIA

+ +
+

NEW YORK

+ +
+

HAWAII

+ +
+

PENNSYLVANIA

+ +
+

IOWA

+ +
+

RHODE ISLAND

+ +
+

MASSACHUSETTS

+ +
+

UTAH

+ +
+

MICHIGAN

+ +
+

VERMONT

+ +
+

MONTANA

+ +
+

WASHINGTON

+ +
+
+
+
+

A. CALIFORNIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Independent Living with Cooking Facilities -- Eligible individual or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and has cooking and food storage facilities or is provided meals as part of the living + arrangement; or +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent or parents or is + a disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; or +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or +

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 7/1/83, lives in a private medical facility licensed by the State but not + certified under title XIX. (An optional supplementary A payment based on the new instructions + is payable retroactively to 7/1/83.) +

    + +
    +
    +
  10. +
+ +
+

B

+ +

 

+ +

 

+ +
+

Nonmedical Out-of-Home Care (NMOHC) -- Applies when an individual/couple needs nonmedical + care or supervision in the following living arrangement situations: +

+ +

CHILDREN (UNDER AGE 18) +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Effective 10/1/79, disabled child residing in the home of a legal guardian who is + not a relative; or +

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 1/1/84, disabled child residing in the home of a relative who is not a parent + (Major v. McMahon decision), reopening a prior decision to pay OS B under this definition may be retroactive + to 1/1/84; or +

    + +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or +

    + +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    For periods prior to 7/1/83 only, a blind or disabled child placed in any home or + State licensed NMOHC facility as the result of a court order; or +

    + +
    +
    +
  14. +
+ +

ADULTS (AGE 18 AND OVER) +

+ +
    +
  1. +
    +
    8. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or +

    + +
    +
    +
  2. +
  3. +
    +
    9. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in a State licensed NMOHC facility. +

    + +
    +
    +
  4. +
+ +

For California optional supplement purposes, a relative is defined as a parent, child, + sibling, half-sibling, parent's sibling, sibling's child, first cousin, or any person + of the preceding generation denoted by the prefix “grand” or “great.” +

+ +
+

C

+ +
+

Independent Living Without Cooking Facilities -- Aged or disabled individual/couple + who is neither provided any meals nor has access to adequate cooking/food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C. +

+ +
    +
  1. +
    +
    1. 
    +
    +

    An individual/couple qualifies for OS C if any of the following situations exists:

    + +
      +
    1. +
      +
      a. 
      +
      +

      Immediate living quarters do not have cooking and food storage facilities with which + the individual/couple or another person (who is responsible for preparing the individual's/couple's + meals) can prepare meals on a daily basis. +

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf. +

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals. +

      + +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals. +

      + +
      +
      +
    8. +
    9. +
      +
      e. 
      +
      +

      Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the SSI applicant's/recipient's arrangement with the facility + is to purchase only shelter on a monthly basis). +

      + +
      +
      +
    10. +
    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    “Adequate” cooking and food storage facilities exist when an individual/couple has + access to: +

    + +
      +
    1. +
      +
      a. 
      +
      +

      Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.) +

      + +

      OR

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls which + are used for warming food are not considered adequate cooking facilities.) +

      + +

      OR

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature control. +

      + +
      +
      +
    6. +
    + +
    +
    +
  4. +
+ +
+

 

+ +

 

+ +
+
    +
  1. +
    +
    3. 
    +
    +

    Eligibility for OS C begins in the month the applicant/recipient applies for this + supplement rate provided they have been without cooking and food storage facilities + throughout the month. +

    + +

    NOTE: For purposes of OS C, “throughout a month” does not mean the applicant/recipient must lack adequate cooking/food storage facilities from + the very first moment of the month. They need only lack them from some time on the + first day of the month. +

    + +
    +
    +
  2. +
+ +
    +
  1. +
    +
    4. 
    +
    +

    If eligibility is based on temporary loss or non-functioning of an appliance, the + individual should be advised of their responsibility to report immediately when the + temporary condition has ceased. If the individual provides an expected date when the + appliance will be replaced/repaired, diary the case for recontact. +

    + +
    +
    +
  2. +
  3. +
    +
    5. 
    +
    +

    Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available. +

    + +
    +
    +
  4. +
  5. +
    +
    6. 
    +
    +

    For a couple, comprised of an aged/disabled individual and a blind individual, whose + living arrangement lacks adequate cooking and storage facilities, the couple is to + receive the SSI/SSP level for a blind/aged or disabled couple plus the restaurant + meals allowance for the disabled member of the couple. Force payment in this living + arrangement is required. +

    + +
    +
    +
  6. +
+ +
+

D

+ +
+

Living in the Household of Another -- Eligible individual/couple is living in the + household of another and is receiving food and shelter from that individual. Most individuals/couples who are subject to a 1/3 reduction + of their Federal SSI payments (VTR) are eligible for OS D because the criteria for + this supplement level are the same as for charging the VTR. However, when the eligible + individual/couple lives in the home of a relative (other than a spouse) and needs + care and supervision, certification for nonmedical out-of-home care (OS F) should + be obtained from the county welfare office since this is the highest categorical supplement + for which an individual /couple can qualify. +

+ +
+

E

+ +

 

+ +
+

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage. (Until 9/30/79, a disabled child under + age 18 living with a legal guardian also fell into this category.) +

+ +

NOTE: Effective 2/1/82, only FLA A and C are compatible with OS E. If the VTR applies, see + subsection G. below. +

+ +
+

F

+ +

 

+ +
+

Non-medical Out-of-Home Care Living in the Household of Another --Effective 2/1/82. + Applies whenever an eligible individual or couple meets the criteria for the non-medical + out-of-home care payment rate, and is determined to receive the Federal code B payment + for living in the household of another (SI 00835.200). +

+ +
+

G

+ +
+

Disabled Child Under Age 18 Living in the Household of Another --Effective 2/1/82. + Applies to a disabled (not blind) child under age 18, who resides with a parent or + relative by blood or marriage, and is determined to receive the Federal code B payment for living in the household of + another individual (SI 00835.200). +

+ +
+

J

+ +

 

+ +
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Eligible individual or couple who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX and not licensed + by the State (effective 7/1/83). (Prior to 7/1/83, the facility could have been licensed + by the State but not certified under title XIX.) +

    + +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. +

+ +
+
+

 

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

California Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

A

+ +

 

+ +

 

+ +
+

Aged

+ +
+

530.00

+ +
+

182.00

+ +
+

712.00

+ +
+

Blind

+ +
+

530.00

+ +
+

241.00

+ +
+

771.00

+ +
+

Disabled

+ +
+

530.00

+ +
+

182.00

+ +
+

712.00

+ +
+

B

+ +
+

All

+ +
+

530.00

+ +
+

342.00

+ +
+

872.00

+ +
+

C

+ +

 

+ +

 

+ +
+

Aged

+ +
+

530.00

+ +
+

257.00

+ +
+

787.00

+ +
+

Blind

+ +
+

530.00

+ +
+

241.00

+ +
+

771.00

+ +
+

Disabled

+ +
+

530.00

+ +
+

257.00

+ +
+

787.00

+ +
+

E

+ +
+

Disabled

+ +
+

530.00

+ +
+

81.00

+ +
+

611.00

+ +
+

Z

+ +
+

All

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

B

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

D

+ +

 

+ +

 

+ +
+

Aged

+ +
+

353.341

+ +
+

191.66

+ +
+

545.00

+ +
+

Blind

+ +
+

353.341

+ +
+

263.66

+ +
+

617.00

+ +
+

Disabled

+ +
+

353.341

+ +
+

191.66

+ +
+

545.00

+ +
+

F

+ +
+

All

+ +
+

353.341

+ +
+

345.66

+ +
+

699.00

+ +
+

G

+ +
+

Disabled

+ +
+

353.341

+ +
+

79.66

+ +
+

433.00

+ +
+

C

+ +

 

+ +
+

A

+ +
+

Blind

+ +
+

530.00

+ +
+

241.00

+ +
+

771.00

+ +
+

E

+ +
+

Disabled

+ +
+

530.00

+ +
+

81.00

+ +
+

611.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

15.00

+ +
+

45.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

3. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

A

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Aged/Aged

+ +
+

796.00

+ +
+

469.00

+ +
+

1265.00

+ +
+

Blind/Blind

+ +
+

796.00

+ +
+

670.00

+ +
+

1466.00

+ +
+

Disabled/Disabled

+ +
+

796.00

+ +
+

469.00

+ +
+

1265.00

+ +
+

Aged/Blind

+ +
+

796.00

+ +
+

595.00

+ +
+

1391.00

+ +
+

Aged/Disabled

+ +
+

796.00

+ +
+

469.00

+ +
+

1265.00

+ +
+

Blind/Disabled

+ +
+

796.00

+ +
+

595.00

+ +
+

1391.00

+ +
+

B

+ +
+

All

+ +
+

796.00

+ +
+

948.00

+ +
+

1744.00

+ +
+

C

+ +

 

+ +

 

+ +
+

Aged/Aged

+ +
+

796.00

+ +
+

619.00

+ +
+

1415.00

+ +
+

Disabled/Disabled

+ +
+

796.00

+ +
+

619.00

+ +
+

1415.00

+ +
+

Aged/Disabled

+ +
+

796.00

+ +
+

619.00

+ +
+

1415.00

+ +
+

Z

+ +
+

All

+ +
+

796.00

+ +
+

0.00

+ +
+

796.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

530.671

+ +
+

505.33

+ +
+

1036.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

530.671

+ +
+

707.33

+ +
+

1238.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

530.671

+ +
+

505.33

+ +
+

1036.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

530.671

+ +
+

630.33

+ +
+

1161.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

530.671

+ +
+

505.33

+ +
+

1036.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

530.671

+ +
+

630.33

+ +
+

1161.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

530.671

+ +
+

906.33

+ +
+

1437.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

30.00

+ +
+

90.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

B. DELAWARE +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult Residential Care Facility -- Only living arrangement variation in Delaware and + includes only those recipients who are certified by the State medical unit as residents + of an adult care facility. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- All recipients who are not included in A or Y.

+ +

Optional supplementation code Z is the proper code to be used with an “intervening” + Federal code A. (See SM 01301.535.) +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Delaware Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total

Payment Levels +
+

A

+ +
+

A

+ +
+

All

+ +
+

530.00

+ +
+

140.00

+ +
+

670.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

353.341

+ +
+

0.00

+ +
+

353.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

All

+ +
+

796.00

+ +
+

448.00

+ +
+

1244.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

796.00

+ +
+

0.00

+ +
+

796.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

530.671

+ +
+

0.00

+ +
+

530.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

C. DISTRICT OF COLUMBIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by + the District of Columbia, Department of Human Services, as residents of an adult foster + care home with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult Foster Care Home with More than 50 Residents --Recipients who are certified + by the District of Columbia, Department of Human Services, as residents of an adult + foster care home with more than 50 residents. +

+ +
+

G

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

District of Columbia Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

All

+ +
+

530.00

+ +
+

307.00

+ +
+

837.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

530.00

+ +
+

417.00

+ +
+

947.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

353.341

+ +
+

0.00

+ +
+

353.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Code +
Total Payment Levels
+

A

+ +
+

A

+ +
+

All

+ +
+

796.00

+ +
+

878.00

+ +
+

1674.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

796.00

+ +
+

1098.00

+ +
+

1894.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

530.671

+ +
+

0.00

+ +
+

530.67

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

D. HAWAII +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Independent Living – Eligible individual or couple who:

+ +
    +
  • +
    +
    •
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes. + This includes living in a “half-way house,” which is a private non-medical facility + with whom the State has a purchase or services agreement for the short term care of + certain needy individuals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a blind or disabled child under age 18 (or age 21 if the individual qualifies as + a “protected child”) living in the household of a parent or parents. +

    + +
    +
    +
  • +
+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another -- Effective 7/1/83, a supplement is no longer + payable because the combined Federal/State supplementary payment level established + by the State is lower than the FBR. +

+ +
+

H

+ +
+

Domiciliary Care I -- (Maximum of five residents)- Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary Care II -- Same as H except care is provided for six or more residents.

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Eligible for, but has waived their right to receive + an optional supplement. +

+ +
+

Z

+ +

 

+ +

 

+ +
+

No Supplement Cases -- Eligible individual (or couple) who is living in the household + of another (see explanation in definition for optional supplement B) and an eligible + individual (or couple) who is a patient: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    1. In a medical facility where title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    2. In a private medical facility which is not certified under title XIX.

    + +
    +
    +
  4. +
+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Hawaii Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

All

+ +
+

530.00

+ +
+

4.90

+ +
+

534.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

530.00

+ +
+

521.90

+ +
+

1051.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

530.00

+ +
+

629.90

+ +
+

1159.90

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

353.341

+ +
+

0.00

+ +
+

353.34

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

530.00

+ +
+

4.90

+ +
+

534.90

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

All

+ +
+

796.00

+ +
+

8.80

+ +
+

804.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

796.00

+ +
+

1307.80

+ +
+

2103.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

796.00

+ +
+

1523.80

+ +
+

2319.80

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

530.671

+ +
+

0.00

+ +
+

530.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

E. IOWA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Living in Own Household (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, does not have an + EP, and is not otherwise excepted from supplementation. Also included are blind recipients in title XIX facilities where Medicaid pays 50 percent or less of the cost + of care. Optional supplement code A is also compatible with Federal codes A and C. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +
+

B

+ +
+

Living in the Household of Another (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C/H

+ +
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services. +

+ +

The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D/I

+ +
+

Living in a Family Life or Boarding Home -- Eligible individual or each member of + an eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services. +

+ +
+

G

+ +
+

Used to indicate that no supplement is payable to a recipient living in a title XIX + facility and title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under title XIX or all recipients whose Federal payments + are reduced to $30/$60 due to living in a title XIX facility. In addition, aged and + disabled recipients whose Federal payments are not reduced and who live in a title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement. +

+ +

NOTE: The State Department of Human Services administers two optional supplementation programs + -- In-Home Health Related Care and Residential Care. +

+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Iowa Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

Blind

+ +
+

530.00

+ +
+

22.00

+ +
+

552.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

530.00

+ +
+

266.00

+ +
+

796.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

530.00

+ +
+

288.00

+ +
+

818.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

530.00

+ +
+

266.00

+ +
+

796.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

530.00

+ +
+

62.20

+ +
+

592.20

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

 

+ +
+

Z

+ +
+

Aged

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

353.341

+ +
+

22.00

+ +
+

375.34

+ +
+

 

+ +
+

H3

+ +
+

Aged

+ +
+

353.341

+ +
+

266.00

+ +
+

619.34

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

353.341

+ +
+

288.00

+ +
+

641.34

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

353.341

+ +
+

266.00

+ +
+

619.34

+ +
+

 

+ +
+

I3

+ +
+

All

+ +
+

353.341

+ +
+

62.20

+ +
+

415.54

+ +
+

 

+ +
+

Z

+ +
+

Aged

+ +
+

353.341

+ +
+

0.00

+ +
+

353.34

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

353.341

+ +
+

0.00

+ +
+

353.34

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

530.00

+ +
+

22.00

+ +
+

552.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

530.00

+ +
+

288.00

+ +
+

818.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

530.00

+ +
+

266.00

+ +
+

796.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1 Not an FBR; the amount represents the FBR less VTR. +

+

2 Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3 Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible + with the RMA policy computation process. +

+

NOTE:

+

State-administered programs: For Calendar Year 2001 -

+
    +
  1. +
    +
    (1) 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 2000 is $17.36 + to $24.26. The calendar year 2000 personal allowance is $73.00. Rates for calendar + year 2001 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    (2) 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 2000 for care in-home related care is $466.79. The payment rate for calendar + year 2001 was not available for inclusion in this publication. +

    + +
    +
    +
  4. +
+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total

Payment Levels +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

796.00

+ +
+

44.00

+ +
+

840.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

796.00

+ +
+

22.00

+ +
+

818.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

796.00

+ +
+

22.00

+ +
+

818.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

796.00

+ +
+

266.00

+ +
+

1062.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

796.00

+ +
+

310.00

+ +
+

1106.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

796.00

+ +
+

266.00

+ +
+

1062.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

796.00

+ +
+

288.00

+ +
+

1084.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

796.00

+ +
+

266.00

+ +
+

1062.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

796.00

+ +
+

288.00

+ +
+

1084.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

796.00

+ +
+

408.40

+ +
+

1204.40

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

796.00

+ +
+

0.00

+ +
+

796.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

796.00

+ +
+

0.00

+ +
+

796.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

796.00

+ +
+

0.00

+ +
+

796.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

796.00

+ +
+

0.00

+ +
+

796.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

530.671

+ +
+

44.00

+ +
+

574.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

530.671

+ +
+

22.00

+ +
+

552.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

530.671

+ +
+

22.00

+ +
+

552.67

+ +
+

 

+ +
+

H3

+ +
+

Aged/Aged

+ +
+

530.671

+ +
+

266.00

+ +
+

796.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

530.671

+ +
+

310.00

+ +
+

840.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

530.671

+ +
+

266.00

+ +
+

796.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

530.671

+ +
+

288.00

+ +
+

818.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

530.671

+ +
+

266.00

+ +
+

796.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

530.671

+ +
+

288.00

+ +
+

818.67

+ +
+

 

+ +
+

I3

+ +
+

All

+ +
+

530.671

+ +
+

408.40

+ +
+

939.07

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

530.671

+ +
+

0.00

+ +
+

530.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

530.671

+ +
+

0.00

+ +
+

530.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

530.671

+ +
+

0.00

+ +
+

530.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible + with the RMA policy computation process.

+

NOTE:

+

State-administered programs: For Calendar Year 2001 -

+
    +
  1. +
    +
    (1) 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 2000 is $17.36 + to $24.26. The calendar year 2000 personal allowance is $73.00. Rates for calendar + year 2001 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    (2) 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 2000 for care in-home related care is $466.79. The payment rate for calendar + year 2001 was not available for inclusion in this publication. (Members of a couple + are treated as individuals.) +

    + +
    +
    +
  4. +
+
+
+
+
+ +
+
+

F. MASSACHUSETTS +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +

 

+ +

 

+ +
+

Full Cost-of-Living:

+ +
    +
  1. +
    +
    1. 
    +
    +

    An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and are: +

    + +
      +
    1. +
      +
      a. 
      +
      +

      Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences will be considered + living alone provided they do not use the residential kitchen facilities for preparing + meals; or +

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Living only with his/her eligible spouse; or

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Living with his/her eligible spouse and ineligible child/children2 none of whom (children) receive public income maintenance payments;3 + or +

      + +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Living only with their ineligible spouse and/or their ineligible child/children, none + of whom (spouse and children) receive public income maintenance payments. +

      + +

      NOTE: For purposes of a. through d. above, foster children placed with anyone other than + their parents are not considered to be living with the foster parent. +

      + +
      +
      +
    8. +
    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom he/she is living receive public income maintenance + payments. +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in 1. or 2. above will be in State living arrangement A if they + pay at least two-thirds of the household expenses. In making a determination as to + whether the individual pays two-thirds or more of the expenses, use the method defined + in SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses. +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. +

    + +
    +
    +
  8. +
+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +
+

B

+ +
+

Shared Living Expenses -- An individual who is in Federal living arrangement A or + C and who does not meet the criteria listed for State living arrangement A, E or G + is in State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH). +

+ +

Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined above. Also included are individuals placed + under the auspices of the State adult foster care program and residents of publicly + operated emergency shelters throughout a month. +

+ +

An individual living in a household where all members receive public income maintenance + payments unless he/she is paying at least two-thirds of the household expenses (A). +

+ +

An individual living in a mixed household -- i.e., a household where one or more other + members receive a public income maintenance payment -- also is included unless the + individual is paying at least two-thirds of the household expenses (A). +

+ +
+

C

+ +
+

Living in the Household of Another -- Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third. +

+ +
+

E

+ +
+

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home. +

+ +
+

F

+ +
+

Effective 7/1/87, the State elected Federal administration of this optional State + supplementary payment to residents of title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Assisted Living -- Effective 7/1/94, the State elected Federal administration of this + variation. Includes an individual, certified by the State to be residing in an Assisted + Living residence served by a certified Group Adult Foster Care provider, who is not + receiving assistance under any other Federal or State rental assistance program, and + who pays a fixed, non-separable fee for rent and supportive services, other than medically + necessary services reimbursed by Medicaid. The State shall certify to SSA each individual + who is eligible for this optional supplement living arrangement. This living arrangement + was discontinued effective 1/1/96. However, it has been restored, retroactively, to + 1/1/97. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. +

+

1For purposes of determining State living arrangements, a commercial boarding house, + foster home, or halfway house is not considered the person's household. +

+

2Use the SSI definition of child, SI 00501.400. +

+

3A public income maintenance payment is a payment from any of the following programs: + Aid to Families with Dependent Children (AFDC), SSI, the Refugee Act of 1980, the + Disaster Relief Act of 1974, general assistance programs of the Bureau of Indian Affairs, + State or local government income maintenance programs that are based on need, or Department + of Veterans Affairs benefits based on need. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Massachusetts Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

Aged

+ +
+

530.00

+ +
+

128.82

+ +
+

658.82

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

530.00

+ +
+

149.74

+ +
+

679.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

530.00

+ +
+

114.39

+ +
+

644.39

+ +
+

 

+ +
+

B

+ +
+

Aged

+ +
+

530.00

+ +
+

39.26

+ +
+

569.26

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

530.00

+ +
+

149.74

+ +
+

679.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

530.00

+ +
+

30.40

+ +
+

560.40

+ +
+

 

+ +
+

E

+ +
+

Aged

+ +
+

530.00

+ +
+

293.00

+ +
+

823.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

530.00

+ +
+

149.74

+ +
+

679.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

530.00

+ +
+

293.00

+ +
+

823.00

+ +
+

 

+ +
+

G

+ +
+

Aged

+ +
+

530.00

+ +
+

454.00

+ +
+

984.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

530.00

+ +
+

454.00

+ +
+

984.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

530.00

+ +
+

454.00

+ +
+

984.00

+ +
+

B

+ +
+

C

+ +
+

Aged

+ +
+

353.341

+ +
+

104.36

+ +
+

457.70

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

353.341

+ +
+

326.40

+ +
+

679.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

353.341

+ +
+

87.58

+ +
+

440.92

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

530.00

+ +
+

149.74

+ +
+

679.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

530.00

+ +
+

114.39

+ +
+

644.39

+ +
+

 

+ +
+

B

+ +
+

Blind

+ +
+

530.00

+ +
+

149.74

+ +
+

679.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

530.00

+ +
+

30.40

+ +
+

560.40

+ +
+

D

+ +
+

F

+ +
+

All

+ +
+

30.002

+ +
+

35.00

+ +
+

65.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

796.00

+ +
+

201.72

+ +
+

997.72

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

796.00

+ +
+

563.48

+ +
+

1359.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

796.00

+ +
+

180.06

+ +
+

976.06

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

796.00

+ +
+

382.60

+ +
+

1178.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

796.00

+ +
+

190.89

+ +
+

986.89

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

796.00

+ +
+

371.77

+ +
+

1167.77

+ +
+

 

+ +
+

B

+ +
+

Aged/Aged

+ +
+

796.00

+ +
+

201.72

+ +
+

997.72

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

796.00

+ +
+

563.48

+ +
+

1359.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

796.00

+ +
+

180.06

+ +
+

976.06

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

796.00

+ +
+

382.60

+ +
+

1178.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

796.00

+ +
+

190.89

+ +
+

986.89

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

796.00

+ +
+

371.77

+ +
+

1167.77

+ +
+

 

+ +
+

E

+ +
+

Aged/Aged

+ +
+

796.00

+ +
+

850.00

+ +
+

1646.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

796.00

+ +
+

563.48

+ +
+

1359.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

796.00

+ +
+

850.00

+ +
+

1646.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

796.00

+ +
+

706.74

+ +
+

1502.74

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

796.00

+ +
+

850.00

+ +
+

1646.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

796.00

+ +
+

706.74

+ +
+

1502.74

+ +
+

 

+ +
+

G

+ +
+

Aged/Aged

+ +
+

796.00

+ +
+

681.00

+ +
+

1477.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

796.00

+ +
+

681.00

+ +
+

1477.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

796.00

+ +
+

681.00

+ +
+

1477.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

796.00

+ +
+

681.00

+ +
+

1477.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

796.00

+ +
+

681.00

+ +
+

1477.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

796.00

+ +
+

681.00

+ +
+

1477.00

+ +
+

B

+ +
+

C

+ +
+

Aged/Aged

+ +
+

530.671

+ +
+

215.80

+ +
+

746.47

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

530.671

+ +
+

828.80

+ +
+

1359.47

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

530.671

+ +
+

194.18

+ +
+

724.85

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

530.671

+ +
+

522.30

+ +
+

1052.97

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

530.671

+ +
+

204.99

+ +
+

735.66

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

530.671

+ +
+

511.49

+ +
+

1042.16

+ +
+

D

+ +
+

F

+ +
+

All

+ +
+

60.002

+ +
+

70.00

+ +
+

130.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

G. MICHIGAN +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

D

+ +
+

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal Care -- Recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care. +

+ +
+

G

+ +
+

Independent Living with an EP -- Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.) +

+ +
+

H

+ +
+

Living in the Household of Another with an EP --Recipients with an EP and living in + the household of another for Federal purposes. (Children under age 18 are excluded.) +

+ +
+

I

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under title XIX. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Michigan Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

D

+ +
+

All

+ +
+

530.00

+ +
+

87.00

+ +
+

617.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

530.00

+ +
+

157.50

+ +
+

687.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

530.00

+ +
+

179.30

+ +
+

709.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

796.002

+ +
+

14.00

+ +
+

810.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

530.671

+ +
+

9.33

+ +
+

540.00

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 30.003

+ +
+

7.00

+ +
+

37.00

+ +
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement

Level +
Total Payment Levels
+

A

+ +
+

D

+ +
+

All

+ +
+

796.00

+ +
+

438.00

+ +
+

1234.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

796.00

+ +
+

579.00

+ +
+

1375.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

796.00

+ +
+

622.60

+ +
+

1418.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1062.002

+ +
+

21.00

+ +
+

1083.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

708.001

+ +
+

14.00

+ +
+

722.00

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 60.003

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

H. MONTANA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-Certified Personal Care

+ +
+

H

+ +
+

State-Certified Residence in Community Home for Mentally Disabled

+ +
+

I

+ +
+

State-Certified Residence in Community Home for Physically or Developmentally Disabled

+ +
+

J

+ +
+

State-Certified Residence for Child and Adult Foster Care

+ +
+

K

+ +
+

State-Certified Semi-Independent Care

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Includes all individuals and couples not certified in State + codes G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding And Monthly Payment Levels +

+
+
+
+

Montana Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

G

+ +
+

All

+ +
+

530.00

+ +
+

94.00

+ +
+

624.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

530.00

+ +
+

94.00

+ +
+

624.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

530.00

+ +
+

94.00

+ +
+

624.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

530.00

+ +
+

52.75

+ +
+

582.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

530.00

+ +
+

26.00

+ +
+

556.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

353.341

+ +
+

0.00

+ +
+

353.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

G

+ +
+

All

+ +
+

796.00

+ +
+

193.00

+ +
+

989.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

796.00

+ +
+

193.00

+ +
+

989.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

796.00

+ +
+

193.00

+ +
+

989.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

796.00

+ +
+

110.50

+ +
+

906.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

796.00

+ +
+

57.00

+ +
+

853.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

796.00

+ +
+

0.00

+ +
+

796.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

530.671

+ +
+

0.00

+ +
+

530.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

I. NEVADA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living or Living in Parental Household -- Aged or blind eligible individual + or couple who: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes; + or +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. (See SM 01301.535.)

+ +
+

B

+ +
+

Living in the Household of Another -- Aged or blind eligible individual or couple + who is living in the household of another individual and receiving food and shelter from that individual. Aged or blind individuals or couples, who are subject + to a one-third reduction of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B. +

+ +
+

C

+ +
+

Domiciliary Care -- Aged or blind eligible individual or couple who lives in a private + non-medical facility or, as of 10/76, a residential facility serving 16 or fewer persons, + which provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- No supplement cases include:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individuals or disabled members of eligible couples; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individuals or members of eligible couples in a medical facility where title + XIX pays more than 50 percent of the cost; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individuals or members of eligible couples who are patients in a private + medical facility which is not certified under title XIX; or +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    + +
    +
    +
  8. +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Nevada Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

Aged

+ +
+

530.00

+ +
+

36.40

+ +
+

566.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

530.00

+ +
+

109.30

+ +
+

639.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

530.00

+ +
+

350.00

+ +
+

880.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

530.00

+ +
+

350.00

+ +
+

880.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

353.341

+ +
+

24.27

+ +
+

377.61

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

353.341

+ +
+

213.96

+ +
+

567.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

353.341

+ +
+

0.00

+ +
+

353.34

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

530.00

+ +
+

109.30

+ +
+

639.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

796.00

+ +
+

74.46

+ +
+

870.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

796.00

+ +
+

374.60

+ +
+

1170.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

796.00

+ +
+

224.53

+ +
+

1020.53

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

796.00

+ +
+

37.23

+ +
+

833.23

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

796.00

+ +
+

187.30

+ +
+

983.30

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

796.00

+ +
+

881.00

+ +
+

1677.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

796.00

+ +
+

881.00

+ +
+

1677.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

796.00

+ +
+

881.00

+ +
+

1677.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

796.00

+ +
+

440.50

+ +
+

1236.50

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

796.00

+ +
+

440.50

+ +
+

1236.50

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

796.00

+ +
+

0.00

+ +
+

796.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

530.671

+ +
+

49.64

+ +
+

580.31

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

530.671

+ +
+

531.94

+ +
+

1062.61

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

530.671

+ +
+

290.79

+ +
+

821.46

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

530.671

+ +
+

24.82

+ +
+

555.49

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

530.671

+ +
+

265.97

+ +
+

796.64

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

530.671

+ +
+

0.00

+ +
+

530.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

J. NEW JERSEY +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Licensed Residential Health Care Facilities and Certain Licensed Residential Facilities + -- The State provides New Jersey field offices with lists of approved facilities. + Mentally retarded individuals must be placed and supervised by either the State Department + of Youth and Family Services or the State Division of Mental Retardation. +

+ +
+

B

+ +
+

Living Alone or with Others -- Eligible individuals (including children) or eligible + couples whose Federal living arrangements are A or C and who do not meet the requirements + defined in other supplementation categories. +

+ +

Therefore, effective 8/1/81, any eligible adult/couple who meets the requirement for + a Federal code A will be in optional supplement B unless residing in a residential + health care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code C will automatically be + entitled to optional supplement B. +

+ +

This category includes, but is not limited to, those eligible adults/couples who are:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

C

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Living Alone with an Ineligible Spouse -- Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse will receive the same total payment as an eligible + couple or an individual with an EP. Once other persons, even minor children, are present + in the household, this supplementary payment variation cannot exist. However, it is + possible that a claimant and their ineligible spouse live with others and allege that + they are a separate “household” by virtue of the fact that they eat their meals out + or have separate purchase and preparation of food. In this instance, an optional supplement + C is permissible as long as no other person is in their “household.” There is no couple + counterpart in this category. +

+ +

Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B. +

+ +

A transient individual who co-exists only with an ineligible spouse will also qualify + for the O/S - C rate. +

+ +
+

D

+ +
+

Living in the Household of Another -- Persons who are “living in the household of + another” for Federal purposes. +

+ +
+

G

+ +
+

Effective 9/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Individuals and couples in licensed medical facilities where + Medicaid is paying more than 50 percent of the cost of care, individuals and couples + in publicly operated community residences having 16 or less residents, and residents + of publicly operated emergency shelters throughout a month. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

New Jersey Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement

Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

All

+ +
+

530.00

+ +
+

150.05

+ +
+

680.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

530.00

+ +
+

31.25

+ +
+

561.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

530.00

+ +
+

291.36

+ +
+

821.36

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

796.002

+ +
+

25.36

+ +
+

821.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

353.341

+ +
+

44.31

+ +
+

397.65

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

530.00

+ +
+

31.25

+ +
+

561.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

10.00

+ +
+

40.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement

Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

All

+ +
+

796.00

+ +
+

545.36

+ +
+

1341.36

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

796.00

+ +
+

25.36

+ +
+

821.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

796.00

+ +
+

 0.00

+ +
+

796.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

530.671

+ +
+

93.09

+ +
+

623.76

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 60.002

+ +
+

20.00

+ +
+

 80.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

K. NEW YORK +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Living Alone -- Eligible individuals or eligible couples living physically alone, + or living with only a foster child(ren), or a homemaker authorized by the local Department + of Social Services (DSS), or a family care recipient(s) placed by the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabled (OMRDD) + or local DSS, or individuals living with others but paying a “flat fee for room and + board,” or living with others but taking all their meals outside the dwelling unit, + or living with others in a dwelling but separately preparing food, or having his/her + food separately prepared for him/her. +

+ +
+

B

+ +
+

Living with Others -- Individual/child/couple who resides in a dwelling with others + and prepares food in common with at least one other person in the dwelling, or is + a member of a religious community, or child in any living arrangement other than a + family care home (Level I) or community residence (Level II) certified by OMRDD or + OMH. +

+ +
+

C

+ +
+

Congregate Care Level I -- Family type homes and family care homes. Family type homes + are facilities operated for the purpose of providing long-term residential care for + adults and are certified by the New York State DSS and supervised by local departments + of social services. Family care homes are private households that provide care for + mentally disabled persons. +

+ +
+

D

+ +
+

Congregate Care Level II -- Residential facilities for adults and certain children + with mental disabilities. +

+ +
+

E

+ +
+

Congregate Care Level III -- Privately operated non-medical residential facilities. + Although Level III facilities are often called schools, these facilities may not meet + the Federal definition of school. Operated for the purpose of providing treatment, + training and education for mentally retarded or developmentally disabled individuals, + these facilities are certified by OMRDD in accordance with State regulations. +

+ +
+

F

+ +
+

Living in the Household of Another -- Same as Federal definition. The State supplement + payment for the individual/child/couple whose Federal benefit rate is subject to the + one-third reduction is the “living with others” rate but for systems purposes is coded + F. +

+ +
+

G

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Recipients in licensed medical facilities where Medicaid is + paying more than 50 percent of the cost of care, recipients in publicly operated community + residences which serve 16 or fewer residents, and residents of publicly operated emergency + shelters throughout a month. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

New York Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState Supplement LevelTotal Payment Levels
+

A,C

+ +
+

A

+ +
+

All

+ +
+

530.00

+ +
+

87.00

+ +
+

617.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

530.00

+ +
+

23.00

+ +
+

553.00

+ +
+

 

+ +
+

C

+ +
+

NY City

+ +
+

530.00

+ +
+

266.48

+ +
+

796.48

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

530.00

+ +
266.48796.48
+

 

+ +
+

 

+ +
+

All other counties

+ +
530.00 +

228.48

+ +
+

758.48

+ +
+

 

+ +
+

D

+ +
+

NY City

+ +
+

530.00

+ +
+

435.00

+ +
+

965.00

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

530.00

+ +
+

435.00

+ +
+

965.00

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

530.00

+ +
+

405.00

+ +
+

935.00

+ +
+

 

+ +
+

E

+ +
+

NY City

+ +
+

530.00

+ +
+

482.96

+ +
+

1012.96

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

530.00

+ +
+

458.96

+ +
+

988.96

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

530.00

+ +
+

458.96

+ +
988.96
+

 

+ +
+

Z

+ +
+

All

+ +
+

530.00

+ +
+

 0.00

+ +
+

530.00

+ +
+

B

+ +
+

F

+ +
+

All

+ +
+

353.341

+ +
+

23.00

+ +
+

376.34

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 30.002

+ +
+

 5.003

+ +
+

35.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3New York administers a supplement of $20 to some recipients in a title XIX institution. +

+

4Includes and applies to: Nassau, Suffolk, and Westchester counties effective 7/1/85.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState Supplement LevelTotal Payment Levels
+

A,C

+ +
+

A

+ +
+

All

+ +
+

796.00

+ +
+

104.00

+ +
+

900.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

796.00

+ +
+

46.00

+ +
+

842.00

+ +
+

 

+ +
+

C

+ +
+

NY City

+ +
+

796.00

+ +
+

796.96

+ +
+

1592.96

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

796.00

+ +
796.961592.96
+

 

+ +
+

 

+ +
+

All other counties

+ +
796.00 +

720.96

+ +
+

1516.96

+ +
+

 

+ +
+

D

+ +
+

NY City

+ +
+

796.00

+ +
+

1134.00

+ +
+

1930.00

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

796.00

+ +
1134.00 +

1930.00

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

796.00

+ +
1074.00 +

1870.00

+ +
+

 

+ +
+

E

+ +
+

NY City

+ +
+

796.00

+ +
1229.92 +

2025.92

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
796.00 +

1181.92

+ +
+

1977.92

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

796.00

+ +
+

1181.92

+ +
1977.92
+

 

+ +
+

Z

+ +
+

All

+ +
796.00 +

0.00

+ +
+

796.00

+ +
+

B

+ +
+

F

+ +
+

All

+ +
530.67146.00 +

576.67

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 60.002

+ +
+

10.003

+ +
 70.00
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3New York administers a supplement of $20 to some recipients in a title XIX institution. +

+

4Includes and applies to: Nassau, Suffolk, and Westchester counties effective 7/1/85.

+
+
+
+
+ +
+
+

L. PENNSYLVANIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Living Alone -- Recipients in private medical facilities (nursing homes, hospitals, + intermediate care facilities) where title XIX is not paying more than 50 percent of the cost of care, residents of publicly operated emergency + shelters throughout a month, and all other individuals and couples in Federal codes + A and C not meeting the definition of another variation. +

+ +

Used with an "intervening" Federal code A. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients who do not have an EP and who live + in the household of another and receive support and maintenance for Federal purposes. +

+ +
+

C

+ +
+

Living with an EP -- Recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EPs as defined under the + Federal rules; i.e., Public Law 93-66. +

+ +
+

D

+ +
+

Living in the Household of Another with an EP --Recipients who live in the household + of another and who have one or more EPs as defined under the Federal rules; i.e., + Public Law 93-66. +

+ +
+

G

+ +
+

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities (Effective + 7/1/89). +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Includes all recipients who are residing in a medical facility + in which title XIX is paying more than 50 percent of the cost of care. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Pennsylvania Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement

Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

All

+ +
+

530.00

+ +
+

27.40

+ +
+

557.40

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

796.003

+ +
+

43.70

+ +
+

839.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

530.00

+ +
+

329.30

+ +
+

859.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

530.00

+ +
+

334.30

+ +
+

864.30

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

353.341

+ +
+

27.40

+ +
+

380.74

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

530.672

+ +
+

43.70

+ +
+

574.37

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

530.00

+ +
+

27.40

+ +
+

557.40

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.004

+ +
+

 0.00

+ +
+

 30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement

Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

All

+ +
+

796.00

+ +
+

43.70

+ +
+

839.70

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1062.003

+ +
+

68.05

+ +
+

1130.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

796.00

+ +
+

737.40

+ +
+

1533.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

796.00

+ +
+

747.40

+ +
+

1543.40

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

530.671

+ +
+

43.70

+ +
+

574.37

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

708.002

+ +
+

68.05

+ +
+

776.05

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.004

+ +
+

 0.00

+ +
+

 60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

M. RHODE ISLAND +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Living Alone -- Recipients who are in Federal codes A and C.

+ +

Used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied. +

+ +
+

D

+ +
+

Living in a Shelter Care Facility (Effective 10/1/90).

+ +

Revised to: Residential Care/Assisted Living – Adult Individuals Only (Effective 10/1/98).

+ +
+

E

+ +
+

The State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 3/1/91). +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Rhode Island Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement

Level +
Total Payment Levels
+

A

+ +
+

A1

+ +
+

All

+ +
+

530.00

+ +
+

64.35

+ +
+

594.35

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

530.00

+ +
+

582.00

+ +
+

1112.00

+ +
+

B

+ +
+

B1

+ +
+

All

+ +
+

353.342

+ +
+

74.60

+ +
+

427.94

+ +
+

C

+ +
+

A1

+ +
+

All

+ +
+

530.00

+ +
+

64.35

+ +
+

594.35

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

 30.003

+ +
+

20.00

+ +
+

 50.00

+ +
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement

Level +
Total Payment Levels
+

A

+ +
+

A1

+ +
+

All

+ +
+

796.00

+ +
+

120.50

+ +
+

916.50

+ +
+

B

+ +
+

B1

+ +
+

All

+ +
+

530.672

+ +
+

136.50

+ +
+

667.17

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

60.003

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

N. UTAH +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Living Alone or With Others -- This variation includes recipients who are in Federal + codes A and C. +

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients with no EP who are "living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.) +

+ +
+

Z

+ +
+

No Supplement Cases -- No supplement cases include all recipients who are not included + in A or B. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Utah Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement

Level +
Total Payment Level
+

A,C

+ +
+

Z

+ +
+

All

+ +
+

530.00

+ +
+

0.00

+ +
+

530.00

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

353.342

+ +
+

3.13

+ +
+

356.47

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

2Not an FBR, the amount represents the FBR less VTR.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement

Level +
Total Payment Levels
+

A,C

+ +
+

A

+ +
+

All

+ +
+

796.00

+ +
+

4.60

+ +
+

800.60

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

530.672

+ +
+

9.73

+ +
+

540.40

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+ +
+
+

O. VERMONT +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Independent Living (except Chittenden County) -- Recipients not living in the household + of another, not in a custodial care situation, and not otherwise excepted from supplementation. + Includes a child who is living with a parent and recipients residing in a private + title XIX facility where Medicaid is not paying more than 50 percent of the cost of + care. +

+ +

Effective 5/1/83, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A (except Chittenden County). +

+ +
+

B

+ +
+

Independent Living in Chittenden County -- Same as A above except restricted to residents + of Chittenden County. +

+ +

Effective 5/1/83, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +

+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A (Chittenden County only). (See SM 01301.535.) +

+ +
+

C

+ +
+

Assistive Community Care Level III: Recipients living in facilities identified by + the State. +

+ +
+

E

+ +
+

Living in the Household of Another -- Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions), and not otherwise excepted from supplementation. +

+ +
+

G

+ +
+

Custodial Care: Licensed Community Care Home -- Recipients living in Level IV Community + Homes identified by the State. +

+ +
+

H

+ +
+

Custodial Care: Family Home -- Recipients living in another's home in such a manner + that the individual or couple is paying room and board and is receiving one or more + of the services outlined under the custodial care definition. The individual or couple + must also receive the room and board and custodial care in the home in which they + reside. In order to qualify as a home under this arrangement, these services must + not be provided to more than two persons and must be provided by a resident of the + home. +

+ +

Custodial care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service 2-3 times a week) and/or + supervision for the recipient's protection. Supervision for the recipient's protection + deals primarily with protection services for retarded and emotionally disturbed individuals. + A person who receives one or more of these personal services is receiving custodial + care. +

+ +

The change in this arrangement is effective for initial claims filed on or after 1/1/84. + For redeterminations the change is effective with the month after the month in which + the first redetermination on or after 1/1/84, is initiated. +

+ +

This arrangement does not cover:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Institutional Living -- Regardless of whether custodial care is needed in addition + to the medical, training, rehabilitation, educational or similar services as the primary + function of the institution. +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    A person whose Federal living arrangement is based on home ownership or rental liability. + (A flat fee for room and board per SI 00835.120B. is not considered as rental liability for this arrangement.) +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    A child under age 18 not placed by a Vermont Community Mental Health Agency or the + Vermont Department of Mental Health. +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Custodial care or supervision provided by a spouse (as defined by Federal regulations).

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Any home or boarding arrangement which does not meet the Federal SSI definition of + independent living, Federal Code A. +

    + +
    +
    +
  10. +
+ +
+

I

+ +
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents in title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive an optional supplement. +

+ +
+
+

NOTE: When a person has a room in one facility/household and receives board or custodial + care in another facility/household, the custodial rate (F, G, or H) is based on the + facility/household where the person sleeps. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Vermont Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState

Supplement

Level +
Total Payment Levels
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

530.00

+ +
+

59.04

+ +
+

589.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

530.00

+ +
+

59.04

+ +
+

589.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

530.00

+ +
+

48.38

+ +
+

578.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

530.00

+ +
+

223.94

+ +
+

753.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

530.00

+ +
+

98.69

+ +
+

628.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

353.341

+ +
+

39.30

+ +
+

392.64

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

530.00

+ +
+

59.04

+ +
+

589.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

530.00

+ +
+

59.04

+ +
+

589.04

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

17.66

+ +
+

47.66

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County

+ +
+

796.00

+ +
+

110.88

+ +
+

906.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County

+ +
+

796.00

+ +
+

110.88

+ +
+

906.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

796.00

+ +
+

96.77

+ +
+

892.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

796.00

+ +
+

562.06

+ +
+

1358.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

796.00

+ +
+

332.82

+ +
+

1128.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

530.671

+ +
+

48.31

+ +
+

578.98

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

35.33

+ +
+

95.33

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

P. WASHINGTON +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone -- Recipients who are "living in own household” under title XVI. If an + eligible individual/couple is determined to be living in own household (Federal living + arrangement A) for title XVI, the eligible individual/couple will usually be in a + living alone arrangement for State supplementation purposes. +

+ +

This variation includes:

+ +
    +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples living in private households, whether they + are renting, buying, own their home, or have an interest in the home (e.g., a life + estate). The household may be in a house, room, college dormitory, apartment, hotel, + motel, etc. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples living in board and room situations. This + includes commercial, benevolent, religious, or fraternal board and room accommodations. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples residing in homes approved as congregate + care facilities (group homes). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individuals or eligible couples residing in publicly operated community-based + residences of 16 or fewer beds. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individuals and eligible couples residing in adult family homes. Adult family + homes are homes that provide board, room, and laundry. They may also provide necessary + supervision, personal and social services, and, when appropriate, a minimum of nursing + care, and are approved for payment and licensed by the State Department of Social + and Health Services. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    An eligible individual living with an ineligible spouse when natural, step, adoptive + or foster children under age 18 whose needs are included in determining an AFDC grant + are residing in the same household. In these cases we assume that the ineligible spouse's + income has been considered in determining the AFDC payment unless the couple is living + in a holding-out relationship. (Where the holding-out spouse has income, the local + Department of Social and Health Services office must be contacted to determine whether + that income has been considered in an AFDC payment.) This variation does not include + an eligible individual living with an ineligible spouse and grandchildren under age + 18 whose needs are included in determining an AFDC grant. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A child in a Federal code A or C living arrangement.

    + +
    +
    +
  • +
+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + A code. (See SM 01301.535.) +

+ +

Exceptions

+ +

Optional supplement A is not paid when:

+ +
    +
  1. +
    +
    a. 
    +
    +

    An individual is living in a medical care facility throughout an entire calendar month;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    An eligible individual has more than one EP;

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    An eligible couple has one or more EPs; and

    + +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    An eligible individual or couple is residing in a public emergency shelter for the + homeless (effective 5/83). +

    + +
    +
    +
  8. +
+ +
+

B

+ +

 

+ +

 

+ +
+

Living Alone with an Ineligible Spouse -- Eligible individual who is the head of the + household and who lives alone as described in A above and is living with an ineligible + spouse. An ineligible spouse is a spouse who has either not applied for SSI benefits, + has been denied or terminated, or has withdrawn his or her application. It is not + material whether the ineligible spouse is aged, blind, or disabled. An ineligible + spouse includes: +

+ +
    +
  • +
    +
    •
    +
    +

    Legally married and common-law spouses;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “Holding-out” spouses;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Alien spouses not lawfully admitted to the U.S.; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Refugee spouses receiving payments.

    + +
    +
    +
  • +
+ +
+
+

NOTE: Refugee payments are not deemable to the eligible individual. +

+ +
+
+ +

In determining whether an ineligible spouse is a member of the household for the purpose + of paying the optional supplement B to the eligible individual, use the same rules + for making Federal determinations. If an eligible individual marries, or a separated + spouse returns home, the ineligible spouse supplement is paid beginning with the month + after the month of the arrival of the ineligible spouse in the household. +

+ +

Exceptions

+ +

Optional supplement B is not paid when: (1) an individual with an ineligible spouse + also has child(ren) under age 18 whose needs are considered in determining an AFDC + grant. Rather, the optional supplement A is paid. This is true whether or not the + ineligible spouse is actually included on the AFDC grant; (2) an eligible individual + resides in a public emergency shelter for the homeless (effective 5/83). In this case, + use optional supplementation code Z. +

+ +
+

C

+ +

 

+ +

 

+ +
+

Living in the Household of Another -- Applies to most cases which meet the Federal + definition of living in the household of another (Federal code B). +

+ +

Exceptions

+ +

Not paid when: (1) an individual lives in the household of another with more than + one EP; or (2) a couple lives in the household of another with one or more EPs. In + both of these cases the optional supplementation code is Z. +

+ +
+

F

+ +

 

+ +
+

Living in the Household of Another with an Ineligible Spouse -- Individuals living + in the household of another (Federal code B) who have an ineligible spouse or an EP. +

+ +

Exception

+ +

Individuals with more than one EP are not eligible for an optional supplement.

+ +
+

G

+ +
+

Living with an Essential Person -- Applies to an eligible individual who is the head + of the household and who lives alone as described in A above and was converted from + the 12/73 State rolls with an EP who has continued to live in the household. The system + will pay the optional supplement for an EP. If an eligible individual has more than + one EP use optional supplementation code Z. +

+ +
+

H

+ +

 

+ +
+

Living in the Household of Another with an EP -- Applies to individuals living in + the household of another who have an EP. Individuals with more than one EP are not + eligible for an optional supplement. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived his/her + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- The following groups are ineligible for a federally administered + optional supplement: +

+ +

An individual with more than one EP.

+ +
    +
  • +
    +
    •
    +
    +

    A couple with one or more EPs.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals residing in a medical facility throughout a month, regardless of whether + private or public, or if Medicaid is involved in reimbursement for the cost of the + care. (If only one member of an eligible couple is in a medical facility, determine + the optional supplement variation that applies to the other member separately.) The + term “medical facility” includes hospitals, nursing homes, and extended care facilities, + but does not include boarding schools, congregate care facilities, and half-way houses. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Residents of publicly operated emergency shelters throughout a month, effective 5/83.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+
+

Washington Effective 1/1/01

Individual +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

All other counties

+ +
+

530.00

+ +

 

+ +

 

+ +

530.00

+ +
+

25.90

+ +

 

+ +

5.45

+ +
+

555.90

+ +

 

+ +

535.45

+ +
+

 

+ +
+

B

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

All other counties

+ +
+

530.00

+ +

 

+ +

 

+ +

530.00

+ +
+

166.10

+ +

 

+ +

 

+ +

136.15

+ +
+

696.10

+ +

 

+ +

 

+ +

666.15

+ +
+

 

+ +
+

G

+ +
+

Individual with one EP King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

Individual with one EP

+ +

All other counties

+ +
+

796.00

+ +

 

+ +

 

+ +

796.00

+ +

 

+ +
+

19.90

+ +

 

+ +

 

+ +

0.00

+ +
+

815.90

+ +

 

+ +

 

+ +

796.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

530.003

+ +
+

0.00

+ +
+

530.00

+ +
+

B

+ +
+

C

+ +
+

All

+ +
+

353.341

+ +
+

3.71

+ +
+

357.05

+ +
+

 

+ +
+

F

+ +
+

Individual w/Ineligible Spouse

+ +
+

353.341

+ +
+

101.66

+ +
+

455.00

+ +
+

 

+ +
+

H

+ +
+

Individual living with one EP

+ +
+

530.672

+ +
+

4.20

+ +
+

534.87

+ +
+

 

+ +
+

Z

+ +
+

Individual living with more than one EP

+ +
+

353.343

+ +
+

0.00

+ +
+

353.34

+ +
+

C

+ +
+

A

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

All other counties

+ +
+

530.00

+ +



+ +

530.00

+ +
+

25.90

+ +

 

+ +

 

+ +

5.45

+ +
+

555.90

+ +

 

+ +

 

+ +

535.45

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.005

+ +
+

0.004

+ +
+

 30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

3Plus increment for each EP, if appropriate.

+

4Individuals/each member of a couple with income of $45.00 or less will receive a + $11.62 State-administered supplement. Individuals/each member of a couple with income + making them ineligible for SSI payments will be allowed to keep $36.62 a month for + personal expenses.

+

5Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+

Couple

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

All other counties

+ +
+

796.00

+ +

 

+ +

796.00

+ +
+

19.90

+ +

 

+ +

0.00

+ +
+

815.90

+ +

 

+ +

796.00

+ +
+

Z

+ +
+

All

+ +
+

796.002

+ +
+

0.00

+ +
+

796.00

+ +
+

B

+ +
+

C

+ +
+

All

+ +
+

530.671

+ +
+

4.20

+ +
+

534.87

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

530.672

+ +
+

0.00

+ +
+

530.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.003

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Plus increment for each EP, if appropriate.

+

3Individuals/each member of a couple with income of $45.00 or less will each receive + a $11.62 State-administered supplement. Individuals/each member of a couple with + income making them ineligible for SSI payments will be allowed to keep $36.62 a month + for personal expenses.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415033
SI 01415.033 - Federally Administered Optional Supplementary Payment Programs – 1/01 Payment Levels - 07/19/2024
+Batch run: 02/19/2025
+Rev:07/19/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2002.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2002.html new file mode 100644 index 00000000..ce405b81 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2002.html @@ -0,0 +1,16811 @@ + + +SSA - POMS: SI 01415.034 - Federally Administered Optional Supplementary Payment Programs – January 2002 Payment Levels - 08/07/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 69 (08-24)

+

SI 01415.034 Federally Administered Optional Supplementary Payment Programs – January 2002 Payment + Levels +

+ + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

CALIFORNIA

+ +
+

NEVADA

+ +
+

DELAWARE

+ +
+

NEW JERSEY

+ +
+

DISTRICT OF   COLUMBIA

+ +
+

NEW YORK

+ +
+

HAWAII

+ +
+

PENNSYLVANIA

+ +
+

IOWA

+ +
+

RHODE ISLAND

+ +
+

MASSACHUSETTS

+ +
+

UTAH

+ +
+

MICHIGAN

+ +
+

VERMONT

+ +
+

MONTANA

+ +
+

WASHINGTON

+ +
+
+
+
+

A. CALIFORNIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living with Cooking Facilities -- Eligible individual or couple who:

+ +
    +
  • +
    +
    •
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and has cooking and food storage facilities or is provided meals as part of the living + arrangement; or +

    + +
    +
    +
  • +
+ +
​ +
    +
  • +
    +
    •
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a blind child under age 18 living in the household of a parent or parents or is + a disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Effective 7/1/83, lives in a private medical facility licensed by the State but not + certified under title XIX. (An optional supplementary A payment based on the new instructions + is payable retroactively to 7/1/83.) +

    + +
    +
    +
  • +
+ +
+

B

+ +

 

+ +

 

+ +
+

Non-medical Out-of-Home Care (NMOHC) -- Applies when an individual/couple needs non-medical + care or supervision in the following living arrangement situations: +

+ +

CHILDREN (UNDER AGE 18) +

+ +
    +
  • +
    +
    •
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Effective 10/1/79, disabled child residing in the home of a legal guardian who is + not a relative; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Effective 1/1/84, disabled child residing in the home of a relative who is not a parent + (Major v. McMahon decision), reopening a prior decision to pay OS B under this definition may be retroactive + to 1/1/84; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    For periods prior to 7/1/83 only, a blind or disabled child placed in any home or + State licensed NMOHC facility as the result of a court order; or +

    + +
    +
    +
  • +
+ +

 

+ +

ADULTS (AGE 18 AND OVER) +

+ +
    +
  • +
    +
    •
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in a State licensed NMOHC facility. +

    + +
    +
    +
  • +
+ +

For California optional supplement purposes, a relative is defined as a parent, child, + sibling, half-sibling, parent's sibling, sibling's child, first cousin, or any person + of the preceding generation denoted by the prefix “grand” or “great.” +

+ +
+

C

+ +
+

Independent Living Without Cooking Facilities -- Aged or disabled individual/couple + who is neither provided any meals nor has access to adequate cooking/food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C. +

+ +
    +
  • +
    +
    •
    +
    +

    An individual/couple qualifies for OS C if any of the following situations exists:

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities with which + the individual/couple or another person (who is responsible for preparing the individual's/couple's + meals) can prepare meals on a daily basis. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the SSI applicant's/recipient's arrangement with the facility + is to purchase only shelter on a monthly basis). +

    + +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “Adequate” cooking and food storage facilities exist when an individual/couple has + access to: +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.) +

    + +

    OR

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls which + are used for warming food are not considered adequate cooking facilities.) +

    + +

    OR

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +
+

 

+ +

 

+ +
+
    +
  • +
    +
    •
    +
    +

    Eligibility for OS C begins in the month the applicant/recipient applies for this + supplement rate provided they have been without cooking and food storage facilities + throughout the month. +

    + +
    +
    +

    NOTE: For purposes of OS C, “throughout a month” does not mean the applicant/recipient must lack adequate cooking/food storage facilities from + the very first moment of the month. They need only lack them from some time on the + first day of the month. +

    + +
    +
    + +
    +
    +
  • +
+ +
    +
  • +
    +
    •
    +
    +

    If eligibility is based on temporary loss or non-functioning of an appliance, the + individual should be advised of their responsibility to report immediately when the + temporary condition has ceased. If the individual provides an expected date when the + appliance will be replaced/repaired, diary the case for re-contact. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    For a couple, comprised of an aged/disabled individual and a blind individual, whose + living arrangement lacks adequate cooking and storage facilities, the couple is to + receive the SSI/SSP level for a blind/aged or disabled couple plus the restaurant + meals allowance for the disabled member of the couple. Force payment in this living + arrangement is required. +

    + +
    +
    +
  • +
+ +
+

D

+ +
+

Living in the Household of Another -- Eligible individual/couple is living in the + household of another and is receiving food and shelter from that individual. Most individuals/couples who are subject to a 1/3 reduction + of their Federal SSI payments (VTR) are eligible for OS D because the criteria for + this supplement level are the same as for charging the VTR. However, when the eligible + individual/couple lives in the home of a relative (other than a spouse) and needs + care and supervision, certification for non-medical out-of-home care (OS F) should + be obtained from the county welfare office since this is the highest categorical supplement + for which an individual /couple can qualify. +

+ +
+

E

+ +

 

+ +
+

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage. (Until 9/30/79, a disabled child under + age 18 living with a legal guardian also fell into this category.) +

+ +
+
+

NOTE: Effective 2/1/82, only FLA A and C are compatible with OS E. If the VTR applies, see + Code G. below. +

+ +
+
+ +
+

F

+ +

 

+ +
+

Non-medical Out-of-Home Care Living in the Household of Another --Effective 2/1/82. + Applies whenever an eligible individual or couple meets the criteria for the non-medical + out-of-home care payment rate, and is determined to receive the Federal code B payment + for living in the household of another (SI 00835.200). +

+ +
+

G

+ +
+

Disabled Child Under Age 18 Living in the Household of

Another --Effective 2/1/82. Applies to a disabled (not blind) child under age 18, + who resides with a parent or relative by blood or marriage, and is determined to receive the Federal code B payment for living in the household of + another individual (SI 00835.200). +

+ +
+

J

+ +

 

+ +
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Eligible individual or couple who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX and not licensed + by the State (effective 7/1/83). (Prior to 7/1/83, the facility could have been licensed + by the State but not certified under title XIX.) +

    + +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. +

+ +
+
+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

California Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

545.00

+ +
+

205.00

+ +
+

750.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

545.00

+ +
+

267.00

+ +
+

812.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

205.00

+ +
+

750.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

545.00

+ +
+

373.00

+ +
+

918.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

545.00

+ +
+

284.00

+ +
+

829.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

545.00

+ +
+

267.00

+ +
+

812.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

284.00

+ +
+

829.00

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

545.00

+ +
+

98.00

+ +
+

643.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

B

+ +
+

D

+ +

 

+ +
+

Aged

+ +
+

363.341

+ +
+

210.66

+ +
+

574.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

363.341

+ +
+

286.66

+ +
+

650.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

363.341

+ +
+

210.66

+ +
+

574.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

363.341

+ +
+

372.66

+ +
+

736.00

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

363.341

+ +
+

92.66

+ +
+

456.00

+ +
+

C

+ +

 

+ +
+

A

+ +
+

Blind

+ +
+

545.00

+ +
+

267.00

+ +
+

812.00

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

545.00

+ +
+

98.00

+ +
+

643.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

17.00

+ +
+

47.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

817.00

+ +
+

515.00

+ +
+

1332.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

817.00

+ +
+

727.00

+ +
+

1544.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

817.00

+ +
+

515.00

+ +
+

1332.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

817.00

+ +
+

648.00

+ +
+

1465.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

817.00

+ +
+

515.00

+ +
+

1332.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

817.00

+ +
+

648.00

+ +
+

1465.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

817.00

+ +
+

1019.00

+ +
+

1836.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

817.00

+ +
+

673.00

+ +
+

1490.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

817.00

+ +
+

673.00

+ +
+

1490.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

817.00

+ +
+

673.00

+ +
+

1490.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

817.00

+ +
+

0.00

+ +
+

817.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

544.671

+ +
+

546.33

+ +
+

1091.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

544.671

+ +
+

759.33

+ +
+

1304.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

544.671

+ +
+

546.33

+ +
+

1091.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

544.671

+ +
+

678.33

+ +
+

1223.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

544.671

+ +
+

546.33

+ +
+

1091.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

544.671

+ +
+

678.33

+ +
+

1223.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

544.671

+ +
+

968.33

+ +
+

1513.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

34.00

+ +
+

94.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

B. DELAWARE +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult Residential Care Facility -- Only living arrangement variation in Delaware and + includes only those recipients who are certified by the State medical unit as residents + of an adult care facility. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- All recipients who are not included in A or Y.

+ +

Optional supplementation code Z is the proper code to be used with an “intervening” + Federal code A. (See SM 01301.535.) +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Delaware Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

545.00

+ +
+

140.00

+ +
+

685.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

363.341

+ +
+

0.00

+ +
+

363.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

817.00

+ +
+

448.00

+ +
+

1265.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

817.00

+ +
+

0.00

+ +
+

817.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

544.671

+ +
+

0.00

+ +
+

544.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

C. DISTRICT OF COLUMBIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by + the District of Columbia, Department of Human Services, as residents of an adult foster + care home with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult Foster Care Home with More than 50 Residents --Recipients who are certified + by the District of Columbia, Department of Human Services, as residents of an adult + foster care home with more than 50 residents. +

+ +
+

G

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

District of Columbia Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

545.00

+ +
+

307.00

+ +
+

852.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

545.00

+ +
+

417.00

+ +
+

962.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

363.341

+ +
+

0.00

+ +
+

363.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Code +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

817.00

+ +
+

887.00

+ +
+

1704.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

817.00

+ +
+

1107.00

+ +
+

1924.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

544.671

+ +
+

0.00

+ +
+

544.67

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

D. HAWAII +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living – Eligible individual or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Live in their own household as defined for Federal living arrangement A purposes. + This includes living in a “half-way house,” which is a private non-medical facility + with whom the State has a purchase or services agreement for the short term care of + certain needy individuals; or +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind or disabled child under age 18 (or age 21 if the individual qualifies as + a “protected child”) living in the household of a parent or parents. +

    + +
    +
    +
  6. +
+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another -- Effective 7/1/83, a supplement is no longer + payable because the combined Federal/State supplementary payment level established + by the State is lower than the FBR. +

+ +
+

H

+ +
+

Domiciliary Care I -- (Maximum of five residents)- Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary Care II -- Same as Code H except care is provided for six or more residents.

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Eligible for, but have waived their right to receive + an optional supplement. +

+ +
+

Z

+ +

 

+ +

 

+ +
+

No Supplement Cases -- Eligible individual (or couple) who is living in the household + of another (see explanation in definition for optional supplement B) and an eligible + individual (or couple) who is a patient: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX.

    + +
    +
    +
  4. +
+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Hawaii Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

545.00

+ +
+

4.90

+ +
+

549.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

545.00

+ +
+

521.90

+ +
+

1066.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

545.00

+ +
+

629.90

+ +
+

1174.90

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

363.341

+ +
+

0.00

+ +
+

363.34

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

545.00

+ +
+

4.90

+ +
+

549.90

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

817.00

+ +
+

8.80

+ +
+

825.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

817.00

+ +
+

1316.80

+ +
+

2133.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

817.00

+ +
+

1532.80

+ +
+

2349.80

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

544.671

+ +
+

0.00

+ +
+

544.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

E. IOWA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in Own Household (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, does not have an + EP, and is not otherwise excepted from supplementation. Also included are blind recipients in title XIX facilities where Medicaid pays 50 percent or less of the cost + of care. Optional supplement code A is also compatible with Federal codes A and C. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +
+

B

+ +
+

Living in the Household of Another (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C/H

+ +
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services. +

+ +

The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D/I

+ +
+

Living in a Family Life or Boarding Home -- Eligible individual or each member of + an eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services. +

+ +
+

G

+ +
+

Used to indicate that no supplement is payable to a recipient living in a title XIX + facility and title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under title XIX or all recipients whose Federal payments + are reduced to $30/$60 due to living in a title XIX facility. In addition, aged and + disabled recipients whose Federal payments are not reduced and who live in a title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement. +

+ +
+
+

NOTE: The State Department of Human Services administers two optional supplementation programs + -- In-Home Health Related Care and Residential Care. +

+ +
+
+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Iowa Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

545.00

+ +
+

22.00

+ +
+

567.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

545.00

+ +
+

273.00

+ +
+

818.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

545.00

+ +
+

295.00

+ +
+

840.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

273.00

+ +
+

818.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

545.00

+ +
+

62.20

+ +
+

607.20

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

 

+ +
+

Z

+ +
+

Aged

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

363.341

+ +
+

22.00

+ +
+

385.34

+ +
+

 

+ +
+

H3

+ +
+

Aged

+ +
+

363.341

+ +
+

273.00

+ +
+

636.34

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

363.341

+ +
+

295.00

+ +
+

658.34

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

363.341

+ +
+

273.00

+ +
+

636.34

+ +
+

 

+ +
+

I3

+ +
+

All

+ +
+

363.341

+ +
+

62.20

+ +
+

425.54

+ +
+

 

+ +
+

Z

+ +
+

Aged

+ +
+

363.341

+ +
+

0.00

+ +
+

363.34

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

363.341

+ +
+

0.00

+ +
+

363.34

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

545.00

+ +
+

22.00

+ +
+

567.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

545.00

+ +
+

295.00

+ +
+

840.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

273.00

+ +
+

818.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

3Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible with + the RMA policy computation process.

+

NOTE:

+

State-administered programs: For Calendar Year 2002 -

+
    +
  1. +
    +
    1. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 2001 is $17.50 + to $24.50. The calendar year 2001 personal allowance is $75.00. Rates for calendar + year 2002 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 2001 for care in-home related care is $471.06. The payment rate for calendar + year 2002 was not available for inclusion in this publication. +

    + +
    +
    +
  4. +
+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

817.00

+ +
+

44.00

+ +
+

861.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

817.00

+ +
+

22.00

+ +
+

839.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

817.00

+ +
+

22.00

+ +
+

839.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

817.00

+ +
+

273.00

+ +
+

1090.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

817.00

+ +
+

317.00

+ +
+

1134.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

817.00

+ +
+

273.00

+ +
+

1090.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

817.00

+ +
+

295.00

+ +
+

1112.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

817.00

+ +
+

273.00

+ +
+

1090.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

817.00

+ +
+

295.00

+ +
+

1112.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

817.00

+ +
+

408.40

+ +
+

1225.40

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

817.00

+ +
+

0.00

+ +
+

817.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

817.00

+ +
+

0.00

+ +
+

817.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

817.00

+ +
+

0.00

+ +
+

817.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

817.00

+ +
+

0.00

+ +
+

817.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

544.671

+ +
+

44.00

+ +
+

588.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

544.671

+ +
+

22.00

+ +
+

566.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

544.671

+ +
+

22.00

+ +
+

566.67

+ +
+

 

+ +
+

H3

+ +
+

Aged/Aged

+ +
+

544.671

+ +
+

273.00

+ +
+

817.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

544.671

+ +
+

317.00

+ +
+

861.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

544.671

+ +
+

273.00

+ +
+

817.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

544.671

+ +
+

295.00

+ +
+

839.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

544.671

+ +
+

273.00

+ +
+

817.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

544.671

+ +
+

295.00

+ +
+

839.67

+ +
+

 

+ +
+

I3

+ +
+

All

+ +
+

544.671

+ +
+

408.40

+ +
+

953.07

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

544.671

+ +
+

0.00

+ +
+

544.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

544.671

+ +
+

0.00

+ +
+

544.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

544.671

+ +
+

0.00

+ +
+

544.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible with + the RMA policy computation process.

+
+
+

NOTE:

+ +
+
+

State-administered programs: For Calendar Year 2002 -

+
    +
  1. +
    +
    a. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 2001 is $17.50 + to $24.50. The calendar year 2001 personal allowance is $75.00. Rates for calendar + year 2002 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 2001 for care in-home related care is $471.06. The payment rate for calendar + year 2002 was not available for inclusion in this publication. (Members of a couple + are treated as individuals.) +

    + +
    +
    +
  4. +
+
+
+
+
+ +
+
+

F. MASSACHUSETTS +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Full Cost-of-Living:

+ +
​ +
    +
  1. +
    +
    1. 
    +
    +

    An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household and are: +

    + +
      +
    1. +
      +
      a. 
      +
      +

      Living only with their eligible spouse; or

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences will be considered + living alone provided they do not use the residential kitchen facilities for preparing + meals; or +

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Living with their eligible spouse and ineligible child/children 2 none of whom (children) receive public income maintenance payments;3 or +

      + +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Living only with their ineligible spouse and/or their ineligible child/children, none + of whom (spouse and children) receive public income maintenance payments. +

      + +
      +
      +
    8. +
    + +
    +
    +

    NOTE: For purposes of a. through d. above, foster children placed with anyone other than + their parents are not considered to be living with the foster parent. +

    + +
    +
    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments. +

    + +
    +
    +
  4. +
+ +
+

 

+ +
+
    +
  1. +
    +
    3. 
    +
    +

    An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in 1. or 2. above will be in State living arrangement A if they + pay at least two-thirds of the household expenses. In making a determination as to + whether the individual pays two-thirds or more of the expenses, use the method defined + in SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses. +

    + +
    +
    +
  2. +
+ +

A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +
+

B

+ +
+

Shared Living Expenses -- An individual who is in Federal living arrangement A or + C and who does not meet the criteria listed for State living arrangement A, E or G + is in State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH). +

+ +

Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined above. Also included are individuals placed + under the auspices of the State adult foster care program and residents of publicly + operated emergency shelters throughout a month. +

+ +

An individual living in a household where all members receive public income maintenance + payments unless they are paying at least two-thirds of the household expenses (A). +

+ +

An individual living in a mixed household -- i.e., a household where one or more other + members receive a public income maintenance payment -- also is included unless the + individual is paying at least two-thirds of the household expenses (A). +

+ +
+

C

+ +
+

Living in the Household of Another -- Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third. +

+ +
+

E

+ +
+

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home. +

+ +
+

F

+ +
+

Effective 7/1/87, the State elected Federal administration of this optional State + supplementary payment to residents of title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Assisted Living -- Effective 7/1/94, the State elected Federal administration of this + variation. Includes an individual, certified by the State to be residing in an Assisted + Living residence served by a certified Group Adult Foster Care provider, who is not + receiving assistance under any other Federal or State rental assistance program, and + who pays a fixed, non-separable fee for rent and supportive services, other than medically + necessary services reimbursed by Medicaid. The State shall certify to SSA each individual + who is eligible for this optional supplement living arrangement. This living arrangement + was discontinued effective 1/1/96. However, it has been restored, retroactively, to + 1/1/97. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+
+
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. +

+ +
+
+

1For purposes of determining State living arrangements, a commercial boarding house, + foster home, or halfway house is not considered the person's household.

+

2Use the SSI definition of child, SI 00501.400.

+

3A public income maintenance payment is a payment from any of the following programs: + Aid to Families with Dependent Children (AFDC), SSI, the Refugee Act of 1980, the + Disaster Relief Act of 1974, general assistance programs of the Bureau of Indian Affairs, + State or local government income maintenance programs that are based on need, or Department + of Veterans Affairs benefits based on need.

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Massachusetts Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

545.00

+ +
+

128.82

+ +
+

673.82

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

545.00

+ +
+

149.74

+ +
+

694.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

114.39

+ +
+

659.39

+ +
+

 

+ +
+

B

+ +
+

Aged

+ +
+

545.00

+ +
+

39.26

+ +
+

584.26

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

545.00

+ +
+

149.74

+ +
+

694.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

30.40

+ +
+

575.40

+ +
+

 

+ +
+

E

+ +
+

Aged

+ +
+

545.00

+ +
+

293.00

+ +
+

838.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

545.00

+ +
+

149.74

+ +
+

694.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

293.00

+ +
+

838.00

+ +
+

 

+ +
+

G

+ +
+

Aged

+ +
+

545.00

+ +
+

454.00

+ +
+

999.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

545.00

+ +
+

454.00

+ +
+

999.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

454.00

+ +
+

999.00

+ +
+

B

+ +
+

C

+ +
+

Aged

+ +
+

363.341

+ +
+

104.36

+ +
+

467.70

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

363.341

+ +
+

331.40

+ +
+

694.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

363.341

+ +
+

87.58

+ +
+

450.92

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

545.00

+ +
+

149.74

+ +
+

694.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

114.39

+ +
+

659.39

+ +
+

 

+ +
+

B

+ +
+

Blind

+ +
+

545.00

+ +
+

149.74

+ +
+

694.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

545.00

+ +
+

30.40

+ +
+

575.40

+ +
+

D

+ +
+

F

+ +
+

All

+ +
+

30.002

+ +
+

35.00

+ +
+

65.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

817.00

+ +
+

201.72

+ +
+

1018.72

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

817.00

+ +
+

572.48

+ +
+

1389.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

817.00

+ +
+

180.06

+ +
+

997.06

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

817.00

+ +
+

387.10

+ +
+

1204.10

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

817.00

+ +
+

190.89

+ +
+

1007.89

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

817.00

+ +
+

376.27

+ +
+

1193.27

+ +
+

 

+ +
+

B

+ +
+

Aged/Aged

+ +
+

817.00

+ +
+

201.72

+ +
+

1018.72

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

817.00

+ +
+

572.48

+ +
+

1389.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

817.00

+ +
+

180.06

+ +
+

997.06

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

817.00

+ +
+

387.10

+ +
+

1204.10

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

817.00

+ +
+

190.89

+ +
+

1007.89

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

817.00

+ +
+

376.27

+ +
+

1193.27

+ +
+

 

+ +
+

E

+ +
+

Aged/Aged

+ +
+

817.00

+ +
+

859.00

+ +
+

1676.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

817.00

+ +
+

572.48

+ +
+

1389.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

817.00

+ +
+

859.00

+ +
+

1676.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

817.00

+ +
+

715.74

+ +
+

1532.74

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

817.00

+ +
+

859.00

+ +
+

1676.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

817.00

+ +
+

715.74

+ +
+

1532.74

+ +
+

 

+ +
+

G

+ +
+

Aged/Aged

+ +
+

817.00

+ +
+

681.00

+ +
+

1498.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

817.00

+ +
+

681.00

+ +
+

1498.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

817.00

+ +
+

681.00

+ +
+

1498.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

817.00

+ +
+

681.00

+ +
+

1498.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

817.00

+ +
+

681.00

+ +
+

1498.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

817.00

+ +
+

681.00

+ +
+

1498.00

+ +
+

B

+ +
+

C

+ +
+

Aged/Aged

+ +
+

544.671

+ +
+

215.80

+ +
+

760.47

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

544.671

+ +
+

844.80

+ +
+

1389.47

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

544.671

+ +
+

194.18

+ +
+

738.85

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

544.671

+ +
+

530.30

+ +
+

1074.97

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

544.671

+ +
+

204.99

+ +
+

749.66

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

544.671

+ +
+

519.49

+ +
+

1064.16

+ +
+

D

+ +
+

F

+ +
+

All

+ +
+

60.002

+ +
+

70.00

+ +
+

130.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

G. MICHIGAN +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal Care -- Recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care. +

+ +
+

G

+ +
+

Independent Living with an EP -- Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.) +

+ +
+

H

+ +
+

Living in the Household of Another with an EP --Recipients with an EP and living in + the household of another for Federal purposes. (Children under age 18 are excluded.) +

+ +
+

I

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under title XIX. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Michigan Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

545.00

+ +
+

87.00

+ +
+

632.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

545.00

+ +
+

157.50

+ +
+

702.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

545.00

+ +
+

179.30

+ +
+

724.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

818.002

+ +
+

14.00

+ +
+

832.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

545.341

+ +
+

9.33

+ +
+

554.67

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 30.003

+ +
+

7.00

+ +
+

37.00

+ +
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

817.00

+ +
+

447.00

+ +
+

1264.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

817.00

+ +
+

588.00

+ +
+

1405.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

817.00

+ +
+

631.60

+ +
+

1448.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1090.002

+ +
+

21.00

+ +
+

1111.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

726.671

+ +
+

14.00

+ +
+

740.67

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 60.003

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

H. MONTANA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-Certified Personal Care

+ +
+

H

+ +
+

State-Certified Residence in Community Home for Mentally Disabled

+ +
+

I

+ +
+

State-Certified Residence in Community Home for Physically or Developmentally Disabled

+ +
+

J

+ +
+

State-Certified Residence for Child and Adult Foster Care

+ +
+

K

+ +
+

State-Certified Semi-Independent Care

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Includes all individuals and couples not certified in State + codes G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding And Monthly Payment Levels +

+
+
+

Montana Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

545.00

+ +
+

94.00

+ +
+

639.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

545.00

+ +
+

94.00

+ +
+

639.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

545.00

+ +
+

94.00

+ +
+

639.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

545.00

+ +
+

52.75

+ +
+

597.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

545.00

+ +
+

26.00

+ +
+

571.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

363.341

+ +
+

0.00

+ +
+

363.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

817.00

+ +
+

193.00

+ +
+

1010.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

817.00

+ +
+

193.00

+ +
+

1010.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

817.00

+ +
+

193.00

+ +
+

1010.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

817.00

+ +
+

110.50

+ +
+

927.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

817.00

+ +
+

57.00

+ +
+

874.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

817.00

+ +
+

0.00

+ +
+

817.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

544.671

+ +
+

0.00

+ +
+

544.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

I. NEVADA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living or Living in Parental Household -- Aged or blind eligible individual + or couple who: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes; + or +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. (See SM 01301.535.)

+ +
+

B

+ +
+

Living in the Household of Another -- Aged or blind eligible individual or couple + who is living in the household of another individual and receiving food and shelter from that individual. Aged or blind individuals or couples, who are subject + to a one-third reduction of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B. +

+ +
+

C

+ +
+

Domiciliary Care -- Aged or blind eligible individual or couple who lives in a private + non-medical facility or, as of 10/76, a residential facility serving 16 or fewer persons, + which provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- No supplement cases include:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individuals or disabled members of eligible couples; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individuals or members of eligible couples in a medical facility where title + XIX pays more than 50 percent of the cost; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individuals or members of eligible couples who are patients in a private + medical facility which is not certified under title XIX; or +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    + +
    +
    +
  8. +
+ +
+
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Nevada Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

545.00

+ +
+

36.40

+ +
+

581.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

545.00

+ +
+

109.30

+ +
+

654.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

545.00

+ +
+

350.00

+ +
+

895.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

545.00

+ +
+

350.00

+ +
+

895.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

363.341

+ +
+

24.27

+ +
+

387.61

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

363.341

+ +
+

213.96

+ +
+

577.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

363.341

+ +
+

0.00

+ +
+

363.34

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

545.00

+ +
+

109.30

+ +
+

654.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

817.00

+ +
+

74.46

+ +
+

891.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

817.00

+ +
+

374.60

+ +
+

1191.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

817.00

+ +
+

224.53

+ +
+

1041.53

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

817.00

+ +
+

37.23

+ +
+

854.23

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

817.00

+ +
+

187.30

+ +
+

1004.30

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

817.00

+ +
+

881.00

+ +
+

1698.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

817.00

+ +
+

881.00

+ +
+

1698.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

817.00

+ +
+

881.00

+ +
+

1698.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

817.00

+ +
+

440.50

+ +
+

1257.50

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

817.00

+ +
+

440.50

+ +
+

1257.50

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

817.00

+ +
+

0.00

+ +
+

817.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

544.671

+ +
+

49.64

+ +
+

594.31

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

544.671

+ +
+

531.94

+ +
+

1076.61

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

544.671

+ +
+

290.79

+ +
+

835.46

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

544.671

+ +
+

24.82

+ +
+

569.49

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

544.671

+ +
+

265.97

+ +
+

810.64

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

544.671

+ +
+

0.00

+ +
+

544.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

J. NEW JERSEY +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Licensed Residential Health Care Facilities and Certain Licensed Residential Facilities + -- The State provides New Jersey field offices with lists of approved facilities. + Mentally retarded individuals must be placed and supervised by either the State Department + of Youth and Family Services or the State Division of Mental Retardation. +

+ +
+

B

+ +
+

Living Alone or with Others -- Eligible individuals (including children) or eligible + couples whose Federal living arrangements are A or C and who do not meet the requirements + defined in other supplementation categories. +

+ +

Therefore, effective 8/1/81, any eligible adult/couple who meets the requirement for + a Federal code A will be in optional supplement B unless residing in a residential + health care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code C will automatically be + entitled to optional supplement B. +

+ +

This category includes, but is not limited to, those eligible adults/couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    Living physically alone; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services. +

    + +
    +
    +
  • +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

C

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Living Alone with an Ineligible Spouse -- Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse will receive the same total payment as an eligible + couple or an individual with an EP. Once other persons, even minor children, are present + in the household, this supplementary payment variation cannot exist. However, it is + possible that a claimant and their ineligible spouse live with others and allege that + they are a separate “household” by virtue of the fact that they eat their meals out + or have separate purchase and preparation of food. In this instance, an optional supplement + C is permissible as long as no other person is in their “household.” There is no couple + counterpart in this category. +

+ +

Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B. +

+ +

A transient individual who co-exists only with an ineligible spouse will also qualify + for the O/S - C rate. +

+ +
+

D

+ +
+

Living in the Household of Another -- Persons who are “living in the household of + another” for Federal purposes. +

+ +
+

G

+ +
+

Effective 9/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Individuals and couples in licensed medical facilities where + Medicaid is paying more than 50 percent of the cost of care, individuals and couples + in publicly operated community residences having 16 or less residents, and residents + of publicly operated emergency shelters throughout a month. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

New Jersey Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

545.00

+ +
+

150.05

+ +
+

695.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

545.00

+ +
+

31.25

+ +
+

576.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

545.00

+ +
+

297.36

+ +
+

842.36

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

818.002

+ +
+

24.36

+ +
+

842.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

363.341

+ +
+

44.31

+ +
+

407.65

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

545.00

+ +
+

31.25

+ +
+

576.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

10.00

+ +
+

40.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

817.00

+ +
+

554.36

+ +
+

1371.36

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

817.00

+ +
+

25.36

+ +
+

842.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

817.00

+ +
+

  0.00

+ +
+

817.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

544.671

+ +
+

93.09

+ +
+

637.76

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 60.002

+ +
+

20.00

+ +
+

80.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

K. NEW YORK +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone -- Eligible individuals or eligible couples living physically alone, + or living with only a foster child(ren), or a homemaker authorized by the local Department + of Social Services (DSS), or a family care recipient(s) placed by the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabled (OMRDD) + or local DSS, or individuals living with others but paying a “flat fee for room and + board,” or living with others but taking all their meals outside the dwelling unit, + or living with others in a dwelling but separately preparing food, or having their + food separately prepared for them. +

+ +
+

B

+ +
+

Living with Others -- Individual/child/couple who resides in a dwelling with others + and prepares food in common with at least one other person in the dwelling, or is + a member of a religious community, or child in any living arrangement other than a + family care home (Level I) or community residence (Level II) certified by OMRDD or + OMH. +

+ +
+

C

+ +
+

Congregate Care Level I -- Family type homes and family care homes. Family type homes + are facilities operated for the purpose of providing long-term residential care for + adults and are certified by the New York State DSS and supervised by local departments + of social services. Family care homes are private households that provide care for + mentally disabled persons. +

+ +
+

D

+ +
+

Congregate Care Level II -- Residential facilities for adults and certain children + with mental disabilities. +

+ +
+

E

+ +
+

Congregate Care Level III -- Privately operated non-medical residential facilities. + Although Level III facilities are often called schools, these facilities may not meet + the Federal definition of school. Operated for the purpose of providing treatment, + training and education for mentally retarded or developmentally disabled individuals, + these facilities are certified by OMRDD in accordance with State regulations. +

+ +
+

F

+ +
+

Living in the Household of Another -- Same as Federal definition. The State supplement + payment for the individual/child/couple whose Federal benefit rate is subject to the + one-third reduction is the “living with others” rate but for systems purposes is coded + F. +

+ +
+

G

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Recipients in licensed medical facilities where Medicaid is + paying more than 50 percent of the cost of care, recipients in publicly operated community + residences which serve 16 or fewer residents, and residents of publicly operated emergency + shelters throughout a month. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

New York Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All

+ +
+

545.00

+ +
+

87.00

+ +
+

632.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

545.00

+ +
+

23.00

+ +
+

568.00

+ +
+

 

+ +
+

C

+ +
+

NY City

+ +
+

545.00

+ +
+

266.48

+ +
+

811.48

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

545.00

+ +
+

266.48

+ +
+

811.48

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

545.00

+ +
+

228.48

+ +
+

773.48

+ +
+

 

+ +
+

D

+ +
+

NY City

+ +
+

545.00

+ +
+

435.00

+ +
+

980.00

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

545.00

+ +
+

435.00

+ +
+

980.00

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

545.00

+ +
+

405.00

+ +
+

950.00

+ +
+

 

+ +
+

E

+ +
+

NY City

+ +
+

545.00

+ +
+

482.96

+ +
+

1027.96

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

545.00

+ +
+

458.96

+ +
+

1003.96

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

545.00

+ +
+

458.96

+ +
+

1003.96

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

545.00

+ +
+

  0.00

+ +
+

545.00

+ +
+

B

+ +
+

F

+ +
+

All

+ +
+

363.341

+ +
+

23.00

+ +
+

386.34

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 30.002

+ +
+

  5.003

+ +
+

35.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3New York administers a supplement of $20 to some recipients in a title XIX institution. +

+

4Includes and applies to: Nassau, Suffolk, and Westchester counties effective 7/1/85. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All

+ +
+

817.00

+ +
+

104.00

+ +
+

921.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

817.00

+ +
+

46.00

+ +
+

863.00

+ +
+

 

+ +
+

C

+ +
+

NY City

+ +
+

817.00

+ +
+

805.96

+ +
+

1622.96

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

817.00

+ +
+

805.96

+ +
+

1622.96

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

817.00

+ +
+

729.96

+ +
+

1546.96

+ +
+

 

+ +
+

D

+ +
+

NY City

+ +
+

817.00

+ +
+

1143.00

+ +
+

1960.00

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

817.00

+ +
+

1143.00

+ +
+

1960.00

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

817.00

+ +
+

1083.00

+ +
+

1900.00

+ +
+

 

+ +
+

E

+ +
+

NY City

+ +
+

817.00

+ +
+

1238.92

+ +
+

2055.92

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

817.00

+ +
+

1190.92

+ +
+

2007.92

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

817.00

+ +
+

1190.92

+ +
+

2007.92

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

817.00

+ +
+

0.00

+ +
+

817.00

+ +
+

B

+ +
+

F

+ +
+

All

+ +
+

544.671

+ +
+

46.00

+ +
+

590.67

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 60.002

+ +
+

10.003

+ +
+

70.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3New York administers a supplement of $20 to some recipients in a title XIX institution. +

+

4Includes and applies to: Nassau, Suffolk, and Westchester counties effective 7/1/85. +

+
+
+
+
+ +
+
+

L. PENNSYLVANIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone -- Recipients in private medical facilities (nursing homes, hospitals, + intermediate care facilities) where title XIX is not paying more than 50 percent of the cost of care, residents of publicly operated emergency + shelters throughout a month, and all other individuals and couples in Federal codes + A and C not meeting the definition of another variation. +

+ +

Used with an "intervening" Federal code A. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients who do not have an EP and who live + in the household of another and receive support and maintenance for Federal purposes. +

+ +
+

C

+ +
+

Living with an EP -- Recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EPs as defined under the + Federal rules; i.e., Public Law 93-66. +

+ +
+

D

+ +
+

Living in the Household of Another with an EP --Recipients who live in the household + of another and who have one or more EPs as defined under the Federal rules; i.e., + Public Law 93-66. +

+ +
+

G

+ +
+

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities (Effective + 7/1/89). +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Includes all recipients who are residing in a medical facility + in which title XIX is paying more than 50 percent of the cost of care. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Pennsylvania Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

545.00

+ +
+

27.40

+ +
+

572.40

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

818.003

+ +
+

43.70

+ +
+

861.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

545.00

+ +
+

389.30

+ +
+

934.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

545.00

+ +
+

394.30

+ +
+

939.30

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

363.341

+ +
+

27.40

+ +
+

390.74

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

545.342

+ +
+

43.70

+ +
+

589.04

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

545.00

+ +
+

27.40

+ +
+

572.40

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.004

+ +
+

  0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

817.00

+ +
+

43.70

+ +
+

860.70

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1090.003

+ +
+

68.05

+ +
+

1158.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

817.00

+ +
+

857.40

+ +
+

1674.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

817.00

+ +
+

867.40

+ +
+

1684.40

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

544.671

+ +
+

43.70

+ +
+

588.37

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

726.672

+ +
+

68.05

+ +
+

794.72

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.004

+ +
+

  0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

M. RHODE ISLAND +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living -- Recipients who are in Federal codes A and C, except for individuals + residing in a residential care/assisted living facility who have been certified as + eligible for State Code D. +

+ +

Recipients residing in a public emergency shelter for the homeless and those who are + eligible for Section 1619 are included in this category. +

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied. +

+ +
+

D

+ +
+

Residential Care/Assisted Living (Effective 10/1/98). (Formerly Shelter Care from + 10/01/90 – 9/30/98.) This category applies to individuals only. +

+ +
+

E

+ +
+

The State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 3/1/91). +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Rhode Island Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A1

+ +
+

All

+ +
+

545.00

+ +
+

64.35

+ +
+

609.35

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

545.00

+ +
+

582.00

+ +
+

1127.00

+ +
+

B

+ +
+

B1

+ +
+

All

+ +
+

363.342

+ +
+

74.60

+ +
+

437.94

+ +
+

C

+ +
+

A1

+ +
+

All

+ +
+

545.00

+ +
+

64.35

+ +
+

609.35

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

 30.003

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A1

+ +
+

All

+ +
+

817.00

+ +
+

120.50

+ +
+

937.50

+ +
+

B

+ +
+

B1

+ +
+

All

+ +
+

544.672

+ +
+

136.50

+ +
+

681.17

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

60.003

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

N. UTAH +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone or With Others -- This variation includes recipients who are in Federal + codes A and C. +

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients with no EP who are "living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.) +

+ +
+

Z

+ +
+

No Supplement Cases -- No supplement cases include all recipients who are not included + in A or B. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Utah Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Level

+ +
+

A,C

+ +
+

Z

+ +
+

All

+ +
+

545.00

+ +
+

0.00

+ +
+

545.00

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

363.342

+ +
+

3.13

+ +
+

366.47

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

2Not an FBR, the amount represents the FBR less VTR.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All

+ +
+

817.00

+ +
+

4.60

+ +
+

821.60

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

544.672

+ +
+

9.73

+ +
+

554.40

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+ +
+
+

O. VERMONT +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living (except Chittenden County) -- Recipients not living in the household + of another, not in a custodial care situation, and not otherwise excepted from supplementation. + Includes a child who is living with a parent and recipients residing in a private + title XIX facility where Medicaid is not paying more than 50 percent of the cost of + care. +

+ +

Effective 5/1/83, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A (except Chittenden County). +

+ +
+

B

+ +
+

Independent Living in Chittenden County -- Same as A above except restricted to residents + of Chittenden County. +

+ +

Effective 5/1/83, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +

+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A (Chittenden County only). (See SM 01301.535.) +

+ +
+

C

+ +
+

Assistive Community Care Level III: Recipients living in facilities identified by + the State. +

+ +
+

E

+ +
+

Living in the Household of Another -- Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions), and not otherwise excepted from supplementation. +

+ +
+

G

+ +
+

Custodial Care: Licensed Community Care Home -- Recipients living in Level IV Community + Homes identified by the State. +

+ +
+

H

+ +
+

Custodial Care: Family Home -- Recipients living in another's home in such a manner + that the individual or couple is paying room and board and is receiving one or more + of the services outlined under the custodial care definition. The individual or couple + must also receive the room and board and custodial care in the home in which they + reside. In order to qualify as a home under this arrangement, these services must + not be provided to more than two persons and must be provided by a resident of the + home. +

+ +

Custodial care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service 2-3 times a week) and/or + supervision for the recipient's protection. Supervision for the recipient's protection + deals primarily with protection services for retarded and emotionally disturbed individuals. + A person who receives one or more of these personal services is receiving custodial + care. +

+ +

The change in this arrangement is effective for initial claims filed on or after 1/1/84. + For redeterminations the change is effective with the month after the month in which + the first redetermination on or after 1/1/84, is initiated. +

+ +

This arrangement does not cover:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Institutional Living -- Regardless of whether custodial care is needed in addition + to the medical, training, rehabilitation, educational or similar services as the primary + function of the institution. +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    A person whose Federal living arrangement is based on home ownership or rental liability. + (A flat fee for room and board per SI 00835.120B. is not considered as rental liability for this arrangement.) +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    A child under age 18 not placed by a Vermont Community Mental Health Agency or the + Vermont Department of Mental Health. +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Custodial care or supervision provided by a spouse (as defined by Federal regulations).

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Any home or boarding arrangement which does not meet the Federal SSI definition of + independent living, Federal Code A. +

    + +
    +
    +
  10. +
+ +
+

I

+ +
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents in title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+
+
+
+

NOTE: When a person has a room in one facility/household and receives board or custodial + care in another facility/household, the custodial rate (G or H) is based on the facility/household + where the person sleeps. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Vermont Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

545.00

+ +
+

59.04

+ +
+

604.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

545.00

+ +
+

59.04

+ +
+

604.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

545.00

+ +
+

48.38

+ +
+

593.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

545.00

+ +
+

223.94

+ +
+

768.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

545.00

+ +
+

98.69

+ +
+

643.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

363.341

+ +
+

39.30

+ +
+

402.64

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

545.00

+ +
+

59.04

+ +
+

604.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

545.00

+ +
+

59.04

+ +
+

604.04

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

17.66

+ +
+

47.66

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County )

+ +
+

817.00

+ +
+

110.88

+ +
+

927.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County )

+ +
+

817.00

+ +
+

110.88

+ +
+

927.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

817.00

+ +
+

96.77

+ +
+

913.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

817.00

+ +
+

562.06

+ +
+

1379.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

817.00

+ +
+

332.82

+ +
+

1149.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

544.671

+ +
+

48.31

+ +
+

592.98

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

35.33

+ +
+

95.33

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

P. WASHINGTON +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Code +

Definition

+ +
ALiving Alone -- Recipients who are "living in own household” under title XVI. If an + eligible individual/couple is determined to be living in own household (Federal living + arrangement A) for title XVI, the eligible individual/couple will usually be in a + living alone arrangement for State supplementation purposes. +
​ +

This variation includes:

+ +
    +
  1. +
    +
    (1) 
    +
    +

    Eligible individuals or eligible couples living in private households, whether they + are renting, buying, own their home, or have an interest in the home (e.g., a life + estate). The household may be in a house, room, college dormitory, apartment, hotel, + motel, etc. +

    + +
    +
    +
  2. +
  3. +
    +
    (2) 
    +
    +

    Eligible individuals or eligible couples living in board and room situations. This + includes commercial, benevolent, religious, or fraternal board and room accommodations. +

    + +
    +
    +
  4. +
  5. +
    +
    (3) 
    +
    +

    Eligible individuals or eligible couples residing in homes approved as congregate + care facilities (group homes). +

    + +
    +
    +
  6. +
  7. +
    +
    (4) 
    +
    +

    Eligible individuals or eligible couples residing in publicly operated community-based + residences of 16 or fewer beds. +

    + +
    +
    +
  8. +
  9. +
    +
    (5) 
    +
    +

    Eligible individuals and eligible couples residing in adult family homes. Adult family + homes are homes that provide board, room, and laundry. They may also provide necessary + supervision, personal and social services, and, when appropriate, a minimum of nursing + care, and are approved for payment and licensed by the State Department of Social + and Health Services. +

    + +
    +
    +
  10. +
  11. +
    +
    (6) 
    +
    +

    An eligible individual living with an ineligible spouse when natural, step, adoptive + or foster children under age 18 whose needs are included in determining an AFDC grant + are residing in the same household. In these cases we assume that the ineligible spouse's + income has been considered in determining the AFDC payment unless the couple is living + in a holding-out relationship. (Where the holding-out spouse has income, the local + Department of Social and Health Services office must be contacted to determine whether + that income has been considered in an AFDC payment.) This variation does not include + an eligible individual living with an ineligible spouse and grandchildren under age + 18 whose needs are included in determining an AFDC grant. +

    + +
    +
    +
  12. +
  13. +
    +
    (7) 
    +
    +

    A child in a Federal Code A or C living arrangement.

    + +
    +
    +
  14. +
+ +
+

 

+ +
+

Optional supplement code A is the proper code to be used with an “intervening” Federal + A code. (See SM 01301.535.) +

+ +

EXCEPTIONS

+ +

Optional supplement A is not paid when:

+ +
    +
  1. +
    +
    (1) 
    +
    +

    An individual is living in a medical care facility throughout an entire calendar month;

    + +
    +
    +
  2. +
  3. +
    +
    (2) 
    +
    +

    An eligible individual has more than one EP;

    + +
    +
    +
  4. +
  5. +
    +
    (3) 
    +
    +

    An eligible couple has one or more EPs; and

    + +
    +
    +
  6. +
  7. +
    +
    (4) 
    +
    +

    An eligible individual or couple is residing in a public emergency shelter for the + homeless (effective 5/83). +

    + +
    +
    +
  8. +
+ +
+

B

+ +

 

+ +

 

+ +
+

Living Alone with an Ineligible Spouse -- Eligible individual who is the head of the + household and who lives alone as described in A above and is living with an ineligible + spouse. An ineligible spouse is a spouse who has either not applied for SSI benefits, + has been denied or terminated, or have withdrawn their application. It is not material + whether the ineligible spouse is aged, blind, or disabled. An ineligible spouse includes: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Legally married and common-law spouses;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    “Holding-out” spouses;

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Alien spouses not lawfully admitted to the U.S.; and

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Refugee spouses receiving payments.

    + +
    +
    +
  8. +
+ +
+
+

NOTE: Refugee payments are not deemable to the eligible individual. +

+ +
+
+ +

In determining whether an ineligible spouse is a member of the household for the purpose + of paying the optional supplement B to the eligible individual, use the same rules + for making Federal determinations. If an eligible individual marries, or a separated + spouse returns home, the ineligible spouse supplement is paid beginning with the month + after the month of the arrival of the ineligible spouse in the household. +

+ +

Exceptions

+ +

Optional supplement B is not paid when: (1) an individual with an ineligible spouse + also has child(ren) under age 18 whose needs are considered in determining an AFDC + grant. Rather, the optional supplement A is paid. This is true whether or not the + ineligible spouse is actually included on the AFDC grant; (2) an eligible individual + resides in a public emergency shelter for the homeless (effective 5/83). In this case, + use optional supplementation code Z. +

+ +
+

C

+ +

 

+ +

 

+ +
+

Living in the Household of Another -- Applies to most cases which meet the Federal + definition of living in the household of another (Federal code B). +

+ +

Exceptions

+ +

Not paid when: (1) an individual lives in the household of another with more than + one EP; or (2) a couple lives in the household of another with one or more EPs. In + both of these cases the optional supplementation code is Z. +

+ +
+

F

+ +

 

+ +
+

Living in the Household of Another with an Ineligible Spouse -- Individuals living + in the household of another (Federal code B) who have an ineligible spouse or an EP. +

+ +

Exception

+ +

Individuals with more than one EP are not eligible for an optional supplement.

+ +
+

G

+ +
+

Living with an Essential Person -- Applies to an eligible individual who is the head + of the household and who lives alone as described in A above and was converted from + the 12/73 State rolls with an EP who has continued to live in the household. The system + will pay the optional supplement for an EP. If an eligible individual has more than + one EP use optional supplementation code Z. +

+ +
+

H

+ +

 

+ +
+

Living in the Household of Another with an EP -- Applies to individuals living in + the household of another who have an EP. Individuals with more than one EP are not + eligible for an optional supplement. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- The following groups are ineligible for a federally administered + optional supplement: +

+ +

An individual with more than one EP.

+ +
    +
  1. +
    +
    a. 
    +
    +

    A couple with one or more EPs.

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Individuals residing in a medical facility throughout a month, regardless of whether + private or public, or if Medicaid is involved in reimbursement for the cost of the + care. (If only one member of an eligible couple is in a medical facility, determine + the optional supplement variation that applies to the other member separately.) The + term “medical facility” includes hospitals, nursing homes, and extended care facilities, + but does not include boarding schools, congregate care facilities, and half-way houses. +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month, effective 5/83.

    + +
    +
    +
  6. +
+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Washington Effective 1/1/02

Individual +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

All other

counties +

+ +
+

545.00

+ +

 

+ +

 

+ +

 

+ +

545.00

+ +
+

25.90

+ +

 

+ +

 

+ +

5.45

+ +
+

570.90

+ +

 

+ +

 

+ +

550.45

+ +
+

 

+ +
+

B

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

All other

counties +

+ +
+

545.00

+ +

 

+ +

 

+ +

545.00

+ +
+

166.10

+ +

 

+ +

 

+ +

136.15

+ +
+

711.10

+ +

 

+ +

 

+ +

681.15

+ +
+

 

+ +
+

G

+ +
+

Individual with one EP King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

Individual with one EP

+ +

All other

counties +

+ +
+

818.00

+ +

 

+ +

 

+ +

 

+ +

818.00

+ +
+

19.90

+ +

 

+ +

 

+ +

 

+ +

0.00

+ +
+

837.90

+ +

 

+ +

 

+ +

 

+ +

818.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

545.003

+ +
+

0.00

+ +
+

545.00

+ +
+

B

+ +
+

C

+ +
+

All

+ +
+

363.341

+ +
+

3.71

+ +
+

367.05

+ +
+

 

+ +
+

F

+ +
+

Individual w/Ineligible Spouse

+ +
+

363.341

+ +
+

101.66

+ +
+

465.00

+ +
+

 

+ +
+

H

+ +
+

Individual living with one EP

+ +
+

545.342

+ +
+

4.20

+ +
+

549.54

+ +
+

 

+ +
+

Z

+ +
+

Individual living with more than one EP

+ +
+

363.343

+ +
+

0.00

+ +
+

363.34

+ +
+

C

+ +
+

A

+ +
+

King, Kitsap, Pierce, Snohomish, Thurston Counties

+ +

All other counties

+ +
+

545.00

+ +

 

+ +

 

+ +

545.00

+ +
+

25.90

+ +

 

+ +

 

+ +

5.45

+ +
+

570.90

+ +

 

+ +

550.45

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.005

+ +
+

0.004

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

3Plus increment for each EP, if appropriate.

+

4Individuals/each member of a couple with income of $45.00 or less will receive a $11.62 + State-administered supplement. Individuals/each member of a couple with income making + them ineligible for SSI payments will be allowed to keep $36.62 a month for personal + expenses.

+

5Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +
+

King, Kitsap, Pierce,

Snohomish, Thurston Counties +

+ +

All other counties

+ +
+

817.00

+ +

 

+ +

 

+ +

 

+ +

 

+ +

 

+ +

817.00

+ +
+

19.90

+ +

 

+ +

 

+ +

0.00

+ +
+

836.90

+ +

 

+ +

 

+ +

817.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

817.002

+ +
+

0.00

+ +
+

817.00

+ +
+

B

+ +
+

C

+ +
+

All

+ +
+

544.671

+ +
+

4.20

+ +
+

548.87

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

544.672

+ +
+

0.00

+ +
+

544.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

  60.004

+ +
+

0.003

+ +
+

 60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Plus increment for each EP, if appropriate.

+

3Individuals/each member of a couple with income of $45.00 or less will each receive + a $11.62 State-administered supplement. Individuals/each member of a couple with income + making them ineligible for SSI payments will be allowed to keep $36.62 a month for + personal expenses.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

 

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415034
SI 01415.034 - Federally Administered Optional Supplementary Payment Programs – January 2002 Payment Levels - 08/07/2024
+Batch run: 02/19/2025
+Rev:08/07/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2003.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2003.html new file mode 100644 index 00000000..cd06b534 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2003.html @@ -0,0 +1,16999 @@ + + +SSA - POMS: SI 01415.035 - Federally Administered Optional Supplementary Payment Programs - 1/03 Payment Levels - 08/08/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 72 (08-24)

+

SI 01415.035 Federally Administered Optional Supplementary Payment Programs - 1/03 Payment Levels +

+ + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

CALIFORNIA +

+ +
+

NEVADA +

+ +
+

DELAWARE +

+ +
+

NEW + JERSEY

+ +
+

DISTRICT + OF COLUMBIA

+ +
+

NEW + YORK

+ +
+

HAWAII +

+ +
+

PENNSYLVANIA +

+ +
+

IOWA +

+ +
+

RHODE + ISLAND

+ +
+

MASSACHUSETTS +

+ +
+

UTAH +

+ +
+

MICHIGAN +

+ +
+

VERMONT +

+ +
+

MONTANA +

+ +
+

 

+ +
+
+
+
+

A. CALIFORNIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Independent + Living with Cooking Facilities -- Eligible individual or couple + who:

+ +
    +
  • +
    +
    •
    +
    +

    Lives in + their + own household, as defined for Federal living arrangement A purposes, and has cooking + and food + storage facilities or is provided meals as part of the living arrangement; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a + patient in a certified private medical facility where title XIX + does not pay more than 50 percent + of the cost of care; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a + blind child under age 18 living in the household of a parent or + parents or is a disabled child age 18 or over who meets sharing + criteria and is living in the household of a parent or parents; + or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a + blind individual who lives in an independent living arrangement + with or without cooking and food storage facilities; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Effective + 7/1/83, lives in a private medical facility licensed by the State + but not certified under title XIX. (An optional supplementary A + payment based on the new instructions is payable retroactively + to 7/1/83.)

    + +
    +
    +
  • +
+ +
+

B +

+ +

+

+ +

+ +
+

Non-medical + Out-of-Home Care (NMOHC) -- Applies when an individual/couple needs + non-medical care or supervision in the following living arrangement situations: +

+ +

CHILDREN (UNDER AGE 18)

+ +
    +
  • +
    +
    •
    +
    +

    Blind child residing in a State licensed NMOHC + facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Blind + child residing in the home of a relative who is not a parent and + not a legal guardian; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled + child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Effective + 10/1/79, disabled child residing in the home of a legal guardian who + is not a relative; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Effective + 1/1/84, disabled child residing in the home of a relative who is + not a parent (Major + v. McMahon decision), + reopening a prior decision to pay OS B under this definition may + be retroactive to 1/1/84; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A blind + or disabled child in a “certified family” home + approved by a licensed home-finding agency (“certified + family home placement”); or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    For periods + prior to 7/1/83 only, a blind or disabled child placed in any home or + State licensed NMOHC facility as the result of a court order; or

    + +
    +
    +
  • +
+ +

+ +

ADULTS + (AGE 18 AND OVER)

+ +
    +
  • +
    +
    •
    +
    +

    Aged, + blind or disabled individual/couple has been determined to be in + FLA A and resides in the home of a relative, legal conservator + or guardian; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Aged, + blind or disabled individual/couple has been determined to be in + FLA A and resides in a State licensed NMOHC facility.

    + +
    +
    +
  • +
+ +

+ +

For California optional supplement purposes, a relative + is defined as a parent, + child, + sibling, + half-sibling, + parent's + sibling, + sibling's + child, first cousin, or any person of the preceding generation denoted by the + prefix “grand” or “great.”

+ +
+

C +

+ +
+

Independent + Living Without Cooking Facilities -- Aged or disabled individual/couple + who is neither provided any meals nor has access to adequate cooking/food storage + facilities as part of a living arrangement. Transients, as defined + in SI 00835.060, are also eligible for OS C.

+ +
    +
  • +
    +
    •
    +
    +

    An individual/couple + qualifies for OS C if any of the following situations exists:

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Immediate + living quarters do not have cooking and food storage facilities with + which the individual/couple or another person (who is responsible + for preparing the individual's/couple's meals) can prepare meals + on a daily basis.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate + cooking and food storage facilities as part of the living arrangement + (including cooking and food storage facilities which are outside + the immediate living quarters) for the purpose of preparing meals + or having them prepared on their behalf.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives + in a boarding house that does not have a communal kitchen with adequate cooking + and food storage facilities to which they have access for preparation + of meals.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives + with friends or relatives in private living quarters in the same + house or in separate living quarters (for example, “over + the garage”) or in a similar situation and does not have access to the cooking + and food storage facilities in the main residence for preparation + of meals.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives + in a room and board facility and does not contract with the facility to + have meals prepared and provided as part of the living arrangement + (for example, the SSI applicant's/recipient's arrangement with + the facility is to purchase only shelter on a monthly basis).

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “Adequate” cooking + and food storage facilities exist when an individual/couple has + access to:

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Both + a working refrigerator or icebox and a stove without a working oven + but with at least two working burners. (The capacity of the refrigerator + or icebox is not a factor of consideration. An ice chest is not considered adequate storage.)

    + +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both + a working refrigerator or icebox and a hotplate with at least + two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature + controls that are used for warming food are not considered adequate cooking + facilities.)

    + +

    + +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both + a working refrigerator or icebox and a stove with a working + oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature + control.

    + +
    +
    +
  • +
+ +
+

+ +

+ +
+
    +
  • +
    +
    •
    +
    +

    Eligibility for OS C begins in the month the + applicant/recipient applies for this supplement rate provided + they + have + been without cooking and food storage facilities throughout the month.

    + +

    NOTE: For purposes of OS C, “throughout a month” does not mean the applicant/recipient + must lack adequate cooking/food storage facilities from the very first moment of the + month. + They + need only lack them from some time on the first day of the month.

    + +
    +
    +
  • +
+ +
    +
  • +
    +
    •
    +
    +

    If eligibility is based on temporary loss or + non-functioning + of an appliance, the individual should be advised of + their + responsibility to report immediately when the temporary condition has ceased. If the + individual + provides an expected date when the appliance will be replaced/repaired, diary the + case for + re-contact.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligibility + for this supplementary payment ceases the month following the month + in which meals are provided or adequate cooking and food storage + facilities are available.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    For a + couple, comprised of an aged/disabled individual and a blind individual, + whose living arrangement lacks adequate cooking and storage facilities, the + couple is to receive the SSI/SSP level for a blind/aged or disabled + couple plus the restaurant meals allowance for the disabled member + of the couple. Force payment in this living arrangement is required. +

    + +
    +
    +
  • +
+ +
+

D +

+ +
+

Living + in the Household of Another -- Eligible individual/couple is living + in the household of another and is receiving food and shelter from that individual. Most + individuals/couples who are subject to a 1/3 reduction of their + Federal SSI payments (VTR) are eligible for OS D because the criteria + for this supplement level are the same as for charging the VTR. + However, when the eligible individual/couple lives in the home + of a relative (other than a spouse) and needs care and supervision, + certification for non-medical out-of-home care (OS F) should be obtained + from the county welfare office since this is the highest categorical + supplement for which an individual /couple can qualify.

+ +
+

E +

+ +

+ +
+

Disabled + Child Under Age 18 – Disabled (not blind) child under + age 18 who resides with a parent or relative by blood or marriage. + (Until 9/30/79, a disabled child under age 18 living with a legal + guardian also fell into this category.)

+ +

NOTE: Effective 2/1/82, only + FLA A and C are compatible with OS E. If the VTR applies, see code + G.

+ +
+

F +

+ +

+ +
+

Non-medical + Out-of-Home Care Living in the Household of Another --Effective 2/1/82. + Applies whenever an eligible individual or couple meets the criteria + for the non-medical out-of-home care payment rate, and is determined + to receive the Federal code B payment for living in the household + of another (SI 00835.200).

+ +
+

G +

+ +
+

Disabled + Child Under Age 18 Living in the Household of Another --Effective + 2/1/82. Applies to a disabled (not blind) child under age 18, who + resides with a parent or relative by blood or marriage, and is determined to receive + the Federal code B payment for living in the household of another + individual (SI 00835.200).

+ +
+

J +

+ +

+ +
+

Effective + 7/1/87, the State elected Federal administration of an optional + State supplementary payment to residents of title XIX facilities. +

+ +

This + State code is also used to supplement Section 1619 cases.

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+

Z +

+ +
+

No + Supplement Cases -- Eligible individual or couple who is a patient: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where + title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a + private medical facility which is not certified under title XIX + and not licensed by the State (effective 7/1/83). (Prior to 7/1/83, + the facility could have been licensed by the State but not certified + under title XIX.)

    + +
    +
    +
  4. +
+ +

Includes residents of publicly + operated emergency shelters throughout a month.

+ +

NOTE: California is a concurrent + category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+ +
+
+

 

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

California Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +

+ +
+

Aged +

+ +
+

552.00 +

+ +
+

205.00 +

+ +
+

757.00

+ +
+

 

+ +
+

 

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

267.00 +

+ +
+

819.00

+ +
+

 

+ +
+

 

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

205.00 +

+ +
+

757.00

+ +
+

 

+ +
+

B +

+ +
+

All +

+ +
+

552.00 +

+ +
+

373.00 +

+ +
+

925.00

+ +
+

 

+ +
+

C

+ +
+

Aged +

+ +
+

552.00 +

+ +
+

284.00 +

+ +
+

836.00

+ +
+

 

+ +
+

 

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

267.00

+ +
+

819.00

+ +
+

 

+ +
+

 

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

284.00

+ +
+

836.00

+ +
+

 

+ +
+

E +

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

+ 98.00

+ +
+

650.00

+ +
+

 

+ +
+

Z +

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

B

+ +
+

D

+ +
+

Aged +

+ +
+

368.001

+ +
+

210.66 +

+ +
+

578.66

+ +
+

 

+ +
+

 

+ +
+

Blind +

+ +
+

368.001

+ +
+

286.66 +

+ +
+

654.66

+ +
+

 

+ +
+

 

+ +
+

Disabled +

+ +
+

368.001

+ +
+

210.66 +

+ +
+

578.66

+ +
+

 

+ +
+

F +

+ +
+

All +

+ +
+

368.001

+ +
+

372.66 +

+ +
+

740.66

+ +
+

 

+ +
+

G +

+ +
+

Disabled +

+ +
+

368.001

+ +
+

+ 92.66

+ +
+

460.66

+ +
+

C

+ +

+ +
+

A +

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

267.00 +

+ +
+

819.00 +

+ +
+

 

+ +
+

E +

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

+ 98.00

+ +
+

650.00

+ +
+

D +

+ +
+

J +

+ +
+

All +

+ +
+

30.002

+ +
+

+ 17.00

+ +
+

+ 47.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +

+ +
+

Aged/Aged +

+ +
+

829.00 +

+ +
+

515.00 +

+ +
+

1344.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind +

+ +
+

829.00 +

+ +
+

727.00

+ +
+

1556.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled +

+ +
+

829.00 +

+ +
+

515.00 +

+ +
+

1344.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind +

+ +
+

829.00 +

+ +
+

648.00

+ +
+

1477.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled +

+ +
+

829.00 +

+ +
+

515.00

+ +
+

1344.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled +

+ +
+

829.00 +

+ +
+

648.00

+ +
+

1477.00

+ +
+

 

+ +
+

B

+ +
+

All +

+ +
+

829.00 +

+ +
+

1021.00

+ +
+

1850.00

+ +
+

 

+ +
+

C

+ +

+ +
+

Aged/Aged +

+ +
+

829.00 +

+ +
+

673.00

+ +
+

1502.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled +

+ +
+

829.00 +

+ +
+

673.00 +

+ +
+

1502.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled +

+ +
+

829.00 +

+ +
+

673.00

+ +
+

1502.00

+ +
+

 

+ +
+

Z

+ +
+

All +

+ +
+

829.00 +

+ +
+

+ 0.00

+ +
+

829.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged +

+ +
+

552.671

+ +
+

546.33 +

+ +
+

1099.00

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

552.671

+ +
+

759.33 +

+ +
+

1312.00

+ +
+

+ +
+

+ +
+

Disabled/Disabled +

+ +
+

552.671

+ +
+

546.33 +

+ +
+

1099.00

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

552.671

+ +
+

678.33 +

+ +
+

1231.00

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

552.671

+ +
+

546.33 +

+ +
+

1099.00

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

552.671

+ +
+

678.33 +

+ +
+

1231.00

+ +
+

+ +
+

F

+ +
+

All +

+ +
+

552.671

+ +
+

968.33 +

+ +
+

1521.00

+ +
+

D

+ +
+

J

+ +
+

All +

+ +
+

60.002

+ +
+

+ 34.00

+ +
+

+ 94.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+ +
+
+

B. DELAWARE +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult + Residential Care Facility -- Only living arrangement variation + in Delaware and includes only those recipients who are certified + by the State medical unit as residents of an adult care facility. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+

Z

+ +
+

No + Supplement Cases -- All recipients who are not included in A or + Y.

+ +

Optional + supplementation code Z is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.)

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Delaware Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

All +

+ +
+

552.00 +

+ +
+

140.00 +

+ +
+

692.00

+ +
+

+ +
+

Z

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

B

+ +
+

Z

+ +
+

All +

+ +
+

368.001

+ +
+

+ 0.00

+ +
+

368.00

+ +
+

C

+ +
+

Z

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

D

+ +
+

Z

+ +
+

All +

+ +
+

30.002

+ +
+

+ 0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All +

+ +
+

829.00 +

+ +
+

448.00 +

+ +
+

1277.00

+ +
+

+ +
+

Z

+ +
+

All +

+ +
+

829.00 +

+ +
+

+ 0.00

+ +
+

829.00

+ +
+

B

+ +
+

Z

+ +
+

All +

+ +
+

552.671

+ +
+

+ 0.00

+ +
+

552.67

+ +
+

D

+ +
+

Z

+ +
+

All +

+ +
+

60.002

+ +
+

+ 0.00

+ +
+

+ 60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

C. DISTRICT OF COLUMBIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Adult + Foster Care Home with 50 or Fewer Residents --Recipients who are + certified by the District of Columbia, Department of Human Services, + as residents of an adult foster care home with 50 or fewer residents. +

+ +
+

B +

+ +
+

Adult + Foster Care Home with More than 50 Residents --Recipients who are + certified by the District of Columbia, Department of Human Services, + as residents of an adult foster care home with more than 50 residents. +

+ +
+

G +

+ +
+

Effective + 1/1/88, the State elected Federal administration of an optional + State supplementary payment to residents of title XIX facilities. +

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+

Z +

+ +
+

No + Supplement Cases -- All recipients who are not included in A, B, G, + or Y.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

District of Columbia + Effective 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All +

+ +
+

552.00 +

+ +
+

307.00 +

+ +
+

859.00

+ +
+

+ +
+

B

+ +
+

All +

+ +
+

552.00 +

+ +
+

417.00 +

+ +
+

969.00

+ +
+

B

+ +
+

Z

+ +
+

All +

+ +
+

368.001

+ +
+

+ 0.00

+ +
+

368.00

+ +
+

C

+ +
+

Z

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

D

+ +
+

G

+ +
+

All +

+ +
+

30.002

+ +
+

+ 40.00

+ +
+

+ 70.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Code +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All +

+ +
+

829.00 +

+ +
+

+ 889.00

+ +
+

1718.00

+ +
+

+ +
+

B

+ +
+

All +

+ +
+

829.00 +

+ +
+

1109.00 +

+ +
+

1938.00

+ +
+

B

+ +
+

Z

+ +
+

All +

+ +
+

552.671

+ +
+

+ 0.00

+ +
+

552.67

+ +
+

D

+ +
+

G

+ +
+

All +

+ +
+

60.002

+ +
+

+ 80.00

+ +
+

140.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

D. HAWAII +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Independent + Living – Eligible individual or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in + their + own household as defined for Federal living arrangement A purposes. This includes + living in a + “half-way house,” which is a private non-medical facility with whom the State has + a purchase or + services agreement for the short term care of certain needy individuals; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a + patient in a certified private medical facility where title XIX does not pay more than 50 percent + of the cost of care; or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a + blind or disabled child under age 18 (or age 21 if the individual qualifies + as a “protected child”) living in the household + of a parent or parents.

    + +
    +
    +
  6. +
+ +

Optional supplement code + A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.)

+ +

This State code is also + used to supplement Section 1619 cases.

+ +
+

B +

+ +
+

Living + in a Community Care/Foster Care Home -- Effective 1/03.

Persons eligible for SSI and who meet both of the following conditions: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    over age 18 and

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    live + in a State approved Community Care/Foster Care Home

    + +
    +
    +
  4. +
+ +
+

H +

+ +
+

Domiciliary + Care I -- (Maximum of five residents)- Eligible individual (including + a child) or couple living in a domiciliary care facility which + provides varying levels of care and services. A domiciliary care + facility is a private, non-medical facility established and maintained + to provide personal care and services to aged, infirm, or handicapped + persons. The State provides SSA with listings of these facilities. +

+ +
+

I +

+ +
+

Domiciliary + Care II -- Same as H except care is provided for six or more residents. +

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Eligible for, but + has waived + their + right to receive an optional supplement.

+ +
+

Z +

+ +

+

+ +

+ +
+

No + Supplement Cases -- Eligible individual (or couple) who is living + in the household of another (see explanation in definition for + optional supplement B) and an eligible individual (or couple) who + is a patient:

+ +
    +
  1. +
    +
    a. 
    +
    +

    In a + medical facility where title XIX pays more than 50 percent of the + costs; or

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    In a + private medical facility which is not certified under title XIX. +

    + +
    +
    +
  4. +
+ +

Also includes residents of publicly operated + emergency shelters throughout a month.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Hawaii Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

+ +
+

B

+ +
+

All +

+ +
+

552.00 +

+ +
+

521.90 +

+ +
+

1073.90

+ +
+

+ +
+

H

+ +
+

All +

+ +
+

552.00 +

+ +
+

521.90 +

+ +
+

1073.90

+ +
+

+ +
+

I

+ +
+

All +

+ +
+

552.00 +

+ +
+

629.90 +

+ +
+

1181.90

+ +
+

B

+ +
+

Z

+ +
+

All +

+ +
+

368.001

+ +
+

+ 0.00

+ +
+

368.00

+ +
+

C

+ +
+

A

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

D

+ +
+

Z

+ +
+

All +

+ +
+

 30.002

+ +
+

+ 0.00

+ +
+

+ 30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All +

+ +
+

829.00 +

+ +
+

+ 0.00

+ +
+

829.00

+ +
+

+ +
+

B

+ +
+

All +

+ +
+

829.00 +

+ +
+

1318.80 +

+ +
+

2147.80

+ +
+

+ +
+

H

+ +
+

All +

+ +
+

829.00 +

+ +
+

1318.80 +

+ +
+

2147.80

+ +
+

+ +
+

I

+ +
+

All +

+ +
+

829.00 +

+ +
+

1534.80 +

+ +
+

2363.80

+ +
+

B

+ +
+

Z

+ +
+

All +

+ +
+

552.671

+ +
+

+ 0.00

+ +
+

552.67

+ +
+

D

+ +
+

Z

+ +
+

All +

+ +
+

 60.002

+ +
+

+ 0.00

+ +
+

+ 60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

E. IOWA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Living + in Own Household (Blind Only) -- Only an eligible blind individual and the + blind member of a couple who does not live in any other State living arrangement + variation, does not have an EP, and is not otherwise excepted from + supplementation. Also included are blind recipients in title XIX + facilities where Medicaid pays 50 percent or less of the cost of + care. Optional supplement code A is also compatible with Federal + codes A and C.

+ +

Optional supplement code A is the proper code + to be used with an “intervening” Federal code + A. (See SM 01301.535.)

+ +
+

B +

+ +
+

Living + in the Household of Another (Blind Only) -- Only an eligible blind + individual and the blind member of a couple who does not live in any + other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not + otherwise excepted from supplementation.

+ +
+

C/H +

+ +
+

Living with a Dependent Person -- Eligible individual + or each member of an eligible couple in Federal living arrangement A, B, or C who + has an ineligible + spouse, parent, child, or adult child living in the home with + them, + and who is financially dependent upon the eligible individual as defined by the State + Department of + Human Services.

+ +

The + payment level for this variation is increased by $22 for each blind + individual or blind member of a couple to reflect the categorical + blind supplement.

+ +
+

D/I +

+ +
+

Living + in a Family Life or Boarding Home -- Eligible individual or each + member of an eligible couple in Federal living arrangement A or + B who resides in a family life home or boarding home licensed by + the State Department of Health or certified by the State Department + of Human Services.

+ +
+

G +

+ +
+

Used + to indicate that no supplement is payable to a recipient living + in a title XIX facility and title XIX pays more than 50 percent + of the cost of care; however, a Federal D living arrangement is + not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made.

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+

Z +

+ +
+

No + Supplement Cases -- Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or + living in the households of others. No supplement also applies + to all recipients living in medical facilities not certified under + title XIX or all recipients whose Federal payments are reduced + to $30/$60 due to living in a title XIX facility. In addition, + aged and disabled recipients whose Federal payments are not reduced + and who live in a title XIX facility where Medicaid pays 50 percent + or less of the cost of care do not receive a supplement.

+ +
+
+

NOTE: The State Department of + Human Services administers two optional supplementation programs + -- In-Home Health Related Care and Residential Care.

+ +
+
+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Iowa Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A +

+ +
+

A +

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

+ 22.00

+ +
+

574.00

+ +
+

+ +
+

C +

+ +
+

Aged +

+ +
+

552.00 +

+ +
+

279.00 +

+ +
+

831.00

+ +
+

+ +
+

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

301.00 +

+ +
+

853.00

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

279.00 +

+ +
+

831.00

+ +
+

+ +
+

D +

+ +
+

All +

+ +
+

552.00 +

+ +
+

142.00 +

+ +
+

694.00

+ +
+

+ +
+

G +

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

+ +
+

Z +

+ +
+

Aged +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

B +

+ +
+

B +

+ +
+

Blind +

+ +
+

368.001

+ +
+

+ 22.00

+ +
+

390.00

+ +
+

+ +
+

H3

+ +
+

Aged +

+ +
+

368.001

+ +
+

279.00 +

+ +
+

647.00

+ +
+

+ +
+

+ +
+

Blind +

+ +
+

368.001

+ +
+

301.00 +

+ +
+

669.00

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

368.001

+ +
+

279.00 +

+ +
+

647.00

+ +
+

+ +
+

I3

+ +
+

All +

+ +
+

368.001

+ +
+

142.00 +

+ +
+

510.00

+ +
+

+ +
+

Z +

+ +
+

Aged +

+ +
+

368.001

+ +
+

+ 0.00

+ +
+

368.00

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

368.001

+ +
+

+ 0.00

+ +
+

368.00

+ +
+

C +

+ +
+

A +

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

+ 22.00

+ +
+

574.00

+ +
+

+ +
+

C +

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

301.00 +

+ +
+

853.00

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

279.00 +

+ +
+

831.00

+ +
+

+ +
+

Z +

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

D +

+ +
+

Z +

+ +
+

All +

+ +
+

30.002

+ +
+

+ 0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less + VTR.

+

2Not an FBR; the amount represents a payment + cap to recipients in a title XIX institution.

+

3Old FLA/OS codes B/C and B/D + were changed to B/H and B/I to make them compatible with the RMA + policy computation process.

+

NOTE:

+

State-administered programs: For Calendar Year 2003 -

+
    +
  1. +
    +
    1. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 2002 is $17.50 + to $24.50. The calendar year 2002 personal allowance is $75.00. Rates for calendar + year 2003 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 2002 for care in-home related care is $471.06. The payment rate for calendar + year 2003 was not available for inclusion in this publication. +

    + +
    +
    +
  4. +
+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind +

+ +
+

829.00 +

+ +
+

+ 44.00

+ +
+

873.00

+ +
+

+ +
+

+ +
+

Blind/Aged +

+ +
+

829.00 +

+ +
+

+ 22.00

+ +
+

851.00

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

829.00 +

+ +
+

+ 22.00

+ +
+

851.00

+ +
+

+ +
+

C

+ +
+

Aged/Aged +

+ +
+

829.00 +

+ +
+

279.00 +

+ +
+

1108.00

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

829.00 +

+ +
+

323.00 +

+ +
+

1152.00

+ +
+

+ +
+

+ +
+

Disabled/Disabled +

+ +
+

829.00 +

+ +
+

279.00 +

+ +
+

1108.00

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

829.00 +

+ +
+

301.00 +

+ +
+

1130.00

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

829.00 +

+ +
+

279.00 +

+ +
+

1108.00

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

829.00 +

+ +
+

301.00 +

+ +
+

1130.00

+ +
+

+ +
+

D

+ +
+

All +

+ +
+

829.00 +

+ +
+

579.00 +

+ +
+

1408.00

+ +
+

+ +
+

G

+ +
+

All +

+ +
+

829.00 +

+ +
+

+ 0.00

+ +
+

829.00

+ +
+

+ +
+

Z

+ +
+

Aged/Aged +

+ +
+

829.00 +

+ +
+

+ 0.00

+ +
+

829.00

+ +
+

+ +
+

+ +
+

Disabled/Disabled +

+ +
+

829.00 +

+ +
+

+ 0.00

+ +
+

829.00

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

829.00 +

+ +
+

+ 0.00

+ +
+

829.00

+ +
+

B +

+ +
+

B +

+ +
+

Blind/Blind +

+ +
+

552.671

+ +
+

+ 44.00

+ +
+

596.67

+ +
+

+ +
+

+ +
+

Blind/Aged +

+ +
+

552.671

+ +
+

+ 22.00

+ +
+

574.67

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

552.671

+ +
+

+ 22.00

+ +
+

574.67

+ +
+

+ +
+

H3

+ +
+

Aged/Aged +

+ +
+

552.671

+ +
+

279.00 +

+ +
+

831.67

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

552.671

+ +
+

323.00 +

+ +
+

875.67

+ +
+

+ +
+

+ +
+

Disabled/Disabled +

+ +
+

552.671

+ +
+

279.00 +

+ +
+

831.67

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

552.671

+ +
+

301.00 +

+ +
+

853.67

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

552.671

+ +
+

279.00 +

+ +
+

831.67

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

552.671

+ +
+

301.00 +

+ +
+

853.67

+ +
+

+ +
+

I3

+ +
+

All +

+ +
+

552.671

+ +
+

579.00 +

+ +
+

1131.67

+ +
+

+ +
+

Z +

+ +
+

Aged/Aged +

+ +
+

552.671

+ +
+

+ 0.00

+ +
+

552.67

+ +
+

+ +
+

+ +
+

Disabled/Disabled +

+ +
+

552.671

+ +
+

+ 0.00

+ +
+

552.67

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

552.671

+ +
+

+ 0.00

+ +
+

552.67

+ +
+

D +

+ +
+

Z +

+ +
+

All +

+ +
+

60.002

+ +
+

+ 0.00

+ +
+

+ 60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

3Old FLA/OS codes B/C and + B/D were changed to B/H and B/I to make them compatible with the RMA + policy computation process.

+
+
+

NOTE:

+ +
+
+

State-administered programs: For Calendar Year 2003 -

+
    +
  1. +
    +
    a. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 2002 is $17.50 + to $24.50. The calendar year 2002 personal allowance is $75.00. Rates for calendar + year 2003 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 2002 for care in-home related care is $471.06. The payment rate for calendar + year 2003 was not available for inclusion in this publication. (Members of a couple + are treated as individuals.) +

    + +
    +
    +
  4. +
+
+
+
+
+ +
+
+

F. MASSACHUSETTS +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +

+

+ +

+ +
+

Full + Cost-of-Living:

+ +
    +
  1. +
    +
    1. 
    +
    +

    An individual who is in Federal living arrangement A is + in State living arrangement A, if they + are + living in + their + own household1 and + are: +

    + +
      +
    1. +
      +
      a. 
      +
      +

      Living alone -- Individuals who live alone, who rent + rooms in commercial rooming houses which openly advertise to the public and which + do not provide + board, or who live in a hotel. Also, those who rent only rooms in private residences + will be + considered living alone provided they do not use the residential kitchen facilities + for preparing + meals; or

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Living only with their eligible spouse; or

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Living with their eligible spouse and ineligible child/children 2 none of whom (children) receive public income maintenance payments;3 or +

      + +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Living only with their ineligible spouse and/or their ineligible child/children, none + of whom (spouse and children) receive public income maintenance payments. +

      + +
      +
      +
    8. +
    + +
    +
    +

    NOTE: For purposes of a. through d. above, foster children placed with anyone other than + their parents are not considered to be living with the foster parent.

    + +
    +
    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments. +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in 1. or 2. above will be in State living arrangement A if they + pay at least two-thirds of the household expenses. In making a determination as to + whether the individual pays two-thirds or more of the expenses, use the method defined + in SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses. +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. + Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

    + +
    +
    +
  8. +
+ +
+

B +

+ +
+

Shared + Living Expenses -- An individual who is in Federal living arrangement + A or C and who does not meet the criteria listed for State living + arrangement A, E or G is in State living arrangement B. Also included + in this living arrangement are transients, the homeless, and residents + of public emergency shelters for the homeless (PESH).

+ +

Those residing in group-care + facilities such as halfway houses, private medical facilities where + Medicaid is paying 50 percent or less of the cost of care, foster + homes, commercial boarding homes, or other facilities which do + not meet the criteria for living arrangement E or public congregate + housing defined above. Also included are individuals placed under the + auspices of the State adult foster care program and residents of + publicly operated emergency shelters throughout a month.

+ +

An individual living in a household where all members + receive public income maintenance payments unless + they + are + paying at least two-thirds of the household expenses (A).

+ +

An individual living in a mixed household -- + i.e., a household where one or more other members receive a public + income maintenance payment -- also is included unless the individual + is paying at least two-thirds of the household expenses (A).

+ +
+

C +

+ +
+

Living + in the Household of Another -- Recipients determined under Federal + rules to be living in the household of another and receiving support + and maintenance which reduce the Federal benefit by one-third. +

+ +
+

E +

+ +
+

Licensed + Rest Home -- Persons residing in a licensed rest home, all of which + or that portion in which they are living is licensed by and has + a provider agreement with the State. Does not include residents + of a Medicaid certified portion of a rest home.

+ +
+

F +

+ +
+

Effective + 7/1/87, the State elected Federal administration of this optional + State supplementary payment to residents of title XIX facilities + where Medicaid pays more than 50 percent of the cost of care.

+ +
+

G +

+ +
+

Assisted + Living -- Effective 7/1/94, the State elected Federal administration + of this variation. Includes an individual, certified by the State + to be residing in an Assisted Living residence served by a certified + Group Adult Foster Care provider, who is not receiving assistance + under any other Federal or State rental assistance program, and + who pays a fixed, non-separable fee for rent and supportive services, + other than medically necessary services reimbursed by Medicaid. + The State shall certify to SSA each individual who is eligible + for this optional supplement living arrangement. This living arrangement + was discontinued effective 1/1/96. However, it has been restored, + retroactively, to 1/1/97.

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. +

+

1For purposes of determining + State living arrangements, a commercial boarding house, foster + home, or halfway house is not considered the person's household.

+

2Use the SSI definition + of child, SI 00501.400.

+

3A public income maintenance + payment is a payment from any of the following programs: Aid to Families + with Dependent Children (AFDC), SSI, the Refugee Act of 1980, the + Disaster Relief Act of 1974, general assistance programs of the + Bureau of Indian Affairs, State or local government income maintenance programs + that are based on need, or Department of Veterans Affairs benefits + based on need.

+
+
+
+
+

2. Coding and Monthly Payments Levels +

+
+
+

Massachusetts Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged +

+ +
+

552.00 +

+ +
+

128.82 +

+ +
+

680.82

+ +
+

+ +
+

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

149.74 +

+ +
+

701.74

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

114.39 +

+ +
+

666.39

+ +
+

+ +
+

B

+ +
+

Aged +

+ +
+

552.00 +

+ +
+

+ 39.26

+ +
+

591.26

+ +
+

+ +
+

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

149.74 +

+ +
+

701.74

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

+ 30.40

+ +
+

582.40

+ +
+

+ +
+

E

+ +
+

Aged +

+ +
+

552.00 +

+ +
+

293.00 +

+ +
+

845.00

+ +
+

+ +
+

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

149.74 +

+ +
+

701.74

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

293.00 +

+ +
+

845.00

+ +
+

+ +
+

G

+ +
+

Aged +

+ +
+

552.00 +

+ +
+

454.00 +

+ +
+

1006.00

+ +
+

+ +
+

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

454.00 +

+ +
+

1006.00

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

454.00 +

+ +
+

1006.00

+ +
+

B

+ +
+

C

+ +
+

Aged +

+ +
+

368.001

+ +
+

104.36 +

+ +
+

472.36

+ +
+

+ +
+

+ +
+

Blind +

+ +
+

368.001

+ +
+

333.74 +

+ +
+

701.74

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

368.001

+ +
+

+ 87.58

+ +
+

455.58

+ +
+

C

+ +
+

A

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

149.74 +

+ +
+

701.74

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

114.39 +

+ +
+

666.39

+ +
+

+ +
+

B

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

149.74 +

+ +
+

701.74

+ +
+

+ +
+

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

+ 30.40

+ +
+

582.40

+ +
+

D

+ +
+

F

+ +
+

All +

+ +
+

30.002

+ +
+

+ 35.00

+ +
+

65.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A +

+ +
+

A +

+ +
+

Aged/Aged +

+ +
+

829.00 +

+ +
+

201.72 +

+ +
+

1030.72

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

829.00 +

+ +
+

574.48 +

+ +
+

1403.48

+ +
+

+ +
+

+ +
+

Disabled/Disabled +

+ +
+

829.00 +

+ +
+

180.06 +

+ +
+

1009.06

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

829.00 +

+ +
+

388.10 +

+ +
+

1217.10

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

829.00 +

+ +
+

190.89 +

+ +
+

1019.89

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

829.00 +

+ +
+

377.27 +

+ +
+

1206.27

+ +
+

+ +
+

B +

+ +
+

Aged/Aged +

+ +
+

829.00 +

+ +
+

201.72 +

+ +
+

1030.72

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

829.00 +

+ +
+

574.48 +

+ +
+

1403.48

+ +
+

+ +
+

+ +
+

Disabled/Disabled +

+ +
+

829.00 +

+ +
+

180.06 +

+ +
+

1009.06

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

829.00 +

+ +
+

388.10 +

+ +
+

1217.10

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

829.00 +

+ +
+

190.89 +

+ +
+

1019.89

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

829.00 +

+ +
+

377.27 +

+ +
+

1206.27

+ +
+

+ +
+

E +

+ +
+

Aged/Aged +

+ +
+

829.00 +

+ +
+

861.00 +

+ +
+

1690.00

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

829.00 +

+ +
+

574.48 +

+ +
+

1403.48

+ +
+

+ +
+

+ +
+

Disabled/Disabled +

+ +
+

829.00 +

+ +
+

861.00 +

+ +
+

1690.00

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

829.00 +

+ +
+

717.74 +

+ +
+

1546.74

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

829.00 +

+ +
+

861.00 +

+ +
+

1690.00

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

829.00 +

+ +
+

717.74 +

+ +
+

1546.74

+ +
+

+ +
+

G +

+ +
+

Aged/Aged +

+ +
+

829.00 +

+ +
+

681.00 +

+ +
+

1510.00

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

829.00 +

+ +
+

681.00 +

+ +
+

1510.00

+ +
+

+ +
+

+ +
+

Disabled/Disabled +

+ +
+

829.00 +

+ +
+

681.00 +

+ +
+

1510.00

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

829.00 +

+ +
+

681.00 +

+ +
+

1510.00

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

829.00 +

+ +
+

681.00 +

+ +
+

1510.00

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

829.00 +

+ +
+

681.00 +

+ +
+

1510.00

+ +
+

B +

+ +
+

C +

+ +
+

Aged/Aged +

+ +
+

552.671

+ +
+

215.80 +

+ +
+

768.47

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

552.671

+ +
+

850.80 +

+ +
+

1403.47

+ +
+

+ +
+

+ +
+

Disabled/Disabled +

+ +
+

552.671

+ +
+

194.18 +

+ +
+

746.85

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

552.671

+ +
+

533.30 +

+ +
+

1085.97

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

552.671

+ +
+

204.99 +

+ +
+

757.66

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

552.671

+ +
+

522.49 +

+ +
+

1075.16

+ +
+

D +

+ +
+

F +

+ +
+

All +

+ +
+

60.002

+ +
+

+ 70.00

+ +
+

130.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

G. MICHIGAN +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D +

+ +
+

Domiciliary + Care -- Recipients residing in licensed non-medical facilities that + provide room, board, and supervision. The State provides a list + of these facilities and certifies which recipients are residents + requiring this level of care.

+ +
+

E +

+ +
+

Personal + Care -- Recipients residing in licensed non-medical facilities that + provide general supervision, physical care, and assistance in carrying out + the basic activities of daily living. The State provides a list + of these facilities and certifies which recipients are residents + requiring this level of care. Such care situations include, but + are not limited to, licensed homes for the aged.

+ +
+

F +

+ +
+

Home + for the Aged -- Recipients residing in a non-medical facility for the + aged. The State provides SSA with a list of these facilities and + certifies which recipients are residents requiring this level of + care.

+ +
+

G +

+ +
+

Independent + Living with an EP -- Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.)

+ +
+

H +

+ +
+

Living + in the Household of Another with an EP --Recipients with an EP and + living in the household of another for Federal purposes. (Children under + age 18 are excluded.)

+ +
+

I +

+ +
+

Effective + 1/1/88, the State elected Federal administration of an optional State + supplementary payment to residents of title XIX facilities.

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+

Z +

+ +
+

No + Supplement Cases -- Recipients in title XIX facilities where Medicaid + pays more than 50 percent of the cost of care and recipients in + medical facilities not certified under title XIX.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Michigan Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 87.00

+ +
+

639.00

+ +
+

+ +
+

E

+ +
+

All +

+ +
+

552.00 +

+ +
+

157.50 +

+ +
+

709.50

+ +
+

+ +
+

F

+ +
+

All +

+ +
+

552.00 +

+ +
+

179.30 +

+ +
+

731.30

+ +
+

+ +
+

G

+ +
+

All +

+ +
+

829.002

+ +
+

+ 14.00

+ +
+

843.00

+ +
+

B

+ +
+

H

+ +
+

All +

+ +
+

552.671

+ +
+

+ 9.33

+ +
+

562.00

+ +
+

D

+ +
+

I

+ +
+

All +

+ +
+

 30.003

+ +
+

+ 7.00

+ +
+

37.00

+ +
+
+

1Not an FBR; the amount + represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount + represents the FBR plus EP increment.

+

3Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All +

+ +
+

+ 829.00

+ +
+

449.00 +

+ +
+

1278.00

+ +
+

+ +
+

E

+ +
+

All +

+ +
+

+ 829.00

+ +
+

590.00 +

+ +
+

1419.00

+ +
+

+ +
+

F

+ +
+

All +

+ +
+

+ 829.00

+ +
+

633.60 +

+ +
+

1462.60

+ +
+

+ +
+

G

+ +
+

All +

+ +
+

1106.002

+ +
+

+ 21.00

+ +
+

1127.00

+ +
+

B

+ +
+

H

+ +
+

All +

+ +
+

737.341

+ +
+

+ 14.00

+ +
+

751.34

+ +
+

D

+ +
+

I

+ +
+

All +

+ +
+

 60.003

+ +
+

+ 14.00

+ +
+

+ 74.00

+ +
+
+

1Not an FBR; the amount + represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount + represents the FBR plus EP increment.

+

3Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

H. MONTANA +

+
+
+
+
+

1. Definitions of State Living Arrangment Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G +

+ +
+

State-Certified + Personal Care

+ +
+

H +

+ +
+

State-Certified + Residence in Group Home for Mentally Disabled

+ +
+

I +

+ +
+

State-Certified + Residence in Group Home for Physically or Developmentally Disabled +

+ +
+

J +

+ +
+

State-Certified + Residence for Child and Adult Foster Care

+ +
+

K +

+ +
+

State-Certified + Transitional Living for Developmentally Disabled

+ +
+

Y +

+ +
+

Optional + Supplementation Waived -- Individual is eligible for, but has waived + his/her right to receive, an optional supplement.

+ +
+

Z +

+ +
+

No + Supplement Cases -- Includes all individuals and couples not certified in + State codes G, H, I, J, or K.

+ +
+
+
+
+
+
+

2. Coding And Monthly Payment Levels +

+
+
+

Montana Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All +

+ +
+

552.00 +

+ +
+

94.00 +

+ +
+

646.00

+ +
+

+ +
+

H

+ +
+

All +

+ +
+

552.00 +

+ +
+

94.00 +

+ +
+

646.00

+ +
+

+ +
+

I

+ +
+

All +

+ +
+

552.00 +

+ +
+

94.00 +

+ +
+

646.00

+ +
+

+ +
+

J

+ +
+

All +

+ +
+

552.00 +

+ +
+

52.75 +

+ +
+

604.75

+ +
+

+ +
+

K

+ +
+

All +

+ +
+

552.00 +

+ +
+

26.00 +

+ +
+

578.00

+ +
+

+ +
+

Z

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

B

+ +
+

Z

+ +
+

All +

+ +
+

368.001

+ +
+

+ 0.00

+ +
+

368.00

+ +
+

C

+ +
+

Z

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

D

+ +
+

Z

+ +
+

All +

+ +
+

30.002

+ +
+

+ 0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All +

+ +
+

829.00 +

+ +
+

193.00 +

+ +
+

1022.00

+ +
+

+ +
+

H

+ +
+

All +

+ +
+

829.00 +

+ +
+

193.00 +

+ +
+

1022.00

+ +
+

+ +
+

I

+ +
+

All +

+ +
+

829.00 +

+ +
+

193.00 +

+ +
+

1022.00

+ +
+

+ +
+

J

+ +
+

All +

+ +
+

829.00 +

+ +
+

110.50 +

+ +
+

939.50

+ +
+

+ +
+

K

+ +
+

All +

+ +
+

829.00 +

+ +
+

+ 57.00

+ +
+

886.00

+ +
+

+ +
+

Z

+ +
+

All +

+ +
+

829.00 +

+ +
+

+ 0.00

+ +
+

829.00

+ +
+

B

+ +
+

Z

+ +
+

All +

+ +
+

552.671

+ +
+

+ 0.00

+ +
+

552.67

+ +
+

D

+ +
+

Z

+ +
+

All +

+ +
+

60.002

+ +
+

+ 0.00

+ +
+

+ 60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

I. NEVADA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Independent + Living or Living in Parental Household -- Aged or blind eligible + individual or couple who:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in + their + own household as defined for Federal living arrangement A purposes; or

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a + patient in a certified private medical facility where title XIX does not pay more than 50 percent + of the cost of care; or

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    6. Is + a blind child under age 18 (age 21 for individuals who qualify as + a “protected child”) living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Used with an “intervening” Federal + code A. (See SM 01301.535.)

+ +
+

B +

+ +
+

Living + in the Household of Another -- Aged or blind eligible individual or + couple who is living in the household of another individual and + receiving food and shelter from that individual. + Aged or blind individuals or couples, who are subject to a one-third + reduction of their Federal SSI payment, are eligible for optional + supplement B because the criteria for this supplement level are + the same as for Federal code B.

+ +
+

C +

+ +
+

Domiciliary + Care -- Aged or blind eligible individual or couple who lives in + a private non-medical facility or, as of 10/76, a residential facility serving + 16 or fewer persons, which provides personal care and services + to aged, infirm, or handicapped adult persons who are unrelated + to the proprietor.

+ +

These facilities are licensed or authorized + to receive payment by the State. The State provides SSA with listings + of these facilities.

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+

Z +

+ +
+

No + Supplement Cases -- No supplement cases include:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individuals + or disabled members of eligible couples; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible + individuals or members of eligible couples in a medical facility + where title XIX pays more than 50 percent of the cost; or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible + individuals or members of eligible couples who are patients in + a private medical facility which is not certified under title XIX; + or

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents + of publicly operated emergency shelters throughout a month.

    + +
    +
    +
  8. +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Nevada Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A +

+ +
+

A +

+ +
+

Aged +

+ +
+

552.00 +

+ +
+

+ 36.40

+ +
+

588.40

+ +
+

+ +
+

+

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

109.30 +

+ +
+

661.30

+ +
+

+ +
+

C +

+ +
+

Aged +

+ +
+

552.00 +

+ +
+

350.00 +

+ +
+

902.00

+ +
+

+ +
+

+

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

350.00 +

+ +
+

902.00

+ +
+

+ +
+

Z +

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

B +

+ +
+

B +

+ +
+

Aged +

+ +
+

368.001

+ +
+

+ 24.27

+ +
+

392.27

+ +
+

+ +
+

+ +
+

Blind +

+ +
+

368.001

+ +
+

213.96 +

+ +
+

581.96

+ +
+

+ +
+

Z +

+ +
+

Disabled +

+ +
+

368.001

+ +
+

+ 0.00

+ +
+

368.00

+ +
+

C +

+ +
+

A +

+ +
+

Blind +

+ +
+

552.00 +

+ +
+

109.30 +

+ +
+

661.30

+ +
+

+ +
+

Z +

+ +
+

Disabled +

+ +
+

552.00 +

+ +
+

+ 0.00

+ +
+

552.00

+ +
+

D +

+ +
+

Z +

+ +
+

All +

+ +
+

 30.002

+ +
+

+ 0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged +

+ +
+

829.00 +

+ +
+

+ 74.46

+ +
+

+ 903.46

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

829.00 +

+ +
+

374.60 +

+ +
+

1203.60

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

829.00 +

+ +
+

224.53 +

+ +
+

1053.53

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

829.00 +

+ +
+

+ 37.23

+ +
+

866.23

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

829.00 +

+ +
+

187.30 +

+ +
+

1016.30

+ +
+

+ +
+

C

+ +
+

Aged/Aged +

+ +
+

829.00 +

+ +
+

881.00 +

+ +
+

1710.00

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

829.00 +

+ +
+

881.00 +

+ +
+

1710.00

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

829.00 +

+ +
+

881.00 +

+ +
+

1710.00

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

829.00 +

+ +
+

440.50 +

+ +
+

1269.50

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

829.00 +

+ +
+

440.50 +

+ +
+

1269.50

+ +
+

+ +
+

Z

+ +
+

Disabled +

+ +
+

829.00 +

+ +
+

+ 0.00

+ +
+

829.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged +

+ +
+

552.671

+ +
+

+ 49.64

+ +
+

+ 602.31

+ +
+

+ +
+

+ +
+

Blind/Blind +

+ +
+

552.671

+ +
+

531.94 +

+ +
+

1084.61

+ +
+

+ +
+

+ +
+

Aged/Blind +

+ +
+

552.671

+ +
+

290.79 +

+ +
+

843.46

+ +
+

+ +
+

+ +
+

Aged/Disabled +

+ +
+

552.671

+ +
+

+ 24.82

+ +
+

577.49

+ +
+

+ +
+

+ +
+

Blind/Disabled +

+ +
+

552.671

+ +
+

265.97 +

+ +
+

818.64

+ +
+

+ +
+

Z

+ +
+

Disabled +

+ +
+

552.671

+ +
+

+ 0.00

+ +
+

552.67

+ +
+

D

+ +
+

Z

+ +
+

All +

+ +
+

60.002

+ +
+

+ 0.00

+ +
+

+ 60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

J. NEW JERSEY +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Licensed + Residential Health Care Facilities and Certain Licensed Residential + Facilities -- The State provides New Jersey field offices with + lists of approved facilities. Mentally retarded individuals must + be placed and supervised by either the State Department of Youth + and Family Services or the State Division of Mental Retardation. +

+ +
+

B +

+ +
+

Living + Alone or with Others -- Eligible individuals (including children) or + eligible couples whose Federal living arrangements are A or C and + who do not meet the requirements defined in other supplementation + categories.

+ +

Therefore, effective 8/1/81, any eligible adult/couple + who meets the requirement for a Federal code A will be in optional + supplement B unless residing in a residential health care facility + or living alone with an ineligible spouse.

+ +

Likewise, any child meeting + the criteria for a Federal code C will automatically be entitled + to optional supplement B.

+ +

This category includes, + but is not limited to, those eligible adults/couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    Living physically alone; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Living + with others in a private dwelling, but meeting some criteria for + Federal living arrangement A; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Living + in the Transitional Residency Program when the placement is through + the Division of Mental Health and Hospitals, Department of Human + Services.

    + +
    +
    +
  • +
+ +

Optional supplement code + B is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.)

+ +

This State code is also + used to supplement Section 1619 cases.

+ +
+

C +

+ +

+

+ +

+ +

+ +

+ +
+

Living Alone with an Ineligible Spouse -- Used when an + individual lives with + their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse + for State supplementation purposes is determined by using Federal criteria; i.e., + a spouse, either + by marriage or holding out who is either not eligible for SSI or who chooses not to + apply. The State + uses this category to ensure that an individual with an ineligible spouse will receive + the same + total payment as an eligible couple or an individual with an EP. Once other persons, + even minor + children, are present in the household, this supplementary payment variation cannot + exist. However, + it is possible that a claimant and his/her ineligible spouse live with others and + allege that they + are a separate “household” by virtue of the fact that they eat their meals out or + have separate + purchase and preparation of food. In this instance, an optional supplement C is permissible + as long + as no other person is in their “household.” There is no couple counterpart in this + category. +

+ +

Parent(s) with minor children are always considered + to be in the same household and therefore the presence of minor + children in the household of an ineligible spouse would result in + optional supplement B.

+ +

A transient individual who co-exists only with + an ineligible spouse will also qualify for the O/S - C rate.

+ +
+

D +

+ +
+

Living + in the Household of Another -- Persons who are “living + in the household of another” for Federal purposes.

+ +
+

G +

+ +
+

Effective + 9/1/88, the State elected Federal administration of an optional State + supplementary payment to residents of title XIX facilities.

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+

Z +

+ +
+

No + Supplement Cases -- Individuals and couples in licensed medical facilities + where Medicaid is paying less than 50 percent of the cost of care, individuals + and couples in publicly operated community residences having 16 + or less residents, and residents of publicly operated emergency + shelters throughout a month.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

New Jersey Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All +

+ +
+

552.00

+ +
+

150.05

+ +
+

702.05

+ +
+

+ +
+

B

+ +
+

All +

+ +
+

552.00

+ +
+

31.25

+ +
+

583.25

+ +
+

+ +
+

C

+ +
+

Individual +

+ +
+

552.00

+ +
+

302.36

+ +
+

854.36

+ +
+

+ +
+

+ +
+

w/EP +

+ +
+

829.00

+ +
+

25.36

+ +
+

854.36

+ +
+

+ +
+

Z

+ +
+

All +

+ +
+

552.00

+ +
+

0.00

+ +
+

552.00

+ +
+

B

+ +
+

D

+ +
+

All +

+ +
+

368.001

+ +
+

44.31

+ +
+

412.31

+ +
+

C

+ +
+

B

+ +
+

All +

+ +
+

552.00

+ +
+

31.25

+ +
+

583.25

+ +
+

D

+ +
+

G

+ +
+

All +

+ +
+

30.003

+ +
+

10.00

+ +
+

40.00

+ +
+

 

+ +
+

 

+ +
+

 

+ +
+

 

+ +
+

 

+ +
+

 

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents the FBR plus EP increment.

+

3Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All +

+ +
+

829.00 +

+ +
+

556.36

+ +
+

1385.36

+ +
+

+ +
+

B

+ +
+

All +

+ +
+

829.00 +

+ +
+

+ 25.36

+ +
+

854.36

+ +
+

+ +
+

Z

+ +
+

All +

+ +
+

829.00 +

+ +
+

  0.00

+ +
+

829.00

+ +
+

B

+ +
+

D

+ +
+

All +

+ +
+

552.671

+ +
+

+ 93.09

+ +
+

645.76

+ +
+

D

+ +
+

G

+ +
+

All +

+ +
+

 60.002

+ +
+

+ 20.00

+ +
+

+ 80.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

K. NEW YORK +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Living Alone -- Eligible individuals or eligible + couples living physically alone, or living with only a foster child(ren), or a homemaker + authorized + by the local Department of Social Services (DSS), or a family care recipient(s) placed + by the Office + of Mental Health (OMH) or Office of Mental Retardation and Developmentally Disabled + (OMRDD) or local + DSS, or individuals living with others but paying a “flat fee for room and board,” + or living with + others but taking all + their + meals outside the dwelling unit, or living with others in a dwelling but separately + preparing food, + or having + their + food separately prepared for + them. +

+ +
+

B +

+ +
+

Living + with Others -- Individual/child/couple who resides in a dwelling with + others and prepares food in common with at least one other person + in the dwelling, or is a member of a religious community, or child + in any living arrangement other than a family care home (Level + I) or community residence (Level II) certified by OMRDD or OMH. +

+ +
+

C +

+ +
+

Congregate + Care Level I -- Family type homes and family care homes. Family + type homes are facilities operated for the purpose of providing long-term + residential care for adults and are certified by the New York State + DSS and supervised by local departments of social services. Family care + homes are private households that provide care for mentally disabled persons. +

+ +
+

D +

+ +
+

Congregate + Care Level II -- Residential facilities for adults and certain children + with mental disabilities.

+ +
+

E +

+ +
+

Congregate + Care Level III -- Privately operated non-medical residential facilities. + Although Level III facilities are often called schools, these facilities + may not meet the Federal definition of school. Operated for the purpose + of providing treatment, training and education for mentally retarded + or developmentally disabled individuals, these facilities are certified + by OMRDD in accordance with State regulations.

+ +
+

F +

+ +
+

Living + in the Household of Another -- Same as Federal definition. The State + supplement payment for the individual/child/couple whose Federal benefit + rate is subject to the one-third reduction is the “living + with others” rate but for systems purposes is coded F. +

+ +
+

G +

+ +
+

Effective + 1/1/88, the State elected Federal administration of an optional State + supplementary payment to residents of title XIX facilities.

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+

Z +

+ +
+

No + Supplement Cases -- Recipients in licensed medical facilities where Medicaid + is paying more than 50 percent of the cost of care, recipients + in publicly operated community residences which serve 16 or fewer + residents, and residents of publicly operated emergency shelters + throughout a month.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

New York Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement Level

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 87.00

+ +
+

639.00

+ +
+

+ +
+

B

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 23.00

+ +
+

575.00

+ +
+

+ +
+

C

+ +
+

NY + City

+ +
+

552.00 +

+ +
+

266.48 +

+ +
+

818.48

+ +
+

+ +
+

+ +
+

Nassau + County4

+ +
+

552.00 +

+ +
+

266.48

+ +
+

818.48

+ +
+

+ +
+

+ +
+

All + other counties

+ +
+

552.00

+ +
+

228.48 +

+ +
+

780.48

+ +
+

+ +
+

D

+ +
+

NY + City

+ +
+

552.00 +

+ +
+

435.00 +

+ +
+

987.00

+ +
+

+ +
+

+ +
+

Nassau + County4

+ +
+

552.00 +

+ +
+

435.00 +

+ +
+

987.00

+ +
+

+ +
+

+ +
+

All + other counties

+ +
+

552.00 +

+ +
+

405.00 +

+ +
+

957.00

+ +
+

+ +
+

E

+ +
+

NY + City

+ +
+

552.00 +

+ +
+

482.96 +

+ +
+

1,034.96

+ +
+

+ +
+

+ +
+

Nassau + County4

+ +
+

552.00 +

+ +
+

458.96 +

+ +
+

1,010.96

+ +
+

+ +
+

+ +
+

All + other counties

+ +
+

552.00 +

+ +
+

458.96 +

+ +
+

1,010.96

+ +
+

+ +
+

Z

+ +
+

All +

+ +
+

552.00 +

+ +
+

  0.00

+ +
+

552.00

+ +
+

B

+ +
+

F

+ +
+

All +

+ +
+

368.001

+ +
+

+ 23.00

+ +
+

391.00

+ +
+

D

+ +
+

G

+ +
+

All +

+ +
+

 30.002

+ +
+

  5.003

+ +
+

+ 35.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

3New York administers a + supplement of $20 to some recipients in a title XIX institution.

+

4Includes and applies to: + Nassau, Suffolk, and Westchester counties effective 7/1/85.

+

Couple

+ +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement Level

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All +

+ +
+

829.00 +

+ +
+

104.00 +

+ +
+

933.00

+ +
+

+ +
+

B

+ +
+

All +

+ +
+

829.00 +

+ +
+

46.00 +

+ +
+

875.00

+ +
+

+ +
+

C

+ +
+

NY + City

+ +
+

829.00 +

+ +
+

807.96 +

+ +
+

1636.96

+ +
+

+ +
+

+ +
+

Nassau + County4

+ +
+

829.00 +

+ +
+

807.96

+ +
+

1636.96

+ +
+

+ +
+

+ +
+

All + other counties

+ +
+

829.00

+ +
+

731.96 +

+ +
+

1,560.96

+ +
+

+ +
+

D

+ +
+

NY + City

+ +
+

829.00 +

+ +
+

1145.00 +

+ +
+

1974.00

+ +
+

+ +
+

+ +
+

Nassau + County4

+ +
+

829.00 +

+ +
+

1145.00

+ +
+

1974.00

+ +
+

+ +
+

+ +
+

All + other counties

+ +
+

829.00 +

+ +
+

1085.00

+ +
+

1914.00

+ +
+

+ +
+

E

+ +
+

NY + City

+ +
+

829.00 +

+ +
+

1240.92

+ +
+

2069.92

+ +
+

+ +
+

+ +
+

Nassau + County4

+ +
+

829.00

+ +
+

1192.92 +

+ +
+

2021.92

+ +
+

+ +
+

+ +
+

All + other counties

+ +
+

829.00 +

+ +
+

1192.92 +

+ +
+

2021.92

+ +
+

+ +
+

Z

+ +
+

All +

+ +
+

829.00

+ +
+

0.00 +

+ +
+

829.00

+ +
+

B

+ +
+

F

+ +
+

All +

+ +
+

552.671

+ +
+

46.00

+ +
+

598.67

+ +
+

D

+ +
+

G

+ +
+

All +

+ +
+

 60.002

+ +
+

10.003

+ +
+

+ 70.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

3New York administers a + supplement of $20 to some recipients in a title XIX institution.

+

4Includes and applies to: + Nassau, Suffolk, and Westchester counties effective 7/1/85.

+
+
+
+
+ +
+
+

L. PENNSYLVANIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Living + Alone -- Recipients in private medical facilities (nursing homes, hospitals, + intermediate care facilities) where title XIX is not paying more than 50 percent + of the cost of care, residents of publicly operated emergency shelters + throughout a month, and all other individuals and couples in Federal + codes A and C not meeting the definition of another variation.

+ +

Used with an "intervening" + Federal code A. (See SM 01301.535.)

+ +

This State code is also + used to supplement Section 1619 cases.

+ +
+

B +

+ +
+

Living + in the Household of Another -- Recipients who do not have an EP and + who live in the household of another and receive support and maintenance + for Federal purposes.

+ +
+

C +

+ +
+

Living + with an EP -- Recipients who are not living in the household of another + or in a foster care home for adults and who have one or more EPs + as defined under the Federal rules; i.e., Public Law 93-66.

+ +
+

D +

+ +
+

Living + in the Household of Another with an EP --Recipients who live in the + household of another and who have one or more EPs as defined under the + Federal rules; i.e., Public Law 93-66.

+ +
+

G +

+ +
+

Living + in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities. +

+ +
+

H +

+ +
+

Living + in a Personal Care Boarding Home -- Adult Persons (age 18 and over) + certified by the State to be residing in non-medical residential + care facilities (Effective 7/1/89).

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+

Z +

+ +
+

No + Supplement Cases -- Includes all recipients who are residing in + a medical facility in which title XIX is paying more than 50 percent + of the cost of care.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Pennsylvania Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A +

+ +
+

A +

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 27.40

+ +
+

579.40

+ +
+

+ +
+

C +

+ +
+

All +

+ +
+

829.003

+ +
+

+ 43.70

+ +
+

872.70

+ +
+

+ +
+

G +

+ +
+

All +

+ +
+

552.00 +

+ +
+

389.30 +

+ +
+

941.30

+ +
+

+ +
+

H +

+ +
+

All +

+ +
+

552.00 +

+ +
+

394.30 +

+ +
+

946.30

+ +
+

B +

+ +
+

B +

+ +
+

All +

+ +
+

368.001

+ +
+

+ 27.40

+ +
+

395.40

+ +
+

+ +
+

D +

+ +
+

All +

+ +
+

552.672

+ +
+

+ 43.70

+ +
+

596.37

+ +
+

C +

+ +
+

A +

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 27.40

+ +
+

579.40

+ +
+

D +

+ +
+

Z +

+ +
+

All +

+ +
+

 30.004

+ +
+

  0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents the FBR plus EP increment less VTR.

+

3Not an FBR; the amount + represents the FBR plus EP increment.

+

4Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A +

+ +
+

A +

+ +
+

All +

+ +
+

829.00 +

+ +
+

+ 43.70

+ +
+

872.70

+ +
+

+ +
+

C +

+ +
+

All +

+ +
+

1106.003

+ +
+

+ 68.05

+ +
+

1174.05

+ +
+

+ +
+

G +

+ +
+

All +

+ +
+

829.00 +

+ +
+

857.40 +

+ +
+

1686.40

+ +
+

+ +
+

H +

+ +
+

All +

+ +
+

829.00 +

+ +
+

867.40 +

+ +
+

1696.40

+ +
+

B +

+ +
+

B +

+ +
+

All +

+ +
+

552.671

+ +
+

+ 43.70

+ +
+

596.37

+ +
+

+ +
+

D +

+ +
+

All +

+ +
+

737.34

+ +
+

+ 68.05

+ +
+

+ 805.39

+ +
+

D +

+ +
+

Z +

+ +
+

All +

+ +
+

 60.004

+ +
+

  0.00

+ +
+

+ 60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents the FBR plus EP increment less VTR.

+

3Not an FBR; the amount + represents the FBR plus EP increment.

+

4Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

M. RHODE ISLAND +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Independent + Living -- Recipients who are in Federal codes A and C, except for individuals + residing in a residential care/assisted living facility who have + been certified as eligible for State Code D.

+ +

Recipients residing in + a public emergency shelter for the homeless and those who are eligible + for Section 1619 are included in this category.

+ +
+

B +

+ +
+

Living + in the Household of Another -- Recipients who are living in the + household of another and receiving support and maintenance in-kind. + This variation applies only when the one-third reduction to the + Federal benefit is applied.

+ +
+

D +

+ +
+

Residential + Care/Assisted Living (Effective 10/1/98). (Formerly Shelter Care from + 10/01/90 – 9/30/98.) This category applies to individuals + only.

+ +
+

E +

+ +
+

The + State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 3/1/91).

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Rhode Island Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A +

+ +
+

A1

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 57.35

+ +
+

609.35

+ +
+

+ +
+

D +

+ +
+

All +

+ +
+

552.00 +

+ +
+

575.00 +

+ +
+

1127.00

+ +
+

B +

+ +
+

B1

+ +
+

All +

+ +
+

368.002

+ +
+

+ 69.94

+ +
+

437.94

+ +
+

C +

+ +
+

A1

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 57.35

+ +
+

609.35

+ +
+

D +

+ +
+

E +

+ +
+

All +

+ +
+

 30.003

+ +
+

+ 20.00

+ +
+

+ 50.00

+ +
+
+

1Code is systems generated + from the Federal code.

+

2Not an FBR; the amount + represents the FBR less VTR.

+

3Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A +

+ +
+

A1

+ +
+

All +

+ +
+

829.00 +

+ +
+

108.50 +

+ +
+

937.50

+ +
+

B +

+ +
+

B1

+ +
+

All +

+ +
+

552.672

+ +
+

128.50 +

+ +
+

681.17

+ +
+

D +

+ +
+

E +

+ +
+

All +

+ +
+

60.003

+ +
+

+ 40.00

+ +
+

100.00

+ +
+
+

1Code is systems generated + from the Federal code.

+

2Not an FBR; the amount + represents the FBR less VTR.

+

3Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ +
+
+

N. UTAH +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Living + Alone or With Others -- This variation includes recipients who + are in Federal codes A and C.

+ +
+

B +

+ +
+

Living + in the Household of Another -- Recipients with no EP who are "living + in the household of another” for Federal purposes. (Children + under age 18 are included in this living arrangement variation.) +

+ +
+

Z +

+ +
+

No + Supplement Cases -- No supplement cases include all recipients + who are not included in A or B.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Utah Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Level

+ +
+

A,C +

+ +
+

Z +

+ +
+

All +

+ +
+

552.00 +

+ +
+

0.00 +

+ +
+

552.00

+ +
+

B +

+ +
+

B +

+ +
+

All +

+ +
+

368.002

+ +
+

3.13 +

+ +
+

371.13

+ +
+

D +

+ +
+

Z +

+ +
+

All +

+ +
+

30.001

+ +
+

0.00 +

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

2Not an FBR, the amount + represents the FBR less VTR.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A,C +

+ +
+

A +

+ +
+

All +

+ +
+

829.00 +

+ +
+

4.60 +

+ +
+

833.60

+ +
+

B +

+ +
+

B +

+ +
+

All +

+ +
+

552.672

+ +
+

9.73 +

+ +
+

562.40

+ +
+

D +

+ +
+

Z +

+ +
+

All +

+ +
+

60.001

+ +
+

0.00 +

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

2Not an FBR, the amount + represents the FBR less VTR.

+
+
+
+
+ +
+
+

O. VERMONT +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A +

+ +
+

Independent + Living (except Chittenden County) -- Recipients not living in the household + of another, not in a custodial care situation, and not otherwise + excepted from supplementation. Includes a child who is living with + a parent and recipients residing in a private title XIX facility + where Medicaid is not paying more than 50 percent of the cost of + care.

+ +

Effective + 5/1/83, an individual or eligible couple residing in a publicly + operated emergency shelter throughout a month.

+ +

Optional supplement code + A is the proper code to be used with an “intervening” Federal + code A (except Chittenden County).

+ +
+

B +

+ +
+

Independent + Living in Chittenden County -- Same as A above except restricted to + residents of Chittenden County.

+ +

Effective 5/1/83, an individual + or eligible couple residing in a publicly operated emergency shelter + throughout a month.

+ +

Optional supplement code B is the proper code + to be used with an “intervening” Federal code + A (Chittenden County only). (See SM 01301.535.)

+ +
+

C +

+ +
+

Assistive + Community Care Level III: Recipients living in facilities identified + by the State.

+ +
+

E +

+ +
+

Living + in the Household of Another -- Recipients living in the household + of another and receiving support and maintenance (subject to the + Federal one-third reduction provisions), and not otherwise excepted + from supplementation.

+ +
+

G +

+ +
+

Custodial + Care: Licensed Community Care Home -- Recipients living in Level IV + Community Homes identified by the State.

+ +
+

H +

+ +
+

Custodial Care: Family Home -- Recipients living in + another's home in such a manner that the individual or couple is paying room and board + and is + receiving one or more of the services outlined under the custodial care definition. + The individual + or couple must also receive the room and board and custodial care in the home in which + they + reside. In order to qualify as a home under this arrangement, these services must + not be provided to + more than two persons and must be provided by a resident of the home.

+ +

Custodial care means providing basic + room and board, plus personal services such + as: help with feeding, dressing, bathing, moving about under normal circumstances, + occasional tray service (tray service 2-3 times a week) and/or supervision + for the recipient's protection. Supervision for the recipient's + protection deals primarily with protection services for retarded + and emotionally disturbed individuals. A person who receives one + or more of these personal services is receiving custodial care.

+ +

The change in this arrangement + is effective for initial claims filed on or after 1/1/84. For + redeterminations the change is effective with the month after the + month in which the first redetermination on or after 1/1/84, is + initiated.

+ +

This arrangement does not cover:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Institutional Living -- + Regardless of whether custodial care is needed in addition to the + medical, training, rehabilitation, educational or similar services + as the primary function of the institution.

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    A person + whose Federal living arrangement is based on home ownership or + rental liability. (A flat fee for room and board per SI 00835.120B. + is not considered as rental liability for this arrangement.)

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    A child + under age 18 not placed by a Vermont Community Mental Health Agency + or the Vermont Department of Mental Health.

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Custodial + care or supervision provided by a spouse (as defined by Federal regulations).

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Any home + or boarding arrangement which does not meet the Federal SSI definition + of independent living, Federal Code A.

    + +
    +
    +
  10. +
+ +
+

I +

+ +
+

Effective + 7/1/87, the State elected Federal administration of an optional + State supplementary payment to residents in title XIX facilities. +

+ +
+

Y +

+ +
+

Optional Supplementation Waived -- Individual is + eligible for, but has waived + their + right to receive, an optional supplement.

+ +
+
+

NOTE: When a person has a room in one facility/household and receives board or custodial + care in another facility/household, the custodial rate (G or H) is based on the facility/household + where the person sleeps. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Vermont Effective + 1/1/03

+ + Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A +

+ +
+

A +

+ +
+

All + (Except Chittenden County)

+ +
+

552.00 +

+ +
+

+ 52.04

+ +
+

604.04

+ +
+

+ +
+

B +

+ +
+

All + (Restricted to Chittenden County)

+ +
+

552.00 +

+ +
+

+ 52.04

+ +
+

604.04

+ +
+

+ +
+

C +

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 48.38

+ +
+

600.38

+ +
+

+ +
+

G +

+ +
+

All +

+ +
+

552.00 +

+ +
+

223.94 +

+ +
+

775.94

+ +
+

+ +
+

H +

+ +
+

All +

+ +
+

552.00 +

+ +
+

+ 98.69

+ +
+

650.69

+ +
+

B +

+ +
+

E +

+ +
+

All +

+ +
+

368.001

+ +
+

+ 39.30

+ +
+

407.30

+ +
+

C +

+ +
+

A +

+ +
+

All + (Except Chittenden County)

+ +
+

552.00 +

+ +
+

+ 52.04

+ +
+

604.04

+ +
+

+ +
+

B +

+ +
+

All + (Restricted to Chittenden County)

+ +
+

552.00 +

+ +
+

+ 52.04

+ +
+

604.04

+ +
+

D +

+ +
+

I +

+ +
+

All +

+ +
+

30.002

+ +
+

+ 17.66

+ +
+

47.66

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

Couple

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A +

+ +
+

A +

+ +
+

All + (Except Chittenden County

+ +
+

829.00 +

+ +
+

98.88 +

+ +
+

927.88

+ +
+

+ +
+

B +

+ +
+

All + (Restricted to Chittenden County

+ +
+

829.00 +

+ +
+

98.88 +

+ +
+

927.88

+ +
+

+ +
+

C +

+ +
+

All +

+ +
+

829.00 +

+ +
+

96.77 +

+ +
+

925.77

+ +
+

+ +
+

G +

+ +
+

All +

+ +
+

829.00 +

+ +
+

562.06 +

+ +
+

1391.06

+ +
+

+ +
+

H +

+ +
+

All +

+ +
+

829.00 +

+ +
+

332.82 +

+ +
+

1161.82

+ +
+

B +

+ +
+

E +

+ +
+

All +

+ +
+

552.671

+ +
+

48.31 +

+ +
+

+ 600.98

+ +
+

D +

+ +
+

I +

+ +
+

All +

+ +
+

60.002

+ +
+

35.33 +

+ +
+

+ 95.33

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415035
SI 01415.035 - Federally Administered Optional Supplementary Payment Programs - 1/03 Payment Levels - 08/08/2024
+Batch run: 02/19/2025
+Rev:08/08/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2004.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2004.html new file mode 100644 index 00000000..334f4960 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2004.html @@ -0,0 +1,15997 @@ + + +SSA - POMS: SI 01415.036 - Federally Administered Optional Supplementary Payment Programs – 1/04 Payment Levels - 08/23/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 88 (08-24)

+

SI 01415.036 Federally Administered Optional Supplementary Payment Programs – 1/04 Payment Levels +

+ + +
+
+

A. BACKGROUND +

+
+
+

The following states + are participating in the Federally Administered Optional + Supplementary Payment Programs:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

 

+ +
+

 

+ +
+

CALIFORNIA

+ +
+

NEVADA

+ +
+

DELAWARE

+ +
+

NEW JERSEY

+ +
+

DISTRICT OF COLUMBIA

+ +
+

NEW YORK

+ +
+

HAWAII

+ +
+

PENNSYLVANIA

+ +
+

IOWA

+ +
+

RHODE ISLAND

+ +
+

MASSACHUSETTS

+ +
+

UTAH

+ +
+

MICHIGAN

+ +
+

VERMONT

+ +
+

MONTANA

+ +
+

 

+ +
+
+
+
+ +
+
+

B. PROCEDURE - CALIFORNIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living with Cooking Facilities -- Eligible individual or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and has cooking and food storage facilities or is provided meals as part of the living + arrangement; or +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent or parents or is + a disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; or +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or +

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 7/1/83, lives in a private medical facility licensed by the State but not + certified under title XIX. (An optional supplementary A payment based on the new instructions + is payable retroactively to 7/1/83.) +

    + +
    +
    +
  10. +
+ +
+

B

+ +
+

Non-medical Out-of-Home Care (NMOHC) -- Applies when an individual/couple needs non-medical + care or supervision in the following living arrangement situations: +

+ +

CHILDREN + (UNDER AGE 18)

+ +
    +
  1. +
    +
    1. 
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Effective 10/1/79, disabled child residing in the home of a legal guardian who is + not a relative; or +

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 1/1/84, disabled child residing in the home of a relative who is not a parent + (Major v. McMahon decision), reopening a prior decision to pay OS B under this definition may be retroactive + to 1/1/84; or +

    + +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or +

    + +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    For periods prior to 7/1/83 only, a blind or disabled child placed in any home or + State licensed NMOHC facility as the result of a court order; or +

    + +

    ADULTS (AGE 18 AND OVER)

    + +
    +
    +
  14. +
  15. +
    +
    8. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or +

    + +
    +
    +
  16. +
  17. +
    +
    9. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in a State licensed NMOHC facility. +

    + +
    +
    +
  18. +
+ +

For California optional supplement purposes, a relative is defined as a parent, child, + sibling, half-sibling, parent's sibling, sibling's child, first cousin, or any person + of the preceding generation denoted by the prefix “grand” or “great.” +

+ +
+

C

+ +
+

Independent Living Without Cooking Facilities -- Aged or disabled individual/couple + who is neither provided any meals nor has access to adequate cooking/food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C. +

+ +

An individual/couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Immediate living quarters do not have cooking and food storage facilities with which + the individual/couple or another person (who is responsible for preparing the individual's/couple's + meals) can prepare meals on a daily basis. +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf. +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals. +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals. +

    + +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the SSI applicant's/recipient's arrangement with the facility + is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    “Adequate” cooking and food storage facilities exist when an individual/couple has + access to: +

    + +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.) +

    + +

    OR

    + +

    Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls that + are used for warming food are not considered adequate cooking facilities.) +

    + +

    OR

    + +

    Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  14. +
  15. +
    +
    8. 
    +
    +

    Eligibility for OS C begins in the month the applicant/recipient applies for this + supplement rate provided he/she has been without cooking and food storage facilities + throughout the month. +

    + +
    +
    +

    NOTE: For purposes of OS C, “throughout a month” does not mean the applicant/recipient must lack adequate cooking/food storage facilities from + the very first moment of the month. They need only lack them from some time on the + first day of the month. +

    + +

    If eligibility is based on temporary loss or non-functioning of an appliance, the + individual should be advised of their responsibility to report immediately when the + temporary condition has ceased. If the individual provides an expected date when the + appliance will be replaced/repaired, diary the case for re-contact. +

    + +

    Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available. +

    + +

    For a couple, comprised of an aged/disabled individual and a blind individual, whose + living arrangement lacks adequate cooking and storage facilities, the couple is to + receive the SSI/SSP level for a blind/aged or disabled couple plus the restaurant + meals allowance for the disabled member of the couple. Force payment in this living + arrangement is required. +

    + +
    +
    + +
    +
    +
  16. +
+ +
+

D

+ +
+

Living in the Household of Another -- Eligible individual/couple is living in the + household of another and is receiving food and shelter from that individual. Most individuals/couples who are subject to a 1/3 reduction + of their Federal SSI payments (VTR) are eligible for OS D because the criteria for + this supplement level are the same as for charging the VTR. However, when the eligible + individual/couple lives in the home of a relative (other than a spouse) and needs + care and supervision, certification for non-medical out-of-home care (OS F) should + be obtained from the county welfare office since this is the highest categorical supplement + for which an individual /couple can qualify. +

+ +
+

E

+ +
+

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage. (Until 9/30/79, a disabled child under + age 18 living with a legal guardian also fell into this category.) +

+ +
+
+

NOTE: Effective 2/1/82, only FLA A and C are compatible with OS E. If the VTR applies, see + code G. +

+ +
+
+ +
+

F

+ +
+

Non-medical Out-of-Home Care Living in the Household of Another -- Effective 2/1/82. + Applies whenever an eligible individual or couple meets the criteria for the non-medical + out-of-home care payment rate, and is determined to receive the Federal code B payment + for living in the household of another (SI 00835.200). +

+ +
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

G

+ +
+

Disabled Child Under Age 18 Living in the Household of Another --Effective 2/1/82. + Applies to a disabled (not blind) child under age 18, who resides with a parent or + relative by blood or marriage, and is determined to receive the Federal code B payment for living in the household of + another individual (SI 00835.200). +

+ +
+

J

+ +
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Eligible individual or couple who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX and not licensed + by the State (effective 7/1/83). (Prior to 7/1/83, the facility could have been licensed + by the State but not certified under title XIX.) +

    + +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. +

+ +
+
+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

California Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +

 

+ +
+

Aged

+ +
+

564.00

+ +
+

226.00

+ +
+

790.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

564.00

+ +
+

290.00

+ +
+

854.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

226.00

+ +
+

790.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

564.00

+ +
+

400.00

+ +
+

964.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

564.00

+ +
+

308.00

+ +
+

872.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

564.00

+ +
+

290.00

+ +
+

854.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

308.00

+ +
+

872.00

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

564.00

+ +
+

115.00

+ +
+

679.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

376.001

+ +
+

227.00

+ +
+

603.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

376.001

+ +
+

306.00

+ +
+

682.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

376.001

+ +
+

227.00

+ +
+

603.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

376.001

+ +
+

396.00

+ +
+

772.00

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

376.001

+ +
+

105.00

+ +
+

481.00

+ +
+

C

+ +

 

+ +
+

A

+ +
+

Blind

+ +
+

564.00

+ +
+

290.00

+ +
+

854.00

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

564.00

+ +
+

115.00

+ +
+

679.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

19.00

+ +
+

49.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +

 

+ +
+

Aged/Aged

+ +
+

846.00

+ +
+

553.00

+ +
+

1399.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

846.00

+ +
+

773.00

+ +
+

1619.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

846.00

+ +
+

553.00

+ +
+

1399.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

846.00

+ +
+

691.00

+ +
+

1537.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

846.00

+ +
+

553.00

+ +
+

1399.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

846.00

+ +
+

691.00

+ +
+

1537.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

846.00

+ +
+

1082.00

+ +
+

1928.00

+ +
+

 

+ +
+

C

+ +

 

+ +
+

Aged/Aged

+ +
+

846.00

+ +
+

717.00

+ +
+

1563.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

846.00

+ +
+

717.00

+ +
+

1563.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

846.00

+ +
+

717.00

+ +
+

1563.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

846.00

+ +
+

0.00

+ +
+

846.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

564.001

+ +
+

579.33

+ +
+

1143.33

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

564.001

+ +
+

800.33

+ +
+

1364.33

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

564.001

+ +
+

579.33

+ +
+

1143.33

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

564.001

+ +
+

716.83

+ +
+

1280.83

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

564.001

+ +
+

579.33

+ +
+

1143.33

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

564.001

+ +
+

716.33

+ +
+

1280.83

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

564.001

+ +
+

1017.33

+ +
+

1581.33

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

38.00

+ +
+

98.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. PROCEDURE - DELAWARE +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

 

+ +
+

 

+ +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + -- Only living arrangement variation in Delaware and includes only those recipients + who are certified by the State medical unit as residents of one of the above adult + facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- All recipients who are not included in A or Y.

+ +

Optional supplementation code Z is the proper code to be used with an “intervening” + Federal code A. (See SM 01301.535) +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Delaware Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

564.00

+ +
+

140.00

+ +
+

704.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

376.001

+ +
+

0.00

+ +
+

376.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

846.00

+ +
+

448.00

+ +
+

1294.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

846.00

+ +
+

0.00

+ +
+

846.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

564.001

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. PROCEDURE - DISTRICT OF COLUMBIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

 

+ +
+

 

+ +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by + the District of Columbia, Department of Human Services, as residents of an adult foster + care home with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult Foster Care Home with More than 50 Residents --Recipients who are certified + by the District of Columbia, Department of Human Services, as residents of an adult + foster care home with more than 50 residents. +

+ +
+

G

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

District of Columbia Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

564.00

+ +
+

307.00

+ +
+

871.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

564.00

+ +
+

417.00

+ +
+

981.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

376.001

+ +
+

0.00

+ +
+

376.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Code +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

846.00

+ +
+

896.00

+ +
+

1742.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

846.00

+ +
+

1116.00

+ +
+

1962.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

564.001

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

E. PROCEDURE - HAWAII +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living – Eligible individual or couple who:

+ +
    +
  • +
    +
    •
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes. + This includes living in a “half-way house,” which is a private non-medical facility + with whom the State has a purchase or services agreement for the short term care of + certain needy individuals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a blind or disabled child under age 18 (or age 21 if the individual qualifies as + a “protected child”) living in the household of a parent or parents. +

    + +
    +
    +
  • +
+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535) +

+ +

This State code is also used to supplement Section 1619 cases. This State living arrangement + was terminated 12/31/2002. +

+ +
+

B

+ +
+

Living in a Community Care/Foster Care Home -- Effective 1/03.

Persons eligible for SSI and who meet both of the following conditions: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    over age 18 and

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    live in a State approved Community Care/Foster Care Home

    + +
    +
    +
  4. +
+ +
+

H

+ +
+

Domiciliary Care I -- (Maximum of five residents) - Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary Care II -- Same as H except care is provided for six or more residents.

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Eligible for, but has waived their right to receive + an optional supplement. +

+ +
+

Z

+ +

 

+ +

 

+ +
+

No Supplement Cases -- Eligible individual (or couple) who is living in the household + of another (see explanation in definition for optional supplement B) and an eligible + individual (or couple) who is a patient: +

+ +
    +
  1. +
    +
    (1) 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    + +
    +
    +
  2. +
  3. +
    +
    (2) 
    +
    +

    In a private medical facility which is not certified under title XIX.

    + +
    +
    +
  4. +
+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Hawaii Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

564.00

+ +
+

521.90

+ +
+

1085.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

564.00

+ +
+

521.90

+ +
+

1085.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

564.00

+ +
+

629.90

+ +
+

1193.90

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

376.001

+ +
+

0.00

+ +
+

376.00

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

846.00

+ +
+

0.00

+ +
+

846.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

846.00

+ +
+

1325.80

+ +
+

2171.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

846.00

+ +
+

1325.80

+ +
+

2171.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

846.00

+ +
+

1541.80

+ +
+

2387.80

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

564.001

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. PROCEDURE - IOWA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in Own Household (Blind Only) -- Only an eligible blind individual and the blind member + of a couple who does not live in any other State living arrangement variation, does not have an + EP, and is not otherwise excepted from supplementation. Also included are blind recipients in title XIX facilities where Medicaid pays 50 percent or less of the cost + of care. Optional supplement code A is also compatible with Federal codes A and C. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535) +

+ +
+

B

+ +
+

Living in the Household of Another (Blind Only) -- Only an eligible blind individual and the blind member + of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C/H

+ +
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services. +

+ +

The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D/I

+ +
+

Living in a Family Life or Boarding Home -- Eligible individual or each member of + an eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services. +

+ +
+

G

+ +
+

Used to indicate that no supplement is payable to a recipient living in a title XIX + facility and title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under title XIX or all recipients whose Federal payments + are reduced to $30/$60 due to living in a title XIX facility. In addition, aged and + disabled recipients whose Federal payments are not reduced and who live in a title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement. +

+ +
+
+

NOTE: The State Department of Human Services administers two optional supplementation programs + -- In-Home Health Related Care and Residential Care. +

+ +
+
+ +
+
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+ +
+
+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Iowa Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

564.00

+ +
+

22.00

+ +
+

586.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

564.00

+ +
+

285.00

+ +
+

849.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

564.00

+ +
+

307.00

+ +
+

871.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

285.00

+ +
+

849.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

564.00

+ +
+

142.00

+ +
+

706.00

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

 

+ +
+

Z

+ +
+

Aged

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

376.001

+ +
+

22.00

+ +
+

398.00

+ +
+

 

+ +
+

H3

+ +
+

Aged

+ +
+

376.001

+ +
+

285.00

+ +
+

661.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

376.001

+ +
+

307.00

+ +
+

683.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

376.001

+ +
+

285.00

+ +
+

661.00

+ +
+

 

+ +
+

I3

+ +
+

All

+ +
+

376.001

+ +
+

142.00

+ +
+

518.00

+ +
+

 

+ +
+

Z

+ +
+

Aged

+ +
+

376.001

+ +
+

0.00

+ +
+

376.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

376.001

+ +
+

0.00

+ +
+

376.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

564.00

+ +
+

22.00

+ +
+

586.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

564.00

+ +
+

307.00

+ +
+

871.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

285.00

+ +
+

849.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR + less VTR.

+

2Not an FBR; the amount represents a payment + cap to recipients in a title XIX institution.

+

3Old FLA/OS codes B/C and B/D were + changed to B/H and B/I to make them compatible with the RMA policy + computation process.

+
+
+

NOTE:

+ +
+
+

State-administered programs: For Calendar Year 2004 -

+
    +
  1. +
    +
    (1) 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 2002 was $17.50 + to $24.50. The calendar year 2002 personal allowance was $75.00. Rates for calendar + year 2004 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    (2) 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 2002 for care in-home related care was $471.06. The payment rate for calendar + year 2004 was not available for inclusion in this publication. +

    + +
    +
    +
  4. +
+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

846.00

+ +
+

44.00

+ +
+

890.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

846.00

+ +
+

22.00

+ +
+

868.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

846.00

+ +
+

22.00

+ +
+

868.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

846.00

+ +
+

285.00

+ +
+

1131.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

846.00

+ +
+

329.00

+ +
+

1175.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

846.00

+ +
+

285.00

+ +
+

1131.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

846.00

+ +
+

307.00

+ +
+

1153.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

846.00

+ +
+

285.00

+ +
+

1131.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

846.00

+ +
+

307.00

+ +
+

1153.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

846.00

+ +
+

586.00

+ +
+

1432.00

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

846.00

+ +
+

0.00

+ +
+

846.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

846.00

+ +
+

0.00

+ +
+

846.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

846.00

+ +
+

0.00

+ +
+

846.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

846.00

+ +
+

0.00

+ +
+

846.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

564.001

+ +
+

44.00

+ +
+

608.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

564.001

+ +
+

22.00

+ +
+

586.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

564.001

+ +
+

22.00

+ +
+

586.00

+ +
+

 

+ +
+

H3

+ +
+

Aged/Aged

+ +
+

564.001

+ +
+

285.00

+ +
+

849.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

564.001

+ +
+

329.00

+ +
+

893.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

564.001

+ +
+

285.00

+ +
+

849.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

564.001

+ +
+

307.00

+ +
+

871.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

564.001

+ +
+

285.00

+ +
+

849.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

564.001

+ +
+

307.00

+ +
+

871.00

+ +
+

 

+ +
+

I3

+ +
+

All

+ +
+

564.001

+ +
+

586.00

+ +
+

1150.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

564.001

+ +
+

0.00

+ +
+

564.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

564.001

+ +
+

0.00

+ +
+

564.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

564.001

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

3Old FLA/OS codes B/C and + B/D were changed to B/H and B/I to make them compatible with the + RMA policy computation process.

+
+
+

NOTE:

+ +
+
+

State-administered programs: For Calendar Year 2004 -

+
    +
  1. +
    +
    1. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 2002 was $17.50 + to $24.50. The calendar year 2002 personal allowance was $75.00. Rates for calendar + year 2004 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 2002 for care in-home related care was $471.06. The payment rate for calendar + year 2004 was not available for inclusion in this publication. (Members of a couple + are treated as individuals.) +

    + +
    +
    +
  4. +
+
+
+
+
+
+
+ +
+
+

G. PROCEDURE - MASSACHUSETTS +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +

 

+ +
+

Full Cost-of-Living:

+ +
    +
  1. +
    +
    1. 
    +
    +

    An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and is: +

    + +
      +
    1. +
      +
      a. 
      +
      +

      Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences will be considered + living alone provided they do not use the residential kitchen facilities for preparing + meals; or +

      + +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Living only with their eligible spouse; or

      + +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Living with their eligible spouse and ineligible child/children 2 none of whom (children) receive public income maintenance payments;3 + or +

      + +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Living only with their ineligible spouse and/or their ineligible child/children, none + of whom (spouse and children) receive public income maintenance payments. +

      + +
      +
      +

      NOTE: For purposes of a. through d. above, foster children placed with anyone other than + their parents are not considered to be living with the foster parent. +

      + +
      +
      + +
      +
      +
    8. +
    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments. +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in 1. or 2. above will be in State living arrangement A if they + pays at least two-thirds of the household expenses. In making a determination as to + whether the individual pays two-thirds or more of the expenses, use the method defined + in SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses. +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. + Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

    + +
    +
    +
  8. +
+ +
+

B

+ +
+

Shared Living Expenses -- An individual who is in Federal living arrangement A or + C and who does not meet the criteria listed for State living arrangement A, E or G + is in State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH). +

+ +

Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined above. Also included are individuals placed + under the auspices of the State adult foster care program and residents of publicly + operated emergency shelters throughout a month. +

+ +

An individual living in a household where all members receive public income maintenance + payments unless they is paying at least two-thirds of the household expenses (A). +

+ +

An individual living in a mixed household -- i.e., a household where one or more other + members receive a public income maintenance payment -- also is included unless the + individual is paying at least two-thirds of the household expenses (A). +

+ +
+

C

+ +
+

Living in the Household of Another -- Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third. +

+ +
+

E

+ +
+

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home. +

+ +
+

F

+ +
+

Effective 7/1/87, the State elected Federal administration of this optional State + supplementary payment to residents of title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Assisted Living -- Effective 7/1/94, the State elected Federal administration of this + variation. Includes an individual, certified by the State to be residing in an Assisted + Living residence served by a certified Group Adult Foster Care provider, who is not + receiving assistance under any other Federal or State rental assistance program, and + who pays a fixed, non-separable fee for rent and supportive services, other than medically + necessary services reimbursed by Medicaid. The State shall certify to SSA each individual + who is eligible for this optional supplement living arrangement. This living arrangement + was discontinued effective 1/1/96. However, it has been restored, retroactively, to + 1/1/97. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+
+
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. +

+ +
+
+

1For purposes of determining + State living arrangements, a commercial boarding house, foster home, or + halfway house is not considered the person's household.

+

2Use the SSI definition + of child, SI 00501.400.

+

3A public income maintenance + payment is a payment from any of the following programs: Aid to + Families with Dependent Children (AFDC), SSI, the Refugee Act of + 1980, the Disaster Relief Act of 1974, general assistance programs + of the Bureau of Indian Affairs, State or local government income + maintenance programs that are based on need, or Department of Veterans + Affairs benefits based on need.

+
+
+
+
+

2. Coding and Monthly Payments Levels +

+
+
+

Massachusetts Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

564.00

+ +
+

128.82

+ +
+

692.82

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

564.00

+ +
+

149.74

+ +
+

713.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

114.39

+ +
+

678.39

+ +
+

 

+ +
+

B

+ +
+

Aged

+ +
+

564.00

+ +
+

39.26

+ +
+

603.26

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

564.00

+ +
+

149.74

+ +
+

713.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

30.40

+ +
+

594.40

+ +
+

 

+ +
+

E

+ +
+

Aged

+ +
+

564.00

+ +
+

293.00

+ +
+

857.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

564.00

+ +
+

149.74

+ +
+

713.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

293.00

+ +
+

857.00

+ +
+

 

+ +
+

G

+ +
+

Aged

+ +
+

564.00

+ +
+

454.00

+ +
+

1018.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

564.00

+ +
+

454.00

+ +
+

1018.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

454.00

+ +
+

1018.00

+ +
+

B

+ +
+

C

+ +
+

Aged

+ +
+

376.001

+ +
+

104.36

+ +
+

480.36

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

376.001

+ +
+

337.74

+ +
+

713.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

376.001

+ +
+

87.58

+ +
+

463.58

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

564.00

+ +
+

149.74

+ +
+

713.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

114.39

+ +
+

678.39

+ +
+

 

+ +
+

B

+ +
+

Blind

+ +
+

564.00

+ +
+

149.74

+ +
+

713.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

564.00

+ +
+

30.40

+ +
+

594.40

+ +
+

D

+ +
+

F

+ +
+

All

+ +
+

30.002

+ +
+

35.00

+ +
+

65.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

846.00

+ +
+

201.72

+ +
+

1047.72

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

846.00

+ +
+

581.48

+ +
+

1427.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

846.00

+ +
+

180.06

+ +
+

1026.06

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

846.00

+ +
+

391.60

+ +
+

1237.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

846.00

+ +
+

190.89

+ +
+

1036.89

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

846.00

+ +
+

380.77

+ +
+

1226.77

+ +
+

 

+ +
+

B

+ +
+

Aged/Aged

+ +
+

846.00

+ +
+

201.72

+ +
+

1047.72

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

846.00

+ +
+

581.48

+ +
+

1427.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

846.00

+ +
+

180.06

+ +
+

1026.06

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

846.00

+ +
+

391.60

+ +
+

1237.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

846.00

+ +
+

190.89

+ +
+

1036.89

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

846.00

+ +
+

380.77

+ +
+

1226.77

+ +
+

 

+ +
+

E

+ +
+

Aged/Aged

+ +
+

846.00

+ +
+

868.00

+ +
+

1714.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

846.00

+ +
+

581.48

+ +
+

1427.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

846.00

+ +
+

868.00

+ +
+

1714.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

846.00

+ +
+

724.74

+ +
+

1570.74

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

846.00

+ +
+

868.00

+ +
+

1714.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

846.00

+ +
+

724.74

+ +
+

1570.74

+ +
+

 

+ +
+

G

+ +
+

Aged/Aged

+ +
+

846.00

+ +
+

681.00

+ +
+

1527.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

846.00

+ +
+

681.00

+ +
+

1527.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

846.00

+ +
+

681.00

+ +
+

1527.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

846.00

+ +
+

681.00

+ +
+

1527.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

846.00

+ +
+

681.00

+ +
+

1527.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

846.00

+ +
+

681.00

+ +
+

1527.00

+ +
+

B

+ +
+

C

+ +
+

Aged/Aged

+ +
+

564.001

+ +
+

215.80

+ +
+

779.80

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

564.001

+ +
+

863.48

+ +
+

1427.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

564.001

+ +
+

194.18

+ +
+

758.18

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

564.001

+ +
+

539.64

+ +
+

1103.64

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

564.001

+ +
+

204.99

+ +
+

768.99

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

564.001

+ +
+

528.83

+ +
+

1092.83

+ +
+

D

+ +
+

F

+ +
+

All

+ +
+

60.002

+ +
+

70.00

+ +
+

130.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

H. PROCEDURE - MICHIGAN +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal Care -- Recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care. +

+ +
+

G

+ +
+

Independent Living with an EP -- Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.) +

+ +
+

H

+ +
+

Living in the Household of Another with an EP --Recipients with an EP and living in + the household of another for Federal purposes. (Children under age 18 are excluded.) +

+ +
+

I

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under title XIX. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Michigan Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

564.00

+ +
+

87.00

+ +
+

651.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

564.00

+ +
+

157.50

+ +
+

721.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

564.00

+ +
+

179.30

+ +
+

743.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

846.002

+ +
+

14.00

+ +
+

860.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

564.001

+ +
+

9.33

+ +
+

573.33

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 30.003

+ +
+

7.00

+ +
+

37.00

+ +
+
+

1Not an FBR; the amount + represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount + represents the FBR plus EP increment.

+

3Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

846.00

+ +
+

456.00

+ +
+

1302.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

846.00

+ +
+

597.00

+ +
+

1443.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

846.00

+ +
+

640.60

+ +
+

1486.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1128.002

+ +
+

21.00

+ +
+

1149.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

752.001

+ +
+

14.00

+ +
+

766.00

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 60.003

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not an FBR; the amount + represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount + represents the FBR plus EP increment.

+

3Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

I. PROCEDURE - MONTANA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

 

+ +
+

 

+ +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-Certified Personal Care

+ +
+

H

+ +
+

State-Certified Residence in Group Home for Mentally Disabled

+ +
+

I

+ +
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+ +
+

J

+ +
+

State-Certified Residence for Child and Adult Foster Care

+ +
+

K

+ +
+

State-Certified Transitional Living for Developmentally Disabled

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Includes all individuals and couples not certified in State + codes G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding And Monthly Payment Levels +

+
+
+

Montana Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

564.00

+ +
+

94.00

+ +
+

658.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

564.00

+ +
+

94.00

+ +
+

658.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

564.00

+ +
+

94.00

+ +
+

658.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

564.00

+ +
+

52.75

+ +
+

616.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

564.00

+ +
+

26.00

+ +
+

590.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

376.001

+ +
+

0.00

+ +
+

376.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

846.00

+ +
+

193.00

+ +
+

1039.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

846.00

+ +
+

193.00

+ +
+

1039.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

846.00

+ +
+

193.00

+ +
+

1039.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

846.00

+ +
+

110.50

+ +
+

956.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

846.00

+ +
+

57.00

+ +
+

903.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

846.00

+ +
+

0.00

+ +
+

846.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

564.001

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. PROCEDURE - NEVADA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

 

+ +
+

 

+ +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living or Living in Parental Household -- Aged or blind eligible individual + or couple who: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes; + or +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. (See SM 01301.535.)

+ +
+

B

+ +
+

Living in the Household of Another -- Aged or blind eligible individual or couple + who is living in the household of another individual and receiving food and shelter from that individual. Aged or blind individuals or couples, who are subject + to a one-third reduction of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B. +

+ +
+

C

+ +
+

Domiciliary Care -- Aged or blind eligible individual or couple who lives in a private + non-medical facility or, as of 10/76, a residential facility serving 16 or fewer persons, + which provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- No supplement cases include:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individuals or disabled members of eligible couples; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individuals or members of eligible couples in a medical facility where title + XIX pays more than 50 percent of the cost; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individuals or members of eligible couples who are patients in a private + medical facility which is not certified under title XIX; or +

    + +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    + +
    +
    +
  8. +
+ +
+
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Nevada Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

564.00

+ +
+

36.40

+ +
+

600.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

564.00

+ +
+

109.30

+ +
+

673.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

564.00

+ +
+

350.00

+ +
+

914.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

564.00

+ +
+

350.00

+ +
+

914.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

376.001

+ +
+

24.27

+ +
+

400.27

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

376.001

+ +
+

213.96

+ +
+

589.96

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

376.001

+ +
+

0.00

+ +
+

376.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

564.00

+ +
+

109.30

+ +
+

673.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

846.00

+ +
+

74.46

+ +
+

920.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

846.00

+ +
+

374.60

+ +
+

1220.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

846.00

+ +
+

224.53

+ +
+

1070.53

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

846.00

+ +
+

37.23

+ +
+

883.23

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

846.00

+ +
+

187.30

+ +
+

1033.30

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

846.00

+ +
+

881.00

+ +
+

1727.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

846.00

+ +
+

881.00

+ +
+

1727.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

846.00

+ +
+

881.00

+ +
+

1727.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

846.00

+ +
+

440.50

+ +
+

1286.50

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

846.00

+ +
+

440.50

+ +
+

1286.50

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

846.00

+ +
+

0.00

+ +
+

846.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

564.001

+ +
+

49.64

+ +
+

613.64

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

564.001

+ +
+

531.94

+ +
+

1095.94

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

564.001

+ +
+

290.79

+ +
+

854.79

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

564.001

+ +
+

24.82

+ +
+

588.82

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

564.001

+ +
+

265.97

+ +
+

829.97

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

564.001

+ +
+

0.00

+ +
+

564.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

K. PROCEDURE - NEW JERSEY +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Licensed Residential Health Care Facilities and Certain Licensed Residential Facilities + -- The State provides New Jersey field offices with lists of approved facilities. + Mentally retarded individuals must be placed and supervised by either the State Department + of Youth and Family Services or the State Division of Mental Retardation. +

+ +
+

B

+ +
+

Living Alone or with Others -- Eligible individuals (including children) or eligible + couples whose Federal living arrangements are A or C and who do not meet the requirements + defined in other supplementation categories. +

+ +

Therefore, effective 8/1/81, any eligible adult/couple who meets the requirement for + a Federal code A will be in optional supplement B unless residing in a residential + health care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code C will automatically be + entitled to optional supplement B. +

+ +

This category includes, but is not limited to, those eligible adults/couples who are:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone; or

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

C

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Living Alone with an Ineligible Spouse -- Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse will receive the same total payment as an eligible + couple or an individual with an EP. Once other persons, even minor children, are present + in the household, this supplementary payment variation cannot exist. However, it is + possible that a claimant and their ineligible spouse live with others and allege that + they are a separate “household” by virtue of the fact that they eat their meals out + or have separate purchase and preparation of food. In this instance, an optional supplement + C is permissible as long as no other person is in their “household.” There is no couple + counterpart in this category. +

+ +

Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B. +

+ +

A transient individual who co-exists only with an ineligible spouse will also qualify + for the O/S - C rate. +

+ +
+

D

+ +
+

Living in the Household of Another -- Persons who are “living in the household of + another” for Federal purposes. +

+ +
+

G

+ +
+

Effective 9/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Individuals and couples in licensed medical facilities where + Medicaid is paying less than 50 percent of the cost of care, individuals and couples + in publicly operated community residences having 16 or less residents, and residents + of publicly operated emergency shelters throughout a month. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

New Jersey Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

564.00

+ +
+

150.05

+ +
+

714.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

564.00

+ +
+

31.25

+ +
+

595.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

564.00

+ +
+

307.36

+ +
+

871.36

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

846.00

+ +
+

25.36

+ +
+

871.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

376.001

+ +
+

44.31

+ +
+

420.31

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

564.00

+ +
+

31.25

+ +
+

595.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

10.00

+ +
+

40.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents the FBR plus EP increment.

+

3Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

846.00

+ +
+

563.36

+ +
+

1409.36

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

846.00

+ +
+

25.36

+ +
+

871.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

846.00

+ +
+

  0.00

+ +
+

846.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

564.001

+ +
+

93.09

+ +
+

657.09

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 60.002

+ +
+

20.00

+ +
+

80.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

L. PROCEDURE - NEW YORK +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone -- Eligible individuals or eligible couples living physically alone, + or living with only a foster child(ren), or a homemaker authorized by the local Department + of Social Services (DSS), or a family care recipient(s) placed by the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabled (OMRDD) + or local DSS, or individuals living with others but paying a “flat fee for room and + board,” or living with others but taking all their meals outside the dwelling unit, + or living with others in a dwelling but separately preparing food, or having their + food separately prepared for them. +

+ +
+

B

+ +
+

Living with Others -- Individual/child/couple who resides in a dwelling with others + and prepares food in common with at least one other person in the dwelling, or is + a member of a religious community, or child in any living arrangement other than a + family care home (Level I) or community residence (Level II) certified by OMRDD or + OMH. +

+ +
+

C

+ +
+

Congregate Care Level I -- Family type homes and family care homes. Family type homes + are facilities operated for the purpose of providing long-term residential care for + adults and are certified by the New York State DSS and supervised by local departments + of social services. Family care homes are private households that provide care for + mentally disabled persons. +

+ +
+

D

+ +
+

Congregate Care Level II -- Residential facilities for adults and certain children + with mental disabilities. +

+ +
+

E

+ +
+

Congregate Care Level III -- Privately operated non-medical residential facilities. + Although Level III facilities are often called schools, these facilities may not meet + the Federal definition of school. Operated for the purpose of providing treatment, + training and education for mentally retarded or developmentally disabled individuals, + these facilities are certified by OMRDD in accordance with State regulations. +

+ +
+

F

+ +
+

Living in the Household of Another -- Same as Federal definition. The State supplement + payment for the individual/child/couple whose Federal benefit rate is subject to the + one-third reduction is the “living with others” rate but for systems purposes is coded + F. +

+ +
+

G

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. Federal administration was terminated + effective 9/30/03. State began administering this payment 10/1/03. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Recipients in licensed medical facilities where Medicaid is + paying more than 50 percent of the cost of care, recipients in publicly operated community + residences which serve 16 or fewer residents, and residents of publicly operated emergency + shelters throughout a month. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

New York Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement Level

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All

+ +
+

564.00

+ +
+

87.00

+ +
+

651.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

564.00

+ +
+

23.00

+ +
+

587.00

+ +
+

 

+ +
+

C

+ +
+

NY City

+ +
+

564.00

+ +
+

266.48

+ +
+

830.48

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

564.00

+ +
+

266.48

+ +
+

830.48

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

564.00

+ +
+

228.48

+ +
+

792.48

+ +
+

 

+ +
+

D

+ +
+

NY City

+ +
+

564.00

+ +
+

435.00

+ +
+

999.00

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

564.00

+ +
+

435.00

+ +
+

999.00

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

564.00

+ +
+

405.00

+ +
+

969.00

+ +
+

 

+ +
+

E

+ +
+

NY City

+ +
+

564.00

+ +
+

482.96

+ +
+

1,046.96

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

564.00

+ +
+

458.96

+ +
+

1,022.96

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

564.00

+ +
+

458.96

+ +
+

1,022.96

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

564.00

+ +
+

  0.00

+ +
+

564.00

+ +
+

B

+ +
+

F

+ +
+

All

+ +
+

376.001

+ +
+

23.00

+ +
+

399.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 30.002

+ +
+

  0.003

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

3New York administers a + supplement of $20 to some recipients in a title XIX institution.

+

4Includes and applies to: + Nassau, Suffolk, and Westchester counties effective 7/1/85.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement Level

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All

+ +
+

846.00

+ +
+

104.00

+ +
+

950.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

846.00

+ +
+

46.00

+ +
+

892.00

+ +
+

 

+ +
+

C

+ +
+

NY City

+ +
+

846.00

+ +
+

814.96

+ +
+

1660.96

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

846.00

+ +
+

814.96

+ +
+

1660.96

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

846.00

+ +
+

738.96

+ +
+

1,584.96

+ +
+

 

+ +
+

D

+ +
+

NY City

+ +
+

846.00

+ +
+

1152.00

+ +
+

1998.00

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

846.00

+ +
+

1152.00

+ +
+

1998.00

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

846.00

+ +
+

1092.00

+ +
+

1938.00

+ +
+

 

+ +
+

E

+ +
+

NY City

+ +
+

846.00

+ +
+

1247.92

+ +
+

2093.92

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

846.00

+ +
+

1199.92

+ +
+

2045.92

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

846.00

+ +
+

1199.92

+ +
+

2045.92

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

846.00

+ +
+

0.00

+ +
+

846.00

+ +
+

B

+ +
+

F

+ +
+

All

+ +
+

564.001

+ +
+

46.00

+ +
+

610.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 60.002

+ +
+

0.003

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

3New York administers a + supplement of $20 to some recipients in a title XIX institution.

+

4Includes and applies to: + Nassau, Suffolk, and Westchester counties effective 7/1/85.

+
+
+
+
+
+
+ +
+
+

M. PROCEDURE - PENNSYLVANIA +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone -- Recipients in private medical facilities (nursing homes, hospitals, + intermediate care facilities) where title XIX is not paying more than 50 percent of the cost of care, residents of publicly operated emergency + shelters throughout a month, and all other individuals and couples in Federal codes + A and C not meeting the definition of another variation. +

+ +

Used with an "intervening" Federal code A. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients who do not have an EP and who live + in the household of another and receive support and maintenance for Federal purposes. +

+ +
+

C

+ +
+

Living with an EP -- Recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules; i.e., Public Law 93-66. +

+ +
+

D

+ +
+

Living in the Household of Another with an EP --Recipients who live in the household + of another and who have one or more EP’s as defined under the Federal rules; i.e., + Public Law 93-66. +

+ +
+

G

+ +
+

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities (Effective + 7/1/89). +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Includes all recipients who are residing in a medical facility + in which title XIX is paying more than 50 percent of the cost of care. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Pennsylvania Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

564.00

+ +
+

27.40

+ +
+

591.40

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

846.003

+ +
+

43.70

+ +
+

889.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

564.00

+ +
+

389.30

+ +
+

953.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

564.00

+ +
+

394.30

+ +
+

958.30

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

376.001

+ +
+

27.40

+ +
+

403.40

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

564.002

+ +
+

43.70

+ +
+

607.70

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

564.00

+ +
+

27.40

+ +
+

591.40

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.004

+ +
+

  0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents the FBR plus EP increment less VTR.

+

3Not an FBR; the amount + represents the FBR plus EP increment.

+

4Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

846.00

+ +
+

43.70

+ +
+

889.70

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1128.003

+ +
+

68.05

+ +
+

1196.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

846.00

+ +
+

857.40

+ +
+

1703.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

846.00

+ +
+

867.40

+ +
+

1713.40

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

564.001

+ +
+

43.70

+ +
+

607.70

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

752.00

+ +
+

68.05

+ +
+

820.05

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.004

+ +
+

  0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents the FBR plus EP increment less VTR.

+

3Not an FBR; the amount + represents the FBR plus EP increment.

+

4Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

N. PROCEDURE - RHODE ISLAND +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living -- Recipients who are in Federal codes A and C, except for individuals + residing in a residential care/assisted living facility who have been certified as + eligible for State Code D. +

+ +

Recipients residing in a public emergency shelter for the homeless and those who are + eligible for Section 1619 are included in this category. +

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied. +

+ +
+

D

+ +
+

Residential Care/Assisted Living (Effective 10/1/98). (Formerly Shelter Care from + 10/01/90 – 9/30/98.) This category applies to individuals only. +

+ +
+

E

+ +
+

The State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 3/1/91). +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Rhode Island Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A1

+ +
+

All

+ +
+

564.00

+ +
+

57.35

+ +
+

621.35

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

564.00

+ +
+

575.00

+ +
+

1139.00

+ +
+

B

+ +
+

B1

+ +
+

All

+ +
+

376.002

+ +
+

69.94

+ +
+

445.94

+ +
+

C

+ +
+

A1

+ +
+

All

+ +
+

564.00

+ +
+

57.35

+ +
+

621.35

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

 30.003

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Code is systems generated + from the Federal code.

+

2Not an FBR; the amount + represents the FBR less VTR.

+

3Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A1

+ +
+

All

+ +
+

846.00

+ +
+

108.50

+ +
+

954.50

+ +
+

B

+ +
+

B1

+ +
+

All

+ +
+

564.002

+ +
+

128.50

+ +
+

692.50

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

60.003

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Code is systems generated + from the Federal code.

+

2Not an FBR; the amount + represents the FBR less VTR.

+

3Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

O. PROCEDURE - UTAH +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone or With Others -- This variation includes recipients who are in Federal + codes A and C. +

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients with no EP who are "living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.) +

+ +
+

Z

+ +
+

No Supplement Cases -- No supplement cases include all recipients who are not included + in A or B. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Utah Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Level

+ +
+

A,C

+ +
+

Z

+ +
+

All

+ +
+

564.00

+ +
+

0.00

+ +
+

564.00

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

376.002

+ +
+

3.13

+ +
+

379.13

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

2Not an FBR, the amount + represents the FBR less VTR.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All

+ +
+

846.00

+ +
+

4.60

+ +
+

850.60

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

564.002

+ +
+

9.73

+ +
+

573.73

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

2Not an FBR, the amount + represents the FBR less VTR.

+
+
+
+
+
+
+ +
+
+

P. PROCEDURE - VERMONT +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living (except Chittenden County) -- Recipients not living in the household + of another, not in a custodial care situation, and not otherwise excepted from supplementation. + Includes a child who is living with a parent and recipients residing in a private + title XIX facility where Medicaid is not paying more than 50 percent of the cost of + care. +

+ +

Effective 5/1/83, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A (except Chittenden County). +

+ +
+

B

+ +
+

Independent Living in Chittenden County -- Same as Code A above except restricted + to residents of Chittenden County. +

+ +

Effective 5/1/83, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +

+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A (Chittenden County only). (See SM 01301.535.) +

+ +
+

C

+ +
+

Assistive Community Care Level III: Recipients living in facilities identified by + the State. +

+ +
+

E

+ +
+

Living in the Household of Another -- Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions), and not otherwise excepted from supplementation. +

+ +
+

G

+ +
+

Custodial Care: Licensed Community Care Home -- Recipients living in Level IV Community + Homes identified by the State. +

+ +
+

H

+ +
+

Custodial Care: Family Home -- Recipients living in another's home in such a manner + that the individual or couple is paying room and board and is receiving one or more + of the services outlined under the custodial care definition. The individual or couple + must also receive the room and board and custodial care in the home in which they + reside. In order to qualify as a home under this arrangement, these services must + not be provided to more than two persons and must be provided by a resident of the + home. +

+ +

Custodial care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service 2-3 times a week) and/or + supervision for the recipient's protection. Supervision for the recipient's protection + deals primarily with protection services for retarded and emotionally disturbed individuals. + A person who receives one or more of these personal services is receiving custodial + care. +

+ +

The change in this arrangement is effective for initial claims filed on or after 1/1/84. + For redeterminations the change is effective with the month after the month in which + the first redetermination on or after 1/1/84, is initiated. +

+ +

This arrangement does not cover:

+ +
    +
  • +
    +
    •
    +
    +

    Institutional Living -- Regardless of whether custodial care is needed in addition + to the medical, training, rehabilitation, educational or similar services as the primary + function of the institution. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A person whose Federal living arrangement is based on home ownership or rental liability. + (A flat fee for room and board per SI 00835.120B. is not considered as rental liability for this arrangement.) +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A child under age 18 not placed by a Vermont Community Mental Health Agency or the + Vermont Department of Mental Health. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Custodial care or supervision provided by a spouse (as defined by Federal regulations).

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Any home or boarding arrangement which does not meet the Federal SSI definition of + independent living, Federal Code A. +

    + +
    +
    +
  • +
+ +
+

I

+ +
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents in title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+
+
+
+

NOTE: When a person has a room in one facility/household and receives board or custodial + care in another facility/household, the custodial rate (G or H) is based on the facility/household + where the person sleeps. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Vermont Effective 1/1/04

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

564.00

+ +
+

52.04

+ +
+

616.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

564.00

+ +
+

52.04

+ +
+

616.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

564.00

+ +
+

48.38

+ +
+

612.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

564.00

+ +
+

223.94

+ +
+

787.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

564.00

+ +
+

98.69

+ +
+

662.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

376.001

+ +
+

39.30

+ +
+

415.30

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

564.00

+ +
+

52.04

+ +
+

616.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

564.00

+ +
+

52.04

+ +
+

616.04

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

17.66

+ +
+

47.66

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County

+ +
+

846.00

+ +
+

98.88

+ +
+

944.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County

+ +
+

846.00

+ +
+

98.88

+ +
+

944.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

846.00

+ +
+

96.77

+ +
+

942.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

846.00

+ +
+

562.06

+ +
+

1408.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

846.00

+ +
+

332.82

+ +
+

1178.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

564.001

+ +
+

48.31

+ +
+

612.31

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

35.33

+ +
+

95.33

+ +
+
+

1Not an FBR; the amount + represents the FBR less VTR.

+

2Not an FBR; the amount + represents a payment cap to recipients in a title XIX institution.

+

 

+

 

+
+
+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415036
SI 01415.036 - Federally Administered Optional Supplementary Payment Programs – 1/04 Payment Levels - 08/23/2024
+Batch run: 02/19/2025
+Rev:08/23/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2005.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2005.html new file mode 100644 index 00000000..07941ccf --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2005.html @@ -0,0 +1,15786 @@ + + +SSA - POMS: SI 01415.037 - Federally Administered Optional Supplementary Payment Programs – 1/05 Payment Levels - 08/06/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 68 (08-24)

+

SI 01415.037 Federally Administered Optional Supplementary Payment Programs – 1/05 Payment Levels +

+ + +
+
+

CITATIONS:

+
+
+ +
Social Security Act as amended in 1973, Section 1616; Social Security + Amendments of 1972, Section 301;Public Law 93-66, Section 212 +
+ +
+
+
+
+

A. Background +

+
+
+

The following states are participating in the + federally Administered Optional Supplementary Payment Programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

CALIFORNIA

+ +
+

NEVADA

+ +
+

DELAWARE

+ +
+

NEW JERSEY

+ +
+

DISTRICT OF COLUMBIA

+ +
+

NEW YORK

+ +
+

HAWAII

+ +
+

PENNSYLVANIA

+ +
+

IOWA

+ +
+

RHODE ISLAND

+ +
+

MASSACHUSETTS

+ +
+

UTAH

+ +
+

MICHIGAN

+ +
+

VERMONT

+ +
+

MONTANA

+ +
+

 

+ +
+
+
+
+ +
+
+

B. Procedure - California +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living with Cooking Facilities -- Eligible individual or couple who:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and has cooking and food storage facilities or is provided meals as part of the living + arrangement; or +

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 living in the household of a parent or parents or is + a disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; or +

    + +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or +

    + +
    +
    +
  8. +
  9. +
    +
    e. 
    +
    +

    Effective 7/1/83, lives in a private medical facility licensed by the State but not + certified under title XIX. (An optional supplementary A payment based on the new instructions + is payable retroactively to 7/1/83.) +

    + +
    +
    +
  10. +
+ +
+

B

+ +
+

Non-medical Out-of-Home Care (NMOHC) -- Applies when an individual/couple needs non-medical + care or supervision in the following living arrangement situations: +

+ +

CHILDREN (UNDER AGE 18)

+ +
    +
  1. +
    +
    a. 
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Effective 10/1/79, disabled child residing in the home of a legal guardian who is + not a relative; or +

    + +
    +
    +
  8. +
  9. +
    +
    e. 
    +
    +

    Effective 1/1/84, disabled child residing in the home of a relative who is not a parent + (Major v. + McMahon decision), reopening a prior decision to pay OS B under this definition may be retroactive + to 1/1/84; or +

    + +
    +
    +
  10. +
  11. +
    +
    f. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or +

    + +
    +
    +
  12. +
  13. +
    +
    g. 
    +
    +

    For periods prior to 7/1/83 only, a blind or disabled child placed in any home or + State licensed NMOHC facility as the result of a court order; or +

    + +

    ADULTS (AGE 18 AND OVER)

    + +
    +
    +
  14. +
  15. +
    +
    h. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or +

    + +
    +
    +
  16. +
  17. +
    +
    i. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in a State licensed NMOHC facility. +

    + +
    +
    +
  18. +
+ +

For California optional supplement purposes, a relative is defined as a parent, child, + sibling, half-sibling, parent's sibling, sibling's child, first cousin, or any person + of the preceding generation denoted by the prefix “grand” or “great.” +

+ +
+

C

+ +
+

Independent Living Without Cooking Facilities -- Aged or disabled individual/couple + who is neither provided any meals nor has access to adequate cooking/food storage + facilities as part of a living arrangement. Transients, as defined in SI + 00835.060, are also eligible for OS C. +

+ +

An individual/couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Immediate living quarters do not have cooking and food storage facilities with which + the individual/couple or another person (who is responsible for preparing the individual's/couple's + meals) can prepare meals on a daily basis. +

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf. +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Lives in a boarding house that does not + have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals. +

    + +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals. +

    + +
    +
    +
  8. +
  9. +
    +
    e. 
    +
    +

    Lives in a room and board facility and does not + contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the SSI applicant's/recipient's arrangement with the facility + is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  10. +
  11. +
    +
    f. 
    +
    +

    “Adequate” cooking and food storage facilities exist when an individual/couple has + access to: +

    + +
    +
    +
  12. +
  13. +
    +
    g. 
    +
    +

    Both a working refrigerator or icebox and + a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.) +

    + +

    OR

    + +

    Both a working refrigerator or icebox and + a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls that + are used for warming food are not considered adequate cooking facilities.) +

    + +

    OR

    + +

    Both a working refrigerator or icebox and + a stove with a working oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  14. +
  15. +
    +
    h. 
    +
    +

    Eligibility for OS C begins in the month the applicant/recipient applies for this + supplement rate provided they have been without cooking and food storage facilities + throughout the month. +

    + +

    NOTE: For purposes of OS C, “throughout a month” does not mean the applicant/recipient must lack adequate cooking/food storage facilities from + the very first moment of the month. They need only lack them from some time on the + first day of the month. +

    + +

    If eligibility is based on temporary loss or non-functioning of an appliance, the + individual should be advised of their responsibility to report immediately when the + temporary condition has ceased. If the individual provides an expected date when the + appliance will be replaced/repaired, diary the case for re-contact. +

    + +

    Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available. +

    + +

    For a couple, comprised of an aged/disabled individual and a blind individual, whose + living arrangement lacks adequate cooking and storage facilities, the couple is to + receive the SSI/SSP level for a blind/aged or disabled couple plus the restaurant + meals allowance for the disabled member of the couple. Force payment in this living + arrangement is required. +

    + +
    +
    +
  16. +
+ +
+

D

+ +
+

Living in the Household of Another -- Eligible individual/couple is living in the + household of another and is receiving food and shelter from that individual. Most individuals/couples who are subject to a 1/3 reduction + of their Federal SSI payments (VTR) are eligible for OS D because the criteria for + this supplement level are the same as for charging the VTR. However, when the eligible + individual/couple lives in the home of a relative (other than a spouse) and needs + care and supervision, certification for non-medical out-of-home care (OS F) should + be obtained from the county welfare office since this is the highest categorical supplement + for which an individual /couple can qualify. +

+ +
+

E

+ +
+

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage. (Until 9/30/79, a disabled child under + age 18 living with a legal guardian also fell into this category.) +

+ +

NOTE: Effective 2/1/82, only FLA A and C are compatible with OS E. If the VTR applies, see + code G. +

+ +
+

F

+ +
+

Non-medical Out-of-Home Care Living in the Household of Another -- Effective 2/1/82. + Applies whenever an eligible individual or couple meets the criteria for the non-medical + out-of-home care payment rate, and is determined to receive the Federal code B payment + for living in the household of another (SI + 00835.200). +

+ +
+

G

+ +
+

Disabled Child Under Age 18 Living in the Household of Another --Effective 2/1/82. + Applies to a disabled (not blind) child under age 18, who resides with a parent or + relative by blood or marriage, and is determined to receive the Federal code B payment for living in the household of + another individual (SI + 00835.200). +

+ +
+

J

+ +
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Eligible individual or couple who is a patient:

+ +

1. In a medical facility where title XIX pays more than 50 percent of the costs; or

+ +

2. In a private medical facility which is not certified under title XIX and not licensed + by the State (effective 7/1/83). (Prior to 7/1/83, the facility could have been licensed + by the State but not certified under title XIX.) +

+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

California Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

579.00

+ +
+

226.00

+ +
+

805.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

579.00

+ +
+

290.00

+ +
+

869.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

226.00

+ +
+

805.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

579.00

+ +
+

400.00

+ +
+

979.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

579.00

+ +
+

308.00

+ +
+

887.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

579.00

+ +
+

290.00

+ +
+

869.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

308.00

+ +
+

887.00

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

579.00

+ +
+

115.00

+ +
+

694.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

386.001

+ +
+

227.00

+ +
+

613.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

386.001

+ +
+

306.00

+ +
+

692.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

386.001

+ +
+

227.00

+ +
+

613.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

386.001

+ +
+

396.00

+ +
+

782.00

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

386.001

+ +
+

105.00

+ +
+

491.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

579.00

+ +
+

290.00

+ +
+

869.00

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

579.00

+ +
+

115.00

+ +
+

694.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

19.00

+ +
+

49.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

869.00

+ +
+

553.00

+ +
+

1422.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

869.00

+ +
+

773.00

+ +
+

1642.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

869.00

+ +
+

553.00

+ +
+

1422.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

869.00

+ +
+

691.00

+ +
+

1560.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

869.00

+ +
+

553.00

+ +
+

1422.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

869.00

+ +
+

691.00

+ +
+

1560.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

869.00

+ +
+

1089.00

+ +
+

1958.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

869.00

+ +
+

717.00

+ +
+

1586.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

869.00

+ +
+

717.00

+ +
+

1586.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

869.00

+ +
+

717.00

+ +
+

1586.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

579.341

+ +
+

579.33

+ +
+

1158.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

579.341

+ +
+

800.33

+ +
+

1379.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

579.341

+ +
+

579.33

+ +
+

1158.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

579.341

+ +
+

716.33

+ +
+

1295.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

579.341

+ +
+

579.33

+ +
+

1158.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

579.341

+ +
+

716.33

+ +
+

1295.67

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

579.341

+ +
+

1017.33

+ +
+

1596.67

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

38.00

+ +
+

98.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. Procedure - Delaware +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + -- Only living arrangement variation in Delaware and includes only those recipients + who are certified by the State medical unit as residents of one of the above adult + facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- All recipients who are not included in A or Y.

+ +

Optional supplementation code Z is the proper code to be used with an “intervening” + Federal code A. (See SM + 01301.535) +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Delaware Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

579.00

+ +
+

140.00

+ +
+

719.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

386.001

+ +
+

0.00

+ +
+

386.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

869.00

+ +
+

448.00

+ +
+

1317.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

579.341

+ +
+

0.00

+ +
+

579.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Procedure - District of Columbia +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by + the District of Columbia, Department of Human Services, as residents of an adult foster + care home with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult Foster Care Home with More than 50 Residents --Recipients who are certified + by the District of Columbia, Department of Human Services, as residents of an adult + foster care home with more than 50 residents. +

+ +
+

G

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

District of Columbia Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

579.00

+ +
+

307.00

+ +
+

926.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

579.00

+ +
+

457.00

+ +
+

1036.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

386.001

+ +
+

0.00

+ +
+

386.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Code +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

869.00

+ +
+

983.00

+ +
+

1852.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

869.00

+ +
+

1203.00

+ +
+

2072.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

579.341

+ +
+

0.00

+ +
+

579.34

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Procedure - Hawaii +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living – Eligible individual or couple who:

+ +
    +
  • +
    +
    •
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes. + This includes living in a “half-way house,” which is a private non-medical facility + with whom the State has a purchase or services agreement for the short term care of + certain needy individuals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a blind or disabled child under age 18 (or age 21 if the individual qualifies as + a “protected child”) living in the household of a parent or parents. +

    + +
    +
    +
  • +
+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535) +

+ +

This State code is also used to supplement Section 1619 cases. This State living arrangement + was terminated 12/31/2002. +

+ +
+

B

+ +
+

Living in a Community Care/Foster Care Home -- Effective 1/03. 1.

+ +
    +
  1. +
    +
    a. 
    +
    +

    Persons eligible for SSI and who meet both of the following conditions:

    + +

    over age 18 and

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    live in a State approved Community Care/Foster Care Home

    + +
    +
    +
  4. +
+ +
+

H

+ +
+

Domiciliary Care I -- (Maximum of five residents) - Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary Care II -- Same as H except care is provided for six or more residents.

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Eligible for, but has waived their right to receive + an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Eligible individual (or couple) who is living in the household + of another (see explanation in definition for optional supplement B) and an eligible + individual (or couple) who is a patient: +

+ +

1. In a medical facility where title XIX pays more than 50 percent of the costs; or

+ +

2. In a private medical facility which is not certified under title XIX.

+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Hawaii Effective 1/1/05.

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

579.00

+ +
+

521.90

+ +
+

1100.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

579.00

+ +
+

521.90

+ +
+

1100.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

579.00

+ +
+

629.90

+ +
+

1208.90

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

386.001

+ +
+

0.00

+ +
+

386.00

+ +
+

C

+ +
+

A

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

869.00

+ +
+

1332.80

+ +
+

2201.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

869.00

+ +
+

1332.80

+ +
+

2201.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

869.00

+ +
+

1548.80

+ +
+

2417.80

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

579.341

+ +
+

0.00

+ +
+

579.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Procedure - Iowa +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in Own Household (Blind Only) -- Only an eligible + blind individual and the blind member of a couple who does not live in any other State living arrangement variation, does not have an + EP, and is not otherwise excepted from supplementation. Also included are blind recipients in title XIX facilities where Medicaid pays 50 percent or less of the cost + of care. Optional supplement code A is also compatible with Federal codes A and C. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535) +

+ +
+

B

+ +
+

Living in the Household of Another (Blind Only) -- Only + an eligible blind individual and the blind member of a + couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C/H

+ +
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services. +

+ +

The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D/I

+ +
+

Living in a Family Life or Boarding Home -- Eligible individual or each member of + an eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services. +

+ +
+

G

+ +
+

Used to indicate that no supplement is payable to a recipient living in a title XIX + facility and title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under title XIX or all recipients whose Federal payments + are reduced to $30/$60 due to living in a title XIX facility. In addition, aged and + disabled recipients whose Federal payments are not reduced and who live in a title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement. +

+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs -- In-Home Health Related Care; Residential Care and Supplement for Medicare + and Medicaid Eligibles. +

+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Iowa Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

579.00

+ +
+

22.00

+ +
+

601.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

579.00

+ +
+

293.00

+ +
+

872.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

579.00

+ +
+

315.00

+ +
+

894.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

293.00

+ +
+

872.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

579.00

+ +
+

142.00

+ +
+

721.00

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

 

+ +
+

Z

+ +
+

Aged

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

386.001

+ +
+

22.00

+ +
+

408.00

+ +
+

 

+ +
+

H3

+ +
+

Aged

+ +
+

386.001

+ +
+

293.00

+ +
+

679.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

386.001

+ +
+

315.00

+ +
+

701.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

386.001

+ +
+

293.00

+ +
+

679.00

+ +
+

 

+ +
+

I3

+ +
+

All

+ +
+

386.001

+ +
+

142.00

+ +
+

528.00

+ +
+

 

+ +
+

Z

+ +
+

Aged

+ +
+

386.001

+ +
+

0.00

+ +
+

386.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

386.001

+ +
+

0.00

+ +
+

386.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

579.00

+ +
+

22.00

+ +
+

601.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

579.00

+ +
+

315.00

+ +
+

894.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

293.00

+ +
+

872.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

Old FLA/OS Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible + with the RMA Policy computation process. +

+

NOTE:

+

State-administered programs: For Calendar Year 2005 -

+
    +
  1. +
    +
    1. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 2003 was $18.52 + to $25.92. The calendar year 2003 personal allowance was $81.00. Rates for calendar + year 2005 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 2003 for care in-home related care was $498.29. The payment rate for calendar + year 2005 was not available for inclusion in this publication. +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment. The State administered program was effective August 2004 retroactive + to October 2003. +

    + +
    +
    +
  6. +
+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total

Payment Levels +

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

869.00

+ +
+

44.00

+ +
+

913.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

869.00

+ +
+

22.00

+ +
+

891.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

869.00

+ +
+

22.00

+ +
+

891.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

869.00

+ +
+

293.00

+ +
+

1162.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

869.00

+ +
+

337.00

+ +
+

1206.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

869.00

+ +
+

293.00

+ +
+

1162.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

869.00

+ +
+

315.00

+ +
+

1184.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

869.00

+ +
+

293.00

+ +
+

1162.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

869.00

+ +
+

315.00

+ +
+

1184.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

869.00

+ +
+

593.00

+ +
+

1462.00

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

579.341

+ +
+

44.00

+ +
+

623.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

579.341

+ +
+

22.00

+ +
+

601.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

579.341

+ +
+

22.00

+ +
+

601.34

+ +
+

 

+ +
+

H3

+ +
+

Aged/Aged

+ +
+

579.341

+ +
+

293.00

+ +
+

872.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

579.341

+ +
+

337.00

+ +
+

916.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

579.341

+ +
+

293.00

+ +
+

872.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

579.341

+ +
+

315.00

+ +
+

894.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

579.341

+ +
+

293.00

+ +
+

872.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

579.341

+ +
+

315.00

+ +
+

894.34

+ +
+

 

+ +
+

I3

+ +
+

All

+ +
+

579.341

+ +
+

593.00

+ +
+

1172.34

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

579.341

+ +
+

0.00

+ +
+

579.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

579.341

+ +
+

0.00

+ +
+

579.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

579.341

+ +
+

0.00

+ +
+

579.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible with + the RMA policy computation process. +

+

NOTE:

+

State-administered programs: For Calendar Year 2005 -

+
    +
  1. +
    +
    1. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance. The per diem rate for calendar year 2003 was $18.52 + to $25.92. The calendar year 2003 personal allowance was $81.00. Rates for calendar + year 2005 were not available for inclusion in this publication. +

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. The maximum payment for calendar + year 2003 for care in-home related care was $498.29. The payment rate for calendar + year 2005 was not available for inclusion in this publication. (Members of a couple + are treated as individuals.) +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment. This State administered program was effective August 2004 retroactive + to October 2003. +

    + +
    +
    +
  6. +
+
+
+
+
+
+
+ +
+
+

G. Procedure - Massachusetts +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Full Cost-of-Living:

+ +

An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and is: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences will be considered + living alone provided they do not use the residential kitchen facilities for preparing + meals; or +

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Living only with their eligible spouse; or

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Living with their eligible spouse and ineligible child/children 2 none of whom (children) receive public income maintenance payments;3 or +

    + +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Living only with their ineligible spouse and/or their ineligible child/children, none + of whom (spouse and children) receive public income maintenance payments. +

    + +

    NOTE: For purposes of SI 01415.037G.1. (See Code A, 1.a. through 1.d., foster children placed with anyone other than their + parents are not considered to be living with the foster parent. +

    + +
    +
    +
  8. +
+ +

An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments. +

+ +

An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in SI 01415.037G.1. (See Code A, 1. or 2.) will be in State living arrangement A if they pay at least + two-thirds of the household expenses. In making a determination as to whether the + individual pays two-thirds or more of the expenses, use the method defined in SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses. +

+ +

A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. + Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +
+

B

+ +
+

Shared Living Expenses -- An individual who is in Federal living arrangement A or + C and who does not meet the criteria listed for State living arrangement A, E or G + is in State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH). +

+ +

Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined in SI 01415.037G.1., Code A.4. Also included are individuals placed under the auspices of the State adult + foster care program and residents of publicly operated emergency shelters throughout + a month. +

+ +

An individual living in a household where all members receive public income maintenance + payments unless they are paying at least two-thirds of the household expenses (A). +

+ +

An individual living in a mixed household -- i.e., a household where one or more other + members receive a public income maintenance payment -- also is included unless the + individual is paying at least two-thirds of the household expenses (A). +

+ +
+

C

+ +
+

Living in the Household of Another -- Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third. +

+ +
+

E

+ +
+

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home. +

+ +
+

F

+ +
+

Effective 7/1/87, the State elected Federal administration of this optional State + supplementary payment to residents of title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Assisted Living -- Effective 7/1/94, the State elected Federal administration of this + variation. Includes an individual, certified by the State to be residing in an Assisted + Living residence served by a certified Group Adult Foster Care provider, who is not + receiving assistance under any other Federal or State rental assistance program, and + who pays a fixed, non-separable fee for rent and supportive services, other than medically + necessary services reimbursed by Medicaid. The State shall certify to SSA each individual + who is eligible for this optional supplement living arrangement. This living arrangement + was discontinued effective 1/1/96. However, it has been restored, retroactively, to + 1/1/97. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. +

+

1For purposes of determining State living arrangements, a commercial boarding house, + foster home, or halfway house is not considered the person's household. +

+

2Use the SSI definition of child, SI 00501.400. +

+

3A public income maintenance payment is a payment from any of the following programs: + Aid to Families with Dependent Children (AFDC), SSI, the Refugee Act of 1980, the + Disaster Relief Act of 1974, general assistance programs of the Bureau of Indian Affairs, + State or local government income maintenance programs that are based on need, or Department + of Veterans Affairs benefits based on need. +

+
+
+
+
+

2. Coding and Monthly Payments Levels +

+
+
+

Massachusetts Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

579.00

+ +
+

128.82

+ +
+

707.82

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

579.00

+ +
+

149.74

+ +
+

728.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

114.39

+ +
+

693.39

+ +
+

 

+ +
+

B

+ +
+

Aged

+ +
+

579.00

+ +
+

39.26

+ +
+

618.26

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

579.00

+ +
+

149.74

+ +
+

728.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

30.40

+ +
+

609.40

+ +
+

 

+ +
+

E

+ +
+

Aged

+ +
+

579.00

+ +
+

293.00

+ +
+

872.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

579.00

+ +
+

149.74

+ +
+

728.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

293.00

+ +
+

872.00

+ +
+

 

+ +
+

G

+ +
+

Aged

+ +
+

579.00

+ +
+

454.00

+ +
+

1033.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

579.00

+ +
+

454.00

+ +
+

1033.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

454.00

+ +
+

1033.00

+ +
+

B

+ +
+

C

+ +
+

Aged

+ +
+

386.001

+ +
+

104.36

+ +
+

490.36

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

386.001

+ +
+

342.74

+ +
+

728.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

386.001

+ +
+

87.58

+ +
+

473.58

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

579.00

+ +
+

149.74

+ +
+

728.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

114.39

+ +
+

693.39

+ +
+

 

+ +
+

B

+ +
+

Blind

+ +
+

579.00

+ +
+

149.74

+ +
+

728.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

579.00

+ +
+

30.40

+ +
+

609.40

+ +
+

D

+ +
+

F

+ +
+

All

+ +
+

30.002

+ +
+

35.00

+ +
+

65.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

869.00

+ +
+

201.72

+ +
+

1070.72

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

869.00

+ +
+

588.48

+ +
+

1457.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

869.00

+ +
+

180.06

+ +
+

1049.06

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

869.00

+ +
+

395.10

+ +
+

1264.10

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

869.00

+ +
+

190.89

+ +
+

1059.89

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

869.00

+ +
+

384.27

+ +
+

1253.27

+ +
+

 

+ +
+

B

+ +
+

Aged/Aged

+ +
+

869.00

+ +
+

201.72

+ +
+

1070.72

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

869.00

+ +
+

588.48

+ +
+

1457.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

869.00

+ +
+

180.06

+ +
+

1049.06

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

869.00

+ +
+

395.10

+ +
+

1264.10

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

869.00

+ +
+

190.89

+ +
+

1059.89

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

869.00

+ +
+

384.27

+ +
+

1253.27

+ +
+

 

+ +
+

E

+ +
+

Aged/Aged

+ +
+

869.00

+ +
+

875.00

+ +
+

1744.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

869.00

+ +
+

588.48

+ +
+

1457.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

869.00

+ +
+

875.00

+ +
+

1744.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

869.00

+ +
+

731.74

+ +
+

1600.74

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

869.00

+ +
+

875.00

+ +
+

1744.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

869.00

+ +
+

731.74

+ +
+

1600.74

+ +
+

 

+ +
+

G

+ +
+

Aged/Aged

+ +
+

869.00

+ +
+

681.00

+ +
+

1550.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

869.00

+ +
+

681.00

+ +
+

1550.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

869.00

+ +
+

681.00

+ +
+

1550.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

869.00

+ +
+

681.00

+ +
+

1550.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

869.00

+ +
+

681.00

+ +
+

1550.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

869.00

+ +
+

681.00

+ +
+

1550.00

+ +
+

B

+ +
+

C

+ +
+

Aged/Aged

+ +
+

579.341

+ +
+

215.80

+ +
+

795.14

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

579.341

+ +
+

878.14

+ +
+

1457.48

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

579.341

+ +
+

194.18

+ +
+

773.52

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

579.341

+ +
+

546.97

+ +
+

1126.31

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

579.341

+ +
+

204.99

+ +
+

784.33

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

579.341

+ +
+

536.16

+ +
+

1115.50

+ +
+

D

+ +
+

F

+ +
+

All

+ +
+

60.002

+ +
+

70.00

+ +
+

130.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

H. Procedure - Michigan +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal Care -- Recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care. +

+ +
+

G

+ +
+

Independent Living with an EP -- Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.) +

+ +
+

H

+ +
+

Living in the Household of Another with an EP --Recipients with an EP and living in + the household of another for Federal purposes. (Children under age 18 are excluded.) +

+ +
+

I

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under title XIX. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Michigan Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

579.00

+ +
+

87.00

+ +
+

666.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

579.00

+ +
+

157.50

+ +
+

736.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

579.00

+ +
+

179.30

+ +
+

758.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

869.002

+ +
+

14.00

+ +
+

883.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

579.341

+ +
+

9.33

+ +
+

588.67

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 30.003

+ +
+

7.00

+ +
+

37.00

+ +
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR. +

+

2Not an FBR; the amount represents the FBR plus EP increment. +

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

869.00

+ +
+

463.00

+ +
+

1332.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

869.00

+ +
+

604.00

+ +
+

1473.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

869.00

+ +
+

647.60

+ +
+

1516.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1159.002

+ +
+

21.00

+ +
+

1180.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

772.681

+ +
+

14.00

+ +
+

786.68

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

 60.003

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR. +

+

2Not an FBR; the amount represents the FBR plus EP increment. +

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Procedure - Montana +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

G

+ +
+

State-Certified Personal Care

+ +
+

H

+ +
+

State-Certified Residence in Group Home for Mentally Disabled

+ +
+

I

+ +
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+ +
+

J

+ +
+

State-Certified Residence for Child and Adult Foster Care

+ +
+

K

+ +
+

State-Certified Transitional Living for Developmentally Disabled

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Includes all individuals and couples not certified in State + codes G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Montana Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

579.00

+ +
+

94.00

+ +
+

673.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

579.00

+ +
+

94.00

+ +
+

673.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

579.00

+ +
+

94.00

+ +
+

673.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

579.00

+ +
+

52.75

+ +
+

631.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

579.00

+ +
+

26.00

+ +
+

605.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

386.001

+ +
+

0.00

+ +
+

386.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

869.00

+ +
+

193.00

+ +
+

1062.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

869.00

+ +
+

193.00

+ +
+

1062.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

869.00

+ +
+

193.00

+ +
+

1062.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

869.00

+ +
+

110.50

+ +
+

979.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

869.00

+ +
+

57.00

+ +
+

926.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

579.341

+ +
+

0.00

+ +
+

579.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Procedure - Nevada +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
+

A

+ +
+

Independent Living or Living in Parental Household -- Aged or blind eligible individual + or couple who: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes; + or +

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. (See SM01301.535.)

+ +
+

B

+ +
+

Living in the Household of Another -- Aged or blind eligible individual or couple + who is living in the household of another individual and receiving food and shelter from that individual. Aged or blind individuals or couples, who are subject + to a one-third reduction of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B. +

+ +
+

C

+ +
+

Domiciliary Care -- Aged or blind eligible individual or couple who lives in a private + non-medical facility or, as of 10/76, a residential facility serving 16 or fewer persons, + which provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- No supplement cases include:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Disabled eligible individuals or disabled members of eligible couples; or

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Eligible individuals or members of eligible couples in a medical facility where title + XIX pays more than 50 percent of the cost; or +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Eligible individuals or members of eligible couples who are patients in a private + medical facility which is not certified under title XIX; or +

    + +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    + +
    +
    +
  8. +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Nevada Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

579.00

+ +
+

36.40

+ +
+

615.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

579.00

+ +
+

109.30

+ +
+

688.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

579.00

+ +
+

350.00

+ +
+

929.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

579.00

+ +
+

350.00

+ +
+

929.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

386.001

+ +
+

24.27

+ +
+

410.27

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

386.001

+ +
+

213.96

+ +
+

599.96

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

386.001

+ +
+

0.00

+ +
+

386.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

579.00

+ +
+

109.30

+ +
+

688.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

869.00

+ +
+

74.46

+ +
+

943.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

869.00

+ +
+

374.60

+ +
+

1243.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

869.00

+ +
+

224.53

+ +
+

1093.53

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

869.00

+ +
+

37.23

+ +
+

906.23

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

869.00

+ +
+

187.30

+ +
+

1056.30

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

869.00

+ +
+

881.00

+ +
+

1750.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

869.00

+ +
+

881.00

+ +
+

1750.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

869.00

+ +
+

881.00

+ +
+

1750.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

869.00

+ +
+

440.50

+ +
+

1309.50

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

869.00

+ +
+

440.50

+ +
+

1309.50

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

579.341

+ +
+

49.64

+ +
+

628.98

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

579.341

+ +
+

531.94

+ +
+

1111.28

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

579.341

+ +
+

290.79

+ +
+

870.13

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

579.341

+ +
+

24.82

+ +
+

604.16

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

579.341

+ +
+

265.97

+ +
+

845.31

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

579.341

+ +
+

0.00

+ +
+

579.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Procedure - New Jersey +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Licensed Residential Health Care Facilities and Certain Licensed Residential Facilities + -- The State provides New Jersey field offices with lists of approved facilities. + Mentally retarded individuals must be placed and supervised by either the State Department + of Youth and Family Services or the State Division of Mental Retardation. +

+ +
+

B

+ +
+

Living Alone or with Others -- Eligible individuals (including children) or eligible + couples whose Federal living arrangements are A or C and who do not meet the requirements + defined in other supplementation categories. +

+ +

Therefore, effective 8/1/81, any eligible adult/couple who meets the requirement for + a Federal code A will be in optional supplement B unless residing in a residential + health care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code C will automatically be + entitled to optional supplement B. +

+ +

This category includes, but is not limited to, those eligible adults/couples who are:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Living physically alone; or

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.) +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

C

+ +
+

Living Alone with an Ineligible Spouse -- Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse will receive the same total payment as an eligible + couple or an individual with an EP. Once other persons, even minor children, are present + in the household, this supplementary payment variation cannot exist. However, it is + possible that a claimant and their ineligible spouse live with others and allege that + they are a separate “household” by virtue of the fact that they eat their meals out + or have separate purchase and preparation of food. In this instance, an optional supplement + C is permissible as long as no other person is in their “household.” There is no couple + counterpart in this category. +

+ +

Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B. +

+ +

A transient individual who co-exists only with an ineligible spouse will also qualify + for the O/S - C rate. +

+ +
+

D

+ +
+

Living in the Household of Another -- Persons who are “living in the household of + another” for Federal purposes. +

+ +
+

G

+ +
+

Effective 9/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Individuals and couples in licensed medical facilities where + Medicaid is paying less than 50 percent of the cost of care, individuals and couples + in publicly operated community residences having 16 or less residents, and residents + of publicly operated emergency shelters throughout a month. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

New Jersey Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

579.00

+ +
+

150.05

+ +
+

729.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

579.00

+ +
+

31.25

+ +
+

610.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

579.00

+ +
+

315.36

+ +
+

894.36

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

869.00

+ +
+

25.36

+ +
+

894.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

386.001

+ +
+

44.31

+ +
+

430.31

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

579.00

+ +
+

31.25

+ +
+

610.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

10.00

+ +
+

40.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents the FBR plus EP increment. +

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

869.00

+ +
+

570.36

+ +
+

1439.36

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

869.00

+ +
+

25.36

+ +
+

894.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

869.00

+ +
+

  0.00

+ +
+

869.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

579.341

+ +
+

93.09

+ +
+

672.43

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 60.002

+ +
+

20.00

+ +
+

80.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

L. Procedure - New York +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone -- Eligible individuals or eligible couples living physically alone, + or living with only a foster child(ren), or a homemaker authorized by the local Department + of Social Services (DSS), or a family care recipient(s) placed by the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabled (OMRDD) + or local DSS, or individuals living with others but paying a “flat fee for room and + board,” or living with others but taking all their meals outside the dwelling unit, + or living with others in a dwelling but separately preparing food, or having their + food separately prepared for them. +

+ +
+

B

+ +
+

Living with Others -- Individual/child/couple who resides in a dwelling with others + and prepares food in common with at least one other person in the dwelling, or is + a member of a religious community, or child in any living arrangement other than a + family care home (Level I) or community residence (Level II) certified by OMRDD or + OMH. +

+ +
+

C

+ +
+

Congregate Care Level I -- Family type homes and family care homes. Family type homes + are facilities operated for the purpose of providing long-term residential care for + adults and are certified by the New York State DSS and supervised by local departments + of social services. Family care homes are private households that provide care for + mentally disabled persons. +

+ +
+

D

+ +
+

Congregate Care Level II -- Residential facilities for adults and certain children + with mental disabilities. +

+ +
+

E

+ +
+

Congregate Care Level III -- Privately operated non-medical residential facilities. + Although Level III facilities are often called schools, these facilities may not meet + the Federal definition of school. Operated for the purpose of providing treatment, + training and education for mentally retarded or developmentally disabled individuals, + these facilities are certified by OMRDD in accordance with State regulations. +

+ +
+

F

+ +
+

Living in the Household of Another -- Same as Federal definition. The State supplement + payment for the individual/child/couple whose Federal benefit rate is subject to the + one-third reduction is the “living with others” rate but for systems purposes is coded + F. +

+ +
+

G

+ +
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. Federal administration was terminated + effective 9/30/03. State began administering this payment 10/1/03. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Recipients in licensed medical facilities where Medicaid is + paying more than 50 percent of the cost of care, recipients in publicly operated community + residences which serve 16 or fewer residents, and residents of publicly operated emergency + shelters throughout a month. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

New York Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement Level

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All

+ +
+

579.00

+ +
+

87.00

+ +
+

666.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

579.00

+ +
+

23.00

+ +
+

602.00

+ +
+

 

+ +
+

C

+ +
+

NY City

+ +
+

579.00

+ +
+

266.48

+ +
+

845.48

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

579.00

+ +
+

266.48

+ +
+

845.48

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

579.00

+ +
+

228.48

+ +
+

807.48

+ +
+

 

+ +
+

D

+ +
+

NY City

+ +
+

579.00

+ +
+

435.00

+ +
+

1014.00

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

579.00

+ +
+

435.00

+ +
+

1014.00

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

579.00

+ +
+

405.00

+ +
+

984.00

+ +
+

 

+ +
+

E

+ +
+

NY City

+ +
+

579.00

+ +
+

482.96

+ +
+

1,061.96

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

579.00

+ +
+

458.96

+ +
+

1,037.96

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

579.00

+ +
+

458.96

+ +
+

1,037.96

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

  0.00

+ +
+

579.00

+ +
+

B

+ +
+

F

+ +
+

All

+ +
+

386.001

+ +
+

23.00

+ +
+

409.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 30.002

+ +
+

  0.003

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3New York administers a supplement of $20 to some recipients in a title XIX institution. +

+

4Includes and applies to: Nassau, Suffolk, and Westchester counties effective 7/1/85. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement Level

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All

+ +
+

869.00

+ +
+

104.00

+ +
+

973.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

869.00

+ +
+

46.00

+ +
+

915.00

+ +
+

 

+ +
+

C

+ +
+

NY City

+ +
+

869.00

+ +
+

821.96

+ +
+

1690.96

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

869.00

+ +
+

821.96

+ +
+

1690.96

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

869.00

+ +
+

745.96

+ +
+

1614.96

+ +
+

 

+ +
+

D

+ +
+

NY City

+ +
+

869.00

+ +
+

1159.00

+ +
+

2028.00

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

869.00

+ +
+

1159.00

+ +
+

2028.00

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

869.00

+ +
+

1099.00

+ +
+

1968.00

+ +
+

 

+ +
+

E

+ +
+

NY City

+ +
+

869.00

+ +
+

1254.92

+ +
+

2123.92

+ +
+

 

+ +
+

 

+ +
+

Nassau County4

+ +
+

869.00

+ +
+

1206.92

+ +
+

2075.92

+ +
+

 

+ +
+

 

+ +
+

All other counties

+ +
+

869.00

+ +
+

1206.92

+ +
+

2075.92

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

B

+ +
+

F

+ +
+

All

+ +
+

579.341

+ +
+

46.00

+ +
+

625.34

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 60.002

+ +
+

0.003

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

3New York administers a supplement of $20 to some recipients in a title XIX institution. +

+

4Includes and applies to: Nassau, Suffolk, and Westchester counties effective 7/1/85. +

+
+
+
+
+
+
+ +
+
+

M. Procedure - Pennsylvania +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone -- Recipients in private medical facilities (nursing homes, hospitals, + intermediate care facilities) where title XIX is not paying more than 50 percent of the cost of care, residents of publicly operated emergency + shelters throughout a month, and all other individuals and couples in Federal codes + A and C not meeting the definition of another variation. +

+ +

Used with an “intervening” Federal code A. (See SM + 01301.535.) +

+ +

This State code is also used to supplement Section 1619 cases.

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients who do not have an EP and who live + in the household of another and receive support and maintenance for Federal purposes. +

+ +
+

C

+ +
+

Living with an EP -- Recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules; i.e., Public Law 93-66. +

+ +
+

D

+ +
+

Living in the Household of Another with an EP --Recipients who live in the household + of another and who have one or more EP’s as defined under the Federal rules; i.e., + Public Law 93-66. +

+ +
+

G

+ +
+

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities (Effective + 7/1/89). +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+

Z

+ +
+

No Supplement Cases -- Includes all recipients who are residing in a medical facility + in which title XIX is paying more than 50 percent of the cost of care. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Pennsylvania Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

869.003

+ +
+

43.70

+ +
+

912.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

579.00

+ +
+

389.30

+ +
+

968.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

579.00

+ +
+

394.30

+ +
+

973.30

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

386.001

+ +
+

0.00

+ +
+

386.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

579.342

+ +
+

43.70

+ +
+

623.04

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 30.004

+ +
+

  0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not an FBR; the amount represents the FBR plus EP increment. +

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

869.00

+ +
+

0.00

+ +
+

869.00

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1159.003

+ +
+

68.05

+ +
+

1227.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

869.00

+ +
+

857.40

+ +
+

1726.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

869.00

+ +
+

867.40

+ +
+

1736.40

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

579.341

+ +
+

0.00

+ +
+

579.34

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

772.682

+ +
+

68.05

+ +
+

840.73

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

 60.004

+ +
+

  0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not an FBR; the amount represents the FBR plus EP increment. +

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure - Rhode Island +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living -- Recipients who are in Federal codes A and C, except for individuals + residing in a residential care/assisted living facility who have been certified as + eligible for State Code D. +

+ +

Recipients residing in a public emergency shelter for the homeless and those who are + eligible for Section 1619 are included in this category. +

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied. +

+ +
+

D

+ +
+

Residential Care/Assisted Living (Effective 10/1/98). (Formerly Shelter Care from + 10/01/90 – 9/30/98.) This category applies to individuals only. +

+ +
+

E

+ +
+

The State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 3/1/91). +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Rhode Island Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A1

+ +
+

All

+ +
+

579.00

+ +
+

57.35

+ +
+

636.35

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

579.00

+ +
+

575.00

+ +
+

1154.00

+ +
+

B

+ +
+

B1

+ +
+

All

+ +
+

386.002

+ +
+

69.94

+ +
+

455.94

+ +
+

C

+ +
+

A1

+ +
+

All

+ +
+

579.00

+ +
+

57.35

+ +
+

636.35

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

 30.003

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Code is systems generated from the Federal code. +

+

2Not an FBR; the amount represents the FBR less VTR. +

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A1

+ +
+

All

+ +
+

869.00

+ +
+

108.50

+ +
+

977.50

+ +
+

B

+ +
+

B1

+ +
+

All

+ +
+

579.342

+ +
+

128.50

+ +
+

707.84

+ +
+

D

+ +
+

E

+ +
+

All

+ +
+

60.003

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Code is systems generated from the Federal code. +

+

2Not an FBR; the amount represents the FBR less VTR. +

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ +
+
+

O. Procedure - Utah +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living Alone or With Others -- This variation includes recipients who are in Federal + codes A and C. +

+ +
+

B

+ +
+

Living in the Household of Another -- Recipients with no EP who are “living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.) +

+ +
+

Z

+ +
+

No Supplement Cases -- No supplement cases include all recipients who are not included + in A or B. +

+ +
+
+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Utah Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Level

+ +
+

A,C

+ +
+

Z

+ +
+

All

+ +
+

579.00

+ +
+

0.00

+ +
+

579.00

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

386.002

+ +
+

3.13

+ +
+

389.13

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

2Not an FBR, the amount represents the FBR less VTR. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A,C

+ +
+

A

+ +
+

All

+ +
+

869.00

+ +
+

4.60

+ +
+

873.60

+ +
+

B

+ +
+

B

+ +
+

All

+ +
+

579.342

+ +
+

9.73

+ +
+

589.07

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+

2Not an FBR, the amount represents the FBR less VTR. +

+
+
+
+
+
+
+ +
+
+

P. Procedure - Vermont +

+
+
+
+
+

1. Definitions of State Living Arrangement Variations +

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent Living (except Chittenden County) -- Recipients not living in the household + of another, not in a custodial care situation, and not otherwise excepted from supplementation. + Includes a child who is living with a parent and recipients residing in a private + title XIX facility where Medicaid is not paying more than 50 percent of the cost of + care. +

+ +

Effective 5/1/83, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A (except Chittenden County). +

+ +
+

B

+ +
+

Independent Living in Chittenden County -- Same as Code A above except restricted + to residents of Chittenden County. +

+ +

Effective 5/1/83, an individual or eligible couple residing in a publicly operated + emergency shelter throughout a month. +

+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A (Chittenden County only). (See SM + 01301.535.) +

+ +
+

C

+ +
+

Assistive Community Care Level III: Recipients living in facilities identified by + the State. +

+ +
+

E

+ +
+

Living in the Household of Another -- Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions), and not otherwise excepted from supplementation. +

+ +
+

G

+ +
+

Custodial Care: Licensed Community Care Home -- Recipients living in Level IV Community + Homes identified by the State. +

+ +
+

H

+ +
+

Custodial Care: Family Home -- Recipients living in another's home in such a manner + that the individual or couple is paying room and board and is receiving one or more + of the services outlined under the custodial care definition. The individual or couple + must also receive the room and board and custodial care in the home in which they + reside. In order to qualify as a home under this arrangement, these services must + not be provided to more than two persons and must be provided by a resident of the + home. +

+ +

Custodial care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service 2-3 times a week) and/or + supervision for the recipient's protection. Supervision for the recipient's protection + deals primarily with protection services for retarded and emotionally disturbed individuals. + A person who receives one or more of these personal services is receiving custodial + care. +

+ +

The change in this arrangement is effective for initial claims filed on or after 1/1/84. + For redeterminations the change is effective with the month after the month in which + the first redetermination on or after 1/1/84, is initiated. +

+ +

This arrangement does not cover:

+ +
    +
  • +
    +
    •
    +
    +

    Institutional Living -- Regardless of whether custodial care is needed in addition + to the medical, training, rehabilitation, educational or similar services as the primary + function of the institution. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A person whose Federal living arrangement is based on home ownership or rental liability. + (A flat fee for room and board per SI 00835.120B. is not considered as rental liability for this arrangement.) +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A child under age 18 not placed by a Vermont Community Mental Health Agency or the + Vermont Department of Mental Health. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Custodial care or supervision provided by a spouse (as defined by Federal regulations).

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Any home or boarding arrangement which does not meet the Federal SSI definition of + independent living, Federal Code A. +

    + +
    +
    +
  • +
+ +
+

I

+ +
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents in title XIX facilities. +

+ +
+

Y

+ +
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement. +

+ +
+
+

NOTE: When a person has a room in one facility/household and receives board or custodial + care in another facility/household, the custodial rate (Code G or H) is based on the + facility/household where the person sleeps. +

+
+
+
+
+

2. Coding and Monthly Payment Levels +

+
+
+

Vermont Effective 1/1/05

+
+
+

a. Individual +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

+ +

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

579.00

+ +
+

52.04

+ +
+

631.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

579.00

+ +
+

52.04

+ +
+

631.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

579.00

+ +
+

48.38

+ +
+

627.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

579.00

+ +
+

223.94

+ +
+

802.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

579.00

+ +
+

98.69

+ +
+

677.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

386.001

+ +
+

39.30

+ +
+

425.30

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

579.00

+ +
+

52.04

+ +
+

631.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

579.00

+ +
+

52.04

+ +
+

631.04

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

17.66

+ +
+

47.66

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+

b. Couple +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State

Supplement

Level +

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County

+ +
+

869.00

+ +
+

98.88

+ +
+

967.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County

+ +
+

869.00

+ +
+

98.88

+ +
+

967.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

869.00

+ +
+

96.77

+ +
+

965.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

869.00

+ +
+

562.06

+ +
+

1431.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

869.00

+ +
+

332.82

+ +
+

1201.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

579.341

+ +
+

48.31

+ +
+

627.65

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

35.33

+ +
+

95.33

+ +
+
+

1Not an FBR; the amount represents the FBR less VTR. +

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution. +

+
+
+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415037
SI 01415.037 - Federally Administered Optional Supplementary Payment Programs – 1/05 Payment Levels - 08/06/2024
+Batch run: 02/19/2025
+Rev:08/06/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2006.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2006.html new file mode 100644 index 00000000..6783347b --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2006.html @@ -0,0 +1,12689 @@ + + +SSA - POMS: SI 01415.038 - Federally Administered Optional Supplementary Payment Programs – 1/06 Payment Levels - 12/20/2007 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 71 (08-24)

+

SI 01415.038 Federally Administered Optional Supplementary Payment Programs – 1/06 Payment Levels

+ + +
+
+

CITATIONS:

+
+
+
Social Security Act as amended in 1973, + Section 1616; Social Security Amendments of 1972, Section 301;Public + Law 93-66, Section 212
+
+
+
+
+

A. Background

+
+
+

The following states are participating in the federally + Administered Optional Supplementary Payment Programs:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

California

+
+

Nevada

+
+

Delaware

+
+

New Jersey

+
+

District Of Columbia

+
+

New York

+
+

Hawaii

+
+

Pennsylvania

+
+

Iowa

+
+

Rhode Island

+
+

Massachusetts

+
+

Utah

+
+

Michigan

+
+

Vermont

+
+

Montana

+
+

 

+
+
+
+
+ +
+
+

B. Description of Supplements - California

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living with Cooking Facilities -- Eligible individual or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and have cooking and food storage facilities or is provided meals as part of the living + arrangement; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent or parents or is + a disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a private medical facility licensed by the State but not certified under + title XIX.

    +
    +
    +
  10. +
+
+

B

+
+

Non-medical Out-of-Home Care (NMOHC) -- Applies when an individual/couple needs non-medical + care or supervision in the following living arrangement situations:

+ +

CHILDREN + (UNDER AGE 18)

+ +
    +
  1. +
    +
    a. 
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative; or

    +
    +
    +
  8. +
  9. +
    +
    e. 
    +
    +

    Disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision) ; or

    +
    +
    +
  10. +
  11. +
    +
    f. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or

    + +

    ADULTS (AGE 18 AND OVER)

    +
    +
    +
  12. +
  13. +
    +
    g. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or

    +
    +
    +
  14. +
  15. +
    +
    h. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in a State licensed NMOHC facility.

    + +

    For California optional supplement purposes, a relative is defined as a parent, child, + sibling, half-sibling, parent's sibling, sibling's child, first cousin, or any person + of the preceding generation denoted by the prefix “grand” or “great.”

    +
    +
    +
  16. +
+
+

C

+
+

Independent Living Without Cooking Facilities -- Aged or disabled individual/couple + who is neither provided any meals nor has access to adequate cooking/food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C.

+ +

An individual/couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Immediate living quarters do not have cooking and food storage facilities with which + the individual/couple or another person (who is responsible for preparing the individual's/couple's + meals) can prepare meals on a daily basis.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a boarding house that does not + have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a room and board facility and does not + contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the SSI applicant's/recipient's arrangement with the facility + is to purchase only shelter on a monthly basis).

    +
    +
    +
  10. +
+ +

“Adequate” cooking and food storage facilities exist when an individual/couple has + access to:

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and + a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and + a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls that + are used for warming food are not considered adequate cooking facilities.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and + a stove with a working oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature control.

    +
    +
    +
  • +
+ +

Eligibility for OS C begins in the month the applicant/recipient applies for this + supplement rate provided they have been without cooking and food storage facilities + throughout the month.

+ +

NOTE: For purposes of OS C, “throughout a month” does not mean the applicant/recipient must lack adequate cooking/food storage facilities from + the very first moment of the month. They need only lack them from some time on the + first day of the month.

+ +

If eligibility is based on temporary loss or non-functioning of an appliance, the + individual should be advised of their responsibility to report immediately when the + temporary condition has ceased. If the individual provides an expected date when the + appliance will be replaced/repaired, diary the case for re-contact.

+ +

Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available.

+
​ +

For a couple, comprised of an aged/disabled individual and a blind individual, whose + living arrangement lacks adequate cooking and storage facilities, the couple is to + receive the SSI/SSP level for a blind/aged or disabled couple plus the restaurant + meals allowance for the disabled member of the couple. Force payment in this living + arrangement is required.

+
+

D

+
+

Living in the Household of Another -- Eligible individual/couple is living in the + household of another and is receiving food and shelter from that individual. Most individuals/couples who are subject to a 1/3 reduction + of their Federal SSI payments (VTR) are eligible for OS D because the criteria for + this supplement level are the same as for charging the VTR. However, when the eligible + individual/couple lives in the home of a relative (other than a spouse) and needs + care and supervision, certification for non-medical out-of-home care (OS F) should + be obtained from the county welfare office since this is the highest categorical supplement + for which an individual /couple can qualify.

+
+

E

+
+

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage.

+ +

NOTE: Only FLA A and C are compatible with OS E. If the VTR applies, see code G.

+
+

F

+
+

Non-medical Out-of-Home Care Living in the Household of Another -- . Applies whenever + an eligible individual or couple meets the criteria for the non-medical out-of-home + care payment rate, and is determined to receive the Federal code B payment for living + in the household of another (SI 00835.200).

+
+

G

+
+

Disabled Child Under Age 18 Living in the Household of Another --. Applies to a disabled + (not blind) child under age 18, who resides with a parent or relative by blood or + marriage, and is determined to receive the Federal code B payment for living in the household of + another individual (SI 00835.200).

+
+

J

+
+

Residents of title XIX facilities.

+ +

This State code is also used to supplement Section 1619 cases.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible individual or couple who is a patient:

+ +
    +
  1. +
    +
    a. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    In a private medical facility which is not certified under title XIX and not licensed + by the State.

    +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

California Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

603.00

+
+

209.00

+
+

812.00

+
+

 

+
+

 

+
+

Blind

+
+

603.00

+
+

274.00

+
+

877.00

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

209.00

+
+

812.00

+
+

 

+
+

B

+
+

All

+
+

603.00

+
+

412.00

+
+

1015.00

+
+

 

+
+

C

+
+

Aged

+
+

603.00

+
+

293.00

+
+

896.00

+
+

 

+
+

 

+
+

Blind

+
+

603.00

+
+

0.00

+
+

603.00

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

293.00

+
+

896.00

+
+

 

+
+

E

+
+

Disabled

+
+

603.00

+
+

95.00

+
+

698.00

+
+

 

+
+

Z

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

B

+
+

D

+
+

Aged

+
+

402.001

+
+

218.00

+
+

620.00

+
+

 

+
+

 

+
+

Blind

+
+

402.001

+
+

299.00

+
+

701.00

+
+

 

+
+

 

+
+

Disabled

+
+

402.001

+
+

218.00

+
+

620.00

+
+

 

+
+

F

+
+

All

+
+

402.001

+
+

407.00

+
+

809.00

+
+

 

+
+

G

+
+

Disabled

+
+

402.001

+
+

92.00

+
+

494.00

+
+

C

+
+

A

+
+

Blind

+
+

603.00

+
+

274.00

+
+

877.00

+
+

 

+
+

E

+
+

Disabled

+
+

603.00

+
+

95.00

+
+

698.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

904.00

+
+

533.00

+
+

1437.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

904.00

+
+

760.00

+
+

1664.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

904.00

+
+

533.00

+
+

1437.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

904.00

+
+

675.00

+
+

1579.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

904.00

+
+

533.00

+
+

1437.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

904.00

+
+

675.00

+
+

1579.00

+
+

 

+
+

B

+
+

All

+
+

904.00

+
+

1126.00

+
+

2030.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

904.00

+
+

701.00

+
+

1605.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

904.00

+
+

701.00

+
+

1605.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

904.00

+
+

701.00

+
+

1605.00

+
+

 

+
+

Z

+
+

All

+
+

904.00

+
+

0.00

+
+

904.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

602.671

+
+

572.33

+
+

1175.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

602.671

+
+

799.33

+
+

1402.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

602.671

+
+

572.33

+
+

1175.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

602.671

+
+

713.33

+
+

1316.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

602.671

+
+

572.33

+
+

1175.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

602.671

+
+

713.33

+
+

1316.00

+
+

 

+
+

F

+
+

All

+
+

602.671

+
+

1045.66

+
+

1648.33

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of Supplements - Delaware

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + -- Only living arrangement variation in Delaware and includes only those recipients + who are certified by the State medical unit as residents of one of the above adult + facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A or Y.

+ +

Optional supplementation code Z is the proper code to be used with an “intervening” + Federal code A. (See SM 01301.535)

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Delaware Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total
Payment Levels

+
+

A

+
+

A

+
+

All

+
+

603.00

+
+

140.00

+
+

743.00

+
+

 

+
+

Z

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

B

+
+

Z

+
+

All

+
+

402.001

+
+

0.00

+
+

402.00

+
+

C

+
+

Z

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

904.00

+
+

448.00

+
+

1352.00

+
+

 

+
+

Z

+
+

All

+
+

904.00

+
+

0.00

+
+

904.00

+
+

B

+
+

Z

+
+

All

+
+

602.671

+
+

0.00

+
+

602.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. Description of Supplements - District of Columbia

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by + the District of Columbia, Department of Human Services, as residents of an adult foster + care home with 50 or fewer residents.

+
+

B

+
+

Adult Foster Care Home with More than 50 Residents --Recipients who are certified + by the District of Columbia, Department of Human Services, as residents of an adult + foster care home with more than 50 residents.

+
+

G

+
+

Residents of title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

District of Columbia Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

603.00

+
+

347.00

+
+

950.00

+
+

 

+
+

B

+
+

All

+
+

603.00

+
+

457.00

+
+

1060.00

+
+

B

+
+

Z

+
+

All

+
+

402.001

+
+

0.00

+
+

402.00

+
+

C

+
+

Z

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

D

+
+

G

+
+

All

+
+

30.002

+
+

40.00

+
+

70.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Code

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

904.00

+
+

996.00

+
+

1900.00

+
+

 

+
+

B

+
+

All

+
+

904.00

+
+

1216.00

+
+

2120.00

+
+

B

+
+

Z

+
+

All

+
+

602.671

+
+

0.00

+
+

602.67

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

80.00

+
+

140.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

E. Description of Supplements - Hawaii

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

B

+
+

Living in a Community Care/Foster Care Home --

+ +

Persons eligible for SSI and who are both over age 18 and live in a State approved + Care/Foster Care Home.

+
+

H

+
+

Domiciliary Care I -- (Maximum of five residents) - Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities.

+
+

I

+
+

Domiciliary Care II -- Same as H except care is provided for six or more residents.

+
+

Y

+
+

Optional Supplementation Waived -- Eligible for, but have waived their right to receive + an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible individual (or couple) who is living in the household + of another (see explanation in definition for optional supplement B) and an eligible + individual (or couple) who is a patient:

+ +
    +
  1. +
    +
    a. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    In a private medical facility which is not certified under title XIX.

    + +

    Also includes residents of publicly operated emergency shelters throughout a month.

    +
    +
    +
  4. +
+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Hawaii Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A 

+
+

B

+
+

All

+
+

603.00

+
+

521.90

+
+

1124.90

+
+

 

+
+

H

+
+

All

+
+

603.00

+
+

521.90

+
+

1124.90

+
+

 

+
+

I

+
+

All

+
+

603.00

+
+

629.90

+
+

1232.90

+
+

B

+
+

Z

+
+

All

+
+

402.001

+
+

0.00

+
+

402.00

+
+

D

+
+

Z

+
+

All

+
+

 30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

B

+
+

All

+
+

904.00

+
+

1345.80

+
+

2249.80

+
+

 

+
+

H

+
+

All

+
+

904.00

+
+

1345.80

+
+

2249.80

+
+

 

+
+

I

+
+

All

+
+

904.00

+
+

1561.80

+
+

2465.80

+
+

B

+
+

Z

+
+

All

+
+

602.671

+
+

0.00

+
+

602.67

+
+

D

+
+

Z

+
+

All

+
+

 60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. Description of Supplements - Iowa

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living in Own Household (Blind Only) -- Only an eligible blind individual and the blind member + of a couple who does not live in any other State living arrangement variation, does not have an + EP, and is not otherwise excepted from supplementation. Also included are blind recipients in title XIX facilities where Medicaid pays 50 percent or less of the cost + of care. Optional supplement code A is also compatible with Federal codes A and C.

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535)

+
+

B

+
+

Living in the Household of Another (Blind Only) -- Only an eligible blind individual and the blind member + of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation.

+
+

H

+
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who are financially dependent + upon the eligible individual as defined by the State Department of Human Services.

+ +

The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement.

+
+

I

+
+

Living in a Family Life or Boarding Home -- Eligible individual or each member of + an eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services.

+
+

G

+
+

Used to indicate that no supplement is payable to a recipient living in a title XIX + facility and title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under title XIX or all recipients whose Federal payments + are reduced to $30/$60 due to living in a title XIX facility. In addition, aged and + disabled recipients whose Federal payments are not reduced and who live in a title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement.

+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs -- In-Home Health Related Care; Residential Care and Supplement for Medicare + and Medicaid Eligibles.

+
+
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+
+
+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid.

+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Iowa Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind

+
+

603.00

+
+

22.00

+
+

625.00

+
+

 

+
+

C

+
+

Aged

+
+

603.00

+
+

306.00

+
+

909.00

+
+

 

+
+

 

+
+

Blind

+
+

603.00

+
+

328.00

+
+

931.00

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

306.00

+
+

909.00

+
+

 

+
+

D

+
+

All

+
+

603.00

+
+

142.00

+
+

745.00

+
+

 

+
+

G

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

 

+
+

Z

+
+

Aged

+
+

603.00

+
+

0.00

+
+

603.00

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

0.00

+
+

603.00

+
+

B

+
+

B

+
+

Blind

+
+

402.001

+
+

22.00

+
+

424.00

+
+

 

+
+

H3

+
+

Aged

+
+

402.001

+
+

306.00

+
+

708.00

+
+

 

+
+

 

+
+

Blind

+
+

402.001

+
+

328.00

+
+

730.00

+
+

 

+
+

 

+
+

Disabled

+
+

402.001

+
+

306.00

+
+

708.00

+
+

 

+
+

I3

+
+

All

+
+

402.001

+
+

142.00

+
+

544.00

+
+

 

+
+

Z

+
+

Aged

+
+

402.001

+
+

0.00

+
+

402.00

+
+

 

+
+

 

+
+

Disabled

+
+

402.001

+
+

0.00

+
+

402.00

+
+

C

+
+

A

+
+

Blind

+
+

603.00

+
+

22.00

+
+

625.00

+
+

 

+
+

C

+
+

Blind

+
+

603.00

+
+

328.00

+
+

931.00

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

306.00

+
+

909.00

+
+

 

+
+

Z

+
+

Disabled

+
+

603.00

+
+

0.00

+
+

603.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

NOTE: State-administered programs: For Calendar Year 2006 -

+
    +
  1. +
    +
    1. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  6. +
+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total
Payment Levels

+
+

A

+
+

A

+
+

Blind/Blind

+
+

904.00

+
+

44.00

+
+

948.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

904.00

+
+

22.00

+
+

926.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

904.00

+
+

22.00

+
+

926.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

904.00

+
+

306.00

+
+

1210.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

904.00

+
+

350.00

+
+

1254.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

904.00

+
+

306.00

+
+

1210.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

904.00

+
+

328.00

+
+

1232.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

904.00

+
+

306.00

+
+

1210.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

904.00

+
+

328.00

+
+

1232.00

+
+

 

+
+

D

+
+

All

+
+

904.00

+
+

606.00

+
+

1510.00

+
+

 

+
+

G

+
+

All

+
+

904.00

+
+

0.00

+
+

904.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

904.00

+
+

0.00

+
+

904.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

904.00

+
+

0.00

+
+

904.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

904.00

+
+

0.00

+
+

904.00

+
+

B

+
+

B

+
+

Blind/Blind

+
+

602.671

+
+

44.00

+
+

646.67

+
+

 

+
+

 

+
+

Blind/Aged

+
+

602.671

+
+

22.00

+
+

624.67

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

602.671

+
+

22.00

+
+

624.67

+
+

 

+
+

H

+
+

Aged/Aged

+
+

602.671

+
+

306.00

+
+

908.67

+
+

 

+
+

 

+
+

Blind/Blind

+
+

602.671

+
+

350.00

+
+

952.67

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

602.671

+
+

306.00

+
+

908.67

+
+

 

+
+

 

+
+

Aged/Blind

+
+

602.671

+
+

328.00

+
+

930.67

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

602.671

+
+

306.00

+
+

908.67

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

602.671

+
+

328.00

+
+

930.67

+
+

 

+
+

I3

+
+

All

+
+

602.671

+
+

606.00

+
+

1208.67

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

602.671

+
+

0.00

+
+

602.67

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

602.671

+
+

0.00

+
+

602.67

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

602.671

+
+

0.00

+
+

602.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

NOTE: State-administered programs: For Calendar Year 2006 -

+
    +
  1. +
    +
    1. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. (Members of a couple are treated + as individuals.)

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  6. +
+
+
+
+
+
+
+ +
+
+

G. Description of Supplements - Massachusetts

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Full Cost-of-Living:

+ +
    +
  1. +
    +
    1. 
    +
    +

    An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and are:

    + +
      +
    1. +
      +
      a. 
      +
      +

      Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences will be considered + living alone provided they do not use the residential kitchen facilities for preparing + meals; or

      +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Living only with their eligible spouse; or

      +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Living with their eligible spouse and ineligible child/children 2 none of whom (children) receive public income maintenance payments;3 or

      +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Living only with their ineligible spouse and/or their ineligible child/children, none + of whom (spouse and children) receive public income maintenance payments.

      +
      +
      +
    8. +
    +
    +
    +
  2. +
+ +

NOTE: For purposes of 1.a. through 1.d., foster children placed with anyone other than + their parents are not considered to be living with the foster parent.

+ +

An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments.

+ +

An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in SI 01415.038G.1. (See Code A, 1. or 2.) will be in State living arrangement A if they pay at least + two-thirds of the household expenses. In making a determination as to whether the + individual pays two-thirds or more of the expenses, use the method defined in SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses.

+ +

A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. + Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.)

+
+

B

+
+

Shared Living Expenses -- An individual who is in Federal living arrangement A or + C and who does not meet the criteria listed for State living arrangement A, E or G + is in State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH).

+ +

Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined in SI 01415.038G.1., Code A.4. This includes children under the age of 18 who are in Federal living arrangement + D because a private health insurance policy or a combination of Medicaid and a private + health insurance policy pays or is expected to pay over 50 percent of the cost of + care for that month. See SI 00520.011C.1.b, second and third bullets. Also included are individuals placed under the auspices + of the State adult foster care program and residents of publicly operated emergency + shelters throughout a month.

+ +

An individual living in a household where all members receive public income maintenance + payments unless they are paying at least two-thirds of the household expenses (A).

+ +

An individual living in a mixed household -- i.e., a household where one or more other + members receive a public income maintenance payment -- also is included unless the + individual is paying at least two-thirds of the household expenses (A).

+
+

C

+
+

Living in the Household of Another -- Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third.

+
+

E

+
+

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home.

+
+

F

+
+

Effective 7/1/87, the State elected Federal administration of this optional State + supplementary payment to residents of title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. This includes children under the age of 18 for + whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care + for that month.

+
+

G

+
+

Assisted Living -- Effective 7/1/94, the State elected Federal administration of this + variation. Includes an individual, certified by the State to be residing in an Assisted + Living residence served by a certified Group Adult Foster Care provider, who is not + receiving assistance under any other Federal or State rental assistance program, and + who pays a fixed, non-separable fee for rent and supportive services, other than medically + necessary services reimbursed by Medicaid. The State shall certify to SSA each individual + who is eligible for this optional supplement living arrangement. This living arrangement + was discontinued effective 1/1/96. However, it has been restored, retroactively, to + 1/1/97.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify.

+

1For purposes of determining State living arrangements, a commercial boarding house, + foster home, or halfway house is not considered the person's household.

+

2Use the SSI definition of child, SI 00501.400.

+

3A public income maintenance payment is a payment from any of the following programs: + TANF, SSI, the Refugee Act of 1980, the Disaster Relief Act of 1974, general assistance + programs of the Bureau of Indian Affairs, State or local government income maintenance + programs that are based on need, or Department of Veterans Affairs benefits based + on need.

+
+
+
+
+

2. Coding and Monthly Payments Levels

+
+
+

Massachusetts Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

603.00

+
+

128.82

+
+

731.82

+
+

 

+
+

 

+
+

Blind

+
+

603.00

+
+

149.74

+
+

752.74

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

114.39

+
+

717.39

+
+

 

+
+

B

+
+

Aged

+
+

603.00

+
+

39.26

+
+

642.26

+
+

 

+
+

 

+
+

Blind

+
+

603.00

+
+

149.74

+
+

752.74

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

30.40

+
+

633.40

+
+

 

+
+

E

+
+

Aged

+
+

603.00

+
+

293.00

+
+

896.00

+
+

 

+
+

 

+
+

Blind

+
+

603.00

+
+

149.74

+
+

752.74

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

293.00

+
+

896.00

+
+

 

+
+

G

+
+

Aged

+
+

603.00

+
+

454.00

+
+

1057.00

+
+

 

+
+

 

+
+

Blind

+
+

603.00

+
+

454.00

+
+

1057.00

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

454.00

+
+

1057.00

+
+

B

+
+

C

+
+

Aged

+
+

402.001

+
+

104.36

+
+

506.36

+
+

 

+
+

 

+
+

Blind

+
+

402.001

+
+

350.74

+
+

752.74

+
+

 

+
+

 

+
+

Disabled

+
+

402.001

+
+

87.58

+
+

489.58

+
+

C

+
+

A

+
+

Blind

+
+

603.00

+
+

149.74

+
+

752.74

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

114.39

+
+

717.39

+
+

 

+
+

B

+
+

Blind

+
+

603.00

+
+

149.74

+
+

752.74

+
+

 

+
+

 

+
+

Disabled

+
+

603.00

+
+

30.40

+
+

633.40

+
+

D

+
+

B2

+
+

Blind

+
+

30.003

+
+

149.74

+
+

179.74

+
+

 

+
+

 

+
+

Disabled

+
+

30.003

+
+

30.40

+
+

60.40

+
+

 

+
+

F

+
+

All

+
+

30.003

+
+

35.00

+
+

65.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

904.00

+
+

201.72

+
+

1105.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

904.00

+
+

601.48

+
+

1505.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

904.00

+
+

180.06

+
+

1084.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

904.00

+
+

401.60

+
+

1305.60

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

904.00

+
+

190.89

+
+

1094.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

904.00

+
+

390.77

+
+

1294.77

+
+

 

+
+

B

+
+

Aged/Aged

+
+

904.00

+
+

201.72

+
+

1105.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

904.00

+
+

601.48

+
+

1505.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

904.00

+
+

180.06

+
+

1084.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

904.00

+
+

401.60

+
+

1305.60

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

904.00

+
+

190.89

+
+

1094.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

904.00

+
+

390.77

+
+

1294.77

+
+

 

+
+

E

+
+

Aged/Aged

+
+

904.00

+
+

888.00

+
+

1792.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

904.00

+
+

601.48

+
+

1505.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

904.00

+
+

888.00

+
+

1792.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

904.00

+
+

744.74

+
+

1648.74

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

904.00

+
+

888.00

+
+

1792.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

904.00

+
+

744.74

+
+

1648.74

+
+

 

+
+

G

+
+

Aged/Aged

+
+

904.00

+
+

681.00

+
+

1585.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

904.00

+
+

681.00

+
+

1585.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

904.00

+
+

681.00

+
+

1585.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

904.00

+
+

681.00

+
+

1585.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

904.00

+
+

681.00

+
+

1585.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

904.00

+
+

681.00

+
+

1585.00

+
+

B

+
+

C

+
+

Aged/Aged

+
+

602.671

+
+

215.80

+
+

818.47

+
+

 

+
+

 

+
+

Blind/Blind

+
+

602.671

+
+

902.80

+
+

1505.47

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

602.671

+
+

194.18

+
+

796.85

+
+

 

+
+

 

+
+

Aged/Blind

+
+

602.671

+
+

559.30

+
+

1161.97

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

602.671

+
+

204.99

+
+

807.66

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

602.671

+
+

548.49

+
+

1151.16

+
+

D

+
+

F

+
+

All

+
+

60.002

+
+

70.00

+
+

130.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

H. Description of Supplements - Michigan

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care.

+
+

E

+
+

Personal Care -- Recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged.

+
+

F

+
+

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care.

+
+

G

+
+

Independent Living with an EP -- Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.)

+
+

H

+
+

Living in the Household of Another with an EP --Recipients with an EP and living in + the household of another for Federal purposes. (Children under age 18 are excluded.)

+
+

I

+
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under title XIX.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Michigan Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

603.00

+
+

87.00

+
+

690.00

+
+

 

+
+

E

+
+

All

+
+

603.00

+
+

157.50

+
+

760.50

+
+

 

+
+

F

+
+

All

+
+

603.00

+
+

179.30

+
+

782.30

+
+

 

+
+

G

+
+

All

+
+

905.002

+
+

14.00

+
+

919.00

+
+

B

+
+

H

+
+

All

+
+

603.341

+
+

9.33

+
+

612.67

+
+

D

+
+

I

+
+

All

+
+

 30.003

+
+

7.00

+
+

37.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

904.00

+
+

476.00

+
+

1380.00

+
+

 

+
+

E

+
+

All

+
+

904.00

+
+

617.00

+
+

1521.00

+
+

 

+
+

F

+
+

All

+
+

904.00

+
+

660.60

+
+

1564.60

+
+

 

+
+

G

+
+

All

+
+

1206.002

+
+

21.00

+
+

1227.00

+
+

B

+
+

H

+
+

All

+
+

804.001

+
+

14.00

+
+

818.00

+
+

D

+
+

I

+
+

All

+
+

 60.003

+
+

14.00

+
+

74.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

I. Description of Supplements - Montana

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

G

+
+

State-Certified Personal Care

+
+

H

+
+

State-Certified Residence in Group Home for Mentally Disabled

+
+

I

+
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+
+

J

+
+

State-Certified Residence for Child and Adult Foster Care

+
+

K

+
+

State-Certified Transitional Living for Developmentally Disabled

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all individuals and couples not certified in State + codes G, H, I, J, or K.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Montana Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

603.00

+
+

94.00

+
+

697.00

+
+

 

+
+

H

+
+

All

+
+

603.00

+
+

94.00

+
+

697.00

+
+

 

+
+

I

+
+

All

+
+

603.00

+
+

94.00

+
+

697.00

+
+

 

+
+

J

+
+

All

+
+

603.00

+
+

52.75

+
+

655.75

+
+

 

+
+

K

+
+

All

+
+

603.00

+
+

26.00

+
+

629.00

+
+

 

+
+

Z

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

B

+
+

Z

+
+

All

+
+

402.001

+
+

0.00

+
+

402.00

+
+

C

+
+

Z

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

904.00

+
+

193.00

+
+

1097.00

+
+

 

+
+

H

+
+

All

+
+

904.00

+
+

193.00

+
+

1097.00

+
+

 

+
+

I

+
+

All

+
+

904.00

+
+

193.00

+
+

1097.00

+
+

 

+
+

J

+
+

All

+
+

904.00

+
+

110.50

+
+

1014.00

+
+

 

+
+

K

+
+

All

+
+

904.00

+
+

57.00

+
+

961.00

+
+

 

+
+

Z

+
+

All

+
+

904.00

+
+

0.00

+
+

904.00

+
+

B

+
+

Z

+
+

All

+
+

602.671

+
+

0.00

+
+

602.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. Description of Supplements - Nevada

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living or Living in Parental Household -- Aged or blind eligible individual + or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Live in their own household as defined for Federal living arrangement A purposes; + or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household.

    +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. (See SM01301.535.)

+
+

B

+
+

Living in the Household of Another -- Aged or blind eligible individual or couple + who is living in the household of another individual and receiving food and shelter from that individual. Aged or blind individuals or couples, who are subject + to a one-third reduction of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B.

+
+

C

+
+

Domiciliary Care -- Aged or blind eligible individual or couple who lives in a private + non-medical facility or, a residential facility serving 16 or fewer persons, which + provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor.

+ +

These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- No supplement cases include:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individuals or disabled members of eligible couples; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individuals or members of eligible couples in a medical facility where title + XIX pays more than 50 percent of the cost; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individuals or members of eligible couples who are patients in a private + medical facility which is not certified under title XIX; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    +
    +
    +
  8. +
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Nevada Effective 1/1/06.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

603.00

+
+

36.40

+
+

639.40

+
+

 

+
+

 

+
+

Blind

+
+

603.00

+
+

109.30

+
+

712.30

+
+

 

+
+

C

+
+

Aged

+
+

603.00

+
+

391.00

+
+

994.00

+
+

 

+
+

 

+
+

Blind

+
+

603.00

+
+

391.00

+
+

994.00

+
+

 

+
+

Z

+
+

Disabled

+
+

603.00

+
+

0.00

+
+

603.00

+
+

B

+
+

B

+
+

Aged

+
+

402.001

+
+

24.27

+
+

426.27

+
+

 

+
+

 

+
+

Blind

+
+

402.001

+
+

213.96

+
+

615.96

+
+

 

+
+

Z

+
+

Disabled

+
+

402.001

+
+

0.00

+
+

402.00

+
+

C

+
+

A

+
+

Blind

+
+

603.00

+
+

109.30

+
+

712.30

+
+

 

+
+

Z

+
+

Disabled

+
+

603.00

+
+

0.00

+
+

603.00

+
+

D

+
+

Z

+
+

All

+
+

 30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

904.00

+
+

74.46

+
+

978.46

+
+

 

+
+

 

+
+

Blind/Blind

+
+

904.00

+
+

374.60

+
+

1278.60

+
+

 

+
+

 

+
+

Aged/Blind

+
+

904.00

+
+

224.53

+
+

1128.53

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

904.00

+
+

37.23

+
+

941.23

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

904.00

+
+

187.30

+
+

1091.30

+
+

 

+
+

C

+
+

Aged/Aged

+
+

904.00

+
+

881.00

+
+

1785.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

904.00

+
+

881.00

+
+

1785.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

904.00

+
+

881.00

+
+

1785.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

904.00

+
+

440.50

+
+

1344.50

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

904.00

+
+

440.50

+
+

1344.50

+
+

 

+
+

Z

+
+

Disabled

+
+

904.00

+
+

0.00

+
+

904.00

+
+

B

+
+

B

+
+

Aged/Aged

+
+

602.671

+
+

49.64

+
+

652.31

+
+

 

+
+

 

+
+

Blind/Blind

+
+

602.671

+
+

531.94

+
+

1134.61

+
+

 

+
+

 

+
+

Aged/Blind

+
+

602.671

+
+

290.79

+
+

893.46

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

602.671

+
+

24.82

+
+

627.49

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

602.671

+
+

265.97

+
+

868.64

+
+

 

+
+

Z

+
+

Disabled

+
+

602.671

+
+

0.00

+
+

602.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

K. Description of Supplements - New Jersey

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Congregate Care - Eligible individual/child/couple in Federal living arrangement (FLA) + A. The living arrangement includes the following: Recipients in residential facilities + who are under the supervision of the Department of Human Services: Children and adults + under the supervision of and/or placement by the NJ Department of Human Services’ + Division of Developmental Disabilities (DDD) or Division of Youth and Family Services + (DYFS) who are in residential facilities (both in and outside of NJ); and Recipients + in Assisted Living Residences and in Comprehensive Personal Care Homes licensed by + the Department of Health and Senior Services.

+
+

B

+
+

Living Alone or with Others -- Eligible individuals (including children) or eligible + couples whose Federal living arrangements are A or C and who do not meet the requirements + defined in other supplementation categories.

+ +

Therefore, any eligible adult/couple who meets the requirement for a Federal code + A will be in optional supplement B unless residing in a residential health care facility + or living alone with an ineligible spouse.

+ +

Likewise, any child meeting the criteria for a Federal code C will automatically be + entitled to optional supplement B.

+ +

This category includes, but is not limited to, those eligible adults/couples who are:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services.

    +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+
+

C

+
+

Living Alone with an Ineligible Spouse -- Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse will receive the same total payment as an eligible + couple or an individual with an EP. Once other persons, even minor children, are present + in the household, this supplementary payment variation cannot exist. However, it is + possible that a claimant and their ineligible spouse live with others and allege that + they are a separate “household” by virtue of the fact that they eat their meals out + or have separate purchase and preparation of food. In this instance, an optional supplement + C is permissible as long as no other person is in their “household.” There is no couple + counterpart in this category.

+ +

Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B.

+ +

A transient individual who co-exists only with an ineligible spouse will also qualify + for the O/S - C rate.

+
+

D

+
+

Living in the Household of Another -- Persons who are “living in the household of + another” for Federal purposes.

+
+

I

+
+

Licensed Residential Health Care Facilities -- Attached to a nursing home; Assisted + Living Residence; Comprehensive Personal Care Home; or “free standing”. Prior to January + 1, 2006 residents of these facilities were paid at the OS “A” rate.

+ +

Authorization to make this payment is based on the recipient's residence at a facility + listed in the New Jersey + Congregate Care Directory.

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. + Residents of the ALR or CPCH section of a multipurpose facility are paid at the OS + “A” rate. Nursing home residents are D/G if Medicaid pays more than 50% of the cost + of care.

+
+

G

+
+

Effective 9/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Individuals and couples in licensed medical facilities where + Medicaid is paying less than 50 percent of the cost of care, individuals and couples + in publicly operated community residences having 16 or less residents, and residents + of publicly operated emergency shelters throughout a month.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

New Jersey Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

603.00

+
+

150.05

+
+

753.05

+
+

 

+
+

B

+
+

All

+
+

603.00

+
+

31.25

+
+

634.25

+
+

 

+
+

C

+
+

Individual

+
+

603.00

+
+

326.36

+
+

929.36

+
+

 

+
+

 

+
+

w/EP

+
+

904.00

+
+

24.36

+
+

929.36

+
+

 

+
+

I

+
+

All

+
+

603.00

+
+

210.05

+
+

813.05

+
+

 

+
+

Z

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

B

+
+

D

+
+

All

+
+

402.001

+
+

44.31

+
+

446.31

+
+

C

+
+

B

+
+

All

+
+

603.00

+
+

31.25

+
+

634.25

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

10.00

+
+

40.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

904.00

+
+

583.36

+
+

1487.36

+
+

 

+
+

B

+
+

All

+
+

904.00

+
+

25.36

+
+

929.36

+
+

 

+
+

I

+
+

All

+
+

904.00

+
+

703.36

+
+

1607.36

+
+

 

+
+

Z

+
+

All

+
+

904.00

+
+

  0.00

+
+

904.00

+
+

B

+
+

D

+
+

All

+
+

602.671

+
+

93.09

+
+

695.76

+
+

D

+
+

G

+
+

All

+
+

 60.002

+
+

20.00

+
+

80.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

L. Description of Supplements - New York

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone -- Eligible individuals or eligible couples who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Live physically alone.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Pay a fixed, pre-established flat fee for both room and board in a commercial establishment.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives with others but takes all meals outside the dwelling.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Live with others but separately prepares or has someone separately prepare their food. + Occasional preparation of meals in common will not preclude a finding of separate + preparation.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Receive a fixed, pre-established flat fee for room and board from all others in the dwelling.

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Live with only a foster child, or a homemaker authorized by the local department of + social services (DSS), or a family care recipient placed by: the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabilities (OMRDD) + or local DSS.

    +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    Have no permanent living arrangement (i.e., transient or street person) and is not + with a spouse or a child for whom they have primary responsibility.

    +
    +
    +
  14. +
+
+

B

+
+

Living with Others -- Individual/child/couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Resides in a dwelling with others and prepares food in common with at least one other + person in the dwelling. Note - An individual living with an ineligible spouse must be considered living with others + despite any separate preparation. The same is true if an individual/couple lives with + a child for whom they have primary responsibility (except if the child is a foster + child).

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a child who does not meet the criteria for OSS C or OSS D (below).

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a religious community and room and/or board is provided in full or in part + by the religious community.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Has no permanent living arrangement (i.e., transient or street person), but is with + an ineligible spouse or child for whom they have primary responsibility.

    +
    +
    +
  8. +
+
+

C

+
+

Congregate Care Level I –

+ +
    +
  1. +
    +
    1. 
    +
    +

    Individual/couple/child has been placed in a family type home certified by NYS Office + of Children and Family Services and supervised by a local DSS.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individual/couple/child has been placed in a family care home certified by OMH/OMRDD.

    +
    +
    +
  4. +
+
+

D

+
+

Congregate Care Level II – Payable to an eligible individual/couple/child who is a + resident of a licensed level 2 care facility. These consist of facilities, which provide + supportive living environments and include: Residences for Adults certified by the + NYS Department of Health; Privately operated facilities certified by the NYS OMH; + Privately-operated facilities certified by the NYS OMH and OMRDD; and Privately-operated + facilities certified by OASAS.

+
+

E

+
+

Congregate Care Level III -- Enhanced Residential Care

+ +

Payable to an eligible individual/couple who is a resident of a licensed level 3 care + facility which includes: Adult Homes and Enriched Housing programs certified by the + NYS Department of Health or Schools for the Mentally Retarded certified by the NYS + Office of Mental Retardation and Developmental Disabilities. Schools for the Mentally + Retarded usually meet the basic Federal definition of institution and consist of residential + facilities that provide academic, vocational, recreational and social skills programs. + Although sometimes called schools, they often do not meet the Federal definition of + schools. Note - A child residing in a Level 3 facility cannot receive OSS E; they will receive + OSS B.

+
+

F

+
+

Living in the Household of Another -- Payable to recipients who are FLA B.

+
+

G

+
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. Federal administration was terminated + effective 9/30/03. State began administering this payment 10/1/03.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases – Includes Eligible individual/couple in FLA A or B who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Is in a licensed medical facility where Medicaid is paying less than 50% of the cost + of care; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is in a publicly operated community residence which serves 16 or fewer residents; + or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is in a publicly operated emergency shelter (PESH); or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Qualifies under the special provision in SI 00520.130 (1619 eligible goes into medical institution).

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 10/1/03 eligible individual/couple in FLA D and also cases that were FLA + D prior to January 1988.

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Effective 12/1/96, children under age 18 residing in certain public or private facilities + receiving payment for their care under any health insurance policy issued by a private + provider (SI 00520.011).

    +
    +
    +
  12. +
+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

New York Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

603.00

+
+

87.00

+
+

690.00

+
+

 

+
+

B

+
+

All

+
+

603.00

+
+

23.00

+
+

626.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

603.00

+
+

266.48

+
+

869.48

+
+

 

+
+

 

+
+

All other counties

+
+

603.00

+
+

228.48

+
+

831.48

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

603.00

+
+

435.00

+
+

1038.00

+
+

 

+
+

 

+
+

All other counties

+
+

603.00

+
+

405.00

+
+

1008.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

603.00

+
+

525.00

+
+

1128.00

+
+

 

+
+

 

+
+

All other counties

+
+

603.00

+
+

510.00

+
+

1113.00

+
+

 

+
+

Z

+
+

All

+
+

603.00

+
+

  0.00

+
+

603.00

+
+

B

+
+

F

+
+

All

+
+

402.002

+
+

23.00

+
+

425.00

+
+

D

+
+

G

+
+

All

+
+

 30.003

+
+

  0.004

+
+

30.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 1/1/06.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

4New York administers a supplement of $20 to some recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

904.00

+
+

104.00

+
+

1008.00

+
+

 

+
+

B

+
+

All

+
+

904.00

+
+

46.00

+
+

950.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

904.00

+
+

834.96

+
+

1738.96

+
+

 

+
+

 

+
+

All other counties

+
+

904.00

+
+

758.96

+
+

1662.96

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

904.00

+
+

1172.00

+
+

2076.00

+
+

 

+
+

 

+
+

All other counties

+
+

904.00

+
+

1112.00

+
+

2016.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

904.00

+
+

1339.00

+
+

2243.00

+
+

 

+
+

 

+
+

All other counties

+
+

904.00

+
+

1309.00

+
+

2213.00

+
+

 

+
+

Z

+
+

All

+
+

904.00

+
+

0.00

+
+

904.00

+
+

B

+
+

F

+
+

All

+
+

602.672

+
+

46.00

+
+

648.67

+
+

D

+
+

G

+
+

All

+
+

 60.003

+
+

0.004

+
+

60.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 1/1/06.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

4New York administers a supplement of $20 to some recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

M. Description of Supplements - Pennsylvania

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone -- Recipients in private medical facilities (nursing homes, hospitals, + intermediate care facilities) where title XIX is not paying more than 50 percent of the cost of care, residents of publicly operated emergency + shelters throughout a month, and all other individuals and couples in Federal codes + A and C not meeting the definition of another variation.

+ +

Used with an “intervening” Federal code A. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+
+

B

+
+

Living in the Household of Another -- Recipients who do not have an EP and who live + in the household of another and receive support and maintenance for Federal purposes.

+
+

C

+
+

Living with an EP -- Recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules.

+
+

D

+
+

Living in the Household of Another with an EP --Recipients who live in the household + of another and who have one or more EP’s as defined under the Federal rules.

+
+

G

+
+

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

H

+
+

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all recipients who are residing in a medical facility + in which title XIX is paying more than 50 percent of the cost of care.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Pennsylvania Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

Z

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

 

+
+

C

+
+

All

+
+

904.001

+
+

43.70

+
+

948.70

+
+

 

+
+

G

+
+

All

+
+

603.00

+
+

389.30

+
+

992.30

+
+

 

+
+

H

+
+

All

+
+

603.00

+
+

394.30

+
+

997.30

+
+

B

+
+

Z

+
+

All

+
+

402.002

+
+

0.00

+
+

402.00

+
+

 

+
+

D

+
+

All

+
+

603.343

+
+

43.70

+
+

647.04

+
+

C

+
+

Z

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

D

+
+

Z

+
+

All

+
+

 30.004

+
+

  0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

904.00

+
+

0.00

+
+

904.00

+
+

 

+
+

C

+
+

All

+
+

1206.001

+
+

68.05

+
+

1274.05

+
+

 

+
+

G

+
+

All

+
+

904.00

+
+

857.40

+
+

1761.40

+
+

 

+
+

H

+
+

All

+
+

904.00

+
+

867.40

+
+

1771.40

+
+

B

+
+

B

+
+

All

+
+

602.672

+
+

0.00

+
+

602.67

+
+

 

+
+

D

+
+

All

+
+

804.003

+
+

68.05

+
+

872.05

+
+

D

+
+

Z

+
+

All

+
+

 60.004

+
+

  0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

N. Description of Supplements - Rhode Island

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living -- Recipients who are in Federal codes A and C, except for individuals + residing in a residential care/assisted living facility who have been certified as + eligible for State Code D. This includes children under the age of 18 who are in Federal + living arrangement D because a private health insurance policy or a combination of + Medicaid and a private health insurance policy pays or is expected to pay over 50 + percent of the cost of care for that month. See SI 00520.011C.1.b, second and third bullets.

+ +

Recipients residing in a public emergency shelter for the homeless and those who are + eligible for Section 1619 are included in this category.

+
+

B

+
+

Living in the Household of Another -- Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied.

+
+

D

+
+

Residential Care/Assisted Living -- This category applies to individuals only.

+
+

E

+
+

The State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 3/1/91). This includes children under + the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of + the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Rhode Island Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A1

+
+

All

+
+

603.00

+
+

57.35

+
+

660.35

+
+

 

+
+

D

+
+

All

+
+

603.00

+
+

575.00

+
+

1178.00

+
+

B

+
+

B1

+
+

All

+
+

402.002

+
+

69.94

+
+

471.94

+
+

C

+
+

A1

+
+

All

+
+

603.00

+
+

57.35

+
+

660.35

+
+

D

+
+

A3

+
+

Children Private Insurance

+
+

30.004

+
+

57.35

+
+

87.35

+
+

 

+
+

E

+
+

All

+
+

 30.004

+
+

20.00

+
+

50.00

+
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3State OS Code A applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A1

+
+

All

+
+

904.00

+
+

108.50

+
+

1012.50

+
+

B

+
+

B1

+
+

All

+
+

602.672

+
+

128.50

+
+

731.17

+
+

D

+
+

E

+
+

All

+
+

60.003

+
+

40.00

+
+

100.00

+
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

O. Description of Supplements - Utah

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone or With Others -- This variation includes recipients who are in Federal + codes A and C.

+
+

B

+
+

Living in the Household of Another -- Recipients with no EP who are “living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.)

+
+

Z

+
+

No Supplement Cases -- No supplement cases include all recipients who are not included + in A or B.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Utah Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Level

+
+

A,C

+
+

Z

+
+

All

+
+

603.00

+
+

0.00

+
+

603.00

+
+

B

+
+

B

+
+

All

+
+

402.002

+
+

3.13

+
+

405.13

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement
Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

904.00

+
+

4.60

+
+

908.60

+
+

B

+
+

B

+
+

All

+
+

602.672

+
+

9.73

+
+

612.40

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+
+
+ +
+
+

P. Description of Supplements - Vermont

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living (except Chittenden County) -- Recipients not living in the household + of another and not in a residential or custodial care situation. This includes a child + who is living with a parent and recipients residing in a private title XIX facility + where Medicaid is not paying more than 50 percent of the cost of care. It includes + children under the age of 18 who are in Federal living arrangement D because a private + health insurance policy or a combination of Medicaid and a private health insurance + policy pays or is expected to pay over 50 percent of the cost of care for that month. + See SI 00520.011C.1.b, second and third bullets.

+ +

An individual or eligible couple residing in a publicly operated emergency shelter + throughout a month.

+
+

B

+
+

Independent Living in Chittenden County -- Same as Code A above except restricted + to residents of Chittenden County.

+
+

C

+
+

Licensed Residential Care Home or Assisted Living Residence with Assistive Community + Care Services (Level III) -- Recipients residing in Level III facilities identified + by the State. Refer to the Vermont Community Care Facilities (OS C and G) list on + BOSNet to determine if a residence meets the requirements for Optional Supplement + C.

+
+

E

+
+

Living in the Household of Another -- Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions).

+
+

G

+
+

Licensed Residential Care Home or Therapeutic Community Residence (Level IV) -- Recipients + residing in Level IV facilities identified by the State. Refer to the Vermont Community + Care Facilities (OS C and G) list on BOSNET to determine if a residence meets the + requirements for Optional Supplement G.

+
+

H

+
+

Custodial Care: Family Home -- Recipients living in another's home in such a manner + that the individual or couple is paying room and board and is receiving one or more + of the services outlined under the custodial care definition. The individual or couple + must also receive the room and board and custodial care in the home in which they + reside. In order to qualify as a home under this arrangement, these services must + not be provided to more than two persons and must be provided by a resident of the + home.

+ +

In some cases the Vermont Department of Disabiities, Aging, and Independent Living(DAIL) + has established outplacement programs meeting the definition of L/A H. To qualify + these programs must meet the requirements stated above.

+ +

Custodial + care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service 2-3 times a week) and/or + supervision for the recipient's protection. Supervision for the recipient's protection + deals primarily with protection services for retarded and emotionally disturbed individuals. + A person who receives one or more of these personal services is receiving custodial + care.

+
+

I

+
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents in title XIX facilities. This includes children under the age + of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of the cost + of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Vermont Effective 1/1/06

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County)

+
+

603.00

+
+

52.04

+
+

655.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

603.00

+
+

52.04

+
+

655.04

+
+

 

+
+

C

+
+

All

+
+

603.00

+
+

48.38

+
+

651.38

+
+

 

+
+

G

+
+

All

+
+

603.00

+
+

223.94

+
+

826.94

+
+

 

+
+

H

+
+

All

+
+

603.00

+
+

98.69

+
+

701.69

+
+

B

+
+

E

+
+

All

+
+

402.001

+
+

39.30

+
+

441.30

+
+

C

+
+

A

+
+

All (Except Chittenden County)

+
+

603.00

+
+

52.04

+
+

655.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

603.00

+
+

52.04

+
+

655.04

+
+

D

+
+

A or B2

+
+

Children Private Insurance

+
+

30.003

+
+

52.04

+
+

82.04

+
+

 

+
+

I

+
+

All

+
+

30.003

+
+

17.66

+
+

47.66

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County

+
+

904.00

+
+

98.88

+
+

1002.88

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County

+
+

904.00

+
+

98.88

+
+

1002.88

+
+

 

+
+

C

+
+

All

+
+

904.00

+
+

96.77

+
+

1000.77

+
+

 

+
+

G

+
+

All

+
+

904.00

+
+

562.06

+
+

1466.06

+
+

 

+
+

H

+
+

All

+
+

904.00

+
+

332.82

+
+

1236.82

+
+

B

+
+

E

+
+

All

+
+

602.671

+
+

48.31

+
+

650.98

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

35.33

+
+

95.33

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415038
SI 01415.038 - Federally Administered Optional Supplementary Payment Programs – 1/06 Payment Levels - 12/20/2007
+Batch run: 04/27/2026
+Rev:12/20/2007
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2007.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2007.html new file mode 100644 index 00000000..e5d2a7ca --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2007.html @@ -0,0 +1,12646 @@ + + +SSA - POMS: SI 01415.039 - Federally Administered Optional Supplementary Payment Programs – 1/07 Payment Levels - 12/20/2007 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 74 (08-24)

+

SI 01415.039 Federally Administered Optional Supplementary Payment Programs – 1/07 Payment Levels

+ + +
+
+

CITATIONS:

+
+
+
Social Security Act as amended in 1973, + Section 1616; Social Security Amendments of 1972, Section 301;Public + Law 93-66, Section 212
+
+
+
+
+

A. Background

+
+
+

The following states are participating in the federally Administered Optional Supplementary + Payment Programs:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

California

+
+

Nevada

+
+

Delaware

+
+

New Jersey

+
+

District Of Columbia

+
+

New York

+
+

Hawaii

+
+

Pennsylvania

+
+

Iowa

+
+

Rhode Island

+
+

Massachusetts

+
+

Utah

+
+

Michigan

+
+

Vermont

+
+

Montana

+
+

 

+
+
+
+
+ +
+
+

B. Description of Supplements - California

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living with Cooking Facilities -- Eligible individual or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and has cooking and food storage facilities or is provided meals as part of the living + arrangement; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent or parents or is + a disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a private medical facility licensed by the State but not certified under + title XIX.

    +
    +
    +
  10. +
+
+

B

+
+

Non-medical Out-of-Home Care (NMOHC) -- Applies when an individual/couple needs non-medical + care or supervision in the following living arrangement situations:

+ +

CHILDREN + (UNDER AGE 18)

+ +

1. Blind child residing in a State licensed NMOHC facility; or

+ +

2. Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or

+ +

3. Disabled child residing in a State licensed NMOHC facility; or

+ +

4. Disabled child residing in the home of a legal guardian who is not a relative; + or

+ +

5. Disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision) ; or

+ +

6. A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or

+ +

ADULTS + (AGE 18 AND OVER)

+ +

7. Aged, blind or disabled individual/couple has been determined to be in FLA A and + resides in the home of a relative, legal conservator or guardian; or

+ +

8. Aged, blind or disabled individual/couple has been determined to be in FLA A and + resides in a State licensed NMOHC facility.

+ +

For California optional supplement purposes, a relative is defined as a parent, child, + sibling, half-sibling, parent's sibling, sibling's child, first cousin, or any person + of the preceding generation denoted by the prefix “grand” or “great.”

+
+

C

+
+

Independent Living Without Cooking Facilities -- Aged or disabled individual/couple + who is neither provided any meals nor has access to adequate cooking/food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C.

+ +

An individual/couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Immediate living quarters do not have cooking and food storage facilities with which + the individual/couple or another person (who is responsible for preparing the individual's/couple's + meals) can prepare meals on a daily basis.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the SSI applicant's/recipient's arrangement with the facility + is to purchase only shelter on a monthly basis).

    +
    +
    +
  10. +
+ +

“Adequate” cooking and food storage facilities exist when an individual/couple has + access to:

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls that + are used for warming food are not considered adequate cooking facilities.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature control.

    +
    +
    +
  • +
+ +

Eligibility for OS C begins in the month the applicant/recipient applies for this + supplement rate provided they have been without cooking and food storage facilities + throughout the month.

+ +
+
+

NOTE: For purposes of OS C, “throughout a month” does not mean the applicant/recipient must lack adequate cooking/food storage facilities from + the very first moment of the month. They need only lack them from some time on the + first day of the month.

+
+
+ +

If eligibility is based on temporary loss or non-functioning of an appliance, the + individual should be advised of their responsibility to report immediately when the + temporary condition has ceased. If the individual provides an expected date when the + appliance will be replaced/repaired, diary the case for re-contact.

+ +

Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available.

+
+

 

+
+

For a couple, comprised of an aged/disabled individual and a blind individual, whose + living arrangement lacks adequate cooking and storage facilities, the couple is to + receive the SSI/SSP level for a blind/aged or disabled couple plus the restaurant + meals allowance for the disabled member of the couple. Force payment in this living + arrangement is required.

+
+

D

+
+

Living in the Household of Another -- Eligible individual/couple is living in the + household of another and is receiving food and shelter from that individual. Most individuals/couples who are subject to a 1/3 reduction + of their Federal SSI payments (VTR) are eligible for OS D because the criteria for + this supplement level are the same as for charging the VTR. However, when the eligible + individual/couple lives in the home of a relative (other than a spouse) and needs + care and supervision, certification for non-medical out-of-home care (OS F) should + be obtained from the county welfare office since this is the highest categorical supplement + for which an individual /couple can qualify.

+
+

E

+
+

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage.

+ +
+
+

NOTE: Only FLA A and C are compatible with OS E. If the VTR applies, see code G.

+
+
+
+

F

+
+

Non-medical Out-of-Home Care Living in the Household of Another -- . Applies whenever + an eligible individual or couple meets the criteria for the non-medical out-of-home + care payment rate, and is determined to receive the Federal code B payment for living + in the household of another (SI 00835.200).

+
+

G

+
+

Disabled Child Under Age 18 Living in the Household of Another --. Applies to a disabled + (not blind) child under age 18, who resides with a parent or relative by blood or + marriage, and is determined to receive the Federal code B payment for living in the household of + another individual (SI 00835.200).

+
+

J

+
+

Residents of title XIX facilities.

+ +

This State code is also used to supplement Section 1619 cases.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible individual or couple who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX and not licensed + by the State.

    +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify.

+
+
+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

California effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

623.00

+
+

233.00

+
+

856.00

+
+

 

+
+

 

+
+

Blind

+
+

623.00

+
+

298.00

+
+

921.00

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

233.00

+
+

856.00

+
+

 

+
+

B

+
+

All

+
+

623.00

+
+

412.00

+
+

1035.00

+
+

 

+
+

C

+
+

Aged

+
+

623.00

+
+

317.00

+
+

940.00

+
+

 

+
+

 

+
+

Blind

+
+

623.00

+
+

0.00

+
+

623.00

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

317.00

+
+

940.00

+
+

 

+
+

E

+
+

Disabled

+
+

623.00

+
+

119.00

+
+

742.00

+
+

 

+
+

Z

+
+

All

+
+

623.00

+
+

0.00

+
+

623.00

+
+

B

+
+

D

+
+

Aged

+
+

415.341

+
+

234.00

+
+

649.34

+
+

 

+
+

 

+
+

Blind

+
+

415.341

+
+

315.00

+
+

730.34

+
+

 

+
+

 

+
+

Disabled

+
+

415.341

+
+

234.00

+
+

649.34

+
+

 

+
+

F

+
+

All

+
+

415.341

+
+

407.00

+
+

822.34

+
+

 

+
+

G

+
+

Disabled

+
+

415.341

+
+

108.00

+
+

523.34

+
+

C

+
+

A

+
+

Blind

+
+

623.00

+
+

298.00

+
+

921.00

+
+

 

+
+

E

+
+

Disabled

+
+

623.00

+
+

119.00

+
+

742.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

934.00

+
+

568.00

+
+

1502.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

934.00

+
+

795.00

+
+

1729.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

934.00

+
+

568.00

+
+

1502.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

934.00

+
+

710.00

+
+

1644.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

934.00

+
+

568.00

+
+

1502.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

934.00

+
+

710.00

+
+

1644.00

+
+

 

+
+

B

+
+

All

+
+

934.00

+
+

1136.00

+
+

2070.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

934.00

+
+

736.00

+
+

1670.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

934.00

+
+

736.00

+
+

1670.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

934.00

+
+

736.00

+
+

1670.00

+
+

 

+
+

Z

+
+

All

+
+

934.00

+
+

0.00

+
+

934.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

622.671

+
+

595.66

+
+

1218.33

+
+

 

+
+

 

+
+

Blind/Blind

+
+

622.671

+
+

822.66

+
+

1445.33

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

622.671

+
+

595.66

+
+

1218.33

+
+

 

+
+

 

+
+

Aged/Blind

+
+

622.671

+
+

736.66

+
+

1359.33

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

622.671

+
+

595.66

+
+

1218.33

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

622.671

+
+

736.66

+
+

1359.33

+
+

 

+
+

F

+
+

All

+
+

622.671

+
+

1045.66

+
+

1668.33

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of Supplements - Delaware

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + -- Only living arrangement variation in Delaware and includes only those recipients + who are certified by the State medical unit as residents of one of the above adult + facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A or Y.

+ +

Optional supplementation code Z is the proper code to be used with an “intervening” + Federal code A. (See SM 01301.535)

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Delaware effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total
Payment Levels

+
+

A

+
+

A

+
+

All

+
+

623.00

+
+

140.00

+
+

763.00

+
+

 

+
+

Z

+
+

All

+
+

623.00

+
+

0.00

+
+

623.00

+
+

B

+
+

Z

+
+

All

+
+

415.341

+
+

0.00

+
+

415.34

+
+

C

+
+

Z

+
+

All

+
+

623.00

+
+

0.00

+
+

623.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

934.00

+
+

448.00

+
+

1382.00

+
+

 

+
+

Z

+
+

All

+
+

934.00

+
+

0.00

+
+

934.00

+
+

B

+
+

Z

+
+

All

+
+

622.671

+
+

0.00

+
+

622.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. Description of Supplements - District of Columbia

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by + the District of Columbia, Department of Human Services, as residents of an adult foster + care home with 50 or fewer residents.

+
+

B

+
+

Adult Foster Care Home with More than 50 Residents --Recipients who are certified + by the District of Columbia, Department of Human Services, as residents of an adult + foster care home with more than 50 residents.

+
+

G

+
+

Residents of title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

District of Columbia effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

623.00

+
+

485.00

+
+

1108.00

+
+

 

+
+

B

+
+

All

+
+

623.00

+
+

595.00

+
+

1218.00

+
+

B

+
+

Z

+
+

All

+
+

415.341

+
+

0.00

+
+

415.34

+
+

C

+
+

Z

+
+

All

+
+

623.00

+
+

0.00

+
+

623.00

+
+

D

+
+

G

+
+

All

+
+

30.002

+
+

40.00

+
+

70.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Code

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

934.00

+
+

1282.00

+
+

2216.00

+
+

 

+
+

B

+
+

All

+
+

934.00

+
+

1502.00

+
+

2436.00

+
+

B

+
+

Z

+
+

All

+
+

622.671

+
+

0.00

+
+

622.67

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

80.00

+
+

140.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

E. Description of Supplements - Hawaii

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

B

+
+

Living in a Community Care/Foster Care Home --

+ +

Persons eligible for SSI and who are both over age 18 and live in a State approved + Care/Foster Care Home.

+
+

H

+
+

Domiciliary Care I -- (Maximum of five residents) - Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities.

+
+

I

+
+

Domiciliary Care II -- Same as H except care is provided for six or more residents.

+
+

Y

+
+

Optional Supplementation Waived -- Eligible for, but have waived their right to receive + an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible individual (or couple) who is living in the household + of another (see explanation in definition for optional supplement B) and an eligible + individual (or couple) who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX.

    +
    +
    +
  4. +
+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Hawaii effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A 

+
+

B

+
+

All

+
+

623.00

+
+

621.90

+
+

1244.90

+
+

 

+
+

H

+
+

All

+
+

623.00

+
+

621.90

+
+

1244.90

+
+

 

+
+

I

+
+

All

+
+

623.00

+
+

729.90

+
+

1352.90

+
+

B

+
+

Z

+
+

All

+
+

415.341

+
+

0.00

+
+

415.34

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

B

+
+

All

+
+

934.00

+
+

1555.80

+
+

2489.80

+
+

 

+
+

H

+
+

All

+
+

934.00

+
+

1555.80

+
+

2489.80

+
+

 

+
+

I

+
+

All

+
+

934.00

+
+

1771.80

+
+

2705.80

+
+

B

+
+

Z

+
+

All

+
+

622.671

+
+

0.00

+
+

622.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. Description of Supplements - Iowa

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living in Own Household (Blind Only) -- Only an eligible blind individual and the blind member + of a couple who does not live in any other State living arrangement variation, does not have an + EP, and is not otherwise excepted from supplementation. Also included are blind recipients in title XIX facilities where Medicaid pays 50 percent or less of the cost + of care. Optional supplement code A is also compatible with Federal codes A and C.

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535)

+
+

B

+
+

Living in the Household of Another (Blind Only) -- Only an eligible blind individual and the blind member + of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation.

+
+

H

+
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with him or her, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services.

+ +

The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement.

+
+

I

+
+

Living in a Family Life or Boarding Home -- Eligible individual or each member of + an eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services.

+
+

G

+
+

Used to indicate that no supplement is payable to a recipient living in a title XIX + facility and title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under title XIX or all recipients whose Federal payments + are reduced to $30/$60 due to living in a title XIX facility. In addition, aged and + disabled recipients whose Federal payments are not reduced and who live in a title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement.

+ +
+
+

NOTE: The State Department of Human Services administers three optional supplementation + programs -- In-Home Health Related Care; Residential Care and Supplement for Medicare + and Medicaid Eligibles.

+
+
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid.

+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Iowa effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind

+
+

623.00

+
+

22.00

+
+

645.00

+
+

 

+
+

C

+
+

Aged

+
+

623.00

+
+

317.00

+
+

940.00

+
+

 

+
+

 

+
+

Blind

+
+

623.00

+
+

339.00

+
+

962.00

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

317.00

+
+

940.00

+
+

 

+
+

D

+
+

All

+
+

623.00

+
+

142.00

+
+

765.00

+
+

 

+
+

Z

+
+

Aged

+
+

623.00

+
+

0.00

+
+

623.00

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

0.00

+
+

623.00

+
+

B

+
+

B

+
+

Blind

+
+

415.341

+
+

22.00

+
+

437.34

+
+

 

+
+

H3

+
+

Aged

+
+

415.341

+
+

317.00

+
+

732.34

+
+

 

+
+

 

+
+

Blind

+
+

415.341

+
+

339.00

+
+

754.34

+
+

 

+
+

 

+
+

Disabled

+
+

415.341

+
+

317.00

+
+

732.34

+
+

 

+
+

I3

+
+

All

+
+

415.341

+
+

142.00

+
+

557.34

+
+

 

+
+

Z

+
+

Aged

+
+

415.341

+
+

0.00

+
+

415.34

+
+

 

+
+

 

+
+

Disabled

+
+

415.341

+
+

0.00

+
+

415.34

+
+

C

+
+

A

+
+

Blind

+
+

623.00

+
+

22.00

+
+

645.00

+
+

 

+
+

C

+
+

Blind

+
+

623.00

+
+

339.00

+
+

962.00

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

317.00

+
+

940.00

+
+

 

+
+

Z

+
+

Disabled

+
+

623.00

+
+

0.00

+
+

623.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+

NOTE:

+
+
+

State-administered programs: For Calendar Year 2007:

+
    +
  1. +
    +
    1. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  6. +
+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total
Payment Levels

+
+

A

+
+

A

+
+

Blind/Blind

+
+

934.00

+
+

44.00

+
+

978.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

934.00

+
+

22.00

+
+

956.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

934.00

+
+

22.00

+
+

956.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

934.00

+
+

317.00

+
+

1251.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

934.00

+
+

361.00

+
+

1295.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

934.00

+
+

317.00

+
+

1251.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

934.00

+
+

339.00

+
+

1273.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

934.00

+
+

317.00

+
+

1251.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

934.00

+
+

339.00

+
+

1273.00

+
+

 

+
+

D

+
+

All

+
+

934.00

+
+

616.00

+
+

1550.00

+
+

 

+
+

 

+
+

 

+
+

 

+
+

 

+
+

 

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

934.00

+
+

0.00

+
+

934.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

934.00

+
+

0.00

+
+

934.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

934.00

+
+

0.00

+
+

934.00

+
+

B

+
+

B

+
+

Blind/Blind

+
+

622.671

+
+

44.00

+
+

666.67

+
+

 

+
+

 

+
+

Blind/Aged

+
+

622.671

+
+

22.00

+
+

644.67

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

622.671

+
+

22.00

+
+

644.67

+
+

 

+
+

H

+
+

Aged/Aged

+
+

622.671

+
+

317.00

+
+

939.67

+
+

 

+
+

 

+
+

Blind/Blind

+
+

622.671

+
+

361.00

+
+

983.67

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

622.671

+
+

317.00

+
+

939.67

+
+

 

+
+

 

+
+

Aged/Blind

+
+

622.671

+
+

339.00

+
+

961.67

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

622.671

+
+

317.00

+
+

939.67

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

622.671

+
+

339.00

+
+

961.67

+
+

 

+
+

I3

+
+

All

+
+

622.671

+
+

616.00

+
+

1238.67

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

622.671

+
+

0.00

+
+

622.67

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

622.671

+
+

0.00

+
+

622.67

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

622.671

+
+

0.00

+
+

622.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+

NOTE:

+
+
+

State-administered programs: For Calendar Year 2007:

+
    +
  1. +
    +
    1. 
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. (Members of a couple are treated + as individuals.)

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  6. +
+
+
+
+
+
+
+ +
+
+

G. Description of Supplements - Massachusetts

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Full Cost-of-Living:

+ +
    +
  1. +
    +
    1. 
    +
    +

    An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and are:

    + +
      +
    1. +
      +
      a. 
      +
      +

      Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences will be considered + living alone provided they do not use the residential kitchen facilities for preparing + meals; or

      +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      Living only with their eligible spouse; or

      +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      Living with their eligible spouse and ineligible child/children 2 none of whom (children) receive public income maintenance payments;3 or

      +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      Living only with their ineligible spouse and/or their ineligible child/children, none + of whom (spouse and children) receive public income maintenance payments.

      +
      +
      +
    8. +
    +
    +
    +
  2. +
+ +
+
+

NOTE: For purposes of 1.a. through 1.d., foster children placed with anyone other than + their parents are not considered to be living with the foster parent.

+
+
+ +

An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments.

+ +

An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in SI 01415.038G.1. (See Code A, 1. or 2.) will be in State living arrangement A if they pay at least + two-thirds of the household expenses. In making a determination as to whether the + individual pays two-thirds or more of the expenses, use the method defined in SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses.

+ +

A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. + Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.)

+
+

B

+
+

Shared Living Expenses -- An individual who is in Federal living arrangement A or + C and who does not meet the criteria listed for State living arrangement A, E or G + is in State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH).

+ +

Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined in SI 01415.039G.1., Code A.4. This includes children under the age of 18 who are in Federal living arrangement + D because a private health insurance policy or a combination of Medicaid and a private + health insurance policy pays or is expected to pay over 50 percent of the cost of + care for that month. See SI 00520.011C.1.b, second and third bullets. Also included are individuals placed under the auspices + of the State adult foster care program and residents of publicly operated emergency + shelters throughout a month.

+ +

An individual living in a household where all members receive public income maintenance + payments unless they are paying at least two-thirds of the household expenses (A).

+ +

An individual living in a mixed household -- i.e., a household where one or more other + members receive a public income maintenance payment -- also is included unless the + individual is paying at least two-thirds of the household expenses (A).

+
+

C

+
+

Living in the Household of Another -- Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third.

+
+

E

+
+

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home.

+
+

F

+
+

Effective 7/1/87, the State elected Federal administration of this optional State + supplementary payment to residents of title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. This includes children under the age of 18 for + whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care + for that month.

+
+

G

+
+

Assisted Living -- Effective 7/1/94, the State elected Federal administration of this + variation. Includes an individual, certified by the State to be residing in an Assisted + Living residence served by a certified Group Adult Foster Care provider, who is not + receiving assistance under any other Federal or State rental assistance program, and + who pays a fixed, non-separable fee for rent and supportive services, other than medically + necessary services reimbursed by Medicaid. The State shall certify to SSA each individual + who is eligible for this optional supplement living arrangement. This living arrangement + was discontinued effective 1/1/96. However, it has been restored, retroactively, to + 1/1/97.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+
+
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify.

+
+
+

1For purposes of determining State living arrangements, a commercial boarding house, + foster home, or halfway house is not considered the person's household.

+

2Use the SSI definition of child, SI 00501.400.

+

3A public income maintenance payment is a payment from any of the following programs: + TANF, SSI, the Refugee Act of 1980, the Disaster Relief Act of 1974, general assistance + programs of the Bureau of Indian Affairs, State or local government income maintenance + programs that are based on need, or Department of Veterans Affairs benefits based + on need.

+
+
+
+
+

2. Coding and Monthly Payments Levels

+
+
+

Massachusetts effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

623.00

+
+

128.82

+
+

751.82

+
+

 

+
+

 

+
+

Blind

+
+

623.00

+
+

149.74

+
+

772.74

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

114.39

+
+

737.39

+
+

 

+
+

B

+
+

Aged

+
+

623.00

+
+

39.26

+
+

662.26

+
+

 

+
+

 

+
+

Blind

+
+

623.00

+
+

149.74

+
+

772.74

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

30.40

+
+

653.40

+
+

 

+
+

E

+
+

Aged

+
+

623.00

+
+

293.00

+
+

916.00

+
+

 

+
+

 

+
+

Blind

+
+

623.00

+
+

149.74

+
+

772.74

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

293.00

+
+

916.00

+
+

 

+
+

G

+
+

Aged

+
+

623.00

+
+

454.00

+
+

1077.00

+
+

 

+
+

 

+
+

Blind

+
+

623.00

+
+

454.00

+
+

1077.00

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

454.00

+
+

1077.00

+
+

B

+
+

C

+
+

Aged

+
+

415.341

+
+

104.36

+
+

519.70

+
+

 

+
+

 

+
+

Blind

+
+

415.341

+
+

357.40

+
+

772.74

+
+

 

+
+

 

+
+

Disabled

+
+

415.341

+
+

87.58

+
+

502.92

+
+

C

+
+

A

+
+

Blind

+
+

623.00

+
+

149.74

+
+

772.74

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

114.39

+
+

737.39

+
+

 

+
+

B

+
+

Blind

+
+

623.00

+
+

149.74

+
+

772.74

+
+

 

+
+

 

+
+

Disabled

+
+

623.00

+
+

30.40

+
+

653.40

+
+

D

+
+

B2

+
+

Blind

+
+

30.003

+
+

149.74

+
+

179.74

+
+

 

+
+

 

+
+

Disabled

+
+

30.003

+
+

30.40

+
+

60.40

+
+

 

+
+

F

+
+

All

+
+

30.003

+
+

35.00

+
+

65.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

934.00

+
+

201.72

+
+

1135.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

934.00

+
+

611.48

+
+

1545.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

934.00

+
+

180.06

+
+

1114.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

934.00

+
+

406.60

+
+

1340.60

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

934.00

+
+

190.89

+
+

1124.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

934.00

+
+

395.77

+
+

1329.77

+
+

 

+
+

B

+
+

Aged/Aged

+
+

934.00

+
+

201.72

+
+

1135.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

934.00

+
+

611.48

+
+

1545.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

934.00

+
+

180.06

+
+

1114.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

934.00

+
+

406.60

+
+

1340.60

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

934.00

+
+

190.89

+
+

1124.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

934.00

+
+

395.77

+
+

1329.77

+
+

 

+
+

E

+
+

Aged/Aged

+
+

934.00

+
+

898.00

+
+

1832.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

934.00

+
+

611.48

+
+

1545.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

934.00

+
+

898.00

+
+

1832.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

934.00

+
+

754.74

+
+

1688.74

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

934.00

+
+

898.00

+
+

1832.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

934.00

+
+

754.74

+
+

1688.74

+
+

 

+
+

G

+
+

Aged/Aged

+
+

934.00

+
+

681.00

+
+

1615.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

934.00

+
+

681.00

+
+

1615.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

934.00

+
+

681.00

+
+

1615.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

934.00

+
+

681.00

+
+

1615.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

934.00

+
+

681.00

+
+

1615.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

934.00

+
+

681.00

+
+

1615.00

+
+

B

+
+

C

+
+

Aged/Aged

+
+

622.671

+
+

215.80

+
+

838.47

+
+

 

+
+

 

+
+

Blind/Blind

+
+

622.671

+
+

922.80

+
+

1545.47

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

622.671

+
+

194.18

+
+

816.85

+
+

 

+
+

 

+
+

Aged/Blind

+
+

622.671

+
+

569.30

+
+

1191.97

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

622.671

+
+

204.99

+
+

827.66

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

622.671

+
+

558.49

+
+

1181.16

+
+

D

+
+

F

+
+

All

+
+

60.002

+
+

70.00

+
+

130.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

H. Description of Supplements - Michigan

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care.

+
+

E

+
+

Personal Care -- Recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged.

+
+

F

+
+

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care.

+
+

G

+
+

Independent Living with an EP -- Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.)

+
+

H

+
+

Living in the Household of Another with an EP --Recipients with an EP and living in + the household of another for Federal purposes. (Children under age 18 are excluded.)

+
+

I

+
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under title XIX.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Michigan effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

623.00

+
+

87.00

+
+

710.00

+
+

 

+
+

E

+
+

All

+
+

623.00

+
+

157.50

+
+

780.50

+
+

 

+
+

F

+
+

All

+
+

623.00

+
+

179.30

+
+

802.30

+
+

 

+
+

G

+
+

All

+
+

935.002

+
+

14.00

+
+

949.00

+
+

B

+
+

H

+
+

All

+
+

623.341

+
+

9.33

+
+

632.67

+
+

D

+
+

I

+
+

All

+
+

 30.003

+
+

7.00

+
+

37.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

934.00

+
+

486.00

+
+

1420.00

+
+

 

+
+

E

+
+

All

+
+

934.00

+
+

627.00

+
+

1561.00

+
+

 

+
+

F

+
+

All

+
+

934.00

+
+

670.60

+
+

1604.60

+
+

 

+
+

G

+
+

All

+
+

1246.002

+
+

21.00

+
+

1267.00

+
+

B

+
+

H

+
+

All

+
+

830.671

+
+

14.00

+
+

844.67

+
+

D

+
+

I

+
+

All

+
+

60.003

+
+

14.00

+
+

74.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

I. Description of Supplements - Montana

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

G

+
+

State-Certified Personal Care

+
+

H

+
+

State-Certified Residence in Group Home for Mentally Disabled

+
+

I

+
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+
+

J

+
+

State-Certified Residence for Child and Adult Foster Care

+
+

K

+
+

State-Certified Transitional Living for Developmentally Disabled

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all individuals and couples not certified in State + codes G, H, I, J, or K.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Montana effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

623.00

+
+

94.00

+
+

717.00

+
+

 

+
+

H

+
+

All

+
+

623.00

+
+

94.00

+
+

717.00

+
+

 

+
+

I

+
+

All

+
+

623.00

+
+

94.00

+
+

717.00

+
+

 

+
+

J

+
+

All

+
+

623.00

+
+

52.75

+
+

675.75

+
+

 

+
+

K

+
+

All

+
+

623.00

+
+

26.00

+
+

649.00

+
+

 

+
+

Z

+
+

All

+
+

623.00

+
+

0.00

+
+

623.00

+
+

B

+
+

Z

+
+

All

+
+

415.341

+
+

0.00

+
+

415.34

+
+

C

+
+

Z

+
+

All

+
+

623.00

+
+

0.00

+
+

623.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

934.00

+
+

193.00

+
+

1127.00

+
+

 

+
+

H

+
+

All

+
+

934.00

+
+

193.00

+
+

1127.00

+
+

 

+
+

I

+
+

All

+
+

934.00

+
+

193.00

+
+

1127.00

+
+

 

+
+

J

+
+

All

+
+

934.00

+
+

110.50

+
+

1044.00

+
+

 

+
+

K

+
+

All

+
+

934.00

+
+

57.00

+
+

991.00

+
+

 

+
+

Z

+
+

All

+
+

934.00

+
+

0.00

+
+

934.00

+
+

B

+
+

Z

+
+

All

+
+

622.671

+
+

0.00

+
+

622.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. Description of Supplements - Nevada

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living or Living in Parental Household -- Aged or blind eligible individual + or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes; + or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household.

    +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. (See SM01301.535.)

+
+

B

+
+

Living in the Household of Another -- Aged or blind eligible individual or couple + who is living in the household of another individual and receiving food and shelter from that individual. Aged or blind individuals or couples, who are subject + to a one-third reduction of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B.

+
+

C

+
+

Domiciliary Care -- Aged or blind eligible individual or couple who lives in a private + non-medical facility or, a residential facility serving 16 or fewer persons, which + provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor.

+ +

These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- No supplement cases include:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individuals or disabled members of eligible couples; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individuals or members of eligible couples in a medical facility where title + XIX pays more than 50 percent of the cost; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individuals or members of eligible couples who are patients in a private + medical facility which is not certified under title XIX; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    +
    +
    +
  8. +
+
+
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Nevada effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

623.00

+
+

36.40

+
+

659.40

+
+

 

+
+

 

+
+

Blind

+
+

623.00

+
+

109.30

+
+

732.30

+
+

 

+
+

C

+
+

Aged

+
+

623.00

+
+

391.00

+
+

1014.00

+
+

 

+
+

 

+
+

Blind

+
+

623.00

+
+

391.00

+
+

1014.00

+
+

 

+
+

Z

+
+

Disabled

+
+

623.00

+
+

0.00

+
+

623.00

+
+

B

+
+

B

+
+

Aged

+
+

415.341

+
+

24.27

+
+

439.61

+
+

 

+
+

 

+
+

Blind

+
+

415.341

+
+

213.96

+
+

629.30

+
+

 

+
+

Z

+
+

Disabled

+
+

415.341

+
+

0.00

+
+

415.34

+
+

C

+
+

A

+
+

Blind

+
+

623.00

+
+

109.30

+
+

732.30

+
+

 

+
+

Z

+
+

Disabled

+
+

623.00

+
+

0.00

+
+

623.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

934.00

+
+

74.46

+
+

1008.46

+
+

 

+
+

 

+
+

Blind/Blind

+
+

934.00

+
+

374.60

+
+

1308.60

+
+

 

+
+

 

+
+

Aged/Blind

+
+

934.00

+
+

224.53

+
+

1158.53

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

934.00

+
+

37.23

+
+

971.23

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

934.00

+
+

187.30

+
+

1121.30

+
+

 

+
+

C

+
+

Aged/Aged

+
+

934.00

+
+

881.00

+
+

1815.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

934.00

+
+

881.00

+
+

1815.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

934.00

+
+

881.00

+
+

1815.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

934.00

+
+

440.50

+
+

1374.50

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

934.00

+
+

440.50

+
+

1374.50

+
+

 

+
+

Z

+
+

Disabled

+
+

934.00

+
+

0.00

+
+

934.00

+
+

B

+
+

B

+
+

Aged/Aged

+
+

622.671

+
+

49.64

+
+

672.31

+
+

 

+
+

 

+
+

Blind/Blind

+
+

622.671

+
+

531.94

+
+

1154.61

+
+

 

+
+

 

+
+

Aged/Blind

+
+

622.671

+
+

290.79

+
+

913.46

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

622.671

+
+

24.82

+
+

647.49

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

622.671

+
+

265.97

+
+

888.64

+
+

 

+
+

Z

+
+

Disabled

+
+

622.671

+
+

0.00

+
+

622.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

K. Description of Supplements - New Jersey

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Congregate Care - Eligible individual/child/couple in Federal living arrangement (FLA) + A. The living arrangement includes the following: Recipients in residential facilities + who are under the supervision of the Department of Human Services: Children and adults + under the supervision of and/or placement by the NJ Department of Human Services’ + Division of Developmental Disabilities (DDD) or Division of Youth and Family Services + (DYFS) who are in residential facilities (both in and outside of NJ); and Recipients + in Assisted Living Residences and in Comprehensive Personal Care Homes licensed by + the Department of Health and Senior Services.

+
+

B

+
+

Living Alone or with Others -- Eligible individuals (including children) or eligible + couples whose Federal living arrangements are A or C and who do not meet the requirements + defined in other supplementation categories.

+ +

Therefore, any eligible adult/couple who meets the requirement for a Federal code + A will be in optional supplement B unless residing in a residential health care facility + or living alone with an ineligible spouse.

+ +

Likewise, any child meeting the criteria for a Federal code C will automatically be + entitled to optional supplement B.

+ +

This category includes, but is not limited to, those eligible adults/couples who are:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services.

    +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+
+

C

+
+

Living Alone with an Ineligible Spouse -- Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse will receive the same total payment as an eligible + couple or an individual with an EP. Once other persons, even minor children, are present + in the household, this supplementary payment variation cannot exist. However, it is + possible that a claimant and their ineligible spouse live with others and allege that + they are a separate “household” by virtue of the fact that they eat their meals out + or have separate purchase and preparation of food. In this instance, an optional supplement + C is permissible as long as no other person is in their “household.” There is no couple + counterpart in this category.

+ +

Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B.

+ +

A transient individual who co-exists only with an ineligible spouse will also qualify + for the O/S - C rate.

+
+

D

+
+

Living in the Household of Another -- Persons who are “living in the household of + another” for Federal purposes.

+
+

I

+
+

Licensed Residential Health Care Facilities -- Attached to a nursing home; Assisted + Living Residence; Comprehensive Personal Care Home; or “free standing”. Prior to January + 1, 2006 residents of these facilities were paid at the OS “A” rate.

+ +

Authorization to make this payment is based on the recipient's residence at a facility + listed in the New Jersey + Congregate Care Directory.

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. + Residents of the ALR or CPCH section of a multipurpose facility are paid at the OS + “A” rate. Nursing home residents are D/G if Medicaid pays more than 50% of the cost + of care.

+
+

G

+
+

Effective 9/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Individuals and couples in licensed medical facilities where + Medicaid is paying less than 50 percent of the cost of care, individuals and couples + in publicly operated community residences having 16 or less residents, and residents + of publicly operated emergency shelters throughout a month.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

New Jersey effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

623.00

+
+

150.05

+
+

773.05

+
+

 

+
+

B

+
+

All

+
+

623.00

+
+

31.25

+
+

654.25

+
+

 

+
+

C

+
+

Individual

+
+

623.00

+
+

336.36

+
+

959.36

+
+

 

+
+

 

+
+

w/EP

+
+

935.00

+
+

24.36

+
+

959.36

+
+

 

+
+

I

+
+

All

+
+

623.00

+
+

210.05

+
+

833.05

+
+

 

+
+

Z

+
+

All

+
+

623.00

+
+

0.00

+
+

623.00

+
+

B

+
+

D

+
+

All

+
+

415.341

+
+

44.31

+
+

459.65

+
+

C

+
+

B

+
+

All

+
+

623.00

+
+

31.25

+
+

654.25

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

10.00

+
+

40.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

934.00

+
+

593.36

+
+

1527.36

+
+

 

+
+

B

+
+

All

+
+

934.00

+
+

25.36

+
+

959.36

+
+

 

+
+

I

+
+

All

+
+

934.00

+
+

713.36

+
+

1647.36

+
+

 

+
+

Z

+
+

All

+
+

934.00

+
+

  0.00

+
+

934.00

+
+

B

+
+

D

+
+

All

+
+

622.671

+
+

93.09

+
+

715.76

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

20.00

+
+

80.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

L. Description of Supplements - New York

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone -- Eligible individuals or eligible couples who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Live physically alone.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Pay a fixed, pre-established flat fee for both room and board in a commercial establishment.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives with others but takes all meals outside the dwelling.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Live with others but separately prepares or has someone separately prepare their food. + Occasional preparation of meals in common will not preclude a finding of separate + preparation.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Receive a fixed, pre-established flat fee for room and board from all others in the dwelling.

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Live with only a foster child, or a homemaker authorized by the local department of + social services (DSS), or a family care recipient placed by: the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabilities (OMRDD) + or local DSS.

    +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    Have no permanent living arrangement (i.e., transient or street person) and is not + with a spouse or a child for whom they have primary responsibility.

    +
    +
    +
  14. +
+
+

B

+
+

Living with Others -- Individual/child/couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Resides in a dwelling with others and prepares food in common with at least one other + person in the dwelling. Note - An individual living with an ineligible spouse must be considered living with others + despite any separate preparation. The same is true if an individual/couple lives with + a child for whom they have primary responsibility (except if the child is a foster + child).

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a child who does not meet the criteria for OSS C or OSS D (below).

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a religious community and room and/or board is provided in full or in part + by the religious community.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Has no permanent living arrangement (i.e., transient or street person), but is with + an ineligible spouse or child for whom they have primary responsibility.

    +
    +
    +
  8. +
+
+

C

+
+

Congregate Care Level I –

+ +
    +
  1. +
    +
    1. 
    +
    +

    Individual/couple/child has been placed in a family type home certified by NYS Office + of Children and Family Services and supervised by a local DSS.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individual/couple/child has been placed in a family care home certified by OMH/OMRDD.

    +
    +
    +
  4. +
+
+

D

+
+

Congregate Care Level II – Payable to an eligible individual/couple/child who is a + resident of a licensed level 2 care facility. These consist of facilities, which provide + supportive living environments and include: Residences for Adults certified by the + NYS Department of Health; Privately operated facilities certified by the NYS OMH; + Privately-operated facilities certified by the NYS OMH and OMRDD; and Privately-operated + facilities certified by OASAS.

+
+

E

+
+

Congregate Care Level III -- Enhanced Residential Care

+ +

Payable to an eligible individual/couple who is a resident of a licensed level 3 care + facility which includes: Adult Homes and Enriched Housing programs certified by the + NYS Department of Health or Schools for the Mentally Retarded certified by the NYS + Office of Mental Retardation and Developmental Disabilities. Schools for the Mentally + Retarded usually meet the basic Federal definition of institution and consist of residential + facilities that provide academic, vocational, recreational and social skills programs. + Although sometimes called schools, they often do not meet the Federal definition of + schools. NOTE - A child residing in a Level 3 facility cannot receive OSS E; they will receive + OSS B.

+
+

F

+
+

Living in the Household of Another -- Payable to recipients who are FLA B.

+
+

G

+
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. Federal administration was terminated + effective 9/30/03. State began administering this payment 10/1/03.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases – Includes Eligible individual/couple in FLA A or B who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Is in a licensed medical facility where Medicaid is paying less than 50% of the cost + of care; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is in a publicly operated community residence which serves 16 or fewer residents; + or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is in a publicly operated emergency shelter (PESH); or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Qualifies under the special provision in SI 00520.130 (1619 eligible goes into medical institution).

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 10/1/03 eligible individual/couple in FLA D and also cases that were FLA + D prior to January 1988.

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Effective 12/1/96, children under age 18 residing in certain public or private facilities + receiving payment for their care under any health insurance policy issued by a private + provider (SI 00520.011).

    +
    +
    +
  12. +
+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

New York effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

623.00

+
+

87.00

+
+

710.00

+
+

 

+
+

B

+
+

All

+
+

623.00

+
+

23.00

+
+

646.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

623.00

+
+

266.48

+
+

889.48

+
+

 

+
+

 

+
+

All other counties

+
+

623.00

+
+

228.48

+
+

851.48

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

623.00

+
+

435.00

+
+

1058.00

+
+

 

+
+

 

+
+

All other counties

+
+

623.00

+
+

405.00

+
+

1028.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

623.00

+
+

641.00

+
+

1264.00

+
+

 

+
+

 

+
+

All other counties

+
+

623.00

+
+

641.00

+
+

1264.00

+
+

 

+
+

Z

+
+

All

+
+

623.00

+
+

  0.00

+
+

623.00

+
+

B

+
+

F

+
+

All

+
+

415.342

+
+

23.00

+
+

438.34

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

0.004

+
+

30.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 1/1/07.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

4New York administers a supplement of $20 to some recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

934.00

+
+

104.00

+
+

1038.00

+
+

 

+
+

B

+
+

All

+
+

934.00

+
+

46.00

+
+

980.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

934.00

+
+

844.96

+
+

1778.96

+
+

 

+
+

 

+
+

All other counties

+
+

934.00

+
+

768.96

+
+

1702.96

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

934.00

+
+

1182.00

+
+

2116.00

+
+

 

+
+

 

+
+

All other counties

+
+

934.00

+
+

1122.00

+
+

2056.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

934.00

+
+

1594.00

+
+

2528.00

+
+

 

+
+

 

+
+

All other counties

+
+

934.00

+
+

1594.00

+
+

2528.00

+
+

 

+
+

Z

+
+

All

+
+

934.00

+
+

0.00

+
+

934.00

+
+

B

+
+

F

+
+

All

+
+

622.672

+
+

46.00

+
+

668.67

+
+

D

+
+

G

+
+

All

+
+

60.003

+
+

0.004

+
+

60.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 1/1/07.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

4New York administers a supplement of $20 to some recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

M. Description of Supplements - Pennsylvania

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone -- Recipients in private medical facilities (nursing homes, hospitals, + intermediate care facilities) where title XIX is not paying more than 50 percent of the cost of care, residents of publicly operated emergency + shelters throughout a month, and all other individuals and couples in Federal codes + A and C not meeting the definition of another variation.

+ +

Used with an “intervening” Federal code A. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+
+

B

+
+

Living in the Household of Another -- Recipients who do not have an EP and who live + in the household of another and receive support and maintenance for Federal purposes.

+
+

C

+
+

Living with an EP -- Recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules.

+
+

D

+
+

Living in the Household of Another with an EP --Recipients who live in the household + of another and who have one or more EP’s as defined under the Federal rules.

+
+

G

+
+

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

H

+
+

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all recipients who are residing in a medical facility + in which title XIX is paying more than 50 percent of the cost of care.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Pennsylvania effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

Z

+
+

All

+
+

623.00

+
+

0.00

+
+

623.00

+
+

 

+
+

C

+
+

All

+
+

935.001

+
+

43.70

+
+

978.70

+
+

 

+
+

G

+
+

All

+
+

623.00

+
+

389.30

+
+

1012.30

+
+

 

+
+

H

+
+

All

+
+

623.00

+
+

439.30

+
+

1062.30

+
+

B

+
+

Z

+
+

All

+
+

415.342

+
+

0.00

+
+

415.34

+
+

 

+
+

D

+
+

All

+
+

623.343

+
+

43.70

+
+

667.04

+
+

C

+
+

Z

+
+

All

+
+

623.00

+
+

0.00

+
+

623.00

+
+

D

+
+

Z

+
+

All

+
+

30.004

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

934.00

+
+

0.00

+
+

934.00

+
+

 

+
+

C

+
+

All

+
+

1246.001

+
+

68.05

+
+

1314.05

+
+

 

+
+

G

+
+

All

+
+

934.00

+
+

857.40

+
+

1791.40

+
+

 

+
+

H

+
+

All

+
+

934.00

+
+

957.40

+
+

1891.40

+
+

B

+
+

B

+
+

All

+
+

622.672

+
+

0.00

+
+

622.67

+
+

 

+
+

D

+
+

All

+
+

830.673

+
+

68.05

+
+

898.72

+
+

D

+
+

Z

+
+

All

+
+

60.004

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

N. Description of Supplements - Rhode Island

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living -- Recipients who are in Federal codes A and C, except for individuals + residing in a residential care/assisted living facility who have been certified as + eligible for State Code D. This includes children under the age of 18 who are in Federal + living arrangement D because a private health insurance policy or a combination of + Medicaid and a private health insurance policy pays or is expected to pay over 50 + percent of the cost of care for that month. See SI 00520.011C.1.b, second and third bullets.

+ +

Recipients residing in a public emergency shelter for the homeless and those who are + eligible for Section 1619 are included in this category.

+
+

B

+
+

Living in the Household of Another -- Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied.

+
+

D

+
+

Residential Care/Assisted Living -- This category applies to individuals only.

+
+

E

+
+

The State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 3/1/91). This includes children under + the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of + the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Rhode Island effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A1

+
+

All

+
+

623.00

+
+

57.35

+
+

680.35

+
+

 

+
+

D

+
+

All

+
+

623.00

+
+

575.00

+
+

1198.00

+
+

B

+
+

B1

+
+

All

+
+

415.342

+
+

69.94

+
+

485.28

+
+

C

+
+

A1

+
+

All

+
+

623.00

+
+

57.35

+
+

680.35

+
+

D

+
+

A3

+
+

Children Private Insurance

+
+

30.004

+
+

57.35

+
+

87.35

+
+

 

+
+

E

+
+

All

+
+

30.004

+
+

20.00

+
+

50.00

+
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3State OS Code A applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A1

+
+

All

+
+

934.00

+
+

108.50

+
+

1042.50

+
+

B

+
+

B1

+
+

All

+
+

622.672

+
+

128.50

+
+

751.17

+
+

D

+
+

E

+
+

All

+
+

60.003

+
+

40.00

+
+

100.00

+
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

O. Description of Supplements - Utah

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone or With Others -- This variation includes recipients who are in Federal + codes A and C.

+
+

B

+
+

Living in the Household of Another -- Recipients with no EP who are “living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.)

+
+

Z

+
+

No Supplement Cases -- No supplement cases include all recipients who are not included + in A or B.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Utah effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Level

+
+

A,C

+
+

Z

+
+

All

+
+

623.00

+
+

0.00

+
+

623.00

+
+

B

+
+

B

+
+

All

+
+

415.342

+
+

3.13

+
+

418.47

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement
Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

934.00

+
+

4.60

+
+

938.60

+
+

B

+
+

B

+
+

All

+
+

622.672

+
+

9.73

+
+

632.40

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+
+
+ +
+
+

P. Description of Supplements - Vermont

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living (except Chittenden County) -- Recipients not living in the household + of another and not in a residential or custodial care situation. This includes a child + who is living with a parent and recipients residing in a private title XIX facility + where Medicaid is not paying more than 50 percent of the cost of care. It includes + children under the age of 18 who are in Federal living arrangement D because a private + health insurance policy or a combination of Medicaid and a private health insurance + policy pays or is expected to pay over 50 percent of the cost of care for that month. + See SI 00520.011C.1.b, second and third bullets.

+ +

An individual or eligible couple residing in a publicly operated emergency shelter + throughout a month.

+
+

B

+
+

Independent Living in Chittenden County -- Same as Code A above except restricted + to residents of Chittenden County.

+
+

C

+
+

Licensed Residential Care Home or Assisted Living Residence with Assistive Community + Care Services (Level III) -- Recipients residing in Level III facilities identified + by the State. Refer to the Vermont Community Care Facilities (OS C and G) list on + BOSNet to determine if a residence meets the requirements for Optional Supplement + C.

+
+

E

+
+

Living in the Household of Another -- Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions).

+
+

G

+
+

Licensed Residential Care Home or Therapeutic Community Residence (Level IV) -- Recipients + residing in Level IV facilities identified by the State. Refer to the Vermont Community + Care Facilities (OS C and G) list on BOSNET to determine if a residence meets the + requirements for Optional Supplement G.

+
+

H

+
+

Custodial Care: Family Home -- Recipients living in another's home in such a manner + that the individual or couple is paying room and board and is receiving one or more + of the services outlined under the custodial care definition. The individual or couple + must also receive the room and board and custodial care in the home in which they + reside. In order to qualify as a home under this arrangement, these services must + not be provided to more than two persons and must be provided by a resident of the + home.

+ +

In some cases the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of L/A H. To qualify + these programs must meet the requirements stated above.

+ +

Custodial + care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service 2-3 times a week) and/or + supervision for the recipient's protection. Supervision for the recipient's protection + deals primarily with protection services for retarded and emotionally disturbed individuals. + A person who receives one or more of these personal services is receiving custodial + care.

+
+

I

+
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents in title XIX facilities. This includes children under the age + of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of the cost + of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

Vermont effective 1/1/07.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County)

+
+

623.00

+
+

52.04

+
+

675.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

623.00

+
+

52.04

+
+

675.04

+
+

 

+
+

C

+
+

All

+
+

623.00

+
+

48.38

+
+

671.38

+
+

 

+
+

G

+
+

All

+
+

623.00

+
+

223.94

+
+

846.94

+
+

 

+
+

H

+
+

All

+
+

623.00

+
+

98.69

+
+

721.69

+
+

B

+
+

E

+
+

All

+
+

415.341

+
+

39.30

+
+

454.64

+
+

C

+
+

A

+
+

All (Except Chittenden County)

+
+

623.00

+
+

52.04

+
+

675.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

623.00

+
+

52.04

+
+

675.04

+
+

D

+
+

A or B2

+
+

Children Private Insurance

+
+

30.003

+
+

52.04

+
+

82.04

+
+

 

+
+

I

+
+

All

+
+

30.003

+
+

17.66

+
+

47.66

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County

+
+

934.00

+
+

98.88

+
+

1032.88

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County

+
+

934.00

+
+

98.88

+
+

1032.88

+
+

 

+
+

C

+
+

All

+
+

934.00

+
+

96.77

+
+

1030.77

+
+

 

+
+

G

+
+

All

+
+

934.00

+
+

562.06

+
+

1496.06

+
+

 

+
+

H

+
+

All

+
+

934.00

+
+

332.82

+
+

1266.82

+
+

B

+
+

E

+
+

All

+
+

622.671

+
+

48.31

+
+

670.98

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

35.33

+
+

95.33

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

 

+
+
+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415039
SI 01415.039 - Federally Administered Optional Supplementary Payment Programs – 1/07 Payment Levels - 12/20/2007
+Batch run: 04/27/2026
+Rev:12/20/2007
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+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html new file mode 100644 index 00000000..41015f01 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2008.html @@ -0,0 +1,12911 @@ + + +SSA - POMS: SI 01415.040 - Federally Administered Optional Supplementary Payment Programs – 1/08 Payment Levels - 01/17/2008 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 70 (08-24)

+

SI 01415.040 Federally Administered Optional Supplementary Payment Programs – 1/08 Payment Levels

+ + +
+
+

CITATIONS:

+
+
+
Social Security Act as amended in 1973, + Section + 1616;
+
Social Security Amendments of 1972, + Section + 301;
+
Public Law 93-66, + Section + 212
+
+
+
+
+

A. Background

+
+
+

The following states are participating in the federally Administered Optional Supplementary + Payment Programs:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

 

+
+

 

+
+

California

+
+

Nevada

+
+

Delaware

+
+

New Jersey

+
+

District Of Columbia

+
+

New York

+
+

Hawaii

+
+

Pennsylvania

+
+

Iowa

+
+

Rhode Island

+
+

Massachusetts

+
+

Utah

+
+

Michigan

+
+

Vermont

+
+

Montana

+
+

 

+
+
+
+
+ +
+
+

B. Description of Supplements - California

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living with Cooking Facilities -- Eligible individual or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and have cooking and food storage facilities or is provided meals as part of the living + arrangement; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent or parents or is + a disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a private medical facility licensed by the State but not certified under + title XIX.

    +
    +
    +
  10. +
+
+

B

+
+

Non-medical Out-of-Home Care (NMOHC) -- Applies when an individual/couple needs non-medical + care or supervision in the following living arrangement situations:

+ +

CHILDREN + (UNDER AGE 18)

+ +
    +
  1. +
    +
    1. 
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative; or

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or

    + +

    ADULTS (AGE 18 AND OVER)

    +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or

    +
    +
    +
  14. +
  15. +
    +
    8. 
    +
    +

    Aged, blind or disabled individual/couple has been determined to be in FLA A and resides + in a State licensed NMOHC facility.

    +
    +
    +
  16. +
+ +

For California optional supplement purposes, a relative is defined as a parent, child, + sibling, half-sibling, parent's sibling, sibling's child, first cousin, or any person + of the preceding generation denoted by the prefix “grand” or “great.”

+
+

C

+
+

Independent Living Without Cooking Facilities -- Aged or disabled individual/couple + who is neither provided any meals nor has access to adequate cooking/food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C.

+ +

An individual/couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Immediate living quarters do not have cooking and food storage facilities with which + the individual/couple or another person (who is responsible for preparing the individual's/couple's + meals) can prepare meals on a daily basis.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the SSI applicant's/recipient's arrangement with the facility + is to purchase only shelter on a monthly basis).

    +
    +
    +
  10. +
+ +

“Adequate” cooking and food storage facilities exist when an individual/couple has + access to:

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls that + are used for warming food are not considered adequate cooking facilities.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature control.

    +
    +
    +
  • +
+ +

Eligibility for OS C begins in the month the applicant/recipient applies for this + supplement rate provided they have been without cooking and food storage facilities + throughout the month.

+ +
+
+

NOTE: For purposes of OS C, “throughout a month” does not mean the applicant/recipient must lack adequate cooking/food storage facilities from + the very first moment of the month. They need only lack them from some time on the + first day of the month.

+
+
+ +

If eligibility is based on temporary loss or non-functioning of an appliance, the + individual should be advised of their responsibility to report immediately when the + temporary condition has ceased. If the individual provides an expected date when the + appliance will be replaced/repaired, diary the case for re-contact.

+ +

Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available.

+
+

 

+
+

For a couple, comprised of an aged/disabled individual and a blind individual, whose + living arrangement lacks adequate cooking and storage facilities, the couple is to + receive the SSI/SSP level for a blind/aged or disabled couple plus the restaurant + meals allowance for the disabled member of the couple. Force payment in this living + arrangement is required.

+
+

D

+
+

Living in the Household of Another -- Eligible individual/couple is living in the + household of another and is receiving food and shelter from that individual. Most individuals/couples who are subject to a 1/3 reduction + of their Federal SSI payments (VTR) are eligible for OS D because the criteria for + this supplement level are the same as for charging the VTR. However, when the eligible + individual/couple lives in the home of a relative (other than a spouse) and needs + care and supervision, certification for non-medical out-of-home care (OS F) should + be obtained from the county welfare office since this is the highest categorical supplement + for which an individual/couple can qualify.

+
+

E

+
+

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage.

+ +
+
+

NOTE: Only FLA A and C are compatible with OS E. If the VTR applies, see code G.

+
+
+
+

F

+
+

Non-medical Out-of-Home Care Living in the Household of Another -- Applies whenever + an eligible individual or couple meets the criteria for the non-medical out-of-home + care payment rate, and is determined to receive the Federal code B payment for living + in the household of another (SI 00835.200).

+
+

G

+
+

Disabled Child Under Age 18 Living in the Household of Another -- Applies to a disabled + (not blind) child under age 18, who resides with a parent or relative by blood or + marriage, and is determined to receive the Federal code B payment for living in the household of + another individual (SI 00835.200).

+
+

J

+
+

Residents of title XIX facilities.

+ +

This State code is also used to supplement Section 1619 cases.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible individual or couple who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where title XIX pays more than 50 percent of the costs; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under title XIX and not licensed + by the State.

    +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify.

+
+
+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for California effective 1/1/08 are shown in + the following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

637.00

+
+

233.00

+
+

870.00

+
+

 

+
+

 

+
+

Blind

+
+

637.00

+
+

298.00

+
+

935.00

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

233.00

+
+

870.00

+
+

 

+
+

B

+
+

All

+
+

637.00

+
+

412.00

+
+

1049.00

+
+

 

+
+

C

+
+

Aged

+
+

637.00

+
+

317.00

+
+

954.00

+
+

 

+
+

 

+
+

Blind

+
+

637.00

+
+

0.00

+
+

637.00

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

317.00

+
+

954.00

+
+

 

+
+

E

+
+

Disabled

+
+

637.00

+
+

119.00

+
+

756.00

+
+

 

+
+

Z

+
+

All

+
+

637.00

+
+

0.00

+
+

637.00

+
+

B

+
+

D

+
+

Aged

+
+

424.671

+
+

234.00

+
+

658.67

+
+

 

+
+

 

+
+

Blind

+
+

424.671

+
+

315.00

+
+

739.67

+
+

 

+
+

 

+
+

Disabled

+
+

424.671

+
+

234.00

+
+

658.67

+
+

 

+
+

F

+
+

All

+
+

424.671

+
+

407.00

+
+

831.67

+
+

 

+
+

G

+
+

Disabled

+
+

424.671

+
+

108.00

+
+

532.67

+
+

C

+
+

A

+
+

Blind

+
+

637.00

+
+

298.00

+
+

935.00

+
+

 

+
+

E

+
+

Disabled

+
+

637.00

+
+

119.00

+
+

756.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

956.00

+
+

568.00

+
+

1524.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

956.00

+
+

795.00

+
+

1751.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

956.00

+
+

568.00

+
+

1524.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

956.00

+
+

710.00

+
+

1666.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

956.00

+
+

568.00

+
+

1524.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

956.00

+
+

710.00

+
+

1666.00

+
+

 

+
+

B

+
+

All

+
+

956.00

+
+

1142.00

+
+

2098.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

956.00

+
+

736.00

+
+

1692.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

956.00

+
+

736.00

+
+

1692.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

956.00

+
+

736.00

+
+

1692.00

+
+

 

+
+

Z

+
+

All

+
+

956.00

+
+

0.00

+
+

956.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

637.341

+
+

595.66

+
+

1233.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

637.341

+
+

822.66

+
+

1460.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

637.341

+
+

595.66

+
+

1233.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

637.341

+
+

736.66

+
+

1374.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

637.341

+
+

595.66

+
+

1233.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

637.341

+
+

736.66

+
+

1374.00

+
+

 

+
+

F

+
+

All

+
+

637.341

+
+

1045.66

+
+

1683.00

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of Supplements - Delaware

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + -- Only living arrangement variation in Delaware and includes only those recipients + who are certified by the State medical unit as residents of one of the above adult + facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A or Y.

+ +

Optional supplementation code Z is the proper code to be used with an “intervening” + Federal code A. (See SM 01301.535)

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payments levels for Delaware effective 1/1/08 are shown in + the following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total
Payment Levels

+
+

A

+
+

A

+
+

All

+
+

637.00

+
+

140.00

+
+

777.00

+
+

 

+
+

Z

+
+

All

+
+

637.00

+
+

0.00

+
+

637.00

+
+

B

+
+

Z

+
+

All

+
+

424.671

+
+

0.00

+
+

424.67

+
+

C

+
+

Z

+
+

All

+
+

637.00

+
+

0.00

+
+

637.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

956.00

+
+

448.00

+
+

1404.00

+
+

 

+
+

Z

+
+

All

+
+

956.00

+
+

0.00

+
+

956.00

+
+

B

+
+

Z

+
+

All

+
+

637.341

+
+

0.00

+
+

637.34

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. Description of Supplements - District of Columbia

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by + the District of Columbia, Department of Health, as residents of an adult foster care + home with 50 or fewer residents.

+
+

B

+
+

Adult Foster Care Home with More than 50 Residents --Recipients who are certified + by the District of Columbia, Department of Health, as residents of an adult foster + care home with more than 50 residents.

+
+

G

+
+

Residents of title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for the District of Columbia effective 1/1/08 + are shown in the following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

637.00

+
+

485.00

+
+

1122.00

+
+

 

+
+

B

+
+

All

+
+

637.00

+
+

595.00

+
+

1232.00

+
+

B

+
+

Z

+
+

All

+
+

424.671

+
+

0.00

+
+

424.67

+
+

C

+
+

Z

+
+

All

+
+

637.00

+
+

0.00

+
+

637.00

+
+

D

+
+

G

+
+

All

+
+

30.002

+
+

40.00

+
+

70.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Code

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

956.00

+
+

1288.00

+
+

2244.00

+
+

 

+
+

B

+
+

All

+
+

956.00

+
+

1508.00

+
+

2464.00

+
+

B

+
+

Z

+
+

All

+
+

637.341

+
+

0.00

+
+

637.34

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

80.00

+
+

140.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

E. Description of Supplements - Hawaii

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

B

+
+

Living in a Community Care/Foster Care Home --

+ +

Persons eligible for SSI and who are both over age 18 and live in a State approved + Care/Foster Care Home.

+
+

D

+
+

Living in a Certified Medical Facility – Eligible individual living in a medical treatment + facility where a substantial part (more than 50%) of the cost of care is paid under + title XIX.

+
+

H

+
+

Domiciliary Care I -- (Maximum of five residents) - Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities.

+
+

I

+
+

Domiciliary Care II -- Same as H except care is provided for six or more residents.

+
+

Y

+
+

Optional Supplementation Waived -- Eligible for, but have waived their right to receive + an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible individual (or couple) who is living in the household + of another (see explanation in definition for optional supplement B) and an eligible + individual (or couple) who is a patient in a private medical facility which is not + certified under title XIX.

+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for Hawaii effective 1/1/08 are shown in the + following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A 

+
+

B

+
+

All

+
+

637.00

+
+

641.90

+
+

1278.90

+
+

 

+
+

H

+
+

All

+
+

637.00

+
+

641.90

+
+

1278.90

+
+

 

+
+

I

+
+

All

+
+

637.00

+
+

749.90

+
+

1386.90

+
+

B

+
+

Z

+
+

All

+
+

424.671

+
+

0.00

+
+

424.67

+
+

D

+
+

D

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

B

+
+

All

+
+

956.00

+
+

1601.80

+
+

2557.80

+
+

 

+
+

H

+
+

All

+
+

956.00

+
+

1601.80

+
+

2557.80

+
+

 

+
+

I

+
+

All

+
+

956.00

+
+

1817.80

+
+

2773.80

+
+

B

+
+

Z

+
+

All

+
+

637.341

+
+

0.00

+
+

637.34

+
+

D

+
+

D

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. Description of Supplements - Iowa

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living in Own Household (Blind Only) -- Only an eligible blind individual and the blind member + of a couple who does not live in any other State living arrangement variation, does not have an + EP, and is not otherwise excepted from supplementation. Also included are blind recipients in title XIX facilities where Medicaid pays 50 percent or less of the cost + of care. Optional supplement code A is also compatible with Federal codes A and C.

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535)

+
+

B

+
+

Living in the Household of Another (Blind Only) -- Only an eligible blind individual and the blind member + of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation.

+
+

H

+
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services.

+ +

The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement.

+
+

I

+
+

Living in a Family Life or Boarding Home -- Eligible individual or each member of + an eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services.

+
+

G

+
+

Used to indicate that no supplement is payable to a recipient living in a title XIX + facility and title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under title XIX or all recipients whose Federal payments + are reduced to $30/$60 due to living in a title XIX facility. In addition, aged and + disabled recipients whose Federal payments are not reduced and who live in a title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement.

+ +
+
+

NOTE: The State Department of Human Services administers three optional supplementation + programs -- In-Home Health Related Care; Residential Care and Supplement for Medicare + and Medicaid Eligibles.

+
+
+
+
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+
+
+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid.

+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for Iowa effective 1/1/08 are shown in the following + charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind

+
+

637.00

+
+

22.00

+
+

659.00

+
+

 

+
+

C

+
+

Aged

+
+

637.00

+
+

325.00

+
+

962.00

+
+

 

+
+

 

+
+

Blind

+
+

637.00

+
+

347.00

+
+

984.00

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

325.00

+
+

962.00

+
+

 

+
+

D

+
+

Aged

+
+

637.00

+
+

142.00

+
+

779.00

+
+

 

+
+

 

+
+

Blind

+
+

637.00

+
+

164.00

+
+

801.00

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

142.00

+
+

779.00

+
+

 

+
+

Z

+
+

Aged

+
+

637.00

+
+

0.00

+
+

637.00

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

0.00

+
+

637.00

+
+

B

+
+

B

+
+

Blind

+
+

424.671

+
+

22.00

+
+

446.67

+
+

 

+
+

H3

+
+

Aged

+
+

424.671

+
+

325.00

+
+

749.67

+
+

 

+
+

 

+
+

Blind

+
+

424.671

+
+

347.00

+
+

771.67

+
+

 

+
+

 

+
+

Disabled

+
+

424.671

+
+

325.00

+
+

749.67

+
+

 

+
+

I3

+
+

Aged

+
+

424.671

+
+

142.00

+
+

566.67

+
+

 

+
+

 

+
+

Disabled

+
+

424.67

+
+

142.00

+
+

566.67

+
+

 

+
+

 

+
+

Blind

+
+

424.67

+
+

164.00

+
+

588.67

+
+

 

+
+

Z

+
+

Aged

+
+

424.671

+
+

0.00

+
+

424.67

+
+

 

+
+

 

+
+

Disabled

+
+

424.671

+
+

0.00

+
+

424.67

+
+

C

+
+

A

+
+

Blind

+
+

637.00

+
+

22.00

+
+

659.00

+
+

 

+
+

C

+
+

Blind

+
+

637.00

+
+

347.00

+
+

984.00

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

325.00

+
+

962.00

+
+

 

+
+

Z

+
+

Disabled

+
+

637.00

+
+

0.00

+
+

637.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

NOTE:

+

State-administered programs: For Calendar Year 2008:

+
    +
  • +
    +
    •
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total
Payment Levels

+
+

A

+
+

A

+
+

Blind/Blind

+
+

956.00

+
+

44.00

+
+

1000.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

956.00

+
+

22.00

+
+

978.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

956.00

+
+

22.00

+
+

978.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

956.00

+
+

325.00

+
+

1281.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

956.00

+
+

369.00

+
+

1325.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

956.00

+
+

325.00

+
+

1281.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

956.00

+
+

347.00

+
+

1303.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

956.00

+
+

325.00

+
+

1281.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

956.00

+
+

347.00

+
+

1303.00

+
+

 

+
+

D

+
+

Aged/Aged

+
+

956.00

+
+

622.00

+
+

1578.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

956.00

+
+

666.00

+
+

1622.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

956.00

+
+

622.00

+
+

1578.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

956.00

+
+

644.00

+
+

1600.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

956.00

+
+

622.00

+
+

1578.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

956.00

+
+

644.00

+
+

1600.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

956.00

+
+

0.00

+
+

956.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

956.00

+
+

0.00

+
+

956.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

956.00

+
+

0.00

+
+

956.00

+
+

B

+
+

B

+
+

Blind/Blind

+
+

637.341

+
+

44.00

+
+

681.34

+
+

 

+
+

 

+
+

Blind/Aged

+
+

637.341

+
+

22.00

+
+

659.34

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

637.341

+
+

22.00

+
+

659.34

+
+

 

+
+

H

+
+

Aged/Aged

+
+

637.341

+
+

325.00

+
+

962.34

+
+

 

+
+

 

+
+

Blind/Blind

+
+

637.341

+
+

369.00

+
+

1006.34

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

637.341

+
+

325.00

+
+

962.34

+
+

 

+
+

 

+
+

Aged/Blind

+
+

637.341

+
+

347.00

+
+

984.34

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

637.341

+
+

325.00

+
+

962.34

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

637.341

+
+

347.00

+
+

984.34

+
+

 

+
+

I

+
+

Aged/Aged

+
+

637.341

+
+

622.00

+
+

1259.34

+
+

 

+
+

 

+
+

Blind/Blind

+
+

637.341

+
+

666.00

+
+

1303.34

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

637.341

+
+

622.00

+
+

1259.34

+
+

 

+
+

 

+
+

Aged/Blind

+
+

637.341

+
+

644.00

+
+

1281.34

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

637.341

+
+

622.00

+
+

1259.34

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

637.341

+
+

644.00

+
+

1281.34

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

637.341

+
+

0.00

+
+

637.34

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

637.341

+
+

0.00

+
+

637.34

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

637.341

+
+

0.00

+
+

637.34

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+

NOTE:

+
+
+

State-administered programs: For Calendar Year 2008:

+
    +
  • +
    +
    •
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. (Members of a couple are treated + as individuals.)

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of Supplements - Massachusetts

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Full Cost-of-Living:

+ +

An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and are:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences will be considered + living alone provided they do not use the residential kitchen facilities for preparing + meals; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living only with their eligible spouse; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living with their eligible spouse and ineligible child/children 2 none of whom (children) receive public income maintenance payments;3 + or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Living only with their ineligible spouse and/or their ineligible child/children, none + of whom (spouse and children) receive public income maintenance payments.

    +
    +
    +
  8. +
+ +
+
+

NOTE: For purposes of 1 through 4, foster children placed with anyone other than their + parents are not considered to be living with the foster parent.

+
+
+ +

An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments.

+ +

An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in SI 01415.040G.1. (See Code A, 1. or 2.) will be in State living arrangement A if they pay at least + two-thirds of the household expenses. In making a determination as to whether the + individual pays two-thirds or more of the expenses, use the method defined in SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses.

+ +

A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. + Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.)

+
+

B

+
+

Shared Living Expenses -- An individual who is in Federal living arrangement A or + C and who does not meet the criteria listed for State living arrangement A, E or G + is in State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH).

+ +

Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined in SI 01415.040G.1., Code A.4. This includes children under the age of 18 who are in Federal living arrangement + D because a private health insurance policy or a combination of Medicaid and a private + health insurance policy pays or is expected to pay over 50 percent of the cost of + care for that month. See SI 00520.011C.1.b, second and third bullets. Also included are individuals placed under the auspices + of the State adult foster care program and residents of publicly operated emergency + shelters throughout a month.

+ +

An individual living in a household where all members receive public income maintenance + payments unless they are paying at least two-thirds of the household expenses (A).

+ +

An individual living in a mixed household -- i.e., a household where one or more other + members receive a public income maintenance payment -- also is included unless the + individual is paying at least two-thirds of the household expenses (A).

+
+

C

+
+

Living in the Household of Another -- Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third.

+
+

E

+
+

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home.

+
+

F

+
+

Effective 7/1/87, the State elected Federal administration of this optional State + supplementary payment to residents of title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. This includes children under the age of 18 for + whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care + for that month.

+
+

G

+
+

Assisted Living -- Effective 7/1/94, the State elected Federal administration of this + variation. Includes an individual, certified by the State to be residing in an Assisted + Living residence served by a certified Group Adult Foster Care provider, who is not + receiving assistance under any other Federal or State rental assistance program, and + who pays a fixed, non-separable fee for rent and supportive services, other than medically + necessary services reimbursed by Medicaid. The State shall certify to SSA each individual + who is eligible for this optional supplement living arrangement. This living arrangement + was discontinued effective 1/1/96. However, it has been restored, retroactively, to + 1/1/97.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+
+
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify.

+
+
+

1For purposes of determining State living arrangements, a commercial boarding house, + foster home, or halfway house is not considered the person's household.

+

2Use the SSI definition of child, SI 00501.010.

+

3A public income maintenance payment is a payment from any of the following programs: + TANF, SSI, the Refugee Act of 1980, the Disaster Relief Act of 1974, general assistance + programs of the Bureau of Indian Affairs, State or local government income maintenance + programs that are based on need, or Department of Veterans Affairs benefits based + on need.

+
+
+
+
+

2. Coding and Monthly Payments Levels

+
+
+

The coding and monthly payment levels for Massachusetts effective 1/1/08 are shown + in the following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

637.00

+
+

128.82

+
+

765.82

+
+

 

+
+

 

+
+

Blind

+
+

637.00

+
+

149.74

+
+

786.74

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

114.39

+
+

751.39

+
+

 

+
+

B

+
+

Aged

+
+

637.00

+
+

39.26

+
+

676.26

+
+

 

+
+

 

+
+

Blind

+
+

637.00

+
+

149.74

+
+

786.74

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

30.40

+
+

667.40

+
+

 

+
+

E

+
+

Aged

+
+

637.00

+
+

293.00

+
+

930.00

+
+

 

+
+

 

+
+

Blind

+
+

637.00

+
+

149.74

+
+

786.74

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

293.00

+
+

930.00

+
+

 

+
+

G

+
+

Aged

+
+

637.00

+
+

454.00

+
+

1091.00

+
+

 

+
+

 

+
+

Blind

+
+

637.00

+
+

454.00

+
+

1091.00

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

454.00

+
+

1091.00

+
+

B

+
+

C

+
+

Aged

+
+

424.671

+
+

104.36

+
+

529.03

+
+

 

+
+

 

+
+

Blind

+
+

424.671

+
+

362.07

+
+

786.74

+
+

 

+
+

 

+
+

Disabled

+
+

424.671

+
+

87.58

+
+

512.25

+
+

C

+
+

A

+
+

Blind

+
+

637.00

+
+

149.74

+
+

786.74

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

114.39

+
+

751.39

+
+

 

+
+

B

+
+

Blind

+
+

637.00

+
+

149.74

+
+

786.74

+
+

 

+
+

 

+
+

Disabled

+
+

637.00

+
+

30.40

+
+

667.40

+
+

D

+
+

B2

+
+

Blind

+
+

30.003

+
+

149.74

+
+

179.74

+
+

 

+
+

 

+
+

Disabled

+
+

30.003

+
+

30.40

+
+

60.40

+
+

 

+
+

F

+
+

All

+
+

30.003

+
+

42.80

+
+

72.80

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

956.00

+
+

201.72

+
+

1157.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

956.00

+
+

617.48

+
+

1573.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

956.00

+
+

180.06

+
+

1136.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

956.00

+
+

406.60

+
+

1365.60

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

956.00

+
+

190.89

+
+

1146.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

956.00

+
+

398.77

+
+

1354.77

+
+

 

+
+

B

+
+

Aged/Aged

+
+

956.00

+
+

201.72

+
+

1157.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

956.00

+
+

617.48

+
+

1573.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

956.00

+
+

180.06

+
+

1136.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

956.00

+
+

406.60

+
+

1365.60

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

956.00

+
+

190.89

+
+

1146.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

956.00

+
+

398.77

+
+

1354.77

+
+

 

+
+

E

+
+

Aged/Aged

+
+

956.00

+
+

904.00

+
+

1860.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

956.00

+
+

617.48

+
+

1573.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

956.00

+
+

904.00

+
+

1860.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

956.00

+
+

760.74

+
+

1716.74

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

956.00

+
+

904.00

+
+

1860.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

956.00

+
+

760.74

+
+

1716.74

+
+

 

+
+

G

+
+

All

+
+

956.00

+
+

681.00

+
+

1637.00

+
+

B

+
+

C

+
+

Aged/Aged

+
+

637.341

+
+

215.80

+
+

853.14

+
+

 

+
+

 

+
+

Blind/Blind

+
+

637.341

+
+

936.14

+
+

1573.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

637.341

+
+

194.18

+
+

831.52

+
+

 

+
+

 

+
+

Aged/Blind

+
+

637.341

+
+

575.97

+
+

1213.31

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

637.341

+
+

204.99

+
+

842.33

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

637.341

+
+

565.16

+
+

1202.50

+
+

D

+
+

F

+
+

All

+
+

60.002

+
+

85.60

+
+

145.60

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

H. Description of Supplements - Michigan

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care.

+
+

E

+
+

Personal Care -- Recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged.

+
+

F

+
+

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care.

+
+

G

+
+

Independent Living with an EP -- Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.)

+
+

H

+
+

Living in the Household of Another with an EP --Recipients with an EP and living in + the household of another for Federal purposes. (Children under age 18 are excluded.)

+
+

I

+
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Recipients in title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under title XIX.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for Michigan effective 1/1/08 are shown in the + following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

637.00

+
+

87.00

+
+

724.00

+
+

 

+
+

E

+
+

All

+
+

637.00

+
+

157.50

+
+

794.50

+
+

 

+
+

F

+
+

All

+
+

637.00

+
+

179.30

+
+

816.30

+
+

 

+
+

G

+
+

All

+
+

956.002

+
+

14.00

+
+

970.00

+
+

B

+
+

H

+
+

All

+
+

637.341

+
+

9.33

+
+

646.67

+
+

D

+
+

I

+
+

All

+
+

 30.003

+
+

7.00

+
+

37.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

956.00

+
+

492.00

+
+

1448.00

+
+

 

+
+

E

+
+

All

+
+

956.00

+
+

633.00

+
+

1589.00

+
+

 

+
+

F

+
+

All

+
+

956.00

+
+

676.60

+
+

1632.60

+
+

 

+
+

G

+
+

All

+
+

1275.002

+
+

21.00

+
+

1296.00

+
+

B

+
+

H

+
+

All

+
+

850.00

+
+

14.00

+
+

864.00

+
+

D

+
+

I

+
+

All

+
+

60.003

+
+

14.00

+
+

74.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

I. Description of Supplements - Montana

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

G

+
+

State-Certified Personal Care

+
+

H

+
+

State-Certified Residence in Group Home for Mentally Disabled

+
+

I

+
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+
+

J

+
+

State-Certified Residence for Child and Adult Foster Care

+
+

K

+
+

State-Certified Transitional Living for Developmentally Disabled

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all individuals and couples not certified in State + codes G, H, I, J, or K.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for Montana effective 1/1/08 are shown in the + following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

637.00

+
+

94.00

+
+

731.00

+
+

 

+
+

H

+
+

All

+
+

637.00

+
+

94.00

+
+

731.00

+
+

 

+
+

I

+
+

All

+
+

637.00

+
+

94.00

+
+

731.00

+
+

 

+
+

J

+
+

All

+
+

637.00

+
+

52.75

+
+

689.75

+
+

 

+
+

K

+
+

All

+
+

637.00

+
+

26.00

+
+

663.00

+
+

 

+
+

Z

+
+

All

+
+

637.00

+
+

0.00

+
+

637.00

+
+

B

+
+

Z

+
+

All

+
+

424.671

+
+

0.00

+
+

424.67

+
+

C

+
+

Z

+
+

All

+
+

637.00

+
+

0.00

+
+

637.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

956.00

+
+

193.00

+
+

1149.00

+
+

 

+
+

H

+
+

All

+
+

956.00

+
+

193.00

+
+

1149.00

+
+

 

+
+

I

+
+

All

+
+

956.00

+
+

193.00

+
+

1149.00

+
+

 

+
+

J

+
+

All

+
+

956.00

+
+

110.50

+
+

1066.50

+
+

 

+
+

K

+
+

All

+
+

956.00

+
+

57.00

+
+

1013.00

+
+

 

+
+

Z

+
+

All

+
+

956.00

+
+

0.00

+
+

956.00

+
+

B

+
+

Z

+
+

All

+
+

637.341

+
+

0.00

+
+

637.34

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. Description of Supplements - Nevada

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living or Living in Parental Household -- Aged or blind eligible individual + or couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Live in their own household as defined for Federal living arrangement A purposes; + or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household.

    +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. (See SM01301.535.)

+
+

B

+
+

Living in the Household of Another -- Aged or blind eligible individual or couple + who is living in the household of another individual and receiving food and shelter from that individual. Aged or blind individuals or couples, who are subject + to a one-third reduction of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B.

+
+

C

+
+

Domiciliary Care -- Aged or blind eligible individual or couple who lives in a private + non-medical facility or, a residential facility serving 16 or fewer persons, which + provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor.

+ +

These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- No supplement cases include:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individuals or disabled members of eligible couples; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individuals or members of eligible couples in a medical facility where title + XIX pays more than 50 percent of the cost; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individuals or members of eligible couples who are patients in a private + medical facility which is not certified under title XIX; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    +
    +
    +
  8. +
+
+
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for Nevada effective 1/1/08 are shown in the + following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

637.00

+
+

36.40

+
+

673.40

+
+

 

+
+

 

+
+

Blind

+
+

637.00

+
+

109.30

+
+

746.30

+
+

 

+
+

C

+
+

Aged

+
+

637.00

+
+

391.00

+
+

1028.00

+
+

 

+
+

 

+
+

Blind

+
+

637.00

+
+

391.00

+
+

1028.00

+
+

 

+
+

Z

+
+

Disabled

+
+

637.00

+
+

0.00

+
+

637.00

+
+

B

+
+

B

+
+

Aged

+
+

424.671

+
+

24.27

+
+

448.94

+
+

 

+
+

 

+
+

Blind

+
+

424.671

+
+

213.96

+
+

638.63

+
+

 

+
+

Z

+
+

Disabled

+
+

424.671

+
+

0.00

+
+

424.67

+
+

C

+
+

A

+
+

Blind

+
+

637.00

+
+

109.30

+
+

746.30

+
+

 

+
+

Z

+
+

Disabled

+
+

637.00

+
+

0.00

+
+

637.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

956.00

+
+

74.46

+
+

1030.46

+
+

 

+
+

 

+
+

Blind/Blind

+
+

956.00

+
+

374.60

+
+

1330.60

+
+

 

+
+

 

+
+

Aged/Blind

+
+

956.00

+
+

224.53

+
+

1180.53

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

956.00

+
+

37.23

+
+

993.23

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

956.00

+
+

187.30

+
+

1143.30

+
+

 

+
+

C

+
+

Aged/Aged

+
+

956.00

+
+

881.00

+
+

1837.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

956.00

+
+

881.00

+
+

1837.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

956.00

+
+

881.00

+
+

1837.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

956.00

+
+

440.50

+
+

1396.50

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

956.00

+
+

440.50

+
+

1396.50

+
+

 

+
+

Z

+
+

Disabled

+
+

956.00

+
+

0.00

+
+

956.00

+
+

B

+
+

B

+
+

Aged/Aged

+
+

637.341

+
+

49.64

+
+

686.98

+
+

 

+
+

 

+
+

Blind/Blind

+
+

637.341

+
+

531.94

+
+

1169.28

+
+

 

+
+

 

+
+

Aged/Blind

+
+

637.341

+
+

290.79

+
+

928.13

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

637.341

+
+

24.82

+
+

662.16

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

637.341

+
+

265.97

+
+

903.31

+
+

 

+
+

Z

+
+

Disabled

+
+

637.341

+
+

0.00

+
+

637.34

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

K. Description of Supplements - New Jersey

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Congregate Care - Eligible individual/child/couple in Federal living arrangement (FLA) + A. The living arrangement includes the following: Recipients in residential facilities + who are under the supervision of the Department of Human Services: Children and adults + under the supervision of and/or placement by the NJ Department of Human Services’ + Division of Developmental Disabilities (DDD) or Division of Youth and Family Services + (DYFS) who are in residential facilities (both in and outside of NJ); and Recipients + in Assisted Living Residences and in Comprehensive Personal Care Homes licensed by + the Department of Health and Senior Services.

+
+

B

+
+

Living Alone or with Others -- Eligible individuals (including children) or eligible + couples whose Federal living arrangements are A or C and who do not meet the requirements + defined in other supplementation categories.

+ +

Therefore, any eligible adult/couple who meets the requirement for a Federal code + A will be in optional supplement B unless residing in a residential health care facility + or living alone with an ineligible spouse.

+ +

Likewise, any child meeting the criteria for a Federal code C will automatically be + entitled to optional supplement B.

+ +

This category includes, but is not limited to, those eligible adults/couples who are:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services.

    +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. (See SM 01301.535.)

+ +

This State code is also used to supplement Section 1619 cases.

+
+

C

+
+

Living Alone with an Ineligible Spouse -- Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse will receive the same total payment as an eligible + couple or an individual with an EP. Once other persons, even minor children, are present + in the household, this supplementary payment variation cannot exist. However, it is + possible that a claimant and his/her ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, an optional + supplement C is permissible as long as no other person is in their “household.” There + is no couple counterpart in this category.

+ +

Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B.

+ +

A transient individual who co-exists only with an ineligible spouse will also qualify + for the O/S - C rate.

+
+

D

+
+

Living in the Household of Another -- Persons who are “living in the household of + another” for Federal purposes.

+
+

I

+
+

Licensed Residential Health Care Facilities -- Attached to a nursing home; Assisted + Living Residence; Comprehensive Personal Care Home; or “free standing”. Prior to January + 1, 2006 residents of these facilities were paid at the OS “A” rate.

+ +

Authorization to make this payment is based on the recipient's residence at a facility + listed in the New Jersey + Congregate Care Directory.

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. + Residents of the ALR or CPCH section of a multipurpose facility are paid at the OS + “A” rate. Nursing home residents are D/G if Medicaid pays more than 50% of the cost + of care.

+
+

G

+
+

Effective 9/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Individuals and couples in licensed medical facilities where + Medicaid is paying less than 50 percent of the cost of care, individuals and couples + in publicly operated community residences having 16 or less residents, and residents + of publicly operated emergency shelters throughout a month.

+ +

It also includes cases that were FLA D prior to January 1988 or effective 12/1/96 + children under age 18 residing in certain public or private facilities receiving payment + for their care under any health insurance policy issued by a private provider (SI 00520.011).

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payments levels for New Jersey effective 1/1/08 are shown in + the following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

637.00

+
+

150.05

+
+

787.05

+
+

 

+
+

B

+
+

All

+
+

637.00

+
+

31.25

+
+

668.25

+
+

 

+
+

C

+
+

Individual

+
+

637.00

+
+

344.36

+
+

981.36

+
+

 

+
+

 

+
+

w/EP

+
+

956.00

+
+

25.36

+
+

981.36

+
+

 

+
+

I

+
+

All

+
+

637.00

+
+

210.05

+
+

847.05

+
+

 

+
+

Z

+
+

All

+
+

637.00

+
+

0.00

+
+

637.00

+
+

B

+
+

D

+
+

All

+
+

424.671

+
+

44.31

+
+

468.98

+
+

C

+
+

B

+
+

All

+
+

637.00

+
+

31.25

+
+

668.25

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

10.00

+
+

40.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

956.00

+
+

599.36

+
+

1555.36

+
+

 

+
+

B

+
+

All

+
+

956.00

+
+

25.36

+
+

981.36

+
+

 

+
+

I

+
+

All

+
+

956.00

+
+

719.36

+
+

1675.36

+
+

 

+
+

Z

+
+

All

+
+

956.00

+
+

  0.00

+
+

956.00

+
+

B

+
+

D

+
+

All

+
+

637.341

+
+

93.09

+
+

730.43

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

20.00

+
+

80.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

L. Description of Supplements - New York

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone -- Eligible individuals or eligible couples who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Live physically alone.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Pay a fixed, pre-established flat fee for both room and board in a commercial establishment.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives with others but takes all meals outside the dwelling.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Live with others but separately prepares or has someone separately prepare their food. + Occasional preparation of meals in common will not preclude a finding of separate + preparation.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Receive a fixed, pre-established flat fee for room and board from all others in the dwelling.

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Live with only a foster child, or a homemaker authorized by the local department of + social services (DSS), or a family care recipient placed by: the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabilities (OMRDD) + or local DSS.

    +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    Have no permanent living arrangement (i.e., transient or street person) and is not + with a spouse or a child for whom they have primary responsibility.

    +
    +
    +
  14. +
+
+

B

+
+

Living with Others -- Individual/child/couple who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Resides in a dwelling with others and prepares food in common with at least one other + person in the dwelling.

    + +
    +
    +

    NOTE: An individual living with an ineligible spouse must be considered living with others + despite any separate preparation. The same is true if an individual/couple lives with + a child for whom he/she has primary responsibility (except if the child is a foster + child).

    +
    +
    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a child who does not meet the criteria for OSS C or OSS D (below).

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a religious community and room and/or board are provided in full or in part + by the religious community.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Has no permanent living arrangement (i.e., transient or street person), but is with + an ineligible spouse or child for whom they have primary responsibility.

    +
    +
    +
  8. +
+
+

C

+
+

Congregate Care Level I –

+ +
    +
  1. +
    +
    1. 
    +
    +

    Individual/couple/child has been placed in a family type home certified by NYS Office + of Children and Family Services and supervised by a local DSS.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Individual/couple/child has been placed in a family care home certified by OMH/OMRDD.

    +
    +
    +
  4. +
+
+

D

+
+

Congregate Care Level II – Payable to an eligible individual/couple/child who is a + resident of a licensed level 2 care facility. These consist of facilities, which provide + supportive living environments and include: Residences for Adults certified by the + NYS Department of Health; Privately operated facilities certified by the NYS OMH; + Privately-operated facilities certified by the NYS OMH and OMRDD; and Privately-operated + facilities certified by OASAS.

+
+

E

+
+

Congregate Care Level III -- Enhanced Residential Care

+ +

Payable to an eligible individual/couple who is a resident of a licensed level 3 care + facility which includes: Adult Homes and Enriched Housing programs certified by the + NYS Department of Health or Schools for the Mentally Retarded certified by the NYS + Office of Mental Retardation and Developmental Disabilities. Schools for the Mentally + Retarded usually meet the basic Federal definition of institution and consist of residential + facilities that provide academic, vocational, recreational and social skills programs. + Although sometimes called schools, they often do not meet the Federal definition of + schools.

+ +
+
+

NOTE - A child residing in a Level 3 facility cannot receive OSS E; he/she will receive + OSS B.

+
+
+
+

F

+
+

Living in the Household of Another -- Payable to recipients who are FLA B.

+
+

G

+
+

Effective 1/1/88, the State elected Federal administration of an optional State supplementary + payment to residents of title XIX facilities. Federal administration was terminated + effective 9/30/03. State began administering this payment 10/1/03.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases – Includes Eligible individual/couple in FLA A or B who:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Is in a licensed medical facility where Medicaid is paying less than 50% of the cost + of care; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is in a publicly operated community residence which serves 16 or fewer residents; + or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is in a publicly operated emergency shelter (PESH); or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Qualifies under the special provision in SI 00520.130 (1619 eligible goes into medical institution).

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 10/1/03 eligible individual/couple in FLA D and also cases that were FLA + D prior to January 1988.

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Effective 12/1/96, children under age 18 residing in certain public or private facilities + receiving payment for their care under any health insurance policy issued by a private + provider (SI 00520.011).

    +
    +
    +
  12. +
+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for New York effective 1/1/08 are shown in the + following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

637.00

+
+

87.00

+
+

724.00

+
+

 

+
+

B

+
+

All

+
+

637.00

+
+

23.00

+
+

660.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

637.00

+
+

266.48

+
+

903.48

+
+

 

+
+

 

+
+

All other counties

+
+

637.00

+
+

228.48

+
+

865.48

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

637.00

+
+

435.00

+
+

1072.00

+
+

 

+
+

 

+
+

All other counties

+
+

637.00

+
+

405.00

+
+

1042.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

637.00

+
+

656.00

+
+

1293.00

+
+

 

+
+

 

+
+

All other counties

+
+

637.00

+
+

656.00

+
+

1293.00

+
+

 

+
+

Z

+
+

All

+
+

637.00

+
+

  0.00

+
+

637.00

+
+

B

+
+

F

+
+

All

+
+

424.672

+
+

23.00

+
+

447.67

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

0.004

+
+

30.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 1/1/07.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

4New York administers a supplement of $20 to some recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

956.00

+
+

104.00

+
+

1060.00

+
+

 

+
+

B

+
+

All

+
+

956.00

+
+

46.00

+
+

1002.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

956.00

+
+

850.96

+
+

1806.96

+
+

 

+
+

 

+
+

All other counties

+
+

956.00

+
+

774.96

+
+

1730.96

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

956.00

+
+

1188.00

+
+

2144.00

+
+

 

+
+

 

+
+

All other counties

+
+

956.00

+
+

1128.00

+
+

2084.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

956.00

+
+

1630.00

+
+

2586.00

+
+

 

+
+

 

+
+

All other counties

+
+

956.00

+
+

1630.00

+
+

2586.00

+
+

 

+
+

Z

+
+

All

+
+

956.00

+
+

0.00

+
+

956.00

+
+

B

+
+

F

+
+

All

+
+

637.342

+
+

46.00

+
+

683.34

+
+

D

+
+

G

+
+

All

+
+

60.003

+
+

0.004

+
+

60.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 1/1/07.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

4New York administers a supplement of $20 to some recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

M. Description of Supplements - Pennsylvania

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

C

+
+

Living with an EP -- Recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules.

+
+

D

+
+

Living in the Household of Another with an EP -- Recipients who live in the household + of another and who have one or more EP’s as defined under the Federal rules.

+
+

G

+
+

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

H

+
+

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all recipients who are residing in a medical facility + in which title XIX is paying more than 50 percent of the cost of care and recipients + in FLA-A or FLA-B who receive a State-administered supplement.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for Pennsylvania effective 1/1/08 are shown + in the following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

Z

+
+

All

+
+

637.00

+
+

0.00

+
+

637.00

+
+

 

+
+

C

+
+

All

+
+

956.001

+
+

43.70

+
+

999.70

+
+

 

+
+

G

+
+

All

+
+

637.00

+
+

434.30

+
+

1071.30

+
+

 

+
+

H

+
+

All

+
+

637.00

+
+

439.30

+
+

1076.30

+
+

B

+
+

Z

+
+

All

+
+

424.672

+
+

0.00

+
+

424.67

+
+

 

+
+

D

+
+

All

+
+

637.343

+
+

43.70

+
+

681.04

+
+

C

+
+

Z

+
+

All

+
+

637.00

+
+

0.00

+
+

637.00

+
+

D

+
+

Z

+
+

All

+
+

30.004

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

956.00

+
+

0.00

+
+

956.00

+
+

 

+
+

C

+
+

All

+
+

1275.001

+
+

68.05

+
+

1343.05

+
+

 

+
+

G

+
+

All

+
+

956.00

+
+

947.40

+
+

1903.40

+
+

 

+
+

H

+
+

All

+
+

956.00

+
+

957.40

+
+

1913.40

+
+

B

+
+

B

+
+

All

+
+

637.342

+
+

0.00

+
+

637.34

+
+

 

+
+

D

+
+

All

+
+

850.00

+
+

68.05

+
+

918.05

+
+

D

+
+

Z

+
+

All

+
+

60.004

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

N. Description of Supplements - Rhode Island

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living -- Recipients who are in Federal codes A and C, except for individuals + residing in a residential care/assisted living facility who have been certified as + eligible for State Code D. This includes children under the age of 18 who are in Federal + living arrangement D because a private health insurance policy or a combination of + Medicaid and a private health insurance policy pays or is expected to pay over 50 + percent of the cost of care for that month. See SI 00520.011C.1.b., second and third bullets.

+ +

Recipients residing in a public emergency shelter for the homeless and those who are + eligible for Section 1619 are included in this category.

+
+

B

+
+

Living in the Household of Another -- Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied.

+
+

D

+
+

Residential Care/Assisted Living -- This category applies to individuals only.

+
+

E

+
+

The State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 3/1/91). This includes children under + the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of + the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for Rhode Island effective 1/1/08 are shown + in the following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A1

+
+

All

+
+

637.00

+
+

57.35

+
+

694.35

+
+

 

+
+

D

+
+

All

+
+

637.00

+
+

575.00

+
+

1212.00

+
+

B

+
+

B1

+
+

All

+
+

424.672

+
+

69.94

+
+

494.61

+
+

C

+
+

A1

+
+

All

+
+

637.00

+
+

57.35

+
+

694.35

+
+

D

+
+

A3

+
+

Children Private Insurance

+
+

30.004

+
+

57.35

+
+

87.35

+
+

 

+
+

E

+
+

All

+
+

30.004

+
+

20.00

+
+

50.00

+
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3State OS Code A applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

4Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A1

+
+

All

+
+

956.00

+
+

108.50

+
+

1064.50

+
+

B

+
+

B1

+
+

All

+
+

637.342

+
+

128.50

+
+

765.84

+
+

D

+
+

E

+
+

All

+
+

60.003

+
+

40.00

+
+

100.00

+
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+ +
+
+

O. Description of Supplements - Utah

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone or With Others -- This variation includes recipients who are in Federal + codes A and C.

+
+

B

+
+

Living in the Household of Another -- Recipients with no EP who are “living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.)

+
+

Z

+
+

No Supplement Cases -- No supplement cases include all recipients who are not included + in A or B.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for Utah effective 1/1/08 are shown in the following + charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Level

+
+

A,C

+
+

Z

+
+

All

+
+

637.00

+
+

0.00

+
+

637.00

+
+

B

+
+

B

+
+

All

+
+

424.672

+
+

3.13

+
+

427.80

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement
Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

956.00

+
+

4.60

+
+

960.60

+
+

B

+
+

B

+
+

All

+
+

637.342

+
+

9.73

+
+

647.07

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+
+
+ +
+
+

P. Description of Supplements - Vermont

+
+
+
+
+

1. Definitions of State Living Arrangement Variations

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living (except Chittenden County) -- Recipients not living in the household + of another and not in a residential or custodial care situation. This includes a child + who is living with a parent and recipients residing in a private title XIX facility + where Medicaid is not paying more than 50 percent of the cost of care. It includes + children under the age of 18 who are in Federal living arrangement D because a private + health insurance policy or a combination of Medicaid and a private health insurance + policy pays or is expected to pay over 50 percent of the cost of care for that month. + See SI 00520.011C.1.b., second and third bullets.

+ +

An individual or eligible couple residing in a publicly operated emergency shelter + throughout a month.

+
+

B

+
+

Independent Living in Chittenden County -- Same as Code A above except restricted + to residents of Chittenden County.

+
+

C

+
+

Licensed Residential Care Home or Assisted Living Residence with Assistive Community + Care Services (Level III) -- Recipients residing in Level III facilities identified + by the State. Refer to the Vermont Community Care Facilities (OS C and G) list on + BOSNet to determine if a residence meets the requirements for Optional Supplement + C.

+
+

E

+
+

Living in the Household of Another -- Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions).

+
+

G

+
+

Licensed Residential Care Home or Therapeutic Community Residence (Level IV) -- Recipients + residing in Level IV facilities identified by the State. Refer to the Vermont Community + Care Facilities (OS C and G) list on BOSNET to determine if a residence meets the + requirements for Optional Supplement G.

+
+

H

+
+

Custodial Care: Family Home -- Recipients living in another's home in such a manner + that the individual or couple is paying room and board and is receiving one or more + of the services outlined under the custodial care definition. The individual or couple + must also receive the room and board and custodial care in the home in which he/she + (they) reside. In order to qualify as a home under this arrangement, these services + must not be provided to more than two persons and must be provided by a resident of + the home.

+ +

In some cases the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of L/A H. To qualify + these programs must meet the requirements stated above.

+ +

Custodial + care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service 2-3 times a week) and/or + supervision for the recipient's protection. Supervision for the recipient's protection + deals primarily with protection services for retarded and emotionally disturbed individuals. + A person who receives one or more of these personal services is receiving custodial + care.

+
+

I

+
+

Effective 7/1/87, the State elected Federal administration of an optional State supplementary + payment to residents in title XIX facilities. This includes children under the age + of 18 for whom Medicaid alone pays or is expected to pay over 50 percent of the cost + of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+
+
+
+
+
+

2. Coding and Monthly Payment Levels

+
+
+

The coding and monthly payment levels for Vermont effective 1/1/08 are shown in the + following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County)

+
+

637.00

+
+

52.04

+
+

689.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

637.00

+
+

52.04

+
+

689.04

+
+

 

+
+

C

+
+

All

+
+

637.00

+
+

48.38

+
+

685.38

+
+

 

+
+

G

+
+

All

+
+

637.00

+
+

223.94

+
+

860.94

+
+

 

+
+

H

+
+

All

+
+

637.00

+
+

98.69

+
+

735.69

+
+

B

+
+

E

+
+

All

+
+

424.671

+
+

39.30

+
+

463.97

+
+

C

+
+

A

+
+

All (Except Chittenden County)

+
+

637.00

+
+

52.04

+
+

689.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

637.00

+
+

52.04

+
+

689.04

+
+

D

+
+

A or B2

+
+

Children Private Insurance

+
+

30.003

+
+

52.04

+
+

82.04

+
+

 

+
+

I

+
+

All

+
+

30.003

+
+

17.66

+
+

47.66

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County

+
+

956.00

+
+

98.88

+
+

1054.88

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County

+
+

956.00

+
+

98.88

+
+

1054.88

+
+

 

+
+

C

+
+

All

+
+

956.00

+
+

96.77

+
+

1052.77

+
+

 

+
+

G

+
+

All

+
+

956.00

+
+

562.06

+
+

1518.06

+
+

 

+
+

H

+
+

All

+
+

956.00

+
+

332.82

+
+

1288.82

+
+

B

+
+

E

+
+

All

+
+

637.341

+
+

48.31

+
+

685.65

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

35.33

+
+

95.33

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a title XIX institution.

+
+
+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415040
SI 01415.040 - Federally Administered Optional Supplementary Payment Programs – 1/08 Payment Levels - 01/17/2008
+Batch run: 05/27/2026
+Rev:01/17/2008
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html new file mode 100644 index 00000000..c9a10a17 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2009.html @@ -0,0 +1,15062 @@ + + +SSA - POMS: SI 01415.041 - Federally Administered Optional Supplementary Payment Programs for 01/09 Payment Levels - 08/07/2009 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 82 (08-24)

+

SI 01415.041 Federally Administered Optional Supplementary Payment Programs for 01/09 Payment Levels

+ + +

CITATIONS: Social Security Act as amended in 1973, Section 1616; Social Security Amendments of 1972, Section 301; Public Law 93-66, Section 212

+ +
+
+

A. Background

+
+
+

The following states are participating in the federally Administered Optional Supplementary + Payment Programs:

+

 

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+
+

Reference

+
+

California

+
+

SI 01415.041B

+
+

Delaware

+
+

SI 01415.041C

+
+

District Of Columbia

+
+

SI 01415.041D

+
+

Hawaii

+
+

SI 01415.041E

+
+

Iowa

+
+

SI 01415.041F

+
+

Massachusetts

+
+

SI 01415.041G

+
+

Michigan

+
+

SI 01415.041H

+
+

Montana

+
+

SI 01415.041I

+
+

Nevada

+
+

SI 01415.041J

+
+

New Jersey

+
+

SI 01415.041K

+
+

New York

+
+

SI 01415.041L

+
+

Pennsylvania

+
+

SI 01415.041M

+
+

Rhode Island

+
+

SI 01415.041N

+
+

Utah

+
+

SI 01415.041O

+
+

Vermont

+
+

SI 01415.041P

+
+
+

 

+
+
+ +
+
+

B. Description of supplements for California

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living with Cooking Facilities for an Eligible individual or couple who + meets one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and has cooking and food storage facilities or is provided meals as part of the living + arrangement;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent, or parents, or + is a disabled child age 18, or over who meets sharing criteria and is living in the + household of a parent or parents;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a private medical facility licensed by the State but not certified under + Title XIX.

    +
    +
    +
  10. +
+
+

B

+
+

Non-medical Out-of-Home Care (NMOHC) applies when an individual or couple needs non-medical + care or supervision in the following living arrangement situations:

+ +

 

+ +

CHILDREN (UNDER AGE 18)

+ +
    +
  1. +
    +
    a. 
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative; or

    +
    +
    +
  8. +
  9. +
    +
    e. 
    +
    +

    Disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

    +
    +
    +
  10. +
  11. +
    +
    f. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or

    +
    +
    +
  12. +
+ +

 

+ +

ADULTS (AGE 18 AND OVER)

+ +
    +
  1. +
    +
    a. 
    +
    +

    Aged, blind or disabled individual or couple has been determined to be in FLA A and + resides in the home of a relative, legal conservator or guardian; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Aged, blind, or disabled individual or couple is determined to be in FLA A and resides + in a State licensed NMOHC facility.

    +
    +
    +
  4. +
+ +

 

+ +

For California optional supplement (OS) purposes, a relative is defined as a parent, + child, silbling, half-sibling, parent's sibling, child's sibling, first cousin, or + any person of the preceding generation denoted by the prefix “grand” or “great.”

+
+

C

+
+

Independent Living Without Cooking Facilities -- Aged or disabled individual or couple + who is neither provided any meals, nor has access to adequate cooking or food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C.

+ +

An individual or couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Immediate living quarters do not have cooking and food storage facilities with which + the individual or couple or another person (who is responsible for preparing their + meals) can prepare meals on a daily basis.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis).

    +
    +
    +
  10. +
+ +

“Adequate” cooking and food storage facilities exist when an individual or couple + has access to:

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls that + are used for warming food are not considered adequate cooking facilities.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature control.

    +
    +
    +
  • +
+ +

Eligibility for OS C begins in the month the recipient applies for this supplement + rate provided they have been without cooking and food storage facilities throughout + the month.

+ +
+
+

NOTE: For purposes of OS C, “throughout a month” does not mean the recipient must lack adequate cooking or food storage facilities from the + very first moment of the month. The recipient need only lack them from some time on + the first day of the month.

+
+
+ +

If eligibility is based on temporary loss or non-functioning of an appliance, advise + the individual of their responsibility to report immediately when the temporary condition + has ceased. If the individual provides an expected date when the appliance will be + replaced or repaired, diary the case for re-contact.

+ +

Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available.

+
+

 

+
+

For a couple, comprised of an aged or disabled individual and a blind individual, + whose living arrangement lacks adequate cooking and storage facilities, the couple + is to receive the Supplemental Security Income and State Supplement Payment level + for a blind or aged or disabled couple plus the restaurant meals allowance for the + disabled member of the couple. Force payment in this living arrangement is required.

+
+

D

+
+

Living in the Household of Another -- Eligible individual or couple is living in the + household of another and is receiving food and shelter from that individual. Most individuals or couples who are subject to a one-third + reduction of their Federal SSI payments are eligible for OS D because the criteria + for this supplement level are the same as for charging the one-third reduction. However, + when the eligible individual or couple lives in the home of a relative (other than + a spouse) and needs care and supervision, certification for non-medical out-of-home + care (OS F) should be obtained from the county welfare office since this is the highest + categorical supplement for which an individual or couple can qualify.

+
+

E

+
+

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage.

+ +

NOTE: Only FLA A and C are compatible with OS E. If the VTR applies, see code G.

+
+

F

+
+

Non-medical Out-of-Home Care Living in the Household of Another -- Applies whenever + an eligible individual or couple meets the criteria for the non-medical out-of-home + care payment rate, and is determined to receive the Federal code B payment for living + in the household of another. For the One-Third Reduction Provision see SI 00835.200.

+
+

G

+
+

Disabled Child Under Age 18 Living in the Household of Another -- Applies to a disabled + (not blind) child under age 18, who resides with a parent or relative by blood or + marriage, and is determined to receive the Federal code B payment for living in the household of + another individual. For the One-Third Reduction Provision see SI 00835.200.

+
+

J

+
+

Residents of Title XIX facilities.

+ +

This State code is also used to supplement Section 1619 cases.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible recipient who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where Title XIX pays more than 50 percent of the costs; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under Title XIX and not licensed + by the State.

    +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify.

+
+
+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for California effective 07/01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

176.00

+
+

850.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

239.00

+
+

913.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

176.00

+
+

850.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

412.00

+
+

1,086.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

260.00

+
+

934.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

260.00

+
+

934.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

65.00

+
+

739.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

Aged

+
+

449.341

+
+

194.18

+
+

643.52

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

273.32

+
+

722.66

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

194.18

+
+

643.52

+
+

 

+
+

F

+
+

All

+
+

449.341

+
+

407.00

+
+

856.34

+
+

 

+
+

G

+
+

Disabled

+
+

449.341

+
+

71.08

+
+

520.42

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

239.00

+
+

913.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

65.00

+
+

739.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

478.00

+
+

1489.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

700.00

+
+

1711.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

478.00

+
+

1489.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

617.00

+
+

1628.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

478.00

+
+

1489.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

617.00

+
+

1628.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1161.00

+
+

2172.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

646.00

+
+

1657.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

646.00

+
+

1657.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

646.00

+
+

1657.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

674.001

+
+

530.64

+
+

1204.64

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

752.42

+
+

1426.42

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

530.64

+
+

1204.64

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

668.40

+
+

1342.40

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

530.64

+
+

1204.64

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

668.40

+
+

1342.40

+
+

 

+
+

F

+
+

All

+
+

674.001

+
+

1045.66

+
+

1719.66

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+

3. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for California effective 05/01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

196.00

+
+

870.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

261.00

+
+

935.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

196.00

+
+

870.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

412.00

+
+

1,086.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

280.00

+
+

954.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

280.00

+
+

954.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

82.00

+
+

756.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

Aged

+
+

449.341

+
+

209.33

+
+

658.67

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

290.33

+
+

739.67

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

209.33

+
+

658.67

+
+

 

+
+

F

+
+

All

+
+

449.341

+
+

407.00

+
+

856.34

+
+

 

+
+

G

+
+

Disabled

+
+

449.341

+
+

83.33

+
+

532.67

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

261.00

+
+

935.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

82.00

+
+

756.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

513.00

+
+

1524.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

740.00

+
+

1751.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

513.00

+
+

1524.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

655.00

+
+

1666.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

513.00

+
+

1524.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

655.00

+
+

1666.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1161.00

+
+

2172.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

681.00

+
+

1692.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

681.00

+
+

1692.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

681.00

+
+

1692.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

674.001

+
+

559.00

+
+

1233.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

786.00

+
+

1460.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

559.00

+
+

1233.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

700.00

+
+

1374.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

559.00

+
+

1233.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

700.00

+
+

1374.00

+
+

 

+
+

F

+
+

All

+
+

674.001

+
+

1045.66

+
+

1719.66

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+

4. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for California effective 01/01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

233.00

+
+

907.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

298.00

+
+

972.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

233.00

+
+

907.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

412.00

+
+

1,086.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

317.00

+
+

991.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

317.00

+
+

991.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

119.00

+
+

793.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

Aged

+
+

449.341

+
+

234.00

+
+

633.34

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

315.00

+
+

764.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

234.00

+
+

683.34

+
+

 

+
+

F

+
+

All

+
+

449.341

+
+

407.00

+
+

856.34

+
+

 

+
+

G

+
+

Disabled

+
+

449.341

+
+

108.00

+
+

557.34

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

298.00

+
+

972.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

119.00

+
+

793.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

568.00

+
+

1579.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

795.00

+
+

1806.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

568.00

+
+

1579.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

710.00

+
+

1721.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

568.00

+
+

1579.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

710.00

+
+

1721.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1161.00

+
+

2172.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

736.00

+
+

1747.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

736.00

+
+

1747.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

736.00

+
+

1747.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

674.001

+
+

595.66

+
+

1269.66

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

822.66

+
+

1496.66

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

595.66

+
+

1269.66

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

736.66

+
+

1410.66

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

595.66

+
+

1269.66

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

736.66

+
+

1410.66

+
+

 

+
+

F

+
+

All

+
+

674.001

+
+

1045.66

+
+

1719.66

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of supplements - Delaware

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + -- Only living arrangement variation in Delaware and includes only those recipients + who are certified by the State medical unit as residents of one of the above adult + facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A or Y.

+ +

Optional supplementation code Z is the proper code to be used with an “intervening” + Federal code A. For Optional State Supplement codes see SM 01301.535

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payments levels for Delaware effective 01/01/09 are shown in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total
Payment Levels

+
+

A

+
+

A

+
+

All

+
+

674.00

+
+

140.00

+
+

814.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

448.00

+
+

1459.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. Description of supplements - District of Columbia

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by + the District of Columbia, Department of Health, as residents of an adult foster care + home with 50 or fewer residents.

+
+

B

+
+

Adult Foster Care Home with More than 50 Residents --Recipients who are certified + by the District of Columbia, Department of Health, as residents of an adult foster + care home with more than 50 residents.

+
+

G

+
+

Residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for the District of Columbia effective 01/01/09 + are shown in the following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

674.00

+
+

485.00

+
+

1159.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

595.00

+
+

1269.00

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

G

+
+

All

+
+

30.002

+
+

40.00

+
+

70.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Code

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

1307.00

+
+

2318.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1527.00

+
+

2538.00

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

80.00

+
+

140.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

E. Description of supplements - Hawaii

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

B

+
+

Living in a Community Care or Foster Care Home --

+ +

Persons eligible for SSI and who are both over age 18 and live in a State approved + Care or Foster Care Home.

+
+

D

+
+

Living in a Certified Medical Facility – Eligible individual living in a medical treatment + facility where a substantial part (more than 50 percent) of the cost of care is paid + under Title XIX.

+
+

H

+
+

Domiciliary Care I -- (Maximum of five residents) - Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities.

+
+

I

+
+

Domiciliary Care II -- Same as H except care is provided for six or more residents.

+
+

Y

+
+

Optional Supplementation Waived -- Eligible for, but have waived their right to receive + an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible recipient who is living in the household of another + (see explanation in definition for optional supplement B) and an eligible recipient + who is a patient in a private medical facility which is not certified under Title + XIX.

+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Hawaii effective 01/01/09 are shown in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A 

+
+

B

+
+

All

+
+

674.00

+
+

651.90

+
+

1325.90

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

651.90

+
+

1325.90

+
+

 

+
+

I

+
+

All

+
+

674.00

+
+

759.90

+
+

1433.90

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

D

+
+

D

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

B

+
+

All

+
+

1011.00

+
+

1640.80

+
+

2651.80

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

1640.80

+
+

2651.80

+
+

 

+
+

I

+
+

All

+
+

1011.00

+
+

1856.80

+
+

2867.80

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

D

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. Description of supplements - Iowa

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living in Own Household (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, does not have an + Essential Person (EP), and is not otherwise excepted from supplementation. Also included + are blind recipients in Title XIX facilities where Medicaid pays 50 percent or less of the cost + of care. Optional supplement code A is also compatible with Federal codes A and C.

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. For State Supplement codes see SM 01301.535.

+
+

B

+
+

Living in the Household of Another (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation.

+
+

H

+
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services.

+ +

The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement.

+
+

I

+
+

Living in a Family Life or Boarding Home -- Eligible individual or each member of + an eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services.

+
+

G

+
+

Used to indicate that no supplement is payable to a recipient living in a Title XIX + facility and Title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under Title XIX or all recipients whose Federal payments + are reduced to $30 or $60 due to living in a Title XIX facility. In addition, aged + and disabled recipients whose Federal payments are not reduced and who live in a Title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement.

+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs -- In-Home Health Related Care; Residential Care and Supplement for Medicare + and Medicaid Eligibles.

+
+
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+
+
+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid.

+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Iowa effective 01/01/09 are shown in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind

+
+

674.00

+
+

22.00

+
+

696.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

366.00

+
+

1040.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

344.00

+
+

1018.00

+
+

 

+
+

D

+
+

Aged

+
+

674.00

+
+

142.00

+
+

816.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

164.00

+
+

838.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

142.00

+
+

816.00

+
+

 

+
+

Z

+
+

Aged

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

B

+
+

Blind

+
+

449.341

+
+

22.00

+
+

471.34

+
+

 

+
+

H3

+
+

Aged

+
+

449.341

+
+

344.00

+
+

793.34

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

366.00

+
+

815.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

344.00

+
+

793.34

+
+

 

+
+

I3

+
+

Aged

+
+

449.341

+
+

142.00

+
+

591.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.34

+
+

142.00

+
+

591.34

+
+

 

+
+

 

+
+

Blind

+
+

449.34

+
+

164.00

+
+

613.34

+
+

 

+
+

Z

+
+

Aged

+
+

449.341

+
+

0.00

+
+

449.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

22.00

+
+

696.00

+
+

 

+
+

C

+
+

Blind

+
+

674.00

+
+

366.00

+
+

1040.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

344.00

+
+

1018.00

+
+

 

+
+

Z

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE:

+

State-administered programs: For Calendar Year 2009:

+
    +
  • +
    +
    •
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total
Payment Levels

+
+

A

+
+

A

+
+

Blind/Blind

+
+

1011.00

+
+

44.00

+
+

1055.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

1011.00

+
+

22.00

+
+

1033.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

22.00

+
+

1033.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

344.00

+
+

1355.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

388.00

+
+

1399.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

344.00

+
+

1355.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

366.00

+
+

1377.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

344.00

+
+

1355.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

366.00

+
+

1377.00

+
+

 

+
+

D

+
+

Aged/Aged

+
+

1011.00

+
+

641.00

+
+

1652.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

685.00

+
+

1696.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

641.00

+
+

1652.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

663.00

+
+

1674.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

641.00

+
+

1652.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

663.00

+
+

1674.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

B

+
+

Blind/Blind

+
+

674.001

+
+

44.00

+
+

718.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

674.001

+
+

22.00

+
+

696.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

22.00

+
+

696.00

+
+

 

+
+

H

+
+

Aged/Aged

+
+

674.001

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

388.00

+
+

1062.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

366.00

+
+

1040.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

366.00

+
+

1040.00

+
+

 

+
+

I

+
+

Aged/Aged

+
+

674.001

+
+

641.00

+
+

1315.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

685.00

+
+

1359.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

641.00

+
+

1315.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

663.00

+
+

1337.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

641.00

+
+

1315.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

663.00

+
+

1337.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

674.001

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE:

+

State-administered programs: For Calendar Year 2009:

+
    +
  • +
    +
    •
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. (Members of a couple are treated + as individuals.)

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements - Massachusetts

+
+
+
    +
  1. +
    +
    1. 
    +
    +

    Definitions of State living arrangement variations

    +
    +
    +
  2. +
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Full Cost-of-Living:

+ +

An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and meets one of the following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences are considered living + alone provided they do not use the residential kitchen facilities for preparing meals;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living only with their eligible spouse;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living with their eligible spouse and ineligible child or children 2 none of whom (children) receive public income maintenance payments;3 or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Living only with their ineligible spouse or their ineligible child or children, none + of whom (spouse and children) receive public income maintenance payments.

    +
    +
    +
  8. +
+ +

NOTE: For purposes of 1 through 4, foster children placed with anyone other than their + parents are not considered to be living with the foster parent.

+
​ +

An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments.

+ +

An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in SI 01415.040G.1. (See Code A, 1 or 2 (in this chart)) is in State living arrangement A if they pay + at least two-thirds of the household expenses. In making a determination as to whether + the individual pays two-thirds or more of the expenses, use the method defined in + SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses.

+ +

A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. + Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. For Optional State Supplement codes see SM 01301.535.

+
+

B

+
+

Shared Living Expenses -- An individual who is in Federal living arrangement A or + C and who does not meet the criteria listed for State living arrangement A, E or G + is in State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH).

+ +

Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined in SI 01415.040G.1., Code A.4. This includes children under the age of 18 who are in Federal living arrangement + D because a private health insurance policy or a combination of Medicaid and a private + health insurance policy pays or is expected to pay over 50 percent of the cost of + care for that month. For determination of applicability of $30 payment limit see second + and third bullets in SI 00520.011C.1.b. Also included are individuals placed under the auspices of the State adult foster + care program and residents of publicly operated emergency shelters throughout a month.

+ +

An individual living in a household where all members receive public income maintenance + payments unless they are paying at least two-thirds of the household expenses (A).

+ +

An individual living in a mixed household -- i.e., a household where one or more other + members receive a public income maintenance payment -- also is included unless the + individual is paying at least two-thirds of the household expenses (A).

+
+

C

+
+

Living in the Household of Another -- Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third.

+
+

E

+
+

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home.

+
+

F

+
+

Effective 07/01/87, the State elected Federal administration of this optional State + supplementary payment to residents of Title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. This includes children under the age of 18 for + whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care + for that month.

+
+

G

+
+

Assisted Living -- Effective 07/01/94, the State elected Federal administration of + this variation. Includes an individual, certified by the State to be residing in an + Assisted Living residence served by a certified Group Adult Foster Care provider, + who is not receiving assistance under any other Federal or State rental assistance + program, and who pays a fixed, non-separable fee for rent and supportive services, + other than medically necessary services reimbursed by Medicaid. The State shall certify + to SSA each individual who is eligible for this optional supplement living arrangement. + This living arrangement was discontinued effective 01/01/96. However, it has been + restored, retroactively, to 01/01/97.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+
+
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify.

+
+
+

1For purposes of determining State living arrangements, a commercial boarding house, + foster home, or halfway house is not considered the person's household.

+

2Use the SSI definition of child in, SI 00501.010.

+

3A public income maintenance payment is a payment from any of the following programs: + Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), + the Refugee Act of 1980, the Disaster Relief Act of 1974, general assistance programs + of the Bureau of Indian Affairs, State or local government income maintenance programs + that are based on need, or Department of Veterans Affairs benefits based on need.

+
+
+

1. Coding and monthly payments levels

+
+
+

The coding and monthly payment levels for Massachusetts effective 01/01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

128.82

+
+

802.82

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

114.39

+
+

788.39

+
+

 

+
+

B

+
+

Aged

+
+

674.00

+
+

39.26

+
+

713.26

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

30.40

+
+

704.40

+
+

 

+
+

E

+
+

Aged

+
+

674.00

+
+

293.00

+
+

967.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

293.00

+
+

967.00

+
+

 

+
+

G

+
+

Aged

+
+

674.00

+
+

454.00

+
+

1128.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

454.00

+
+

1128.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

454.00

+
+

1128.00

+
+

B

+
+

C

+
+

Aged

+
+

449.341

+
+

104.36

+
+

553.70

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

374.40

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

87.58

+
+

536.92

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

114.39

+
+

788.39

+
+

 

+
+

B

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

30.40

+
+

704.40

+
+

D

+
+

B2

+
+

Blind

+
+

30.003

+
+

149.74

+
+

179.74

+
+

 

+
+

 

+
+

Disabled

+
+

30.003

+
+

30.40

+
+

60.40

+
+

 

+
+

F

+
+

All

+
+

30.003

+
+

42.80

+
+

72.80

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

201.72

+
+

1212.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

636.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

180.06

+
+

1191.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

419.10

+
+

1430.10

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

190.89

+
+

1201.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

408.27

+
+

1419.27

+
+

 

+
+

B

+
+

Aged/Aged

+
+

1011.00

+
+

201.72

+
+

1212.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

636.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

180.06

+
+

1191.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

419.10

+
+

1430.10

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

190.89

+
+

1201.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

408.27

+
+

1419.27

+
+

 

+
+

E

+
+

Aged/Aged

+
+

1011.00

+
+

923.00

+
+

1934.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

636.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

923.00

+
+

1934.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

779.74

+
+

1790.74

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

923.00

+
+

1934.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

779.74

+
+

1790.74

+
+

 

+
+

G

+
+

All

+
+

1011.00

+
+

681.00

+
+

1692.00

+
+

B

+
+

C

+
+

Aged/Aged

+
+

674.001

+
+

215.80

+
+

889.80

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

973.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

194.18

+
+

868.18

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

594.64

+
+

1268.64

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

204.99

+
+

878.99

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

583.83

+
+

1257.83

+
+

D

+
+

F

+
+

All

+
+

60.002

+
+

85.60

+
+

145.60

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

H. Description of supplements - Michigan

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care.

+
+

E

+
+

Personal Care -- Recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged.

+
+

F

+
+

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care.

+
+

G

+
+

Independent Living with an EP -- Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.)

+
+

H

+
+

Living in the Household of Another with an EP -- Recipients with an EP and living + in the household of another for Federal purposes. (Children under age 18 are excluded.)

+
+

I

+
+

Effective 01/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waived their right + to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Recipients in Title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under Title XIX.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Michigan effective 01/01/09 are shown in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

674.00

+
+

87.00

+
+

761.00

+
+

 

+
+

E

+
+

All

+
+

674.00

+
+

157.50

+
+

831.50

+
+

 

+
+

F

+
+

All

+
+

674.00

+
+

179.30

+
+

853.30

+
+

 

+
+

G

+
+

All

+
+

1012.002

+
+

14.00

+
+

1026.00

+
+

B

+
+

H

+
+

All

+
+

674.671

+
+

9.33

+
+

684.00

+
+

D

+
+

I

+
+

All

+
+

  30.003

+
+

7.00

+
+

37.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

1011.00

+
+

511.00

+
+

1522.00

+
+

 

+
+

E

+
+

All

+
+

1011.00

+
+

652.00

+
+

1663.00

+
+

 

+
+

F

+
+

All

+
+

1011.00

+
+

695.60

+
+

1706.60

+
+

 

+
+

G

+
+

All

+
+

1349.002

+
+

21.00

+
+

1370.00

+
+

B

+
+

H

+
+

All

+
+

899.34

+
+

14.00

+
+

913.34

+
+

D

+
+

I

+
+

All

+
+

60.003

+
+

14.00

+
+

74.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

I. Description of supplements - Montana

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

G

+
+

State-Certified Personal Care

+
+

H

+
+

State-Certified Residence in Group Home for Mentally Disabled

+
+

I

+
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+
+

J

+
+

State-Certified Residence for Child and Adult Foster Care

+
+

K

+
+

State-Certified Transitional Living for Developmentally Disabled

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all individuals and couples not certified in State + codes G, H, I, J, or K.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Montana effective 01/01/09 are shown in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

674.00

+
+

94.00

+
+

768.00

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

94.00

+
+

768.00

+
+

 

+
+

I

+
+

All

+
+

674.00

+
+

94.00

+
+

768.00

+
+

 

+
+

J

+
+

All

+
+

674.00

+
+

52.75

+
+

726.75

+
+

 

+
+

K

+
+

All

+
+

674.00

+
+

26.00

+
+

700.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

1011.00

+
+

193.00

+
+

1204.00

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

193.00

+
+

1204.00

+
+

 

+
+

I

+
+

All

+
+

1011.00

+
+

193.00

+
+

1204.00

+
+

 

+
+

J

+
+

All

+
+

1011.00

+
+

110.50

+
+

1121.50

+
+

 

+
+

K

+
+

All

+
+

1011.00

+
+

57.00

+
+

1068.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. Description of supplements - Nevada

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living or Living in Parental Household -- Aged or blind eligible recipient + who meets one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household.

    +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. For Optional State Supplement codes see + SM 01301.535.

+
+

B

+
+

Living in the Household of Another -- Aged or blind eligible recipient who is living + in the household of another individual and receiving food and shelter from that individual. Aged or blind recipient who are subject to a one-third + reduction (VTR) of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B.

+
+

C

+
+

Domiciliary Care -- Aged or blind eligible recipient who lives in a private non-medical + facility or, a residential facility serving 16 or fewer persons, which provides personal + care and services to aged, infirm, or handicapped adult persons who are unrelated + to the proprietor.

+ +

These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- No supplement cases include one of the following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individual or disabled member of eligible couple;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individual or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individual or member of eligible couple who is patient in a private medical + facility which is not certified under Title XIX; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    +
    +
    +
  8. +
+
+
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Nevada effective 01/01/09 are shown in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

36.40

+
+

710.40

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

109.30

+
+

783.30

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

391.00

+
+

1065.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

391.00

+
+

1065.00

+
+

 

+
+

Z

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

B

+
+

Aged

+
+

449.341

+
+

24.27

+
+

473.61

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

213.96

+
+

663.30

+
+

 

+
+

Z

+
+

Disabled

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

109.30

+
+

783.30

+
+

 

+
+

Z

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

74.46

+
+

1085.46

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

374.60

+
+

1385.60

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

224.53

+
+

1235.53

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

37.23

+
+

1048.23

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

187.30

+
+

1198.30

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

881.00

+
+

1892.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

881.00

+
+

1892.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

881.00

+
+

1892.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

440.50

+
+

1451.50

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

440.50

+
+

1451.50

+
+

 

+
+

Z

+
+

Disabled

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

B

+
+

Aged/Aged

+
+

674.001

+
+

49.64

+
+

723.64

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

531.94

+
+

1205.94

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

290.79

+
+

964.79

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

24.82

+
+

698.82

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

265.97

+
+

939.97

+
+

 

+
+

Z

+
+

Disabled

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

K. Description of supplements - New Jersey (NJ)

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Congregate Care - Eligible recipient in Federal living arrangement (FLA) A. The living + arrangement includes the following: Recipients in residential facilities who are under + the supervision of the Department of Human Services: Children and adults under the + supervision of or placed by the NJ Department of Human Services’ Division of Developmental + Disabilities (DDD) or Division of Youth and Family Services (DYFS) who are in residential + facilities (both in and outside of NJ); and Recipients in Assisted Living Residences + and in Comprehensive Personal Care Homes (CPCH) licensed by the Department of Health + and Senior Services.

+
+

B

+
+

Living Alone or with Others -- Eligible recipients whose Federal living arrangements + are A or C and do not meet the requirements defined in other supplementation categories.

+ +

Therefore, any eligible recipient who meets the requirement for a Federal code A is + in optional supplement B unless residing in a residential health care facility or + living alone with an ineligible spouse.

+ +

Likewise, any child meeting the criteria for a Federal code C is automatically entitled + to optional supplement B.

+ +

This category includes, but is not limited to, those eligible recipients who are in + one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services.

    +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. For State Supplement codes see SM 01301.535.

+ +

This State code is also used to supplement Section 1619 cases.

+
+

C

+
+

Living Alone with an Ineligible Spouse -- Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse receives the same total payment as an eligible + recipient with an EP. Once other persons, even minor children, are present in the + household, this supplementary payment variation cannot exist. However, it is possible + that a claimant and their ineligible spouse live with others and allege that they + are a separate “household” by virtue of the fact that they eat their meals out or + have separate purchase and preparation of food. In this instance, an optional supplement + C is permissible as long as no other person is in their “household.” There is no couple + counterpart in this category.

+ +

Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B.

+ +

A transient individual who co-exists only with an ineligible spouse also qualifies + for the Optional Supplement (OS) - C rate.

+
+

D

+
+

Living in the Household of Another -- Persons who are “living in the household of + another” for Federal purposes.

+
+

I

+
+

Licensed Residential Health Care Facilities -- Attached to a nursing home; Assisted + Living Residence; CPCH; or “free standing”. Prior to 01/01/06 residents of these facilities + were paid at the OS “A” rate.

+ +

Authorization to make this payment is based on the recipient's residence at a facility + listed in the New Jersey Congregate Care Directory .

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. + Residents of the Assisted Living Resident (ALR) or CPCH section of a multipurpose + facility are paid at the OS “A” rate. Nursing home residents are living arrangement + (D/G) if Medicaid pays more than 50 percent of the cost of care.

+
+

G

+
+

Effective 09/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases – Recipients in licensed medical facilities where Medicaid is + paying less than 50 percent of the cost of care, recipients in publicly operated community + residences having 16 or less residents, and residents of publicly operated emergency + shelters throughout a month.

+ +

It also includes cases that were FLA D prior to 01/1988 or effective 12/01/96 children + under age 18 residing in certain public or private facilities receiving payment for + their care under any health insurance policy issued by a private provider. For determination + of applicability of $30 payment limit see SI 00520.011.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payments levels for New Jersey effective 01/01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

674.00

+
+

150.05

+
+

824.05

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

31.25

+
+

705.25

+
+

 

+
+

C

+
+

Individual

+
+

674.00

+
+

344.36

+
+

1018.36

+
+

 

+
+

 

+
+

w/EP

+
+

1012.002

+
+

25.36

+
+

1037.36

+
+

 

+
+

I

+
+

All

+
+

674.00

+
+

210.05

+
+

884.05

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

All

+
+

449.341

+
+

44.31

+
+

493.65

+
+

C

+
+

B

+
+

All

+
+

674.00

+
+

31.25

+
+

705.25

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

10.00

+
+

40.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

599.36

+
+

1610.36

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

25.36

+
+

1036.36

+
+

 

+
+

I

+
+

All

+
+

1011.00

+
+

719.36

+
+

1730.36

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

  0.00

+
+

1011.00

+
+

B

+
+

D

+
+

All

+
+

674.001

+
+

93.09

+
+

767.09

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

20.00

+
+

80.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

L. Description of supplements - New York

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone - Eligible recipient who meet one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Live physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Pay a fixed, pre-established flat fee for both room and board in a commercial establishment;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives with others but takes all meals outside the dwelling;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Live with others but separately prepares or has someone separately prepare their food. + Occasional preparation of meals in common does not preclude a finding of separate + preparation;

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Receive a fixed, pre-established flat fee for room and board from all others in the dwelling;

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Live with only a foster child, or a homemaker authorized by the local department of + social services (DSS), or a family care recipient placed by: the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabilities (OMRDD) + or local DSS; or

    +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    Have no permanent living arrangement (i.e., transient or street person) and is not + with a spouse or a child for whom they have primary responsibility.

    +
    +
    +
  14. +
+
+

B

+
+

Living with Others - Recipient who meets one of the following situations:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Resides in a dwelling with others and prepares food in common with at least one other + person in the dwelling.

    + +

    NOTE: An individual living with an ineligible spouse must be considered living with others + despite any separate preparation. The same is true if a recipient lives with a child + for whom they have primary responsibility (except if the child is a foster child)

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a child who does not meet the criteria for OSS C or OSS D (below);

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Lives in a religious community and room and board are provided in full or in part + by the religious community; or

    +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Has no permanent living arrangement (i.e., transient or street person), but is with + an ineligible spouse or child for whom they have primary responsibility.

    +
    +
    +
  8. +
+
+

C

+
+

Congregate Care Level I

+ +
    +
  1. +
    +
    1. 
    +
    +

    Recipient is placed in a family type home certified by New York State (NYS) Office + of Children and Family Services and supervised by a local DSS.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Recipient is placed in a family care home certified by OMH or OMRDD.

    +
    +
    +
  4. +
+
+

D

+
+

Congregate Care Level II – Payable to an eligible recipient who is a resident of a + licensed Level II care facility. These consist of facilities, which provide supportive + living environments and include: Residences for Adults certified by the NYS Department + of Health; Privately operated facilities certified by the NYS OMH; Privately-operated + facilities certified by the NYS OMH and OMRDD; and Privately-operated facilities certified + by OASAS.

+
+

E

+
+

Congregate Care Level III -- Enhanced Residential Care

+ +

Payable to an eligible recipient who is a resident of a licensed level 3 care facility + which includes: Adult Homes and Enriched Housing programs certified by the NYS Department + of Health or Schools for the Mentally Retarded certified by the NYS Office of Mental + Retardation and Developmental Disabilities. Schools for the Mentally Retarded usually + meet the basic Federal definition of institution and consist of residential facilities + that provide academic, vocational, recreational and social skills programs. Although + sometimes called schools, they often do not meet the Federal definition of schools.

+ +
+
+

NOTE - A child residing in a Level III facility cannot receive OSS E; they receive OSS + B.

+
+
+
+

F

+
+

Living in the Household of Another -- Payable to recipients who are FLA B.

+
+

G

+
+

Effective 01/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities. Federal administration + was terminated effective 09/30/03. State began administering this payment 10/01/03.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but have waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases – Includes Eligible recipient in FLA A or D who meet one of the + following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Is in a licensed medical facility where Medicaid is paying less than 50 percent of + the cost of care;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is in a publicly operated community residence which serves 16 or fewer residents;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is in a publicly operated emergency shelter (PESH);

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Qualifies under the special provision in SI 00520.130 (1619 eligible goes into medical institution);

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 10/01/03 eligible recipient in FLA D and also cases that were FLA D prior + to January 1988; or

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Effective 12/01/96, children under age 18 residing in certain public or private facilities + receiving payment for their care under any health insurance policy issued by a private + provider. For determination of applicability of $30 payment limit see SI 00520.011).

    +
    +
    +
  12. +
+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for New York effective 01/01/09 are shown in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

674.00

+
+

87.00

+
+

761.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

23.00

+
+

697.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

674.00

+
+

266.48

+
+

940.48

+
+

 

+
+

 

+
+

All other counties

+
+

674.00

+
+

228.48

+
+

902.48

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

674.00

+
+

435.00

+
+

1109.00

+
+

 

+
+

 

+
+

All other counties

+
+

674.00

+
+

405.00

+
+

1079.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

674.00

+
+

694.00

+
+

1368.00

+
+

 

+
+

 

+
+

All other counties

+
+

674.00

+
+

694.00

+
+

1368.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

  0.00

+
+

674.00

+
+

B

+
+

F

+
+

All

+
+

449.342

+
+

23.00

+
+

472.34

+
+

D

+
+

Z

+
+

All

+
+

30.003

+
+

0.004

+
+

30.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1011.00

+
+

104.00

+
+

1115.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

46.00

+
+

1057.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

1011.00

+
+

869.96

+
+

1880.96

+
+

 

+
+

 

+
+

All other counties

+
+

1011.00

+
+

793.96

+
+

1804.96

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

1011.00

+
+

1207.00

+
+

2218.00

+
+

 

+
+

 

+
+

All other counties

+
+

1011.00

+
+

1147.00

+
+

2158.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

1011.00

+
+

1725.00

+
+

2736.00

+
+

 

+
+

 

+
+

All other counties

+
+

1011.00

+
+

1725.00

+
+

2736.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

F

+
+

All

+
+

674.002

+
+

46.00

+
+

720.00

+
+

D

+
+

Z

+
+

All

+
+

60.003

+
+

0.004

+
+

60.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

M. Description of supplements - Pennsylvania

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

C

+
+

Living with an EP -- Recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules.

+
+

D

+
+

Living in the Household of Another with an EP -- Recipients who live in the household + of another and have one or more EP’s as defined under the Federal rules.

+
+

G

+
+

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

H

+
+

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waived their right + to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all recipients who are residing in a medical facility + in which Title XIX is paying more than 50 percent of the cost of care and recipients + in FLA-A or FLA-B who receive a State-administered supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Pennsylvania effective 01/01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

C

+
+

All

+
+

1012.001

+
+

43.70

+
+

1055.70

+
+

 

+
+

G

+
+

All

+
+

674.00

+
+

434.30

+
+

1108.30

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

439.30

+
+

1113.30

+
+

B

+
+

Z

+
+

All

+
+

449.342

+
+

0.00

+
+

449.34

+
+

 

+
+

D

+
+

All

+
+

674.673

+
+

43.70

+
+

718.37

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.004

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

 

+
+

C

+
+

All

+
+

1349.001

+
+

68.05

+
+

1417.05

+
+

 

+
+

G

+
+

All

+
+

1011.00

+
+

947.40

+
+

1958.40

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

957.40

+
+

1968.40

+
+

B

+
+

B

+
+

All

+
+

674.002

+
+

0.00

+
+

674.00

+
+

 

+
+

D

+
+

All

+
+

899.34

+
+

68.05

+
+

967.39

+
+

D

+
+

Z

+
+

All

+
+

60.004

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

N. Description of supplements - Rhode Island

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living -- Recipients who are in Federal codes A and C, except for individuals + residing in a residential care or assisted living facility who are certified as eligible + for State Code D. This includes children under the age of 18 who are in Federal living + arrangement D because a private health insurance policy or a combination of Medicaid + and a private health insurance policy pays or is expected to pay over 50 percent of + the cost of care for that month. For determination of applicability of $30 payment + limit see second and third bullets in SI 00520.011C.1.b.

+ +

Recipients residing in a public emergency shelter for the homeless and those who are + eligible for Section 1619 are included in this category.

+
+

B

+
+

Living in the Household of Another -- Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied.

+
+

D

+
+

Residential Care or Assisted Living -- This category applies to individuals only.

+
+

E

+
+

The State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 03/01/91). This includes children + under the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent + of the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waived their right + to receive, an optional supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Rhode Island effective 01/01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A1

+
+

All

+
+

674.00

+
+

39.92

+
+

713.92

+
+

 

+
+

D

+
+

All

+
+

674.00

+
+

538.00

+
+

1212.00

+
+

B

+
+

B1

+
+

All

+
+

449.342

+
+

51.92

+
+

501.26

+
+

C

+
+

A1

+
+

All

+
+

674.00

+
+

39.92

+
+

713.92

+
+

D

+
+

A3

+
+

Children Private Insurance

+
+

30.004

+
+

39.92

+
+

69.92

+
+

 

+
+

E

+
+

All

+
+

30.004

+
+

20.00

+
+

50.00

+
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3State OS Code A applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

4Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A1

+
+

All

+
+

1011.00

+
+

79.38

+
+

1090.38

+
+

B

+
+

B1

+
+

All

+
+

674.002

+
+

97.30

+
+

771.30

+
+

D

+
+

E

+
+

All

+
+

60.003

+
+

40.00

+
+

100.00

+
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

O. Description of supplements - Utah

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone or With Others -- This variation includes recipients who are in Federal + codes A and C.

+
+

B

+
+

Living in the Household of Another -- Recipients with no EP who are “living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.)

+
+

Z

+
+

No Supplement Cases -- No supplement cases include all recipients who are not included + in A or B.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Utah effective 01/01/09 are shown in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Level

+
+

A,C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

B

+
+

All

+
+

449.342

+
+

3.13

+
+

452.47

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement
Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1011.00

+
+

4.60

+
+

1015.60

+
+

B

+
+

B

+
+

All

+
+

674.002

+
+

9.73

+
+

683.73

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+
+
+ +
+
+

P. Description of supplements - Vermont

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living (except Chittenden County) – Recipients not living in the household + of another and not in a residential or custodial care situation. This includes a child + who is living with a parent and recipients residing in a private Title XIX facility + where Medicaid is not paying more than 50 percent of the cost of care. It includes + children under the age of 18 who are in Federal living arrangement D because a private + health insurance policy or a combination of Medicaid and a private health insurance + policy pays or is expected to pay over 50 percent of the cost of care for that month. + For determination of applicability of $30 payment limit see second and third bullets + in SI 00520.011C.1.b.

+ +

A recipient residing in a publicly operated emergency shelter throughout a month.

+
+

B

+
+

Independent Living in Chittenden County -- Same as Code A above except restricted + to residents of Chittenden County.

+
+

C

+
+

Licensed Residential Care Home or Assisted Living Residence with Assistive Community + Care Services (Level III) -- Recipients residing in Level III facilities identified + by the State. Refer to the Vermont Community Care Facilities (OS C and G) list on + BOSNET to determine if a residence meets the requirements for Optional Supplement + C.

+
+

E

+
+

Living in the Household of Another -- Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions).

+
+

G

+
+

Licensed Residential Care Home or Therapeutic Community Residence (Level IV) -- Recipients + residing in Level IV facilities identified by the State. Refer to the Vermont Community + Care Facilities (OS C and G) list on BOSNET to determine if a residence meets the + requirements for Optional Supplement G.

+
+

H

+
+

Custodial Care: Family Home -- Recipients living in another's home in such a manner + that the recipient is paying room and board and is receiving one or more of the services + outlined under the custodial care definition. The recipient must also receive the + room and board and custodial care in the home in which they reside. In order to qualify + as a home under this arrangement, these services must not be provided to more than + two persons and must be provided by a resident of the home.

+ +

In some cases the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) H. To qualify these programs must meet the requirements stated above.

+ +

Custodial care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service two-three times a week) + which may include supervision for the recipient's protection. Supervision for the + recipient's protection deals primarily with protection services for retarded and emotionally + disturbed individuals. A person who receives one or more of these personal services + is receiving custodial care.

+
+

I

+
+

Effective 07/01/87, the State elected Federal administration of an optional State + supplementary payment to residents in Title XIX facilities. This includes children + under the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent + of the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Vermont effective 01/01/09 are shown in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State

+ +

Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

 

+
+

C

+
+

All

+
+

674.00

+
+

48.38

+
+

722.38

+
+

 

+
+

G

+
+

All

+
+

674.00

+
+

223.94

+
+

897.94

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

98.69

+
+

772.69

+
+

B

+
+

E

+
+

All

+
+

449.341

+
+

39.30

+
+

488.64

+
+

C

+
+

A

+
+

All (Except Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

D

+
+

A or B2

+
+

Children Private Insurance

+
+

30.003

+
+

52.04

+
+

82.04

+
+

 

+
+

I

+
+

All

+
+

30.003

+
+

17.66

+
+

47.66

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County

+
+

1011.00

+
+

98.88

+
+

1109.88

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County

+
+

1011.00

+
+

98.88

+
+

1109.88

+
+

 

+
+

C

+
+

All

+
+

1011.00

+
+

96.77

+
+

1107.77

+
+

 

+
+

G

+
+

All

+
+

1011.00

+
+

562.06

+
+

1573.06

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

332.82

+
+

1343.82

+
+

B

+
+

E

+
+

All

+
+

674.001

+
+

48.31

+
+

722.31

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

35.33

+
+

95.33

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

 

+
+
+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415041
SI 01415.041 - Federally Administered Optional Supplementary Payment Programs for 01/09 Payment Levels - 08/07/2009
+Batch run: 05/27/2026
+Rev:08/07/2009
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html new file mode 100644 index 00000000..78689e96 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2010.html @@ -0,0 +1,16200 @@ + + +SSA - POMS: SI 01415.042 - Federally Administered Optional Supplementary Payment Programs for 01/10 Payment Levels - 01/07/2011 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 81 (08-24)

+

SI 01415.042 Federally Administered Optional Supplementary Payment Programs for 01/10 Payment Levels

+ + +

CITATIONS: Social Security Act as amended in 1973, Section 1616; Social Security Amendments of 1972, Section 301; Public Law 93-66, Section 212

+ +
+
+

A. Background

+
+
+

The following states are participating in the federally Administered Optional Supplementary + Payment Programs:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+
+

Reference

+
+

California

+
+

SI 01415.042B

+
+

Delaware

+
+

SI 01415.042C

+
+

District Of Columbia

+
+

SI 01415.042D

+
+

Hawaii

+
+

SI 01415.042E

+
+

Iowa

+
+

SI 01415.042F

+
+

Massachusetts

+
+

SI 01415.042G

+
+

Michigan

+
+

SI 01415.042H

+
+

Montana

+
+

SI 01415.042I

+
+

Nevada

+
+

SI 01415.042J

+
+

New Jersey

+
+

SI 01415.042K

+
+

New York

+
+

SI 01415.042L

+
+

Pennsylvania

+
+

SI 01415.042M

+
+

Rhode Island

+
+

SI 01415.042N

+
+

Utah

+
+

SI 01415.042O

+
+

Vermont

+
+

SI 01415.042P

+
+
+
+
+ +
+
+

B. Description of supplements for California

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living with Cooking Facilities for an Eligible individual or couple who + meets one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and have cooking and food storage facilities or are provided meals as part of the + living arrangement;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent, or parents, or + is a disabled child age 18, or over who meets sharing criteria and is living in the + household of a parent or parents;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a private medical facility licensed by the State but not certified under + Title XIX.

    +
    +
    +
  10. +
+
+

B

+
+

Non-medical Out-of-Home Care (NMOHC) applies when an individual or couple needs non-medical + care or supervision in the following living arrangement situations:

+ +

 

+ +

CHILDREN (UNDER AGE 18)

+ +
    +
  1. +
    +
    a. 
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative; or

    +
    +
    +
  8. +
  9. +
    +
    e. 
    +
    +

    Disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

    +
    +
    +
  10. +
  11. +
    +
    f. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or

    +
    +
    +
  12. +
+ +

 

+ +

ADULTS (AGE 18 AND OVER)

+ +
    +
  1. +
    +
    a. 
    +
    +

    Aged, blind or disabled individual or couple has been determined to be in FLA A and + resides in the home of a relative, legal conservator or guardian; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Aged, blind, or disabled individual or couple is determined to be in FLA A and resides + in a State licensed NMOHC facility.

    +
    +
    +
  4. +
+ +

 

+ +

For California optional supplement (OS) purposes, a relative is defined as a parent, + child, sibling, half-sibling, parent's sibling, sibling's child, first cousin, or + any person of the preceding generation denoted by the prefix “grand” or “great.”

+
+

C

+
+

Independent Living Without Cooking Facilities -- Aged or disabled individual or couple + who is neither provided any meals, nor has access to adequate cooking or food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C.

+ +

An individual or couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Immediate living quarters do not have cooking and food storage facilities with which + the individual or couple or another person (who is responsible for preparing their + meals) can prepare meals on a daily basis.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis).

    +
    +
    +
  10. +
+ +

“Adequate” cooking and food storage facilities exist when an individual or couple + has access to:

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. An ice chest is not considered adequate storage.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Hotplates without temperature controls that + are used for warming food are not considered adequate cooking facilities.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at least + one working burner on a stove or a one-burner hotplate with a temperature control.

    +
    +
    +
  • +
+ +

Eligibility for OS C begins in the month the recipient applies for this supplement + rate provided they have been without cooking and food storage facilities throughout + the month.

+ +
+
+

NOTE: For purposes of OS C, “throughout a month” does not mean the recipient must lack adequate cooking or food storage facilities from the + very first moment of the month. The recipient need only lack them from some time on + the first day of the month.

+
+
+ +

If eligibility is based on temporary loss or non-functioning of an appliance, advise + the individual of their responsibility to report immediately when the temporary condition + has ceased. If the individual provides an expected date when the appliance will be + replaced or repaired, diary the case for re-contact.

+ +

Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available.

+
+

 

+
+

For a couple, comprised of an aged or disabled individual and a blind individual, + whose living arrangement lacks adequate cooking and storage facilities, the couple + is to receive the Supplemental Security Income and State Supplement Payment level + for a blind or aged or disabled couple plus the restaurant meals allowance for the + disabled member of the couple. Force payment in this living arrangement is required.

+
+

D

+
+

Living in the Household of Another -- Eligible individual or couple is living in the + household of another and is receiving food and shelter from that individual. Most individuals or couples who are subject to a one-third + reduction of their Federal SSI payments are eligible for OS D because the criteria + for this supplement level are the same as for charging the one-third reduction. However, + when the eligible individual or couple lives in the home of a relative (other than + a spouse) and needs care and supervision, certification for non-medical out-of-home + care (OS F) should be obtained from the county welfare office since this is the highest + categorical supplement for which an individual or couple can qualify.

+
+

E

+
+

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage.

+ +

NOTE: Only FLA A and C are compatible with OS E. If the VTR applies, see code G.

+
+

F

+
+

Non-medical Out-of-Home Care Living in the Household of Another -- Applies whenever + an eligible individual or couple meets the criteria for the non-medical out-of-home + care payment rate, and is determined to receive the Federal code B payment for living + in the household of another. For the One-Third Reduction Provision see SI 00835.200.

+
+

G

+
+

Disabled Child Under Age 18 Living in the Household of Another -- Applies to a disabled + (not blind) child under age 18, who resides with a parent or relative by blood or + marriage, and is determined to receive the Federal code B payment for living in the household of + another individual. For the One-Third Reduction Provision see SI 00835.200.

+
+

J

+
+

Residents of Title XIX facilities.

+ +

This State code is also used to supplement Section 1619 cases.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible recipient who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where Title XIX pays more than 50 percent of the costs; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility which is not certified under Title XIX and not licensed + by the State.

    +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +
+
+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify.

+
+
+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for California effective 11 /01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

171.00

+
+

845.00

+
​ +

 

+
+

Blind

+
+

674.00

+
+

234.00

+
+

908.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

171.00

+
+

845.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

412.00

+
+

1,086.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

255.00

+
+

929.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

255.00

+
+

929.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

65.00

+
+

739.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

Aged

+
+

449.341

+
+

190.32

+
+

639.66

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

268.98

+
+

718.32

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

190.32

+
+

639.66

+
+

 

+
+

F

+
+

All

+
+

449.341

+
+

407.00

+
+

856.34

+
+

 

+
+

G

+
+

Disabled

+
+

449.341

+
+

67.96

+
+

517.30

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

234.00

+
+

908.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

63.40

+
+

737.40

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX + institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

396.20

+
+

1407.20

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

543.20

+
+

1554.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

396.20

+
+

1407.20

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

487.20

+
+

1498.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

396.20

+
+

1407.20

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

487.20

+
+

1498.20

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1161.00

+
+

2172.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

564.20

+
+

1575.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

564.20

+
+

1575.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

564.20

+
+

1575.20

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

674.001

+
+

401.33

+
+

1075.33

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

548.33

+
+

1222.33

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

401.33

+
+

1075.33

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

492.33

+
+

1166.33

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

401.33

+
+

1075.33

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

492.33

+
+

1166.33

+
+

 

+
+

F

+
+

All

+
+

674.001

+
+

1045.66

+
+

1719.66

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX + institution.

+
+
+
+
+
+
+

3. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for California effective 07/01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Leve
l

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

176.00

+
+

850.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

239.00

+
+

913.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

176.00

+
+

850.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

412.00

+
+

1,086.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

260.00

+
+

934.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

260.00

+
+

934.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

65.00

+
+

739.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

Aged

+
+

449.341

+
+

194.18

+
+

643.52

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

273.32

+
+

722.66

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

194.18

+
+

643.52

+
+

 

+
+

F

+
+

All

+
+

449.341

+
+

407.00

+
+

856.34

+
+

 

+
+

G

+
+

Disabled

+
+

449.341

+
+

71.08

+
+

520.42

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

239.00

+
+

913.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

65.00

+
+

739.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

478.00

+
+

1489.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

700.00

+
+

1711.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

478.00

+
+

1489.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

617.00

+
+

1628.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

478.00

+
+

1489.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

617.00

+
+

1628.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1161.00

+
+

2172.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

646.00

+
+

1657.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

646.00

+
+

1657.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

646.00

+
+

1657.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

674.001

+
+

530.64

+
+

1204.64

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

752.42

+
+

1426.42

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

530.64

+
+

1204.64

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

668.40

+
+

1342.40

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

530.64

+
+

1204.64

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

668.40

+
+

1342.40

+
+

 

+
+

F

+
+

All

+
+

674.001

+
+

1045.66

+
+

1719.66

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+

4. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for California effective 05/01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

196.00

+
+

870.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

261.00

+
+

935.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

196.00

+
+

870.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

412.00

+
+

1,086.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

280.00

+
+

954.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

280.00

+
+

954.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

82.00

+
+

756.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

Aged

+
+

449.341

+
+

209.33

+
+

658.67

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

290.33

+
+

739.67

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

209.33

+
+

658.67

+
+

 

+
+

F

+
+

All

+
+

449.341

+
+

407.00

+
+

856.34

+
+

 

+
+

G

+
+

Disabled

+
+

449.341

+
+

83.33

+
+

532.67

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

261.00

+
+

935.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

82.00

+
+

756.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

513.00

+
+

1524.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

740.00

+
+

1751.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

513.00

+
+

1524.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

655.00

+
+

1666.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

513.00

+
+

1524.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

655.00

+
+

1666.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1161.00

+
+

2172.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

681.00

+
+

1692.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

681.00

+
+

1692.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

681.00

+
+

1692.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

674.001

+
+

559.00

+
+

1233.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

786.00

+
+

1460.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

559.00

+
+

1233.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

700.00

+
+

1374.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

559.00

+
+

1233.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

700.00

+
+

1374.00

+
+

 

+
+

F

+
+

All

+
+

674.001

+
+

1045.66

+
+

1719.66

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+

5. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for California effective 01/01/09 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

233.00

+
+

907.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

298.00

+
+

972.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

233.00

+
+

907.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

412.00

+
+

1,086.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

317.00

+
+

991.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

317.00

+
+

991.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

119.00

+
+

793.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

Aged

+
+

449.341

+
+

234.00

+
+

633.34

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

315.00

+
+

764.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

234.00

+
+

683.34

+
+

 

+
+

F

+
+

All

+
+

449.341

+
+

407.00

+
+

856.34

+
+

 

+
+

G

+
+

Disabled

+
+

449.341

+
+

108.00

+
+

557.34

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

298.00

+
+

972.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

119.00

+
+

793.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

568.00

+
+

1579.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

795.00

+
+

1806.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

568.00

+
+

1579.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

710.00

+
+

1721.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

568.00

+
+

1579.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

710.00

+
+

1721.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1161.00

+
+

2172.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

736.00

+
+

1747.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

736.00

+
+

1747.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

736.00

+
+

1747.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

674.001

+
+

595.66

+
+

1269.66

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

822.66

+
+

1496.66

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

595.66

+
+

1269.66

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

736.66

+
+

1410.66

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

595.66

+
+

1269.66

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

736.66

+
+

1410.66

+
+

 

+
+

F

+
+

All

+
+

674.001

+
+

1045.66

+
+

1719.66

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of supplements - Delaware

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + -- Only living arrangement variation in Delaware and includes only those recipients + who are certified by the State medical unit as residents of one of the above adult + facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A or Y.

+ +

Optional supplementation code Z is the proper code to be used with an “intervening” + Federal code A. For Optional State Supplement codes see SM 01301.535

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payments levels for Delaware effective 01/01/10 are shown in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total
+ + Payment Levels

+
+

A

+
+

A

+
+

All

+
+

674.00

+
+

140.00

+
+

814.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

448.00

+
+

1459.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. Description of supplements - District of Columbia

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by + the District of Columbia, Department of Health, as residents of an adult foster care + home with 50 or fewer residents.

+
+

B

+
+

Adult Foster Care Home with More than 50 Residents --Recipients who are certified + by the District of Columbia, Department of Health, as residents of an adult foster + care home with more than 50 residents.

+
+

G

+
+

Residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for the District of Columbia effective 01/01/10 + are shown in the following charts.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

674.00

+
+

485.00

+
+

1159.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

595.00

+
+

1269.00

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

G

+
+

All

+
+

30.002

+
+

40.00

+
+

70.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Code

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

1307.00

+
+

2318.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1527.00

+
+

2538.00

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

80.00

+
+

140.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

E. Description of supplements - Hawaii

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

B

+
+

Living in a Community Care or Foster Care Home --

+ +

Persons eligible for SSI and who are both over age 18 and live in a State approved + Care or Foster Care Home.

+
+

D

+
+

Living in a Certified Medical Facility – Eligible individual living in a medical treatment + facility where a substantial part (more than 50 percent) of the cost of care is paid + under Title XIX.

+
+

H

+
+

Domiciliary Care I -- (Maximum of five residents) - Eligible individual (including + a child) or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities.

+
+

I

+
+

Domiciliary Care II -- Same as H except care is provided for six or more residents.

+
+

Y

+
+

Optional Supplementation Waived -- Eligible for, but have waived their right to receive + an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible recipient who is living in the household of another + (see explanation in definition for optional supplement B) and an eligible recipient + who is a patient in a private medical facility which is not certified under Title + XIX.

+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Hawaii effective 01/01/10 are shown in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A 

+
+

B

+
+

All

+
+

674.00

+
+

651.90

+
+

1325.90

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

651.90

+
+

1325.90

+
+

 

+
+

I

+
+

All

+
+

674.00

+
+

759.90

+
+

1433.90

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

D

+
+

D

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

B

+
+

All

+
+

1011.00

+
+

1640.80

+
+

2651.80

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

1640.80

+
+

2651.80

+
+

 

+
+

I

+
+

All

+
+

1011.00

+
+

1856.80

+
+

2867.80

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

D

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. Description of supplements - Iowa

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living in Own Household (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, does not have an + Essential Person (EP), and is not otherwise excepted from supplementation. Also included + are blind recipients in Title XIX facilities where Medicaid pays 50 percent or less of the cost + of care. Optional supplement code A is also compatible with Federal codes A and C.

+ +

Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. For State Supplement codes see SM 01301.535.

+
+

B

+
+

Living in the Household of Another (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation.

+
+

H

+
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement A, B, or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services.

+ +

The payment level for this variation is increased by $22 for each blind individual + or blind member of a couple to reflect the categorical blind supplement.

+
+

I

+
+

Living in a Family Life or Boarding Home -- Eligible individual or each member of + an eligible couple in Federal living arrangement A or B who resides in a family life + home or boarding home licensed by the State Department of Health or certified by the + State Department of Human Services.

+
+

G

+
+

Used to indicate that no supplement is payable to a recipient living in a Title XIX + facility and Title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households or living + in the households of others. No supplement also applies to all recipients living in + medical facilities not certified under Title XIX or all recipients whose Federal payments + are reduced to $30 or $60 due to living in a Title XIX facility. In addition, aged + and disabled recipients whose Federal payments are not reduced and who live in a Title + XIX facility where Medicaid pays 50 percent or less of the cost of care do not receive + a supplement.

+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs -- In-Home Health Related Care; Residential Care and Supplement for Medicare + and Medicaid Eligibles.

+
+
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+
+
+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid.

+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Iowa effective 01/01/10 are shown in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind

+
+

674.00

+
+

22.00

+
+

696.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

366.00

+
+

1040.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

344.00

+
+

1018.00

+
+

 

+
+

D

+
+

Aged

+
+

674.00

+
+

142.00

+
+

816.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

164.00

+
+

838.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

142.00

+
+

816.00

+
+

 

+
+

Z

+
+

Aged

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

B

+
+

Blind

+
+

449.341

+
+

22.00

+
+

471.34

+
+

 

+
+

H3

+
+

Aged

+
+

449.341

+
+

344.00

+
+

793.34

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

366.00

+
+

815.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

344.00

+
+

793.34

+
+

 

+
+

I3

+
+

Aged

+
+

449.341

+
+

142.00

+
+

591.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.34

+
+

142.00

+
+

591.34

+
+

 

+
+

 

+
+

Blind

+
+

449.34

+
+

164.00

+
+

613.34

+
+

 

+
+

Z

+
+

Aged

+
+

449.341

+
+

0.00

+
+

449.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

22.00

+
+

696.00

+
+

 

+
+

C

+
+

Blind

+
+

674.00

+
+

366.00

+
+

1040.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

344.00

+
+

1018.00

+
+

 

+
+

Z

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+

NOTE:

+
+
+

State-administered programs: For Calendar Year 2010 :

+
    +
  • +
    +
    •
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total
+ + Payment Levels

+
+

A

+
+

A

+
+

Blind/Blind

+
+

1011.00

+
+

44.00

+
+

1055.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

1011.00

+
+

22.00

+
+

1033.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

22.00

+
+

1033.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

344.00

+
+

1355.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

388.00

+
+

1399.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

344.00

+
+

1355.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

366.00

+
+

1377.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

344.00

+
+

1355.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

366.00

+
+

1377.00

+
+

 

+
+

D

+
+

Aged/Aged

+
+

1011.00

+
+

641.00

+
+

1652.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

685.00

+
+

1696.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

641.00

+
+

1652.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

663.00

+
+

1674.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

641.00

+
+

1652.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

663.00

+
+

1674.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

B

+
+

Blind/Blind

+
+

674.001

+
+

44.00

+
+

718.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

674.001

+
+

22.00

+
+

696.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

22.00

+
+

696.00

+
+

 

+
+

H

+
+

Aged/Aged

+
+

674.001

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

388.00

+
+

1062.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

366.00

+
+

1040.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

366.00

+
+

1040.00

+
+

 

+
+

I

+
+

Aged/Aged

+
+

674.001

+
+

641.00

+
+

1315.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

685.00

+
+

1359.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

641.00

+
+

1315.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

663.00

+
+

1337.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

641.00

+
+

1315.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

663.00

+
+

1337.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

674.001

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+

NOTE:

+
+
+

State-administered programs: For Calendar Year 2010 :

+
    +
  • +
    +
    •
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. (Members of a couple are treated + as individuals.)

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements - Massachusetts

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Full Cost-of-Living:

+ +

An individual who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and meet one of the following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, those who rent only rooms in private residences are considered living + alone provided they do not use the residential kitchen facilities for preparing meals;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living only with their eligible spouse;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living with their eligible spouse and ineligible child or children 2 none of whom (children) receive public income maintenance payments;3 or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Living only with their ineligible spouse or their ineligible child or children, none + of whom (spouse and children) receive public income maintenance payments.

    +
    +
    +
  8. +
+ +

NOTE: For purposes of 1 through 4, foster children placed with anyone other than their + parents are not considered to be living with the foster parent.

+
​ +

An individual who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments.

+ +

An individual who is in Federal living arrangement A or C and who does not meet the + criteria contained in SI 01415.040G.1. (See Code A, 1 or 2 (in this chart)) is in State living arrangement A if they pay + at least two-thirds of the household expenses. In making a determination as to whether + the individual pays two-thirds or more of the expenses, use the method defined in + SI 00835.160. Only the household expenses shown in that section are to be used. An ineligible + spouse's income (except any assistance based upon need) may be used to determine if + the eligible person is paying two-thirds of the household expenses.

+ +

A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. + Optional supplement code A is the proper code to be used with an “intervening” Federal + code A. For Optional State Supplement codes see SM 01301.535.

+
+

B

+
+

Shared Living Expenses -- An individual who is in Federal living arrangement A or + C and who does not meet the criteria listed for State living arrangement A, E or G + is in State living arrangement B. Also included in this living arrangement are transients, + the homeless, and residents of public emergency shelters for the homeless (PESH).

+ +

Those residing in group-care facilities such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined in SI 01415.040G.1., Code A.4. This includes children under the age of 18 who are in Federal living arrangement + D because a private health insurance policy or a combination of Medicaid and a private + health insurance policy pays or is expected to pay over 50 percent of the cost of + care for that month. For determination of applicability of $30 payment limit see second + and third bullets in SI 00520.011C.1.b. Also included are individuals placed under the auspices of the State adult foster + care program and residents of publicly operated emergency shelters throughout a month.

+ +

An individual living in a household where all members receive public income maintenance + payments unless they are paying at least two-thirds of the household expenses (A).

+ +

An individual living in a mixed household -- i.e., a household where one or more other + members receive a public income maintenance payment -- also is included unless the + individual is paying at least two-thirds of the household expenses (A).

+
+

C

+
+

Living in the Household of Another -- Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third.

+
+

E

+
+

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or that + portion in which they are living is licensed by and has a provider agreement with + the State. Does not include residents of a Medicaid certified portion of a rest home.

+
+

F

+
+

Effective 07/01/87, the State elected Federal administration of this optional State + supplementary payment to residents of Title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. This includes children under the age of 18 for + whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care + for that month.

+
+

G

+
+

Assisted Living -- Effective 07/01/94, the State elected Federal administration of + this variation. Includes an individual, certified by the State to be residing in an + Assisted Living residence served by a certified Group Adult Foster Care provider, + who is not receiving assistance under any other Federal or State rental assistance + program, and who pays a fixed, non-separable fee for rent and supportive services, + other than medically necessary services reimbursed by Medicaid. The State shall certify + to SSA each individual who is eligible for this optional supplement living arrangement. + This living arrangement was discontinued effective 01/01/96. However, it has been + restored, retroactively, to 01/01/97.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+
+
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify.

+
+
+

1For purposes of determining State living arrangements, a commercial boarding house, + foster home, or halfway house is not considered the person's household.

+

2Use the SSI definition of child in, SI 00501.010.

+

3A public income maintenance payment is a payment from any of the following programs: + Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), + the Refugee Act of 1980, the Disaster Relief Act of 1974, general assistance programs + of the Bureau of Indian Affairs, State or local government income maintenance programs + that are based on need, or Department of Veterans Affairs benefits based on need.

+
+
+
+
+

2. Coding and monthly payments levels

+
+
+

The coding and monthly payment levels for Massachusetts effective 01/01/10 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

128.82

+
+

802.82

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

114.39

+
+

788.39

+
+

 

+
+

B

+
+

Aged

+
+

674.00

+
+

39.26

+
+

713.26

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

30.40

+
+

704.40

+
+

 

+
+

E

+
+

Aged

+
+

674.00

+
+

293.00

+
+

967.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

293.00

+
+

967.00

+
+

 

+
+

G

+
+

Aged

+
+

674.00

+
+

454.00

+
+

1128.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

454.00

+
+

1128.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

454.00

+
+

1128.00

+
+

B

+
+

C

+
+

Aged

+
+

449.341

+
+

104.36

+
+

553.70

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

374.40

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

87.58

+
+

536.92

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

114.39

+
+

788.39

+
+

 

+
+

B

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

30.40

+
+

704.40

+
+

D

+
+

B2

+
+

Blind

+
+

30.003

+
+

149.74

+
+

179.74

+
+

 

+
+

 

+
+

Disabled

+
+

30.003

+
+

30.40

+
+

60.40

+
+

 

+
+

F

+
+

All

+
+

30.003

+
+

42.80

+
+

72.80

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

201.72

+
+

1212.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

636.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

180.06

+
+

1191.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

419.10

+
+

1430.10

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

190.89

+
+

1201.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

408.27

+
+

1419.27

+
+

 

+
+

B

+
+

Aged/Aged

+
+

1011.00

+
+

201.72

+
+

1212.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

636.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

180.06

+
+

1191.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

419.10

+
+

1430.10

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

190.89

+
+

1201.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

408.27

+
+

1419.27

+
+

 

+
+

E

+
+

Aged/Aged

+
+

1011.00

+
+

923.00

+
+

1934.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

636.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

923.00

+
+

1934.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

779.74

+
+

1790.74

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

923.00

+
+

1934.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

779.74

+
+

1790.74

+
+

 

+
+

G

+
+

All

+
+

1011.00

+
+

681.00

+
+

1692.00

+
+

B

+
+

C

+
+

Aged/Aged

+
+

674.001

+
+

215.80

+
+

889.80

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

973.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

194.18

+
+

868.18

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

594.64

+
+

1268.64

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

204.99

+
+

878.99

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

583.83

+
+

1257.83

+
+

D

+
+

F

+
+

All

+
+

60.002

+
+

85.60

+
+

145.60

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

H. Description of supplements - Michigan

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care.

+
+

E

+
+

Personal Care -- Recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged.

+
+

F

+
+

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care.

+
+

G

+
+

Independent Living with an EP -- Recipients with an EP, not living in the household + of another. (Children under age 18 are excluded.)

+
+

H

+
+

Living in the Household of Another with an EP -- Recipients with an EP and living + in the household of another for Federal purposes. (Children under age 18 are excluded.)

+
+

I

+
+

Effective 01/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waived their right + to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Recipients in Title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under Title XIX.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Michigan effective 01/01/10 are shown in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

674.00

+
+

87.00

+
+

761.00

+
+

 

+
+

E

+
+

All

+
+

674.00

+
+

157.50

+
+

831.50

+
+

 

+
+

F

+
+

All

+
+

674.00

+
+

179.30

+
+

853.30

+
+

 

+
+

G

+
+

All

+
+

1012.002

+
+

14.00

+
+

1026.00

+
+

B

+
+

H

+
+

All

+
+

674.671

+
+

9.33

+
+

684.00

+
+

D

+
+

I

+
+

All

+
+

  30.003

+
+

7.00

+
+

37.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement
+ + Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

1011.00

+
+

511.00

+
+

1522.00

+
+

 

+
+

E

+
+

All

+
+

1011.00

+
+

652.00

+
+

1663.00

+
+

 

+
+

F

+
+

All

+
+

1011.00

+
+

695.60

+
+

1706.60

+
+

 

+
+

G

+
+

All

+
+

1349.002

+
+

21.00

+
+

1370.00

+
+

B

+
+

H

+
+

All

+
+

899.34

+
+

14.00

+
+

913.34

+
+

D

+
+

I

+
+

All

+
+

60.003

+
+

14.00

+
+

74.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

I. Description of supplements - Montana

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

G

+
+

State-Certified Personal Care

+
+

H

+
+

State-Certified Residence in Group Home for Mentally Disabled

+
+

I

+
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+
+

J

+
+

State-Certified Residence for Child and Adult Foster Care

+
+

K

+
+

State-Certified Transitional Living for Developmentally Disabled

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all individuals and couples not certified in State + codes G, H, I, J, or K.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Montana effective 01/01/10 are shown in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

674.00

+
+

94.00

+
+

768.00

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

94.00

+
+

768.00

+
+

 

+
+

I

+
+

All

+
+

674.00

+
+

94.00

+
+

768.00

+
+

 

+
+

J

+
+

All

+
+

674.00

+
+

52.75

+
+

726.75

+
+

 

+
+

K

+
+

All

+
+

674.00

+
+

26.00

+
+

700.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

1011.00

+
+

193.00

+
+

1204.00

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

193.00

+
+

1204.00

+
+

 

+
+

I

+
+

All

+
+

1011.00

+
+

193.00

+
+

1204.00

+
+

 

+
+

J

+
+

All

+
+

1011.00

+
+

110.50

+
+

1121.50

+
+

 

+
+

K

+
+

All

+
+

1011.00

+
+

57.00

+
+

1068.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. Description of supplements - Nevada

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living or Living in Parental Household -- Aged or blind eligible recipient + who meets one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household.

    +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. For Optional State Supplement codes see + SM 01301.535.

+
+

B

+
+

Living in the Household of Another -- Aged or blind eligible recipient who is living + in the household of another individual and receiving food and shelter from that individual. Aged or blind recipient who are subject to a one-third + reduction (VTR) of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B.

+
+

C

+
+

Domiciliary Care -- Aged or blind eligible recipient who lives in a private non-medical + facility or, a residential facility serving 16 or fewer persons, which provides personal + care and services to aged, infirm, or handicapped adult persons who are unrelated + to the proprietor.

+ +

These facilities are licensed or authorized to receive payment by the State. The State + provides SSA with listings of these facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- No supplement cases include one of the following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individual or disabled member of eligible couple;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individual or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individual or member of eligible couple who is patient in a private medical + facility which is not certified under Title XIX; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    +
    +
    +
  8. +
+
+
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Nevada effective 01/01/10 are shown in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

36.40

+
+

710.40

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

109.30

+
+

783.30

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

391.00

+
+

1065.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

391.00

+
+

1065.00

+
+

 

+
+

Z

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

B

+
+

Aged

+
+

449.341

+
+

24.27

+
+

473.61

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

213.96

+
+

663.30

+
+

 

+
+

Z

+
+

Disabled

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

109.30

+
+

783.30

+
+

 

+
+

Z

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

74.46

+
+

1085.46

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

374.60

+
+

1385.60

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

224.53

+
+

1235.53

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

37.23

+
+

1048.23

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

187.30

+
+

1198.30

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

881.00

+
+

1892.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

881.00

+
+

1892.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

881.00

+
+

1892.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

440.50

+
+

1451.50

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

440.50

+
+

1451.50

+
+

 

+
+

Z

+
+

Disabled

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

B

+
+

Aged/Aged

+
+

674.001

+
+

49.64

+
+

723.64

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

531.94

+
+

1205.94

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

290.79

+
+

964.79

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

24.82

+
+

698.82

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

265.97

+
+

939.97

+
+

 

+
+

Z

+
+

Disabled

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

K. Description of supplements - New Jersey (NJ)

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Congregate Care - Eligible recipient in Federal living arrangement (FLA) A. The living + arrangement includes the following: Recipients in residential facilities who are under + the supervision of the Department of Human Services: Children and adults under the + supervision of or placed by the NJ Department of Human Services’ Division of Developmental + Disabilities (DDD) or Division of Youth and Family Services (DYFS) who are in residential + facilities (both in and outside of NJ); and Recipients in Assisted Living Residences + and in Comprehensive Personal Care Homes (CPCH) licensed by the Department of Health + and Senior Services.

+
+

B

+
+

Living Alone or with Others -- Eligible recipients whose Federal living arrangements + are A or C and do not meet the requirements defined in other supplementation categories.

+ +

Therefore, any eligible recipient who meets the requirement for a Federal code A is + in optional supplement B unless residing in a residential health care facility or + living alone with an ineligible spouse.

+ +

Likewise, any child meeting the criteria for a Federal code C is automatically entitled + to optional supplement B.

+ +

This category includes, but is not limited to, those eligible recipients who are in + one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services.

    +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. For State Supplement codes see SM 01301.535.

+ +

This State code is also used to supplement Section 1619 cases.

+
+

C

+
+

Living Alone with an Ineligible Spouse -- Used when an individual lives with their + ineligible spouse and there are no other persons who are part of the household. An + ineligible spouse for State supplementation purposes is determined by using Federal + criteria; i.e., a spouse, either by marriage or holding out who is either not eligible + for SSI or who chooses not to apply. The State uses this category to ensure that an + individual with an ineligible spouse receives the same total payment as an eligible + recipient with an EP. Once other persons, even minor children, are present in the + household, this supplementary payment variation cannot exist. However, it is possible + that a claimant and their ineligible spouse live with others and allege that they + are a separate “household” by virtue of the fact that they eat their meals out or + have separate purchase and preparation of food. In this instance, an optional supplement + C is permissible as long as no other person is in their “household.” There is no couple + counterpart in this category.

+ +

Parent(s) with minor children are always considered to be in the same household and + therefore the presence of minor children in the household of an ineligible spouse + would result in optional supplement B.

+ +

A transient individual who co-exists only with an ineligible spouse also qualifies + for the Optional Supplement (OS) - C rate.

+
+

D

+
+

Living in the Household of Another -- Persons who are “living in the household of + another” for Federal purposes.

+
+

I

+
+

Licensed Residential Health Care Facilities -- Attached to a nursing home; Assisted + Living Residence; CPCH; or “free standing”. Prior to 01/01/06 residents of these facilities + were paid at the OS “A” rate.

+ +

Authorization to make this payment is based on the recipient's residence at a facility + listed in the New Jersey Congregate Care Directory .

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. + Residents of the Assisted Living Resident (ALR) or CPCH section of a multipurpose + facility are paid at the OS “A” rate. Nursing home residents are living arrangement + (D/G) if Medicaid pays more than 50 percent of the cost of care.

+
+

G

+
+

Effective 09/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases – Recipients in licensed medical facilities where Medicaid is + paying less than 50 percent of the cost of care, recipients in publicly operated community + residences having 16 or less residents, and residents of publicly operated emergency + shelters throughout a month.

+ +

It also includes cases that were FLA D prior to 01/1988 or effective 12/01/96 children + under age 18 residing in certain public or private facilities receiving payment for + their care under any health insurance policy issued by a private provider. For determination + of applicability of $30 payment limit see SI 00520.011.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payments levels for New Jersey effective 01/01/10 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement
+ + Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

674.00

+
+

150.05

+
+

824.05

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

31.25

+
+

705.25

+
+

 

+
+

C

+
+

Individual

+
+

674.00

+
+

362.36

+
+

1036.36

+
+

 

+
+

 

+
+

w/EP

+
+

1012.002

+
+

24.36

+
+

1036.36

+
+

 

+
+

I

+
+

All

+
+

674.00

+
+

210.05

+
+

884.05

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

All

+
+

449.341

+
+

44.31

+
+

493.65

+
+

C

+
+

B

+
+

All

+
+

674.00

+
+

31.25

+
+

705.25

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

10.00

+
+

40.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement
+ + Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

618.36

+
+

1629.36

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

25.36

+
+

1036.36

+
+

 

+
+

I

+
+

All

+
+

1011.00

+
+

738.36

+
+

1749.36

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

  0.00

+
+

1011.00

+
+

B

+
+

D

+
+

All

+
+

674.001

+
+

93.09

+
+

767.09

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

20.00

+
+

80.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

L. Description of supplements - New York

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone - Eligible recipient who meet one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Live physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Pay a fixed, pre-established flat fee for both room and board in a commercial establishment;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives with others but takes all meals outside the dwelling;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Live with others but separately prepares or has someone separately prepare their food. + Occasional preparation of meals in common does not preclude a finding of separate + preparation;

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Receive a fixed, pre-established flat fee for room and board from all others in the dwelling;

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Live with only a foster child, or a homemaker authorized by the local department of + social services (DSS), or a family care recipient placed by: the Office of Mental + Health (OMH) or Office of Mental Retardation and Developmentally Disabilities (OMRDD) + or local DSS; or

    +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    Have no permanent living arrangement (i.e., transient or street person) and is not + with a spouse or a child for whom they have primary responsibility.

    +
    +
    +
  14. +
+
+

B

+
+

Living with Others - Recipient who meets one of the following situations:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Resides in a dwelling with others and prepares food in common with at least one other + person in the dwelling.

    + +

    NOTE: An individual living with an ineligible spouse must be considered living with others + despite any separate preparation. The same is true if a recipient lives with a child + for whom they have primary responsibility (except if the child is a foster child)

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a child who does not meet the criteria for OSS C or OSS D (below);

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Lives in a religious community and room and board are provided in full or in part + by the religious community; or

    +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Has no permanent living arrangement (i.e., transient or street person), but is with + an ineligible spouse or child for whom they have primary responsibility.

    +
    +
    +
  8. +
+
+

C

+
+

Congregate Care Level I

+ +
    +
  1. +
    +
    1. 
    +
    +

    Recipient is placed in a family type home certified by New York State (NYS) Office + of Children and Family Services and supervised by a local DSS.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Recipient is placed in a family care home certified by OMH or OMRDD.

    +
    +
    +
  4. +
+
+

D

+
+

Congregate Care Level II – Payable to an eligible recipient who is a resident of a + licensed Level II care facility. These consist of facilities, which provide supportive + living environments and include: Residences for Adults certified by the NYS Department + of Health; Privately operated facilities certified by the NYS OMH; Privately-operated + facilities certified by the NYS OMH and OMRDD; and Privately-operated facilities certified + by OASAS.

+
+

E

+
+

Congregate Care Level III -- Enhanced Residential Care

+ +

Payable to an eligible recipient who is a resident of a licensed level 3 care facility + which includes: Adult Homes and Enriched Housing programs certified by the NYS Department + of Health or Schools for the Mentally Retarded certified by the NYS Office of Mental + Retardation and Developmental Disabilities. Schools for the Mentally Retarded usually + meet the basic Federal definition of institution and consist of residential facilities + that provide academic, vocational, recreational and social skills programs. Although + sometimes called schools, they often do not meet the Federal definition of schools.

+ +
+
+

NOTE - A child residing in a Level III facility cannot receive OSS E; they receive OSS + B.

+
+
+
+

F

+
+

Living in the Household of Another -- Payable to recipients who are FLA B.

+
+

G

+
+

Effective 01/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities. Federal administration + was terminated effective 09/30/03. State began administering this payment 10/01/03.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases – Includes Eligible recipient in FLA A or D who meet one of the + following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Is in a licensed medical facility where Medicaid is paying less than 50 percent of + the cost of care;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is in a publicly operated community residence which serves 16 or fewer residents;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is in a publicly operated emergency shelter (PESH);

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Qualifies under the special provision in SI 00520.130 (1619 eligible goes into medical institution);

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 10/01/03 eligible recipient in FLA D and also cases that were FLA D prior + to January 1988; or

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Effective 12/01/96, children under age 18 residing in certain public or private facilities + receiving payment for their care under any health insurance policy issued by a private + provider. For determination of applicability of $30 payment limit see SI 00520.011).

    +
    +
    +
  12. +
+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for New York effective 01/01/10 are shown in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

674.00

+
+

87.00

+
+

761.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

23.00

+
+

697.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

674.00

+
+

266.48

+
+

940.48

+
+

 

+
+

 

+
+

All other counties

+
+

674.00

+
+

228.48

+
+

902.48

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

674.00

+
+

435.00

+
+

1109.00

+
+

 

+
+

 

+
+

All other counties

+
+

674.00

+
+

405.00

+
+

1079.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

674.00

+
+

694.00

+
+

1368.00

+
+

 

+
+

 

+
+

All other counties

+
+

674.00

+
+

694.00

+
+

1368.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

  0.00

+
+

674.00

+
+

B

+
+

F

+
+

All

+
+

449.342

+
+

23.00

+
+

472.34

+
+

D

+
+

Z

+
+

All

+
+

30.003

+
+

0.004

+
+

30.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1011.00

+
+

104.00

+
+

1115.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

46.00

+
+

1057.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

1011.00

+
+

869.96

+
+

1880.96

+
+

 

+
+

 

+
+

All other counties

+
+

1011.00

+
+

793.96

+
+

1804.96

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

1011.00

+
+

1207.00

+
+

2218.00

+
+

 

+
+

 

+
+

All other counties

+
+

1011.00

+
+

1147.00

+
+

2158.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

1011.00

+
+

1725.00

+
+

2736.00

+
+

 

+
+

 

+
+

All other counties

+
+

1011.00

+
+

1725.00

+
+

2736.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

F

+
+

All

+
+

674.002

+
+

46.00

+
+

720.00

+
+

D

+
+

Z

+
+

All

+
+

60.003

+
+

0.004

+
+

60.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

M. Description of supplements - Pennsylvania

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

C

+
+

Living with an EP -- Recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules.

+
+

D

+
+

Living in the Household of Another with an EP -- Recipients who live in the household + of another and have one or more EP’s as defined under the Federal rules.

+
+

G

+
+

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

H

+
+

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waived their right + to receive, an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all recipients who are residing in a medical facility + in which Title XIX is paying more than 50 percent of the cost of care and recipients + in FLA-A or FLA-B who receive a State-administered supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Pennsylvania effective 01/01/10 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement
+ + Level

+
+

Total Payment Levels

+
+

A

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

C

+
+

All

+
+

1012.001

+
+

43.70

+
+

1055.70

+
+

 

+
+

G

+
+

All

+
+

674.00

+
+

434.30

+
+

1108.30

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

439.30

+
+

1113.30

+
+

B

+
+

Z

+
+

All

+
+

449.342

+
+

0.00

+
+

449.34

+
+

 

+
+

D

+
+

All

+
+

674.673

+
+

43.70

+
+

718.37

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.004

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement
+ + Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

 

+
+

C

+
+

All

+
+

1349.001

+
+

68.05

+
+

1417.05

+
+

 

+
+

G

+
+

All

+
+

1011.00

+
+

947.40

+
+

1958.40

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

957.40

+
+

1968.40

+
+

B

+
+

B

+
+

All

+
+

674.002

+
+

0.00

+
+

674.00

+
+

 

+
+

D

+
+

All

+
+

899.34

+
+

68.05

+
+

967.39

+
+

D

+
+

Z

+
+

All

+
+

60.004

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

N. Description of supplements - Rhode Island

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living -- Recipients who are in Federal codes A and C, except for individuals + residing in a residential care or assisted living facility who are certified as eligible + for State Code D. This includes children under the age of 18 who are in Federal living + arrangement D because a private health insurance policy or a combination of Medicaid + and a private health insurance policy pays or is expected to pay over 50 percent of + the cost of care for that month. For determination of applicability of $30 payment + limit see second and third bullets in SI 00520.011C.1.b.

+ +

Recipients residing in a public emergency shelter for the homeless and those who are + eligible for Section 1619 are included in this category.

+
+

B

+
+

Living in the Household of Another -- Recipients who are living in the household of + another and receiving support and maintenance in-kind. This variation applies only + when the one-third reduction to the Federal benefit is applied.

+
+

D

+
+

Residential Care or Assisted Living -- This category applies to individuals only.

+
+

E

+
+

The State elected Federal Administration of an optional State Supplementary payment + to residents of Title XIX Facilities (Effective 03/01/91). This includes children + under the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent + of the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waived their right + to receive, an optional supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Rhode Island effective 01/01/10 are shown + in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement
+ + Level

+
+

Total Payment Levels

+
+

A

+
+

A1

+
+

All

+
+

674.00

+
+

39.92

+
+

713.92

+
+

 

+
+

D

+
+

All

+
+

674.00

+
+

538.00

+
+

1212.00

+
+

B

+
+

B1

+
+

All

+
+

449.342

+
+

51.92

+
+

501.26

+
+

C

+
+

A1

+
+

All

+
+

674.00

+
+

39.92

+
+

713.92

+
+

D

+
+

A3

+
+

Children Private Insurance

+
+

30.004

+
+

39.92

+
+

69.92

+
+

 

+
+

E

+
+

All

+
+

30.004

+
+

20.00

+
+

50.00

+
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3State OS Code A applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

4Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement
+ + Level

+
+

Total Payment Levels

+
+

A

+
+

A1

+
+

All

+
+

1011.00

+
+

79.38

+
+

1090.38

+
+

B

+
+

B1

+
+

All

+
+

674.002

+
+

97.30

+
+

771.30

+
+

D

+
+

E

+
+

All

+
+

60.003

+
+

40.00

+
+

100.00

+
+
+

1Code is systems generated from the Federal code.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

O. Description of supplements - Utah

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone or With Others -- This variation includes recipients who are in Federal + codes A and C.

+
+

B

+
+

Living in the Household of Another -- Recipients with no EP who are “living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.)

+
+

Z

+
+

No Supplement Cases -- No supplement cases include all recipients who are not included + in A or B.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Utah effective 01/01/10 are shown in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement
+ + Level

+
+

Total Payment Level

+
+

A,C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

B

+
+

All

+
+

449.342

+
+

3.13

+
+

452.47

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement
+ + Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1011.00

+
+

4.60

+
+

1015.60

+
+

B

+
+

B

+
+

All

+
+

674.002

+
+

9.73

+
+

683.73

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+
+
+ +
+
+

P. Description of supplements - Vermont

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living (except Chittenden County) – Recipients not living in the household + of another and not in a residential or custodial care situation. This includes a child + who is living with a parent and recipients residing in a private Title XIX facility + where Medicaid is not paying more than 50 percent of the cost of care. It includes + children under the age of 18 who are in Federal living arrangement D because a private + health insurance policy or a combination of Medicaid and a private health insurance + policy pays or is expected to pay over 50 percent of the cost of care for that month. + For determination of applicability of $30 payment limit see second and third bullets + in SI 00520.011C.1.b.

+ +

A recipient residing in a publicly operated emergency shelter throughout a month.

+
+

B

+
+

Independent Living in Chittenden County -- Same as Code A above except restricted + to residents of Chittenden County.

+
+

C

+
+

Licensed Residential Care Home or Assisted Living Residence with Assistive Community + Care Services (Level III) -- Recipients residing in Level III facilities identified + by the State. Refer to the Vermont Community Care Facilities (OS C and G) list on + BOSNET to determine if a residence meets the requirements for Optional Supplement + C.

+
+

E

+
+

Living in the Household of Another -- Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions).

+
+

G

+
+

Licensed Residential Care Home or Therapeutic Community Residence (Level IV) -- Recipients + residing in Level IV facilities identified by the State. Refer to the Vermont Community + Care Facilities (OS C and G) list on BOSNET to determine if a residence meets the + requirements for Optional Supplement G.

+
+

H

+
+

Custodial Care: Family Home -- Recipients living in another's home in such a manner + that the recipient is paying room and board and is receiving one or more of the services + outlined under the custodial care definition. The recipient must also receive the + room and board and custodial care in the home in which they reside. In order to qualify + as a home under this arrangement, these services must not be provided to more than + two persons and must be provided by a resident of the home.

+ +

In some cases the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) H. To qualify these programs must meet the requirements stated above.

+ +

Custodial care means providing basic room and board, plus personal services such as: help with feeding, dressing, bathing, moving about under + normal circumstances, occasional tray service (tray service two-three times a week) + which may include supervision for the recipient's protection. Supervision for the + recipient's protection deals primarily with protection services for retarded and emotionally + disturbed individuals. A person who receives one or more of these personal services + is receiving custodial care.

+
+

I

+
+

Effective 07/01/87, the State elected Federal administration of an optional State + supplementary payment to residents in Title XIX facilities. This includes children + under the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent + of the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but has waived their + right to receive, an optional supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Vermont effective 01/01/10 are shown in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement
+ + Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

 

+
+

C

+
+

All

+
+

674.00

+
+

48.38

+
+

722.38

+
+

 

+
+

G

+
+

All

+
+

674.00

+
+

223.94

+
+

897.94

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

98.69

+
+

772.69

+
+

B

+
+

E

+
+

All

+
+

449.341

+
+

39.30

+
+

488.64

+
+

C

+
+

A

+
+

All (Except Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

D

+
+

A or B2

+
+

Children Private Insurance

+
+

30.003

+
+

52.04

+
+

82.04

+
+

 

+
+

I

+
+

All

+
+

30.003

+
+

17.66

+
+

47.66

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement
+ + Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County

+
+

1011.00

+
+

98.88

+
+

1109.88

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County

+
+

1011.00

+
+

98.88

+
+

1109.88

+
+

 

+
+

C

+
+

All

+
+

1011.00

+
+

96.77

+
+

1107.77

+
+

 

+
+

G

+
+

All

+
+

1011.00

+
+

562.06

+
+

1573.06

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

332.82

+
+

1343.82

+
+

B

+
+

E

+
+

All

+
+

674.001

+
+

48.31

+
+

722.31

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

35.33

+
+

95.33

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415042
SI 01415.042 - Federally Administered Optional Supplementary Payment Programs for 01/10 Payment Levels - 01/07/2011
+Batch run: 05/27/2026
+Rev:01/07/2011
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html new file mode 100644 index 00000000..d35b662b --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2011.html @@ -0,0 +1,13934 @@ + + +SSA - POMS: SI 01415.043 - Federally Administered Optional Supplementary Payment Programs for 01-11 Payment Levels - 01/28/2013 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 78 (08-24)

+

SI 01415.043 Federally Administered Optional Supplementary Payment Programs for 01-11 Payment Levels

+ + +

CITATIONS: Social Security Act as amended in 1973, Section 1616; Social Security Amendments of 1972, Section 301; Public Law 93-66, Section 212

+ +
+
+

A. States participating in the federally administered optional supplementary payment + programs

+
+
+

The following states are participating in the federally Administered Optional Supplementary + Payment Programs:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+
+

Reference

+
+

California

+
+

SI 01415.043B

+
+

Delaware

+
+

SI 01415.043C

+
+

District Of Columbia

+
+

SI 01415.043D

+
+

Hawaii

+
+

SI 01415.043E

+
+

Iowa

+
+

SI 01415.043F

+
+

Massachusetts

+
+

SI 01415.043G

+
+

Michigan

+
+

SI 01415.043H

+
+

Montana

+
+

SI 01415.043I

+
+

Nevada

+
+

SI 01415.043J

+
+

New Jersey

+
+

SI 01415.043K

+
+

New York

+
+

SI 01415.043L

+
+

Pennsylvania

+
+

SI 01415.043M

+
+

Rhode Island

+
+

SI 01415.043N

+
+

Utah

+
+

SI 01415.043O

+
+

Vermont

+
+

SI 01415.043P

+
+
+
+
+ +
+
+

B. Description of supplements for California

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living with Cooking Facilities for an Eligible individual or couple who + meets one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement (FLA) A purposes, + and has cooking and food storage facilities, or receives meals as part of the living + arrangement;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent, or parents, or + is a disabled child age 18, or over who meets sharing criteria and is living in the + household of a parent or parents;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind individual who lives in an independent living arrangement with or without + cooking and food storage facilities; or

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a private medical facility licensed by the State but not certified under + Title XIX.

    +
    +
    +
  10. +
+
+

B

+
+

Non-medical Out-of-Home Care (NMOHC) applies when an individual or couple needs non-medical + care, or supervision in the following living arrangement situations:

+ +

CHILDREN (UNDER AGE 18)

+ +
    +
  1. +
    +
    a. 
    +
    +

    Blind child residing in a State licensed NMOHC facility;

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian;

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility;

    +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    +
    +
    +
  8. +
  9. +
    +
    e. 
    +
    +

    Disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

    +
    +
    +
  10. +
  11. +
    +
    f. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or

    +
    +
    +
  12. +
+ +

ADULTS (AGE 18 AND OVER)

+ +
    +
  1. +
    +
    a. 
    +
    +

    Aged, blind or disabled individual, or couple has been determined to be in FLA A and + resides in the home of a relative, legal conservator or guardian; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Aged, blind, or disabled individual or couple is determined to be in FLA A and resides + in a State licensed NMOHC facility.

    +
    +
    +
  4. +
+ +

For California optional supplement (OS) purposes, a relative is defined as a parent, + child, sibling, half-sibling, parent's sibling, sibling's child, first cousin, or + any person of the preceding generation denoted by the prefix “grand” or “great.”

+
+

C

+
+

Independent Living Without Cooking Facilities -- Aged or disabled individual or couple + who is neither provided any meals, nor has access to adequate cooking or food storage + facilities as part of a living arrangement. Transients, as defined in SI 00835.060, are also eligible for OS C.

+ +

An individual or couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Immediate living quarters do not have cooking and food storage facilities with which + the individual or couple, or another person (who is responsible for preparing their + meals) can prepare meals on a daily basis.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities that are outside the immediate + living quarters), for the preparation of meals or having meals prepared on their behalf.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + have access to for preparation of meals.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis).

    +
    +
    +
  10. +
+ +

“Adequate” cooking and food storage facilities exist when an individual or couple + has access to:

+ +
    +
  • +
    +
    •
    +
    +

    A working refrigerator or icebox, and a stove without a working oven, but with at least two working burners. (The capacity + of the refrigerator or icebox is not a factor of consideration. Do not consider an + ice-chest as adequate storage.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    A working refrigerator or icebox, and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates that do not have temperature + controls for warming food as adequate cooking facilities.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    A working refrigerator or icebox, and a stove with a working oven or functioning microwave oven, in combination with at + least one working burner on a stove, or a one-burner hotplate with a temperature control.

    +
    +
    +
  • +
+ +

Eligibility for OS C begins in the month the recipient applies for this supplement + rate provided they have been without cooking and food storage facilities throughout + the month.

+ +

NOTE: For purposes of OS C, “throughout a month” does not mean the recipient must lack adequate cooking or food storage facilities from the + very first moment of the month. The recipient need only lack them from some time on + the first day of the month.

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the individual of their responsibility to immediately report when the temporary condition + ceases. If the individual provides an expected repair or replacement date for the + appliance, diary the case for re-contact.

+ +

Eligibility for this supplementary payment ceases the month following the month that + the recipient receives meals, or adequate cooking and food storage facilities are + available.

+
+

 

+
+

For a couple, comprised of an aged or disabled individual and a blind individual, + whose living arrangement lacks adequate cooking and storage facilities, the couple + receives the SSI and State Supplement Payment level for a blind or aged, or disabled + couple, plus the restaurant meals allowance for the disabled member of the couple. + This living arrangement requires force payment.

+
+

D

+
+

Living in the Household of Another -- Eligible individual or couple is living in the + household of another and receives food and shelter from that individual. Most individuals or couples who are subject to a one-third + reduction of their Federal SSI payments are eligible for OS D because the criteria + for this supplement level are the same as charging the one-third reduction. However, + when the eligible individual or couple lives in the home of a relative (other than + a spouse) and needs care and supervision, you must obtain certification for non-medical + out-of-home care (OS F) from the county welfare office since this is the highest categorical + supplement for which an individual or couple can qualify.

+
+

E

+
+

Disabled Child Under Age 18 – Disabled (not blind) child under age 18 who resides + with a parent or relative by blood or marriage.

+ +

NOTE: Only FLA A and C are compatible with OS E. If the value of the one-third reduction + (VTR) applies, see code G in this section.

+
+

F

+
+

Non-medical Out-of-Home Care Living in the Household of Another -- Applies whenever + an eligible individual or couple meets the criteria for the non-medical out-of-home + care payment rate, and is determined to receive the Federal code B payment for living + in the household of another. For the One-Third Reduction Provision see SI 00835.200.

+
+

G

+
+

Disabled Child Under Age 18 Living in the Household of Another -- Applies to a disabled + (not blind) child under age 18, who resides with a parent or relative by blood or + marriage, and is determined to receive the Federal code B payment for living in the household of + another individual. For the One-Third Reduction Provision, see SI 00835.200.

+
+

J

+
+

Residents of Title XIX facilities.

+ +

Use this State code to supplement Section 1619 cases.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible recipient who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where Title XIX pays more than 50 percent of the costs; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility not certified under Title XIX, and not licensed by the + State.

    +
    +
    +
  4. +
+ +

Includes residents of publicly operated emergency shelters throughout a month.

+ +

NOTE: California is a concurrent category State, and permits SSI recipients to receive the + highest categorical supplement for which they can qualify.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for California, effective 07/01/11, are in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

156.40

+
+

830.40

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

211.40

+
+

885.40

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

156.40

+
+

830.40

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

412.00

+
+

1,086.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

240.40

+
+

914.40

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

240.40

+
+

914.40

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

63.40

+
+

737.40

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

Aged

+
+

449.341

+
+

159.83

+
+

609.17

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

214.83

+
+

664.17

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

159.83

+
+

609.17

+
+

 

+
+

F

+
+

All

+
+

449.341

+
+

407.00

+
+

856.34

+
+

 

+
+

G

+
+

Disabled

+
+

449.341

+
+

66.83

+
+

516.17

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

211.40

+
+

885.40

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

63.40

+
+

737.40

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

396.20

+
+

1407.20

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

543.20

+
+

1554.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

396.20

+
+

1407.20

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

487.20

+
+

1498.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

396.20

+
+

1407.20

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

487.20

+
+

1498.20

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1161.00

+
+

2172.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

564.20

+
+

1575.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

564.20

+
+

1575.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

564.20

+
+

1575.20

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

674.001

+
+

401.33

+
+

1075.33

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

548.33

+
+

1222.33

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

401.33

+
+

1075.33

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

492.33

+
+

1166.33

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

401.33

+
+

1075.33

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

492.33

+
+

1166.33

+
+

 

+
+

F

+
+

All

+
+

674.001

+
+

1045.66

+
+

1719.66

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+

3. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for California, effective from 11/01/09 to 06/30/11, + are in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

171.00

+
+

845.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

234.00

+
+

908.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

171.00

+
+

845.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

412.00

+
+

1,086.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

255.00

+
+

929.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

255.00

+
+

929.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

63.40

+
+

737.40

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

Aged

+
+

449.341

+
+

190.32

+
+

639.66

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

268.98

+
+

718.32

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

190.32

+
+

639.66

+
+

 

+
+

F

+
+

All

+
+

449.341

+
+

407.00

+
+

856.34

+
+

 

+
+

G

+
+

Disabled

+
+

449.341

+
+

67.96

+
+

517.30

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

234.00

+
+

908.00

+
+

 

+
+

E

+
+

Disabled

+
+

674.00

+
+

63.40

+
+

737.40

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

396.20

+
+

1407.20

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

543.20

+
+

1554.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

396.20

+
+

1407.20

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

487.20

+
+

1498.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

396.20

+
+

1407.20

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

487.20

+
+

1498.20

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1161.00

+
+

2172.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

564.20

+
+

1575.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

564.20

+
+

1575.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

564.20

+
+

1575.20

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

674.001

+
+

401.33

+
+

1075.33

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

548.33

+
+

1222.33

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

401.33

+
+

1075.33

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

492.33

+
+

1166.33

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

401.33

+
+

1075.33

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

492.33

+
+

1166.33

+
+

 

+
+

F

+
+

All

+
+

674.001

+
+

1045.66

+
+

1719.66

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + -- Only living arrangement variation in Delaware and includes only those recipients + who are certified by the State medical unit as residents of one of the above adult + facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A or Y.

+ +

Use optional supplementation code Z with an “intervening” Federal code A. For Optional + State Supplement codes, see SM 01301.535.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payments levels for Delaware, effective 01/01/11, are in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total
Payment Levels

+
+

A

+
+

A

+
+

All

+
+

674.00

+
+

140.00

+
+

814.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

448.00

+
+

1459.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for the District of Columbia

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Foster Care Home with 50 or Fewer Residents --Recipients who are certified by + the District of Columbia, Department of Health, as residents of an adult foster care + home with 50 or fewer residents.

+
+

B

+
+

Adult Foster Care Home with More than 50 Residents --Recipients who are certified + by the District of Columbia, Department of Health, as residents of an adult foster + care home with more than 50 residents.

+
+

G

+
+

Residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+

Z

+
+

No Supplement Cases -- All recipients who are not included in A, B, G, or Y.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for the District of Columbia, effective 01/01/11, + are in the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

674.00

+
+

485.00

+
+

1159.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

595.00

+
+

1269.00

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

G

+
+

All

+
+

30.002

+
+

40.00

+
+

70.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Code

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

1307.00

+
+

2318.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

1527.00

+
+

2538.00

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

80.00

+
+

140.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

B

+
+

Living in a Community Care or Foster Care Home --

+ +

Persons eligible for SSI who are both over age 18, and live in a State approved Care + or Foster Care Home.

+
+

D

+
+

Living in a Certified Medical Facility – Eligible individual living in a medical treatment + facility where a substantial part (more than 50 percent) of the cost of care is paid + under Title XIX.

+
+

H

+
+

Domiciliary Care I -- (Maximum of five residents) - Eligible individual (including + a child), or couple living in a domiciliary care facility which provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities.

+
+

I

+
+

Domiciliary Care II -- Same as H, except care provided for six or more residents.

+
+

Y

+
+

Optional Supplementation Waived -- Eligible for, but waives their right to receive + an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Eligible recipient who is living in the household of another, + or an eligible recipient who is a patient in a private medical facility not certified + under Title XIX.

+ +

Also includes residents of publicly operated emergency shelters throughout a month.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Hawaii, effective 01/01/11, are in the following + charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A 

+
+

B

+
+

All

+
+

674.00

+
+

651.90

+
+

1325.90

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

651.90

+
+

1325.90

+
+

 

+
+

I

+
+

All

+
+

674.00

+
+

759.90

+
+

1433.90

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

D

+
+

D

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

B

+
+

All

+
+

1011.00

+
+

1640.80

+
+

2651.80

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

1640.80

+
+

2651.80

+
+

 

+
+

I

+
+

All

+
+

1011.00

+
+

1856.80

+
+

2867.80

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

D

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living in Own Household (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, does not have an + Essential Person (EP), and is not otherwise excepted from supplementation. Also included + are blind recipients in Title XIX facilities where Medicaid pays 50 percent or less of the cost + of care. Optional supplement code A is also compatible with Federal codes A and C.

+ +

Use optional supplement code A with an “intervening” Federal code A. For State Supplement + codes, see SM 01301.535.

+
+

B

+
+

Living in the Household of Another (Blind Only) -- Only an eligible blind individual and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation.

+
+

C

+
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement A or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who is financially dependent + upon the eligible individual as defined by the State Department of Human Services.

+ +

The payment level for this variation increases by $22 for each blind individual or + blind member of a couple to reflect the categorical blind supplement.

+
+

H

+
+

Living with a Dependent Person -- Eligible individual or each member of an eligible + couple in Federal living arrangement B who has an ineligible spouse, parent, child, + or adult child living in the home with them, and who is financially dependent upon + the eligible individual as defined by the State Department of Human Services.

+ +

The payment level for this variation increases by $22 for each blind individual or + blind member of a couple to reflect the categorical blind supplement.

+
+

I

+
+

Living in a Family Life or Boarding Home -- Eligible individual or each member of + an eligible couple in FLA A or B, who resides in a family life home or boarding home + licensed by the State Department of Health, or certified by the State Department of + Human Services.

+
+

G

+
+

Indicates that no supplement is payable to a recipient living in a Title XIX facility + and Title XIX pays more than 50 percent of the cost of care; however, a Federal D + living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time of the initial claim input.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+

Z

+
+

No Supplement Cases = Residents of publicly operated emergency shelters throughout + a month and aged and disabled recipients living in their own households, or living + in the households of others. “No supplement” also applies to all recipients living + in medical facilities not certified under Title XIX, or all recipients who receive + reduced Federal payments of $30 or $60 due to living in a Title XIX facility. In addition, + aged and disabled recipients whose Federal payments are not reduced, and who live + in a Title XIX facility where Medicaid pays 50 percent or less of the cost of care + do not receive a supplement.

+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs:

+ +
    +
  • +
    +
    •
    +
    +

    In-Home Health Related Care

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Residential Care

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Supplement for Medicare and Medicaid Eligibles.

    +
    +
    +
  • +
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid.

+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Iowa, effective 01/01/11, are in the following + charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind

+
+

674.00

+
+

22.00

+
+

696.00

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

366.00

+
+

1040.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

344.00

+
+

1018.00

+
+

 

+
+

D

+
+

Aged

+
+

674.00

+
+

142.00

+
+

816.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

164.00

+
+

838.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

142.00

+
+

816.00

+
+

 

+
+

Z

+
+

Aged

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

B

+
+

Blind

+
+

449.341

+
+

22.00

+
+

471.34

+
+

 

+
+

H3

+
+

Aged

+
+

449.341

+
+

344.00

+
+

793.34

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

366.00

+
+

815.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

344.00

+
+

793.34

+
+

 

+
+

I3

+
+

Aged

+
+

449.341

+
+

142.00

+
+

591.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.34

+
+

142.00

+
+

591.34

+
+

 

+
+

 

+
+

Blind

+
+

449.34

+
+

164.00

+
+

613.34

+
+

 

+
+

Z

+
+

Aged

+
+

449.341

+
+

0.00

+
+

449.34

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

22.00

+
+

696.00

+
+

 

+
+

C

+
+

Blind

+
+

674.00

+
+

366.00

+
+

1040.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

344.00

+
+

1018.00

+
+

 

+
+

Z

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

3 Old FLA/OS codes B/C and B/D were changed to B/H and B/I to make them compatible with + the RMA policy computation process.

+

NOTE:

+

State-administered programs for Calendar Year 2011:

+
    +
  • +
    +
    •
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total
Payment Levels

+
+

A

+
+

A

+
+

Blind/Blind

+
+

1011.00

+
+

44.00

+
+

1055.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

1011.00

+
+

22.00

+
+

1033.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

22.00

+
+

1033.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

344.00

+
+

1355.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

388.00

+
+

1399.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

344.00

+
+

1355.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

366.00

+
+

1377.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

344.00

+
+

1355.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

366.00

+
+

1377.00

+
+

 

+
+

D

+
+

Aged/Aged

+
+

1011.00

+
+

641.00

+
+

1652.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

685.00

+
+

1696.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

641.00

+
+

1652.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

663.00

+
+

1674.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

641.00

+
+

1652.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

663.00

+
+

1674.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

B

+
+

Blind/Blind

+
+

674.001

+
+

44.00

+
+

718.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

674.001

+
+

22.00

+
+

696.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

22.00

+
+

696.00

+
+

 

+
+

H

+
+

Aged/Aged

+
+

674.001

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

388.00

+
+

1062.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

366.00

+
+

1040.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

344.00

+
+

1018.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

366.00

+
+

1040.00

+
+

 

+
+

I

+
+

Aged/Aged

+
+

674.001

+
+

641.00

+
+

1315.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

685.00

+
+

1359.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

641.00

+
+

1315.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

663.00

+
+

1337.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

641.00

+
+

1315.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

663.00

+
+

1337.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

674.001

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

0.00

+
+

674.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE:

+

State-administered programs for Calendar Year 2011:

+
    +
  • +
    +
    •
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. (Treat members of a couple as + individuals.)

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligibles receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Massachusetts

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Full Cost-of-Living:

+ +

An individual who is in FLA A is in State living arrangement A, if they are living + in their own household1 and meets one of the following conditions:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living alone -- Individuals who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, consider those who rent only rooms in private residences as living + alone, provided they do not use the residential kitchen facilities for preparing meals;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living only with their eligible spouse;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living with their eligible spouse and ineligible child or children 2 none of whom (children) receive public income maintenance payments;3 or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Living only with their ineligible spouse or their ineligible child or children, none + of whom (spouse and children) receive public income maintenance payments.

    +
    +
    +
  8. +
+ +

NOTE: For purposes of 1 through 4, do not consider foster children placed with anyone other + than their parents to be living with the foster parent.

+
+

 

+
+

An individual who is in FLA C is in State living arrangement A if none of the other + people with whom they are living receive public income maintenance payments.

+ +

An individual who is in FLA A or C, and who does not meet the criteria in SI 01415.040G.1. (see Code A, 1, or 2 (in this chart)) is in State living arrangement A, if they pay + at least two-thirds of the household expenses. In making a determination as to whether + the individual pays two-thirds or more of the expenses, use the method defined in, + SI 00835.160. Only use the household expenses shown in that section. You may use an ineligible + spouse's income (except any assistance based upon need) to determine if the eligible + person is paying two-thirds of the household expenses.

+ +

A person living in a public congregate housing development is in A. The State makes + the determination that a public congregate housing development is eligible for listing. + Use optional supplement code A with an “intervening” Federal code A. For Optional + State Supplement codes, see SM 01301.535.

+
+

B

+
+

Shared Living Expenses -- An individual who is in FLA A or C, and who does not meet + the criteria listed for State living arrangement A, E, or G is in State living arrangement + B. Also included in this living arrangement are transients, the homeless, and residents + of public emergency shelters for the homeless (PESH).

+ +

Those residing in group-care facilities, such as halfway houses, private medical facilities + where Medicaid is paying 50 percent or less of the cost of care, foster homes, commercial + boarding homes, or other facilities which do not meet the criteria for living arrangement + E or public congregate housing defined in SI 01415.040G.1., Code A.4. (in this section). This includes children under the age of 18, who are + in Federal living arrangement D because a private health insurance policy, or a combination + of Medicaid and a private health insurance policy pays, or is expected to pay over + 50 percent of the cost of care for that month. For determination of applicability + of $30 payment limit, see SI 00520.011C.1.b. This also includes individuals placed under the auspices of the State adult foster + care program, and residents of publicly operated emergency shelters throughout a month.

+ +

An individual living in a household where all members receive public income maintenance + payments, unless they are paying at least two-thirds of the household expenses (A).

+ +

An individual living in a mixed household; i.e., a household where one or more other + members receive a public income maintenance payment, is also included, unless the + individual is paying at least two-thirds of the household expenses (A).

+
+

C

+
+

Living in the Household of Another -- Recipients determined under Federal rules to + be living in the household of another and receiving support and maintenance which + reduce the Federal benefit by one-third.

+
+

E

+
+

Licensed Rest Home -- Persons residing in a licensed rest home, all of which or the + portion in which they live in is licensed by, and has a provider agreement with the + State. This does not include residents of a Medicaid certified portion of a rest home.

+
+

F

+
+

Effective 07/01/87, the State elected Federal administration of this optional State + supplementary payment to residents of Title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. This includes children under the age of 18 for + whom Medicaid alone pays or expects to pay over 50 percent of the cost of care for + that month.

+
+

G

+
+

Assisted Living -- Effective 07/01/94, the State elected Federal administration of + this variation. Includes an individual, certified by the State to be residing in an + Assisted Living residence served by a certified Group Adult Foster Care provider, + who does not receive assistance under any other Federal or State rental assistance + program, and who pays a fixed, non-separable fee for rent and supportive services, + other than medically necessary services reimbursed by Medicaid. The State certifies + to SSA each individual who is eligible for this optional supplement living arrangement. + This living arrangement was discontinued effective 01/01/96; but restored, retroactively, + to 01/01/97.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive, an optional supplement.

+
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify.

+

1For purposes of determining State living arrangements, do not consider a commercial boarding house, foster home, or halfway house the person's household.

+

2Use the SSI definition of child in, SI 00501.010 .

+

3A public income maintenance payment is a payment from any of the following programs:

+
    +
  • +
    +
    •
    +
    +

    Temporary Assistance for Needy Families (TANF)

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Supplemental Security Income (SSI)

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Refugee Act of 1980

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disaster Relief Act of 1974

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    General Assistance programs of the Bureau of Indian Affairs

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    State or local government income maintenance programs that are based on need or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Department of Veterans Affairs benefits.

    +
    +
    +
  • +
+
+
+
+
+

2. Coding and monthly payments levels

+
+
+

The coding and monthly payment levels for Massachusetts, effective 01/01/11, are in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

128.82

+
+

802.82

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

114.39

+
+

788.39

+
+

 

+
+

B

+
+

Aged

+
+

674.00

+
+

39.26

+
+

713.26

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

30.40

+
+

704.40

+
+

 

+
+

E

+
+

Aged

+
+

674.00

+
+

293.00

+
+

967.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

293.00

+
+

967.00

+
+

 

+
+

G

+
+

Aged

+
+

674.00

+
+

454.00

+
+

1128.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

454.00

+
+

1128.00

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

454.00

+
+

1128.00

+
+

B

+
+

C

+
+

Aged

+
+

449.341

+
+

104.36

+
+

553.70

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

374.40

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

449.341

+
+

87.58

+
+

536.92

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

114.39

+
+

788.39

+
+

 

+
+

B

+
+

Blind

+
+

674.00

+
+

149.74

+
+

823.74

+
+

 

+
+

 

+
+

Disabled

+
+

674.00

+
+

30.40

+
+

704.40

+
+

D

+
+

B2

+
+

Blind

+
+

30.003

+
+

149.74

+
+

179.74

+
+

 

+
+

 

+
+

Disabled

+
+

30.003

+
+

30.40

+
+

60.40

+
+

 

+
+

F

+
+

All

+
+

30.003

+
+

42.80

+
+

72.80

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

201.72

+
+

1212.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

636.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

180.06

+
+

1191.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

419.10

+
+

1430.10

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

190.89

+
+

1201.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

408.27

+
+

1419.27

+
+

 

+
+

B

+
+

Aged/Aged

+
+

1011.00

+
+

201.72

+
+

1212.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

636.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

180.06

+
+

1191.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

419.10

+
+

1430.10

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

190.89

+
+

1201.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

408.27

+
+

1419.27

+
+

 

+
+

E

+
+

Aged/Aged

+
+

1011.00

+
+

923.00

+
+

1934.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

636.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1011.00

+
+

923.00

+
+

1934.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

779.74

+
+

1790.74

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

923.00

+
+

1934.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

779.74

+
+

1790.74

+
+

 

+
+

G

+
+

All

+
+

1011.00

+
+

681.00

+
+

1692.00

+
+

B

+
+

C

+
+

Aged/Aged

+
+

674.001

+
+

215.80

+
+

889.80

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

973.48

+
+

1647.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

674.001

+
+

194.18

+
+

868.18

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

594.64

+
+

1268.64

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

204.99

+
+

878.99

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

583.83

+
+

1257.83

+
+

D

+
+

F

+
+

All

+
+

60.002

+
+

85.60

+
+

145.60

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Michigan

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Domiciliary Care -- Recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care.

+
+

E

+
+

Personal Care -- Recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance in carrying out the basic activities + of daily living. The State provides a list of these facilities and certifies which + recipients are residents requiring this level of care. Such care situations include, + but are not limited to, licensed homes for the aged.

+
+

F

+
+

Home for the Aged -- Recipients residing in a non-medical facility for the aged. The + State provides SSA with a list of these facilities and certifies which recipients + are residents requiring this level of care.

+
+

G

+
+

Independent Living with an EP -- Recipients with an EP, not living in the household + of another. (Exclude children under age 18.)

+
+

H

+
+

Living in the Household of Another with an EP -- Recipients with an EP and living + in the household of another for Federal purposes. (Exclude children under age 18.)

+
+

I

+
+

Effective 01/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Recipients in Title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under Title XIX.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Michigan, effective 01/01/11, are in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

674.00

+
+

87.00

+
+

761.00

+
+

 

+
+

E

+
+

All

+
+

674.00

+
+

157.50

+
+

831.50

+
+

 

+
+

F

+
+

All

+
+

674.00

+
+

179.30

+
+

853.30

+
+

 

+
+

G

+
+

All

+
+

1012.002

+
+

14.00

+
+

1026.00

+
+

B

+
+

H

+
+

All

+
+

674.671

+
+

9.33

+
+

684.00

+
+

D

+
+

I

+
+

All

+
+

  30.003

+
+

7.00

+
+

37.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

1011.00

+
+

511.00

+
+

1522.00

+
+

 

+
+

E

+
+

All

+
+

1011.00

+
+

652.00

+
+

1663.00

+
+

 

+
+

F

+
+

All

+
+

1011.00

+
+

695.60

+
+

1706.60

+
+

 

+
+

G

+
+

All

+
+

1349.002

+
+

21.00

+
+

1370.00

+
+

B

+
+

H

+
+

All

+
+

899.34

+
+

14.00

+
+

913.34

+
+

D

+
+

I

+
+

All

+
+

60.003

+
+

14.00

+
+

74.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Montana

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

G

+
+

State-Certified Personal Care

+
+

H

+
+

State-Certified Residence in Group Home for Mentally Disabled

+
+

I

+
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+
+

J

+
+

State-Certified Residence for Child and Adult Foster Care

+
+

K

+
+

State-Certified Transitional Living for Developmentally Disabled

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all individuals and couples not certified in State + codes G, H, I, J, or K.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Montana, effective 01/01/11, are in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

674.00

+
+

94.00

+
+

768.00

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

94.00

+
+

768.00

+
+

 

+
+

I

+
+

All

+
+

674.00

+
+

94.00

+
+

768.00

+
+

 

+
+

J

+
+

All

+
+

674.00

+
+

52.75

+
+

726.75

+
+

 

+
+

K

+
+

All

+
+

674.00

+
+

26.00

+
+

700.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

Z

+
+

All

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

1011.00

+
+

193.00

+
+

1204.00

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

193.00

+
+

1204.00

+
+

 

+
+

I

+
+

All

+
+

1011.00

+
+

193.00

+
+

1204.00

+
+

 

+
+

J

+
+

All

+
+

1011.00

+
+

110.50

+
+

1121.50

+
+

 

+
+

K

+
+

All

+
+

1011.00

+
+

57.00

+
+

1068.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

Z

+
+

All

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for Nevada

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living or Living in Parental Household -- Aged or blind eligible recipient + who meets one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household.

    +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code A. For Optional State Supplement codes see + SM 01301.535.

+
+

B

+
+

Living in the Household of Another -- Aged or blind eligible recipient who is living + in the household of another individual and receiving food and shelter from that individual. Aged or blind recipients who are subject to a one-third + reduction (VTR) of their Federal SSI payment, are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B.

+
+

C

+
+

Domiciliary Care -- Aged or blind eligible recipient who lives in a private non-medical + facility or, a residential facility serving 16 or fewer persons, which provides personal + care and services to aged, infirm, or handicapped adult persons who are unrelated + to the proprietor.

+ +

The State provides licenses and authorizes these facilities to receive payment. The + State provides SSA with listings of these facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+

Z

+
+

No Supplement Cases -- No supplement cases include one of the following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Disabled eligible individual or disabled member of eligible couple;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Eligible individual or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Eligible individual or member of eligible couple who is a patient in a private medical + facility which is not certified under Title XIX; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Residents of publicly operated emergency shelters throughout a month.

    +
    +
    +
  8. +
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify.

+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Nevada, effective 01/01/11, are in the following + charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

674.00

+
+

36.40

+
+

710.40

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

109.30

+
+

783.30

+
+

 

+
+

C

+
+

Aged

+
+

674.00

+
+

391.00

+
+

1065.00

+
+

 

+
+

 

+
+

Blind

+
+

674.00

+
+

391.00

+
+

1065.00

+
+

 

+
+

Z

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

B

+
+

Aged

+
+

449.341

+
+

24.27

+
+

473.61

+
+

 

+
+

 

+
+

Blind

+
+

449.341

+
+

213.96

+
+

663.30

+
+

 

+
+

Z

+
+

Disabled

+
+

449.341

+
+

0.00

+
+

449.34

+
+

C

+
+

A

+
+

Blind

+
+

674.00

+
+

109.30

+
+

783.30

+
+

 

+
+

Z

+
+

Disabled

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1011.00

+
+

74.46

+
+

1085.46

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

374.60

+
+

1385.60

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

224.53

+
+

1235.53

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

37.23

+
+

1048.23

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

187.30

+
+

1198.30

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1011.00

+
+

881.00

+
+

1892.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1011.00

+
+

881.00

+
+

1892.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1011.00

+
+

881.00

+
+

1892.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1011.00

+
+

440.50

+
+

1451.50

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1011.00

+
+

440.50

+
+

1451.50

+
+

 

+
+

Z

+
+

Disabled

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

B

+
+

Aged/Aged

+
+

674.001

+
+

49.64

+
+

723.64

+
+

 

+
+

 

+
+

Blind/Blind

+
+

674.001

+
+

531.94

+
+

1205.94

+
+

 

+
+

 

+
+

Aged/Blind

+
+

674.001

+
+

290.79

+
+

964.79

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

674.001

+
+

24.82

+
+

698.82

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

674.001

+
+

265.97

+
+

939.97

+
+

 

+
+

Z

+
+

Disabled

+
+

674.001

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for New Jersey

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Congregate Care - Eligible recipient in FLA A. The living arrangement includes the + following:

+ +
    +
  • +
    +
    •
    +
    +

    Recipients in residential facilities who are under the supervision of the Department + of Human Services

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Children and adults under the supervision of, or placed by, the NJ Department of Human + Services’ Division of Developmental Disabilities (DDD) or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Division of Youth and Family Services (DYFS) who are in residential facilities (both + in and outside of NJ); and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients in Assisted Living Residences and in Comprehensive Personal Care Homes + (CPCH) licensed by the Department of Health and Senior Services.

    +
    +
    +
  • +
+
+

B

+
+

Living Alone or with Others -- Eligible recipients FLA A or C who do not meet the + requirements defined in other supplementation categories.

+ +

Therefore, any eligible recipient who meets the requirement for FLA A is in optional + supplement B unless residing in a residential health care facility or living alone + with an ineligible spouse.

+ +

Automatically entitle any child meeting the criteria for a Federal code C to optional + supplement B.

+ +

This category includes, but is not limited to, those eligible recipients who are in + one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living in the Transitional Residency Program when the placement is through the Division + of Mental Health and Hospitals, Department of Human Services.

    +
    +
    +
  6. +
+ +

Use optional supplement code B with an “intervening” Federal code A. For State Supplement + codes, see SM 01301.535.

+ +

Also, use this State code to supplement Section 1619 cases.

+
+

C

+
+

Living Alone with an Ineligible Spouse -- An individual lives with their ineligible + spouse, and there are no other persons who are part of the household. Determine who + is an ineligible spouse for State supplementation purposes by using Federal criteria; + i.e., a spouse, either by marriage or holding out, who is either not eligible for + SSI, or who chooses not to apply. Once other persons, even minor children, are present + in the household, this supplementary payment variation cannot exist. However, it is + possible that a claimant and their ineligible spouse live with others and allege that + they are a separate “household” by virtue of the fact that they eat their meals out + or have separate purchase and preparation of food. In this instance, an optional supplement + C is permissible as long as no other person is in their “household.” There is no couple + counterpart in this category.

+ +

Consider parent(s) with minor children to be in the same household and therefore the + presence of minor children in the household of an ineligible spouse would result in + optional supplement B.

+ +

A transient individual who co-exists only with an ineligible spouse also qualifies + for the Optional Supplement C rate.

+
+

D

+
+

Living in the Household of Another -- Persons who are “living in the household of + another” for Federal purposes.

+
+

I

+
+

Licensed Residential Health Care Facilities -- Attached to a nursing home; Assisted + Living Residence; CPCH; or “free standing”. Prior to 01/01/06, residents of these + facilities were paid at the OS “A” rate.

+ +

Base authorization to make this payment on the recipient's residence at a facility + listed in the New Jersey Congregate Care Directory .

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. + Pay residents of the Assisted Living Resident (ALR, or CPCH section of a multipurpose + facility at the OS “A” rate. Nursing home residents are in living arrangement (D/G) + if Medicaid pays more than 50 percent of the cost of care.

+
+

G

+
+

Effective 09/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+

Z

+
+

No Supplement Cases – Recipients in licensed medical facilities where Medicaid pays + less than 50 percent of the cost of care, recipients in publicly operated community + residences having 16 or less residents, and residents of publicly operated emergency + shelters throughout a month.

+ +

It also includes cases that were FLA D prior to 01/1988, or effective 12/01/96, for + children under age 18 residing in certain public or private facilities, receiving + payment for their care under any health insurance policy issued by a private provider. + For determination of applicability of $30 payment limit, see SI 00520.011.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payments levels for New Jersey, effective 01/01/11, are in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

674.00

+
+

150.05

+
+

824.05

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

31.25

+
+

705.25

+
+

 

+
+

C

+
+

Individual

+
+

674.00

+
+

153.00

+
+

827.00

+
+

 

+
+

 

+
+

w/EP

+
+

1012.002

+
+

24.36

+
+

1036.36

+
+

 

+
+

I

+
+

All

+
+

674.00

+
+

210.05

+
+

884.05

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

D

+
+

All

+
+

449.341

+
+

44.31

+
+

493.65

+
+

C

+
+

B

+
+

All

+
+

674.00

+
+

31.25

+
+

705.25

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

10.00

+
+

40.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents the FBR plus EP increment.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1011.00

+
+

618.36

+
+

1629.36

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

25.36

+
+

1036.36

+
+

 

+
+

I

+
+

All

+
+

1011.00

+
+

738.36

+
+

1749.36

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

  0.00

+
+

1011.00

+
+

B

+
+

D

+
+

All

+
+

674.001

+
+

93.09

+
+

767.09

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

20.00

+
+

80.00

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for New York

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone - Eligible recipient who meet one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Live physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Pay a fixed, pre-established flat fee for both room and board in a commercial establishment;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives with others but takes all meals outside the dwelling;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Live with others but separately prepares or has someone separately prepare their food. + Occasional preparation of meals in common does not preclude a finding of separate + preparation;

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Receive a fixed, pre-established flat fee for room and board from all others in the dwelling;

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Live with only a foster child, or a homemaker authorized by the local department of + social services (DSS), or a family care recipient placed by the Office of Mental Health + (OMH), or the Office of Mental Retardation and Developmentally Disabilities (OMRDD) + or local DSS; or

    +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    Have no permanent living arrangement (i.e., transient or street person) and is not + with a spouse or a child for whom they have primary responsibility.

    +
    +
    +
  14. +
+
+

B

+
+

Living with Others - Recipient who meets one of the following situations:

+ +

1. Resides in a dwelling with others and prepares food in common with at least one + other person in the dwelling.

+ +

NOTE: You must consider an individual living with an ineligible spouse to be living with + others despite any separate preparation. The same is true if a recipient lives with + a child for whom they have primary responsibility (except if the child is a foster + child).

+ +

2. Is a child who does not meet the criteria for OS C, or OS D (as follows):

+ +

Lives in a religious community that provides room and board in full, or in part by + the religious community; or

+ +

Has no permanent living arrangement (i.e., transient or street person), but is with + an ineligible spouse, or child for whom they have primary responsibility.

+
+

C

+
+

Congregate Care Level I

+ +
    +
  1. +
    +
    1. 
    +
    +

    New York State (NYS) places the recipient in a family type home certified by NYS Office + of Children and Family Services and supervised by a local DSS.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    OMH or OMRDD places the recipient in a certified family care home.

    +
    +
    +
  4. +
+
+

D

+
+

Congregate Care Level II – Payable to an eligible recipient who is a resident of a + licensed Level II care facility. These consist of facilities, which provide supportive + living environments and include:

+ +
    +
  • +
    +
    •
    +
    +

    Residences for Adults certified by the NYS Department of Health;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Privately-operated facilities certified by the NYS OMH;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Privately-operated facilities certified by the NYS OMH and OMRDD;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Privately-operated facilities certified by OASAS.

    +
    +
    +
  • +
+
+

E

+
+

Congregate Care Level III -- Enhanced Residential Care

+ +

Payable to an eligible recipient who is a resident of a licensed level 3 care facility + which includes:

+ +

Adult Homes; and Enriched Housing programs, certified by the NYS Department of Health, + or

+ +

Schools for the Mentally Retarded, certified by the NYS Office of Mental Retardation + and Developmental Disabilities.

+ +

Schools for the Mentally Retarded usually meet the basic Federal definition of institution, + and consist of residential facilities that provide academic, vocational, recreational, + and social skills programs. Although sometimes called schools, they often do not meet + the Federal definition of schools.

+ +

NOTE - A child residing in a Level III facility cannot receive OS E; they receive OS B.

+
+

F

+
+

Living in the Household of Another -- Payable to recipients who are FLA B.

+
+

G

+
+

Effective 01/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities. Federal administration + was terminated effective 09/30/03. State began administering this payment 10/01/03.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+

Z

+
+

No Supplement Cases – Includes Eligible recipient in FLA A, or D who meet one of the + following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Is in a licensed medical facility where Medicaid is paying less than 50 percent of + the cost of care;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is in a publicly operated community residence which serves 16 or fewer residents;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is in a publicly operated emergency shelter (PESH);

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Qualifies under the special provision in SI 00520.130 (1619 eligible goes into medical institution);

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 10/01/03, eligible recipient in FLA D, and also FLA D cases prior to January + 1988; or

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Effective 12/01/96, children under age 18 residing in certain public or private facilities + receiving payment for their care under any health insurance policy issued by a private + provider. (For determination of applicability of $30 payment limit, see SI 00520.011).

    +
    +
    +
  12. +
+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for New York, effective 01/01/11, are in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

674.00

+
+

87.00

+
+

761.00

+
+

 

+
+

B

+
+

All

+
+

674.00

+
+

23.00

+
+

697.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

674.00

+
+

266.48

+
+

940.48

+
+

 

+
+

 

+
+

All other counties

+
+

674.00

+
+

228.48

+
+

902.48

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

674.00

+
+

435.00

+
+

1109.00

+
+

 

+
+

 

+
+

All other counties

+
+

674.00

+
+

405.00

+
+

1079.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

674.00

+
+

694.00

+
+

1368.00

+
+

 

+
+

 

+
+

All other counties

+
+

674.00

+
+

694.00

+
+

1368.00

+
+

 

+
+

Z

+
+

All

+
+

674.00

+
+

  0.00

+
+

674.00

+
+

B

+
+

F

+
+

All

+
+

449.342

+
+

23.00

+
+

472.34

+
+

D

+
+

Z

+
+

All

+
+

30.003

+
+

0.004

+
+

30.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1011.00

+
+

104.00

+
+

1115.00

+
+

 

+
+

B

+
+

All

+
+

1011.00

+
+

46.00

+
+

1057.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

1011.00

+
+

869.96

+
+

1880.96

+
+

 

+
+

 

+
+

All other counties

+
+

1011.00

+
+

793.96

+
+

1804.96

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

1011.00

+
+

1207.00

+
+

2218.00

+
+

 

+
+

 

+
+

All other counties

+
+

1011.00

+
+

1147.00

+
+

2158.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

1011.00

+
+

1725.00

+
+

2736.00

+
+

 

+
+

 

+
+

All other counties

+
+

1011.00

+
+

1725.00

+
+

2736.00

+
+

 

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

B

+
+

F

+
+

All

+
+

674.002

+
+

46.00

+
+

720.00

+
+

D

+
+

Z

+
+

All

+
+

60.003

+
+

0.004

+
+

60.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

M. Description of supplements for Pennsylvania

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

C

+
+

Living with an EP -- Recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules.

+
+

D

+
+

Living in the Household of Another with an EP -- Recipients who live in the household + of another and have one or more EP’s as defined under the Federal rules.

+
+

G

+
+

Living in a Domiciliary Care Facility -- Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

H

+
+

Living in a Personal Care Boarding Home -- Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+

Z

+
+

No Supplement Cases -- Includes all recipients who are residing in a medical facility + where Title XIX pays more than 50 percent of the cost of care, and recipients in FLA-A, + or FLA-B receive a State-administered supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Pennsylvania, effective 01/01/11, are in + the following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

 

+
+

C

+
+

All

+
+

1012.001

+
+

43.70

+
+

1055.70

+
+

 

+
+

G

+
+

All

+
+

674.00

+
+

434.30

+
+

1108.30

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

439.30

+
+

1113.30

+
+

B

+
+

Z

+
+

All

+
+

449.342

+
+

0.00

+
+

449.34

+
+

 

+
+

D

+
+

All

+
+

674.673

+
+

43.70

+
+

718.37

+
+

C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

30.004

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
+ + Supplement
+ + Level

+
+

Total Payment Levels

+
+

A

+
+

Z

+
+

All

+
+

1011.00

+
+

0.00

+
+

1011.00

+
+

 

+
+

C

+
+

All

+
+

1349.001

+
+

68.05

+
+

1417.05

+
+

 

+
+

G

+
+

All

+
+

1011.00

+
+

947.40

+
+

1958.40

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

957.40

+
+

1968.405

+
+

B

+
+

Z

+
+

All

+
+

674.002

+
+

0.00

+
+

674.00

+
+

 

+
+

D

+
+

All

+
+

899.34

+
+

68.05

+
+

967.39

+
+

D

+
+

Z

+
+

All

+
+

60.004

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents the FBR plus EP increment.

+

2Not an FBR; the amount represents the FBR less VTR.

+

3Not an FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not an FBR; the amount represents a payment cap to recipients

+

5The payment level for couples in Pennsylvania’s PCBHs applies only in the month of the move. The month following the month of the move, treat the couple as individuals. For more information, see SI PHI01415.010 BASIC 10/2009.

+
+
+
+
+
+
+ +
+
+

N. Description of supplements for Rhode Island

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Residential Care or Assisted Living -- This category applies to individuals only.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waived their right + to receive, an optional supplement.

+
+

Z

+
+

No State Supplement payable -- The State of Rhode Island does not pay a supplement + unless individual resides in a Licensed Adult Care Facility (“Residential Care or + Assisted Living”) as described in category “D” above.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Rhode Island, effective 10/01/11, are in + the following chart:

+

Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A 

+
+

D

+
+

All

+
+

674.00

+
+

332.00

+
+

1006.00

+
+
+
+
+
+
+

3. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Rhode Island, effective 01/01/11, are in + the following chart:

+

Individual

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A 

+
+

D

+
+

All

+
+

674.00

+
+

538.00

+
+

1212.00

+
+
+
+
+
+
+ +
+
+

O. Description of supplements for Utah

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone or With Others -- This variation includes recipients who are in Federal + codes A and C.

+
+

B

+
+

Living in the Household of Another -- Recipients with no EP who are “living in the + household of another” for Federal purposes. (Children under age 18 are included in + this living arrangement variation.)

+
+

Z

+
+

No Supplement Cases -- No supplement cases include all recipients who are not included + in A or B.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Utah, effective 01/01/11, are in the following + charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Level

+
+

A,C

+
+

Z

+
+

All

+
+

674.00

+
+

0.00

+
+

674.00

+
+

B

+
+

B

+
+

All

+
+

449.342

+
+

3.13

+
+

452.47

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement
Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1011.00

+
+

4.60

+
+

1015.60

+
+

B

+
+

B

+
+

All

+
+

674.002

+
+

9.73

+
+

683.73

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

2Not an FBR, the amount represents the FBR less VTR.

+
+
+
+
+
+
+ +
+
+

P. Description of supplements for Vermont

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+

Definitions of State Living Arrangement Variations

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living (except Chittenden County) – Recipients neither living in the household + of another, and nor in a residential or custodial care situation. This includes a + child who is living with a parent and recipients residing in a private Title XIX facility + where Medicaid is not paying more than 50 percent of the cost of care. It includes + children under the age of 18, who are in Federal living arrangement D because a private + health insurance policy, or a combination of Medicaid and a private health insurance + policy pays, or is expected to pay over 50 percent of the cost of care for that month. + For determination of applicability of $30 payment limit, see SI 00520.011C.1.b.

+ +

A recipient residing in a publicly operated emergency shelter throughout a month.

+
+

B

+
+

Independent Living in Chittenden County -- Same as Code A (in this chart) except restricted + to residents of Chittenden County.

+
+

C

+
+

Licensed Residential Care Home or Assisted Living Residence with Assistive Community + Care Services (Level III) -- Recipients residing in Level III facilities identified + by the State. To determine if a resident meets the requirements for Optional Supplement + C, refer to the Vermont Community Care Facilities (OS C and G) list on BOSNET.

+
+

E

+
+

Living in the Household of Another -- Recipients living in the household of another + and receiving support and maintenance (subject to the Federal one-third reduction + provisions).

+
+

G

+
+

Licensed Residential Care Home or Therapeutic Community Residence (Level IV) -- Recipients + residing in Level IV facilities identified by the State. To determine if a residence + meets the requirements for Optional Supplement G, refer to the Vermont Community Care + Facilities (OS C and G) list on BOSNET.

+
+

H

+
+

Custodial Care: Family Home -- Recipients living in another's home, where the recipient + pays room and board and receives one or more of the services outlined under the custodial + care definition. The recipient must also receive the room and board and custodial + care in the home where they reside. In order to qualify as a home under this arrangement, + these services must not be provided to more than two persons, and must be provided + by a resident of the home.

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) establishes outplacement programs, meeting the definition of living arrangement + (L/A) H. To qualify, these programs must meet the requirements stated.

+ +

Custodial care means providing basic room and board, plus personal services such as:

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection.

    +
    +
    +
  • +
+ +

Supervision for the recipient's protection deals primarily with protection services + for retarded and emotionally disturbed individuals. A person who receives one or more + of these personal services receives custodial care.

+
+

I

+
+

Effective 07/01/87, the State elected Federal administration of an optional State + supplementary payment to residents in Title XIX facilities. This includes children + under the age of 18, for whom Medicaid alone pays, or expects to pay over 50 percent + of the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived -- Individual is eligible for, but waives the right + to receive an optional supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The coding and monthly payment levels for Vermont, effective 01/01/11, are in the + following charts:

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

 

+
+

C

+
+

All

+
+

674.00

+
+

48.38

+
+

722.38

+
+

 

+
+

G

+
+

All

+
+

674.00

+
+

223.94

+
+

897.94

+
+

 

+
+

H

+
+

All

+
+

674.00

+
+

98.69

+
+

772.69

+
+

B

+
+

E

+
+

All

+
+

449.341

+
+

39.30

+
+

488.64

+
+

C

+
+

A

+
+

All (Except Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

674.00

+
+

52.04

+
+

726.04

+
+

D

+
+

A or B2

+
+

Children Private Insurance

+
+

30.003

+
+

52.04

+
+

82.04

+
+

 

+
+

I

+
+

All

+
+

30.003

+
+

17.66

+
+

47.66

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2State OS Code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State
Supplement
Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County

+
+

1011.00

+
+

98.88

+
+

1109.88

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County

+
+

1011.00

+
+

98.88

+
+

1109.88

+
+

 

+
+

C

+
+

All

+
+

1011.00

+
+

96.77

+
+

1107.77

+
+

 

+
+

G

+
+

All

+
+

1011.00

+
+

562.06

+
+

1573.06

+
+

 

+
+

H

+
+

All

+
+

1011.00

+
+

332.82

+
+

1343.82

+
+

B

+
+

E

+
+

All

+
+

674.001

+
+

48.31

+
+

722.31

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

35.33

+
+

95.33

+
+
+

1Not an FBR; the amount represents the FBR less VTR.

+

2Not an FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415043
SI 01415.043 - Federally Administered Optional Supplementary Payment Programs for 01-11 Payment Levels - 01/28/2013
+Batch run: 05/27/2026
+Rev:01/28/2013
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html new file mode 100644 index 00000000..c8525499 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2012.html @@ -0,0 +1,13121 @@ + + +SSA - POMS: SI 01415.044 - Federally Administered Optional Supplementary Payment Programs for 01/12 Payment Levels - 08/06/2012 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 77 (08-24)

+

SI 01415.044 Federally Administered Optional Supplementary Payment Programs for 01/12 Payment Levels

+ + +
+
+

CITATIONS:

+
+
+ +
Social Security Act as amended in 1973, Section 1616 ;Social Security Amendments of 1972, Section 301 ;Public Law 93-66, Section 212
+
+
+
+
+

A. Background

+
+
+

The following states participate in Federally Administered Optional Supplementary + Payment Programs:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+
+

Reference

+
+

California

+
+

SI 01415.044B

+
+

Delaware

+
+

SI 01415.044C

+
+

District of Columbia

+
+

SI 01415.044D

+
+

Hawaii

+
+

SI 01415.044E

+
+

Iowa

+
+

SI 01415.044F

+
+

Massachusetts

+ +

(effective 4/01/12, Massachusetts began self-administering + all categories)

+
+

SI 01415.044G

+
+

Michigan

+
+

SI 01415.044H

+
+

Montana

+
+

SI 01415.044I

+
+

Nevada

+
+

SI 01415.044J

+
+

New Jersey

+
+

SI 01415.044K

+
+

New York

+
+

SI 01415.044L

+
+

Pennsylvania

+
+

SI 01415.044M

+
+

Rhode Island

+
+

SI 01415.044N

+
+

Utah

+
+

SI 01415.044O

+
+

Vermont

+
+

SI 01415.044P

+
+
+
+
+ +
+
+

B. Description of supplements for California

+
+
+
+
+

1. Definitions of State living arrangement variations for California

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living with Cooking Facilities for an eligible individual or couple who + meets one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Lives in their own household, as defined for Federal living arrangement A purposes, + and has cooking and food storage facilities or is provided meals as part of the living + arrangement;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Is a blind child under age 18 living in the household of a parent, or parents, or + is a disabled child age 18 or over who meets sharing criteria and is living in the + household of a parent or parents;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Is a blind recipient who lives in an independent living arrangement with or without + cooking and food storage facilities; or

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a private medical facility licensed by the State but not certified under + Title XIX.

    +
    +
    +
  10. +
+
+

B

+
+

Non-medical Out-of-Home Care (NMOHC) applies when an individual or couple needs non-medical + care or supervision in the following living arrangement situations:

+ +

Children (under age 18)

+ +
    +
  1. +
    +
    a. 
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    +
    +
    +
  6. +
  7. +
    +
    d. 
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative; or

    +
    +
    +
  8. +
  9. +
    +
    e. 
    +
    +

    Disabled child residing in the home of a relative who is not a parent (Major v. McMahon + decision); or

    +
    +
    +
  10. +
  11. +
    +
    f. 
    +
    +

    A blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”); or

    +
    +
    +
  12. +
+ +

Adults (age 18 and over)

+ +
    +
  1. +
    +
    a. 
    +
    +

    Aged, blind or disabled individual or couple is determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Aged, blind, or disabled individual is determined to be in FLA A and resides in a + State licensed NMOHC facility; or

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Aged, blind or disabled individual is determined to be in FLA A and resides in a Family + Home certified by a Family Home Agency under State law.

    +
    +
    +
  6. +
+ +

For California optional supplement (OS) purposes, a relative is defined as a parent, + child, sibling, half-sibling, parent's sibling, sibling's child, first cousin, or + any person of the preceding generation denoted by the prefix “grand” or “great.”

+
+

C

+
+

Independent Living Without Cooking Facilities – Apply this category to aged or disabled + individuals or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    Not given meals, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Do not have access to adequate cooking or food storage facilities as part of a living arrangement

    +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS C.

+ +

An individual or couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Immediate living quarters do not have cooking and food storage facilities with which + the individual or couple or another person (who is responsible for preparing their + meals) can prepare meals on a daily basis.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives in a boarding house that does not + have a communal kitchen with adequate cooking and food storage facilities to which + they have access for preparation of meals.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparation + of meals.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Lives in a room and board facility and does not + contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis).

    +
    +
    +
  10. +
+ +

“Adequate” cooking and food storage facilities exist when an individual or couple has access + to:

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and + a stove without a working oven but with at least two working burners (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”)

    +
    +
    +
  • +
+ +

OR

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove or a one-burner hotplate with a temperature control.

    +
    +
    +
  • +
+ +

Eligibility for OS C begins in the month the recipient applies for this supplement + rate provided they have been without cooking and food storage facilities throughout + the month.

+ +

NOTE: For purposes of OS C, “throughout a month” does not mean the recipient must lack adequate cooking or food storage facilities from the + very first moment of the month. The recipient need only lack them from some time on + the first day of the month.

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + has ceased.

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact.

+ +

Eligibility for this supplementary payment ceases the month following the month in + which meals are provided or adequate cooking and food storage facilities are available.

+
+

 

+
+

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind or aged or disabled couple plus the restaurant meals allowance for the disabled member of the couple. Force payment + in this living arrangement is required.

+
+

D

+
+

Living in the Household of Another – Eligible individual or couple is living in the + household of another and is receiving food and shelter from that person. Most individuals or couples who are subject to a one-third + reduction of their Federal SSI payments are eligible for OS D because the criteria + for this supplement level are the same as for charging the one-third reduction. However, + when the eligible individual or couple lives in the home of a relative (other than + a spouse) and needs care and supervision, you must obtain certification for non-medical + out-of-home care (OS F) from the county welfare office since this is the highest categorical + supplement for which an individual or couple can qualify.

+
+

E

+
+

Disabled Child Under Age 18 – Apply this OS code to a disabled (not blind) child under + age 18 who resides with a parent or relative by blood or marriage.

+ +

NOTE: Only FLA A and C are compatible with OS E. If the VTR applies, see code G.

+
+

F

+
+

Non-medical Out-of-Home Care Living in the Household of Another – Applies whenever + an eligible individual or couple meets the criteria for the non-medical out-of-home + care payment rate, and is determined to receive the Federal code B payment for living + in the household of another. For the One-Third Reduction Provision see SI 00835.200.

+
+

G

+
+

Disabled Child Under Age 18 Living in the Household of Another – Applies to a disabled + (not blind) child under age 18, who resides with a parent or relative by blood or + marriage, and is determined to receive the Federal code B payment for living in the household of + another person. For the One-Third Reduction Provision see SI 00835.200.

+
+

J

+
+

Residents of Title XIX facilities – Also apply this State code to supplement Section + 1619 cases.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – Eligible recipient who is a patient:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In a medical facility where Title XIX pays more than 50 percent of the costs; or

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    In a private medical facility not certified under Title XIX and not licensed by the + State.

    +
    +
    +
  4. +
+ +

Include in this category those recipients who are residing throughout a month in a + publicly operated emergency shelter.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for California + effective 01/01/2012.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

698.00

+
+

156.40

+
+

854.40

+
+

 

+
+

 

+
+

Blind

+
+

698.00

+
+

211.40

+
+

909.40

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

156.40

+
+

854.40

+
+

 

+
+

B

+
+

All

+
+

698.00

+
+

412.00

+
+

1110.00

+
+

 

+
+

C

+
+

Aged

+
+

698.00

+
+

240.40

+
+

938.40

+
+

 

+
+

 

+
+

Blind

+
+

698.00

+
+

0.00

+
+

698.00

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

240.40

+
+

938.40

+
+

 

+
+

E

+
+

Disabled

+
+

698.00

+
+

63.40

+
+

761.40

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

0.00

+
+

698.00

+
+

B

+
+

D

+
+

Aged

+
+

465.341

+
+

159.83

+
+

625.17

+
+

 

+
+

 

+
+

Blind

+
+

465.341

+
+

214.83

+
+

680.17

+
+

 

+
+

 

+
+

Disabled

+
+

465.341

+
+

159.83

+
+

625.17

+
+

 

+
+

F

+
+

All

+
+

465.341

+
+

407.00

+
+

872.34

+
+

 

+
+

G

+
+

Disabled

+
+

465.341

+
+

66.83

+
+

532.17

+
+

C

+
+

A

+
+

Blind

+
+

698.00

+
+

211.40

+
+

909.40

+
+

 

+
+

E

+
+

Disabled

+
+

698.00

+
+

63.40

+
+

761.40

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

0.

+
+

698.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1048.00

+
+

396.20

+
+

1444.20

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1048.00

+
+

543.20

+
+

1591.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1048.00

+
+

396.20

+
+

1444.20

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1048.00

+
+

487.20

+
+

1535.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1048.00

+
+

396.20

+
+

1444.20

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1048.00

+
+

487.20

+
+

1535.20

+
+

 

+
+

B

+
+

All

+
+

1048.00

+
+

1172.00

+
+

2220.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1048.00

+
+

564.20

+
+

1612.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1048.00

+
+

564.20

+
+

1612.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1048.00

+
+

564.20

+
+

1612.20

+
+

 

+
+

Z

+
+

All

+
+

1048.00

+
+

0.00

+
+

1048.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

698.671

+
+

401.33

+
+

1100.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

698.671

+
+

548.33

+
+

1247.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

698.671

+
+

401.33

+
+

1100.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

698.671

+
+

492.33

+
+

1191.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

698.671

+
+

401.33

+
+

1100.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

698.671

+
+

492.33

+
+

1191.00

+
+

 

+
+

F

+
+

All

+
+

698.671

+
+

1045.66

+
+

1744.33

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + – To be eligible for this category the State must provide documentation that a recipient + is a resident of a certified Adult Residential Care Facility, Assisted Living Facility, + or Adult Foster Care Home.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – Use this code for any recipient who is not included in OS categories + A or Y.

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code A.

+ +

For more information on Optional State Supplement codes see SM 01301.535

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

698.00

+
+

140.00

+
+

838.00

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

0.

+
+

698.00

+
+

B

+
+

Z

+
+

All

+
+

465.34

+
+

0.

+
+

465.34

+
+

C

+
+

Z

+
+

All

+
+

698.00

+
+

0.

+
+

698.00

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1048.00

+
+

448.00

+
+

1496.00

+
+

 

+
+

Z

+
+

All

+
+

1048.00

+
+

0.

+
+

1048.00

+
+

B

+
+

Z

+
+

All

+
+

698.67

+
+

0.

+
+

698.67

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Foster Care Home with 50 or Fewer Residents – Use OS code “A” to indicate that + you received certification from the District of Columbia, Department of Health that + the recipient is a resident of an adult foster care home with 50 or fewer + residents

+
+

B

+
+

Adult Foster Care Home with More than 50 Residents – Use OS code “B” to indicate that + you received certification from the District of Columbia, Department of Health that + the recipient is a resident of an adult foster care home with more than 50 + residents.

+
+

G

+
+

Apply this OS code to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – All recipients who are not included in OS codes A, B, G, or + Y.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

698.00

+
+

485.00

+
+

1183.00

+
+

 

+
+

B

+
+

All

+
+

698.00

+
+

595.00

+
+

1293.00

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

0.

+
+

698.00

+
+

B

+
+

Z

+
+

All

+
+

465.341

+
+

0.

+
+

465.34

+
+

C

+
+

Z

+
+

All

+
+

698.00

+
+

0.

+
+

698.00

+
+

D

+
+

G

+
+

All

+
+

30.001

+
+

40.00

+
+

70.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Code

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1048.00

+
+

1318.00

+
+

2366.00

+
+

 

+
+

B

+
+

All

+
+

1048.00

+
+

1538.00

+
+

2586.00

+
+

 

+
+

Z

+
+

All

+
+

1048.00

+
+

0.

+
+

1048.00

+
+

B

+
+

Z

+
+

All

+
+

698.67

+
+

0.

+
+

698.67

+
+

D

+
+

G

+
+

All

+
+

60.001

+
+

80.00

+
+

140.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

B

+
+

Living in a Community Care or Foster Care Home – Apply this OS code to recipients + who are both over age 18 and live in a State approved Care or Foster Care Home.

+
+

D

+
+

Living in a Certified Medical Facility – Eligible individual living in a medical treatment + facility where Title XIX pays a substantial part (more than 50 percent) of the cost + of care.

+
+

H

+
+

Domiciliary Care I – (Maximum of five residents) – Eligible recipient (including a + child) or couple living in a domiciliary care facility that provides varying levels + of care and services. A domiciliary care facility is a private, non-medical facility + established and maintained to provide personal care and services to aged, infirm, + or handicapped persons. The State provides SSA with listings of these facilities.

+
+

I

+
+

Domiciliary Care II – Same as H except the facility provides care for six or more + residents.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

Use OS code “Z” when recipient is not eligible to receive Hawaii state supplement + because they are living in the following situations:

+ +
    +
  • +
    +
    •
    +
    +

    Recipient is living in the household of another;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipient is a patient in a private medical facility which is not certified under + Title XIX; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipient is residing throughout a month in a publicly operated emergency shelter.

    +
    +
    +
  • +
+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A 

+
+

B

+
+

All

+
+

698.00

+
+

651.90

+
+

1349.90

+
+

 

+
+

H

+
+

All

+
+

698.00

+
+

651.90

+
+

1349.90

+
+

 

+
+

I

+
+

All

+
+

698.00

+
+

759.90

+
+

1457.90

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

0.

+
+

698.00

+
+

B

+
+

Z

+
+

All

+
+

465.34

+
+

0.

+
+

465.34

+
+

D

+
+

D

+
+

All

+
+

30.001

+
+

20.00

+
+

50.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

B

+
+

All

+
+

1048.00

+
+

1640.80

+
+

2688.80

+
+

 

+
+

H

+
+

All

+
+

1048.00

+
+

1640.80

+
+

2688.80

+
+

 

+
+

I

+
+

All

+
+

1048.00

+
+

1856.80

+
+

2904.80

+
+

 

+
+

Z

+
+

All

+
+

1048.00

+
+

0.

+
+

1048.00

+
+

B

+
+

Z

+
+

All

+
+

698.67

+
+

0.

+
+

698.67

+
+

D

+
+

D

+
+

All

+
+

60.001

+
+

40.00

+
+

100.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living in Own Household (Blind Only) – Apply code + only to an eligible + blind recipient and the blind + member of a couple who:

+ +
    +
  • +
    +
    •
    +
    +

    Does not live in any other State living arrangement variation, does not have an essential + person (EP) and is not otherwise excepted from supplementation; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code A is also compatible with Federal + codes A and C.

    +
    +
    +
  • +
+ +

Optional supplement code A is the proper code to use with an “intervening” Federal + code A.

+ +

For State Supplement codes, see SM 01301.535.

+
+

B

+
+

Living in the Household of Another (Blind Only) – Only + an eligible blind recipient and + the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation.

+
+

C

+
+

Living with a Dependent Person – Eligible recipient or each member of an eligible + couple in Federal living arrangement A or C who has an ineligible spouse, parent, + child, or adult child living in the home with them, and who is financially dependent + upon the eligible recipient as defined by the State Department of Human Services.

+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement.

+
+

D

+
+

Living in a Family Life or Boarding Home – Eligible recipient or each member of an + eligible couple in Federal living arrangement A who resides in a family life home + or boarding home licensed by the State Department of Health or certified by the State + Department of Human Services

+
+

H

+
+

Living with a Dependent Person – Eligible recipient or each member of an eligible + couple in Federal living arrangement B who has an ineligible spouse, parent, child, + or adult child living in the home with them, and who is financially dependent upon + the eligible recipient as defined by the State Department of Human Services.

+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement.

+
+

G

+
+

Used to indicate that no supplement is payable to a recipient living in a Title XIX + facility and Title XIX pays more than 50 percent of the cost of care; however, a Federal + D living arrangement is not appropriate because the “throughout a month” requirement + is not met at the time initial claims input is made.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – Use this OS code to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Aged or disabled recipients living in their own households or living in the households + of others;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients living in medical facilities not certified under Title XIX;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care.

    +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs:

+ +
    +
  1. +
    +
    1. 
    +
    +

    “In-Home Health Related Care”;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    “Residential Care”; and

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    “Supplement for Medicare and Medicaid Eligible.”

    +
    +
    +
  6. +
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid.

+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind

+
+

698.00

+
+

22.00

+
+

720.00

+
+

 

+
+

C

+
+

Aged

+
+

698.00

+
+

357.00

+
+

1055.00

+
+

 

+
+

 

+
+

Blind

+
+

698.00

+
+

379.00

+
+

1077.00

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

357.00

+
+

1055.00

+
+

 

+
+

D

+
+

Aged

+
+

698.00

+
+

142.00

+
+

840.00

+
+

 

+
+

 

+
+

Blind

+
+

698.00

+
+

164.00

+
+

862.00

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

142.00

+
+

840.00

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

0.00

+
+

698.00

+
+

B

+
+

B

+
+

Blind

+
+

465.341

+
+

22.00

+
+

487.34

+
+

 

+
+

H

+
+

Aged

+
+

465.341

+
+

357.00

+
+

822.34

+
+

 

+
+

 

+
+

Blind

+
+

465.341

+
+

379.00

+
+

844.34

+
+

 

+
+

 

+
+

Disabled

+
+

465.341

+
+

357.00

+
+

822.34

+
+

 

+
+

Z

+
+

All

+
+

465.341

+
+

0.00

+
+

465.34

+
+

C

+
+

A

+
+

Blind

+
+

698.00

+
+

22.00

+
+

720.00

+
+

 

+
+

C

+
+

Blind

+
+

698.00

+
+

379.00

+
+

1077.00

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

357.00

+
+

1055.00

+
+

 

+
+

Z

+
+

Disabled

+
+

698.00

+
+

0.00

+
+

698.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: State-administered programs for calendar year 2012:

+
    +
  • +
    +
    •
    +
    +

    Individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Individuals receiving a supplement for Medicare and Medicaid Eligible receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind/Blind

+
+

1048.00

+
+

44.00

+
+

1092.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

1048.00

+
+

22.00

+
+

1070.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1048.00

+
+

22.00

+
+

1070.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1048.00

+
+

357.00

+
+

1405.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1048.00

+
+

401.00

+
+

1449.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1048.00

+
+

357.00

+
+

1405.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1048.00

+
+

377.00

+
+

1425.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1048.00

+
+

357.00

+
+

1405.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1048.00

+
+

377.00

+
+

1425.00

+
+

 

+
+

D

+
+

Aged/Aged

+
+

1048.00

+
+

652.00

+
+

1700.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1048.00

+
+

696.00

+
+

1744.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1048.00

+
+

652.00

+
+

1700.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1048.00

+
+

672.00

+
+

1720.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1048.00

+
+

652.00

+
+

1700.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1048.00

+
+

672.00

+
+

1720.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

1048.00

+
+

0.00

+
+

1048.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1048.00

+
+

0.00

+
+

1048.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1048.00

+
+

0.00

+
+

1048.00

+
+

B

+
+

B

+
+

Blind/Blind

+
+

698.671

+
+

44.00

+
+

742.67

+
+

 

+
+

 

+
+

Blind/Aged

+
+

698.671

+
+

22.00

+
+

720.67

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

698.671

+
+

22.00

+
+

720.67

+
+

 

+
+

H

+
+

Aged/Aged

+
+

698.671

+
+

357.00

+
+

1055.67

+
+

 

+
+

 

+
+

Blind/Blind

+
+

698.671

+
+

401.00

+
+

1099.67

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

698.671

+
+

357.00

+
+

1055.67

+
+

 

+
+

 

+
+

Aged/Blind

+
+

698.671

+
+

377.00

+
+

1075.67

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

698.671

+
+

357.00

+
+

1055.67

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

698.671

+
+

377.00

+
+

1075.67

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

698.671

+
+

0.00

+
+

698.67

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

698.671

+
+

0.00

+
+

698.67

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

698.671

+
+

0.00

+
+

674.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: State-administered programs for calendar year 2012:

+
    +
  • +
    +
    •
    +
    +

    Recipients receiving “Residential Care” receive payment based on a per diem rate plus + a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. Treat members of a couple as individuals.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients receiving a supplement for Medicare and Medicaid receive a $1 monthly payment.

    +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Massachusetts

+
+
+
+
+

1. Definitions of State living arrangement variations for Massachusetts

+
+
+

IMPORTANT: Effective April 1, 2012, Massachusetts began self-administering all categories. 

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Full Cost-of-Living:

+ +

A recipient who is in Federal living arrangement A is in State living arrangement + A, if they are living in their own household1 and meet one of the following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living alone – recipients who live alone, who rent rooms in commercial rooming houses + which openly advertise to the public and which do not provide board, or who live in + a hotel. Also, recipients who rent only rooms in private residences are considered + living alone provided they do not use the residential kitchen facilities for preparing + meals;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living only with their eligible spouse;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Living with their eligible spouse and ineligible child or children 2 none of whom (children) receive public income maintenance payments;3 or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Living only with their ineligible spouse or their ineligible child or children, none + of whom (spouse and children) receive public income maintenance payments.

    +
    +
    +
  8. +
+ +

NOTE: For purposes of 1 through 4, do not consider foster children placed with anyone other than their parents to be living with the foster parent.

+
+

 

+
+
    +
  • +
    +
    •
    +
    +

    A recipient who is in Federal living arrangement C is in State living arrangement + A if none of the other people with whom they are living receive public income maintenance + payments.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A recipient who is in Federal living arrangement A or C and who does not meet the + criteria contained in SI 01415.040G.1. (See Code A, 1 or 2 (in this chart)) is in State living arrangement A if they pay + at least two-thirds of the household expenses. In making a determination whether the + recipient pays two-thirds or more of the expenses, use the method defined in SI 00835.160. Use only the household expenses shown in that section. You may use an ineligible + spouse's income (except any assistance based upon need) to determine if the eligible + person is paying two-thirds of the household expenses.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A recipient living in a public congregate housing development is in OS category “A.” + The State makes the determination that a public congregate housing development is + eligible for listing. Optional supplement code A is the proper code to use with an + “intervening” Federal code A. For Optional State Supplement codes, see SM 01301.535.

    +
    +
    +
  • +
+
+

B

+
+

Shared Living Expenses – Consider a recipient who is in Federal living arrangement + A or C but who does not meet the criteria listed for State living arrangement A, E + or G to be in OS category “B.” Also include in this living arrangement category:

+ +
    +
  • +
    +
    •
    +
    +

    Transients/homeless;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients residing in public emergency shelters for the homeless (PESH) throughout + a month;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Residents of group-care facilities such as halfway houses;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Claimants residing in private medical facilities where Medicaid is paying 50 percent + or less of the cost of care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Foster homes;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients living in commercial boarding homes;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Any recipient living in a facility which does not meet the criteria for living arrangement + E or public congregate housing defined in SI 01415.040G.1., Code A.4. This includes children under the age of 18 who are in Federal living arrangement + D because a private health insurance policy or a combination of Medicaid and a private + health insurance policy pays or is expected to pay over 50 percent of the cost of + care for that month. For determination of applicability of $30 payment limit, see + second and third bullets in SI 00520.011C.1.b;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients placed under the auspices of the State adult foster care program;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients living in a household where all members receive public income maintenance + payments unless they are paying at least two-thirds of the household expenses (A);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients living in a mixed household – i.e., a household where one or more other + members receive a public income maintenance payment – are also included unless the + individual is paying at least two-thirds of the household expenses (A).

    +
    +
    +
  • +
+
+

C

+
+

Living in the Household of Another – Apply this OS code to recipients who live in + the household of another and receive support and maintenance from them (FLA- B).

+
+

E

+
+

Licensed Rest Home – Persons residing in a licensed rest home, all of which or the + portion in which they live in is licensed by, and has a provider agreement with the + State. This does not include residents of a Medicaid certified portion of a rest home.

+
+

F

+
+

Effective 07/01/87, the State elected Federal administration of this optional State + supplementary payment to residents of Title XIX facilities where Medicaid pays more + than 50 percent of the cost of care. This includes children under the age of 18 for + whom Medicaid alone pays or is expected to pay over 50 percent of the cost of care + for that month.

+
+

G

+
+

Assisted Living – Effective 07/01/94, the State elected Federal administration of + this variation. Includes a recipient, certified by the State to be residing in an + Assisted Living residence served by a certified Group Adult Foster Care provider, + who does not receive assistance under any other Federal or State rental assistance + program, and who pays a fixed, non-separable fee for rent and supportive services, + other than medically necessary services reimbursed by Medicaid. The State certifies + to SSA each recipient who is eligible for this optional supplement living arrangement. + This living arrangement was discontinued effective 01/01/96; but restored retroactively + to 01/01/97.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+
+

NOTE: Massachusetts is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. For more information + on multi-category eligibility, see SI 00501.300B.3.

+

1For purposes of determining State living arrangements, do not consider a commercial + boarding house, foster home, or halfway house to be an individual's household.

+

2Use the SSI definition of “child” found in SI 00501.010.

+

3A public income maintenance payment is a payment from any of the following programs:

+
    +
  • +
    +
    •
    +
    +

    Temporary Assistance for Needy Families (TANF);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Supplemental Security Income (SSI);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The Refugee Act of 1980;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The Disaster Relief Act of 1974:

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    General assistance programs of the Bureau of Indian Affairs;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    State or local government income maintenance programs that are based on need; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Department of Veterans Affairs benefits that are based on need.

    +
    +
    +
  • +
+
+
+
+
+

2. Coding and monthly payments levels

+
+
+

The following charts display the coding and monthly payment levels for Massachusetts + effective 01/01/12.

+

IMPORTANT: Effective 4/01/12, Massachusetts began self-administering all categories.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

698.00

+
+

128.82

+
+

826.82

+
+

 

+
+

 

+
+

Blind

+
+

698.00

+
+

149.74

+
+

847.74

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

114.39

+
+

812.39

+
+

 

+
+

B

+
+

Aged

+
+

698.00

+
+

39.26

+
+

737.26

+
+

 

+
+

 

+
+

Blind

+
+

698.00

+
+

149.74

+
+

847.74

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

30.40

+
+

728.40

+
+

 

+
+

E

+
+

Aged

+
+

698.00

+
+

293.00

+
+

991.00

+
+

 

+
+

 

+
+

Blind

+
+

698.00

+
+

149.74

+
+

847.74

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

293.00

+
+

991.00

+
+

 

+
+

G

+
+

Aged

+
+

698.00

+
+

454.00

+
+

1152.00

+
+

 

+
+

 

+
+

Blind

+
+

698.00

+
+

454.00

+
+

1152.00

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

454.00

+
+

1152.00

+
+

B

+
+

C

+
+

Aged

+
+

465.341

+
+

104.36

+
+

569.70

+
+

 

+
+

 

+
+

Blind

+
+

465.341

+
+

382.40

+
+

847.74

+
+

 

+
+

 

+
+

Disabled

+
+

465.341

+
+

87.58

+
+

552.92

+
+

C

+
+

A

+
+

Blind

+
+

698.00

+
+

149.74

+
+

847.74

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

114.39

+
+

812.39

+
+

 

+
+

B

+
+

Blind

+
+

698.00

+
+

149.74

+
+

847.74

+
+

 

+
+

 

+
+

Disabled

+
+

698.00

+
+

30.40

+
+

728.40

+
+

D

+
+

B2

+
+

Blind

+
+

30.003

+
+

149.74

+
+

179.74

+
+

 

+
+

 

+
+

Disabled

+
+

30.003

+
+

30.40

+
+

60.40

+
+

 

+
+

F

+
+

All

+
+

30.003

+
+

42.80

+
+

72.80

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2State OS Code B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1048.00

+
+

201.72

+
+

1249.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1048.00

+
+

647.48

+
+

1695.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1048.00

+
+

180.06

+
+

1228.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1048.00

+
+

424.60

+
+

1472.60

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1048.00

+
+

190.89

+
+

1238.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1048.00

+
+

413.77

+
+

1461.77

+
+

 

+
+

B

+
+

Aged/Aged

+
+

1048.00

+
+

201.72

+
+

1249.72

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1048.00

+
+

647.48

+
+

1695.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1048.00

+
+

180.06

+
+

1228.06

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1048.00

+
+

424.60

+
+

1472.60

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1048.00

+
+

190.89

+
+

1238.89

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1048.00

+
+

413.77

+
+

1461.77

+
+

 

+
+

E

+
+

Aged/Aged

+
+

1048.00

+
+

934.00

+
+

1982.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1048.00

+
+

647.48

+
+

1695.48

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1048.00

+
+

934.00

+
+

1982.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1048.00

+
+

790.74

+
+

1838.74

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1048.00

+
+

934.00

+
+

1982.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1048.00

+
+

790.74

+
+

1838.74

+
+

 

+
+

G

+
+

All

+
+

1048.00

+
+

681.00

+
+

1729.00

+
+

B

+
+

C

+
+

Aged/Aged

+
+

698.671

+
+

215.80

+
+

914.47

+
+

 

+
+

 

+
+

Blind/Blind

+
+

698.671

+
+

996.80

+
+

1695.47

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

698.671

+
+

194.18

+
+

892.85

+
+

 

+
+

 

+
+

Aged/Blind

+
+

698.671

+
+

606.30

+
+

1304.97

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

698.671

+
+

204.99

+
+

903.66

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

698.671

+
+

595.49

+
+

1294.16

+
+

D

+
+

F

+
+

All

+
+

60.002

+
+

85.60

+
+

145.60

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Michigan

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Domiciliary Care – Use this OS code for recipients residing in licensed non-medical + facilities that provide room, board, and supervision. The State provides a list of + these facilities and certifies which recipients are residents requiring this level + of care.

+
+

E

+
+

Personal Care – Apply this OS code to recipients residing in licensed non-medical + facilities that provide general supervision, physical care, and assistance to residents + as they carry out the basic activities of daily living. The State provides a list + of these facilities and certifies which recipients are residents requiring this level + of care. Such care situations include, but are not limited to, licensed homes for + the aged.

+
+

F

+
+

Home for the Aged – The State provides SSA with a list of these non-medical facilities + for the aged and certifies which recipients are residents requiring this level of + care.

+
+

G

+
+

Independent Living with an EP – This category applies to recipients with an essential + person who are not living in the household of another. Exclude children under age + 18 from this category.

+
+

H

+
+

Living in the Household of Another with an EP – This category applies to recipients + with an EP who are living in the household of another for Federal purposes. Exclude + children under age 18 from this category.

+
+

I

+
+

Effective 01/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – Recipients in Title XIX facilities where Medicaid pays more + than 50 percent of the cost of care and recipients in medical facilities not certified + under Title XIX.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

698.00

+
+

87.00

+
+

785.00

+
+

 

+
+

E

+
+

All

+
+

698.00

+
+

157.50

+
+

855.50

+
+

 

+
+

F

+
+

All

+
+

698.00

+
+

179.30

+
+

877.30

+
+

 

+
+

G

+
+

All

+
+

1048.002

+
+

14.00

+
+

1062.00

+
+

B

+
+

H

+
+

All

+
+

698.671

+
+

9.33

+
+

708.00

+
+

D

+
+

I

+
+

All

+
+

  30.003

+
+

7.00

+
+

37.00

+
+

 

+
+

Z

+
+

All

+
+

30.00

+
+

0.

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment less VTR.

+

2Not the FBR; the amount represents the FBR plus EP increment.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

1048.00

+
+

522.00

+
+

1570.00

+
+

 

+
+

E

+
+

All

+
+

1048.00

+
+

663.00

+
+

1711.00

+
+

 

+
+

F

+
+

All

+
+

1048.00

+
+

706.60

+
+

1754.60

+
+

 

+
+

G

+
+

All

+
+

1398.001

+
+

21.00

+
+

1419.00

+
+

B

+
+

H

+
+

All

+
+

932.00

+
+

14.00

+
+

946.00

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

14.00

+
+

74.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Montana

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

G

+
+

State-Certified Personal Care

+
+

H

+
+

State-Certified Residence in Group Home for Mentally Disabled

+
+

I

+
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+
+

J

+
+

State-Certified Residence for Child and Adult Foster Care

+
+

K

+
+

State-Certified Transitional Living for Developmentally Disabled

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – Includes all individuals and couples not certified in State + codes G, H, I, J, or K.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

698.00

+
+

94.00

+
+

792.00

+
+

 

+
+

H

+
+

All

+
+

698.00

+
+

94.00

+
+

792.00

+
+

 

+
+

I

+
+

All

+
+

698.00

+
+

94.00

+
+

792.00

+
+

 

+
+

J

+
+

All

+
+

698.00

+
+

52.75

+
+

750.75

+
+

 

+
+

K

+
+

All

+
+

698.00

+
+

26.00

+
+

724.00

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

0.00

+
+

698.00

+
+

B

+
+

Z

+
+

All

+
+

465.341

+
+

0.00

+
+

465.34

+
+

C

+
+

Z

+
+

All

+
+

698.00

+
+

0.00

+
+

698.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

1048.00

+
+

193.00

+
+

1241.00

+
+

 

+
+

H

+
+

All

+
+

1048.00

+
+

193.00

+
+

1241.00

+
+

 

+
+

I

+
+

All

+
+

1048.00

+
+

193.00

+
+

1241.00

+
+

 

+
+

J

+
+

All

+
+

1048.00

+
+

110.50

+
+

1158.50

+
+

 

+
+

K

+
+

All

+
+

1048.00

+
+

57.00

+
+

1105.00

+
+

 

+
+

Z

+
+

All

+
+

1048.00

+
+

0.00

+
+

1048.00

+
+

B

+
+

Z

+
+

All

+
+

698.671

+
+

0.00

+
+

698.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for Nevada

+
+
+
+
+

1. Definitions of State living arrangement variations

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living or Living in Parental Household – Aged or blind eligible recipient + who meets one of the following situations:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes;

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household.

    +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. For Optional State Supplement codes, see + SM 01301.535.

+
+

B

+
+

Living in the Household of Another – Aged or blind recipient who is living in the + household of another and receiving food and shelter from that person. Aged or blind recipients who are subject to a one-third + reduction (VTR) of their Federal SSI payment are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B.

+
+

C

+
+

Domiciliary Care – Apply this OS code to aged or blind recipients who the State has + certified live in a private non-medical facility or, a residential facility serving + 16 or fewer persons, which provides personal care and services to aged, infirm, or + handicapped adult persons who are unrelated to the proprietor.

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

Apply this “No Supplement” code to the following recipients:

+ +
    +
  • +
    +
    •
    +
    +

    Disabled eligible individual or disabled member of eligible couple;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individual or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible individual or member of eligible couple who is patient in a private medical + facility which is not certified under Title XIX; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients who are residing throughout a month in publicly operated emergency shelters.

    +
    +
    +
  • +
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

698.00

+
+

36.40

+
+

734.40

+
+

 

+
+

 

+
+

Blind

+
+

698.00

+
+

109.30

+
+

807.30

+
+

 

+
+

C

+
+

Aged

+
+

698.00

+
+

391.00

+
+

1089.00

+
+

 

+
+

 

+
+

Blind

+
+

698.00

+
+

391.00

+
+

1089.00

+
+

 

+
+

Z

+
+

Disabled

+
+

698.00

+
+

0.00

+
+

698.00

+
+

B

+
+

B

+
+

Aged

+
+

465.341

+
+

24.27

+
+

489.61

+
+

 

+
+

 

+
+

Blind

+
+

465.34

+
+

213.96

+
+

679.30

+
+

 

+
+

Z

+
+

Disabled

+
+

465.34

+
+

0.00

+
+

465.34

+
+

C

+
+

A

+
+

Blind

+
+

698.00

+
+

109.30

+
+

807.30

+
+

 

+
+

Z

+
+

Disabled

+
+

698.00

+
+

0.00

+
+

698.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1048.00

+
+

74.46

+
+

1122.46

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1048.00

+
+

374.60

+
+

1422.60

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1048.00

+
+

224.53

+
+

1272.53

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1048.00

+
+

37.23

+
+

1085.23

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1048.00

+
+

187.30

+
+

1235.30

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1048.00

+
+

881.00

+
+

1929.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1048.00

+
+

881.00

+
+

1929.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1048.00

+
+

881.00

+
+

1929.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1048.00

+
+

440.50

+
+

1488.50

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1048.00

+
+

440.50

+
+

1488.50

+
+

 

+
+

Z

+
+

Disabled

+
+

1048.00

+
+

0.00

+
+

1048.00

+
+

B

+
+

B

+
+

Aged/Aged

+
+

698.67

+
+

49.64

+
+

748.31

+
+

 

+
+

 

+
+

Blind/Blind

+
+

698.67

+
+

531.94

+
+

1230.61

+
+

 

+
+

 

+
+

Aged/Blind

+
+

698.67

+
+

290.79

+
+

989.46

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

698.67

+
+

24.82

+
+

723.49

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

698.67

+
+

265.97

+
+

964.64

+
+

 

+
+

Z

+
+

Disabled

+
+

698.67

+
+

0.00

+
+

698.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for New Jersey

+
+
+
+
+

1. Definitions of State living arrangement variations for NJ

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Congregate Care – Apply this OS code to recipients in Federal living arrangement A. + The living arrangement includes the following:

+ +
    +
  • +
    +
    •
    +
    +

    Recipients in residential facilities who are under the supervision of the Department + of Human Services:

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS)); + and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients living in Assisted Living Residences or Comprehensive Personal Care Homes + (CPCH) that are licensed by the Department of Health and Senior Services.

    +
    +
    +
  • +
+
+

B

+
+

Living Alone or with Others – Recipients whose Federal living arrangements are A or + C and do not meet the requirements defined in other supplementation categories.

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + A to be in optional supplement B unless they are residing in a residential health + care facility or living alone with an ineligible spouse.

+ +

Likewise, any child meeting the criteria for a Federal code C is automatically entitled + to optional supplement B.

+ +

This category includes, but is not limited to, those recipients who are in one of + the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Recipients placed in a Transitional Residency Program by the Division of Mental Health + and Hospitals, Department of Human Services.

    +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to be used with an “intervening” Federal + code A. For State Supplement codes, see SM 01301.535.

+ +

Use this OS code to address Section 1619 cases.

+
+

C

+
+

Living Alone with an Ineligible Spouse – Use this OS code when a recipient lives with + ONLY their ineligible spouse and NO other persons are part of the household. Use Federal + criteria to determine an ineligible spouse for State supplementation purposes i.e., + a spouse, either by marriage or holding out who is either not eligible for SSI or + who chooses not to apply. If other persons, even minor children, are present in the household, + you cannot apply this OS code.

+ +

However, it is possible that a claimant and the ineligible spouse live with others + and allege that they are a separate “household” by virtue of the fact that they eat + their meals out or have separate purchase and preparation of food. In this instance, + you may consider an optional supplement C as long as no other person is considered + part of the “household.” There is no couple counterpart in this category.

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS “C.”

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS “B.”

+
+

D

+
+

Living in the Household of Another – Apply this OS code to recipients who are “living + in the household of another” for Federal purposes.

+
+

I

+
+

Licensed Residential Health Care Facilities (RHCF) – Apply this OS code to recipients + living in the following:

+ +
    +
  • +
    +
    •
    +
    +

    Attached nursing homes;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Assisted Living Residence;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “Free standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to 1/1/06.

    +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence + at a facility listed in the New Jersey + Congregate Care Directory .

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. + Pay residents of the Assisted Living Resident (ALR, or CPCH section of a multipurpose + facility at the OS “A” rate. Nursing home residents are in living arrangement (D/G) + if Medicaid pays more than 50 percent of the cost of care.

+
+

G

+
+

Effective 09/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – Apply this OS code to:

+ +
    +
  • +
    +
    •
    +
    +

    Recipients in licensed medical facilities where Medicaid is paying less than 50 percent + of the cost of care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients in publicly operated community residences having 16 or less residents; + and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients residing throughout a month in publicly operated emergency shelters.

    +
    +
    +
  • +
+ +

You can also apply this OS code to cases that were FLA D prior to 01/1988 or to children + residing in public or private facilities whose care was paid by private health insurance + (effective 12/01/96). For determination of applicability of $30 payment limit, see + SI 00520.011.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

698.00

+
+

150.05

+
+

848.05

+
+

 

+
+

B

+
+

All

+
+

698.00

+
+

31.25

+
+

729.25

+
+

 

+
+

C

+
+

Individual

+
+

698.00

+
+

153.00

+
+

851.00

+
+

 

+
+

 

+
+

w/EP

+
+

1048.001

+
+

25.36

+
+

1073.36

+
+

 

+
+

I

+
+

All

+
+

698.00

+
+

210.05

+
+

908.05

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

0.00

+
+

698.00

+
+

B

+
+

D

+
+

All

+
+

465.342

+
+

44.31

+
+

509.65

+
+

C

+
+

B

+
+

All

+
+

698.00

+
+

31.25

+
+

729.25

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

10.00

+
+

40.00

+
+

 

+
+

Z

+
+

All

+
+

30.00

+
+

0.

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1048.00

+
+

618.36

+
+

1666.36

+
+

 

+
+

B

+
+

All

+
+

1048.00

+
+

25.36

+
+

1073.36

+
+

 

+
+

I

+
+

All

+
+

1048.00

+
+

738.36

+
+

1786.36

+
+

 

+
+

Z

+
+

All

+
+

1048.00

+
+

  0.00

+
+

1048.00

+
+

B

+
+

D

+
+

All

+
+

698.671

+
+

93.09

+
+

791.76

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

20.00

+
+

80.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for New York

+
+
+
+
+

1. Definitions of State living arrangement variations for New York

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone – Apply this OS code to recipients living in one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Live physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Pay a fixed, pre-established flat fee for both room and board in a commercial establishment;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Lives with others but takes all meals outside the dwelling;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Live with others but separately prepares or has someone separately prepare their food. + Occasional preparation of meals in common does not preclude a finding of separate + preparation;

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Receive a fixed, pre-established flat fee for room and board from all others in the dwelling;

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Live with only a foster child, or a homemaker authorized by the local Department of + Social Services (DSS), or a family care recipient placed by the Office of Mental Health + (OMH) or Office of Mental Retardation and Developmentally Disabilities (OMRDD) or + local DSS; or

    +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    Have no permanent living arrangement (i.e., transient or street person) and is not + with a spouse or a child for whom they have primary responsibility.

    +
    +
    +
  14. +
+
+

B

+
+

Living with Others – Apply this OS code to recipients living in one of the following + situations:

+ +

1. Resides in a dwelling with others and prepares food in common with at least one + other person in the dwelling.

+ +

NOTE: Consider a recipient living with an ineligible spouse to be living with others despite + any separate preparation. The same is true if a recipient lives with a child for whom + they have primary responsibility (except if the child is a foster child)

+ +

2. Is a child who does not meet the criteria for OS C or OS D (below);

+ +

3. Lives in a religious community and room and board are provided in full or in part + by the religious community; or

+ +

4. Has no permanent living arrangement (i.e., transient or street person), but is + with an ineligible spouse or child for whom they have primary responsibility.

+
+

C

+
+

Congregate Care Level I – Apply this OS code to recipients in the following situations:

+ +
    +
  • +
    +
    •
    +
    +

    Recipient placed in a family type home certified by New York State (NYS) Office of + Children and Family Services and supervised by a local DSS.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipient placed in a family care home certified by OMH or OMRDD.

    +
    +
    +
  • +
+
+

D

+
+

Congregate Care Level II – Apply this OS code to a recipient who is a resident of + a licensed Level II care facility.

+ +

These supportive living facilities include:

+ +
    +
  • +
    +
    •
    +
    +

    Residences for Adults certified by the NYS Department of Health;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Privately operated facilities certified by the NYS OMH;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Privately operated facilities certified by NYS OMH and OMRDD; and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Privately operated facilities certified by OASAS.

    +
    +
    +
  • +
+
+

E

+
+

Congregate Care Level III – Enhanced Residential Care – Apply this OS code to recipients + residing in a licensed level III care facility (including a recipient over age 18 + who still meets the definition of a child per SI 00501.010).

+ +

Level III care facilities include:

+ +
    +
  • +
    +
    •
    +
    +

    Adult homes and enriched housing programs certified by the NYS Department of Health; + or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Schools for the Mentally Retarded – The NYS Office of Mental Retardation and Developmental + Disabilities must certify that these residential facilities provide academic, vocational, + recreational, and social skills programs. Although sometimes called schools, they + often do not meet the Federal definition of schools.

    +
    +
    +
  • +
+ +

NOTE: Do not apply OS E to a situation in which a child, who is receiving SSI, resides in a Level III facility. Apply OS Code B for those + recipients.

+
+

F

+
+

Living in the Household of Another – Payable to recipients who are FLA B.

+
+

G

+
+

Effective 01/01/88, the State elected Federal administration of an optional State + supplementary payment to residents of Title XIX facilities. SSA and the state agreed + to terminate Federal administration effective 09/30/03 and the State began administering + this payment 10/01/03.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – Apply OS Z to recipients in FLA A or D who meet one of the following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Recipient is in a licensed medical facility where Medicaid is paying less than 50 + percent of the cost of care;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Recipient is in a publicly operated community residence which serves 16 or fewer residents;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Recipient is in a publicly operated emergency shelter (PESH) throughout a month;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    Recipient qualifies under the special provision in SI 00520.130 (1619 eligible goes into medical institution);

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    Effective 10/01/03, recipient is FLA-D ; or

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    Recipient is a child, under age 18; whose stay in a public or private facility was + paid by private health insurance (applies prior to 12/1/96). For determination of + applicability of $30 payment limit see SI 00520.011).

    +
    +
    +
  12. +
+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for New York effective + 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

698.00

+
+

87.00

+
+

785.00

+
+

 

+
+

B

+
+

All

+
+

698.00

+
+

23.00

+
+

721.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

698.00

+
+

266.48

+
+

964.48

+
+

 

+
+

 

+
+

All other counties

+
+

698.00

+
+

228.48

+
+

926.48

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

698.00

+
+

435.00

+
+

1133.00

+
+

 

+
+

 

+
+

All other counties

+
+

698.00

+
+

405.00

+
+

1103.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

698.00

+
+

694.00

+
+

1392.00

+
+

 

+
+

 

+
+

All other counties

+
+

698.00

+
+

694.00

+
+

1392.00

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

  0.00

+
+

698.00

+
+

B

+
+

F

+
+

All

+
+

465.342

+
+

23.00

+
+

488.34

+
+

D

+
+

Z

+
+

All

+
+

30.003

+
+

0.004

+
+

30.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1048.00

+
+

104.00

+
+

1152.00

+
+

 

+
+

B

+
+

All

+
+

1048.00

+
+

46.00

+
+

1094.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

1048.00

+
+

880.96

+
+

1928.96

+
+

 

+
+

 

+
+

All other counties

+
+

1048.00

+
+

804.96

+
+

1852.96

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

1048.00

+
+

1218.00

+
+

2266.00

+
+

 

+
+

 

+
+

All other counties

+
+

1048.00

+
+

1158.00

+
+

2206.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

1048.00

+
+

1736.00

+
+

2784.00

+
+

 

+
+

 

+
+

All other counties

+
+

1048.00

+
+

1736.00

+
+

2784.00

+
+

 

+
+

Z

+
+

All

+
+

1048.00

+
+

0.00

+
+

1048.00

+
+

B

+
+

F

+
+

All

+
+

698.672

+
+

46.00

+
+

744.67

+
+

D

+
+

Z

+
+

All

+
+

60.003

+
+

0.004

+
+

60.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

M. Description of supplements for Pennsylvania

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

C

+
+

Living with an Essential Person (EP) – Apply this OS code to recipients who are not + living in the household of another or in a foster care home for adults and who have + one or more EP’s as defined under the Federal rules.

+
+

D

+
+

Living in the Household of Another with an EP – Recipients who live in the household + of another and have one or more EP’s as defined under the Federal rules.

+
+

G

+
+

Living in a Domiciliary Care Facility – Adult persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

H

+
+

Living in a Personal Care Boarding Home (PCBH) – Adult Persons (age 18 and over) certified + by the State to be residing in non-medical residential care facilities.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – Includes all recipients who are residing in a medical facility + in which Title XIX is paying more than 50 percent of the cost of care and recipients + in FLA-A or FLA-B who receive a State-administered supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

C

+
+

All

+
+

1048.001

+
+

43.70

+
+

1091.70

+
+

 

+
+

G

+
+

All

+
+

698.00

+
+

434.30

+
+

1132.30

+
+

 

+
+

H

+
+

All

+
+

698.00

+
+

439.30

+
+

1137.30

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

0.

+
+

698.00

+
+

B

+
+

Z

+
+

All

+
+

465.342

+
+

0.00

+
+

465.34

+
+

 

+
+

D

+
+

All

+
+

698.673

+
+

43.70

+
+

742.37

+
+

C

+
+

Z

+
+

All

+
+

698.00

+
+

0.00

+
+

698.00

+
+

D

+
+

Z

+
+

All

+
+

30.004

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

C

+
+

All

+
+

1398.001

+
+

68.05

+
+

1466.05

+
+

 

+
+

G

+
+

All

+
+

1048.00

+
+

947.40

+
+

1995.40

+
+

 

+
+

H

+
+

All

+
+

1048.00

+
+

957.40

+
+

2005.405

+
+

 

+
+

Z

+
+

All

+
+

1048.00

+
+

0.

+
+

1048.00

+
+

B 

+
+

D

+
+

All

+
+

932.00

+
+

68.05

+
+

1000.05

+
+

D

+
+

Z

+
+

All

+
+

60.004

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not the FBR; the amount represents a payment cap to recipients

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individuals in the month following the + month of move. For more information on this topic, see SI PHI01415.010 BASIC 10/2009.

+
+
+
+
+
+
+ +
+
+

N. Description of supplements for Rhode Island

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Residential Care or Assisted Living – Apply this OS code to recipients only.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No State Supplement payable – The State of Rhode Island does not pay a supplement + unless recipient resides in a Licensed Adult Care Facility (“Residential Care or Assisted + Living”) as described in category “D”.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

698.00

+
+

332.00

+
+

1030.00

+
+

 

+
+

Z

+
+

All

+
+

698.00

+
+

0.

+
+

698.00

+
+
+
+
+
+
+
+
+ +
+
+

O. Description of supplements for Utah

+
+
+
+
+

1. Definitions of State living arrangement variations for Utah

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone or With Others – Apply this OS code to recipients who are in Federal + codes A and C.

+
+

B

+
+

Living in the Household of Another – Apply this OS code to recipients who are “living + in the household of another” for Federal purposes. Children under age 18 are included + in this living arrangement variation.

+
+

Z

+
+

No Supplement Cases – Apply this OS code to all recipients who are not included in + OS codes A or B.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for Utah effective + 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Level

+
+

A,C

+
+

Z

+
+

All

+
+

698.00

+
+

0.00

+
+

698.00

+
+

B

+
+

B

+
+

All

+
+

465.342

+
+

3.13

+
+

468.47

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

2Not the FBR, the amount represents the FBR less VTR.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1048.00

+
+

4.60

+
+

1052.60

+
+

B

+
+

B

+
+

All

+
+

698.672

+
+

9.73

+
+

708.40

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

2Not the FBR, the amount represents the FBR less VTR.

+
+
+
+
+
+
+ +
+
+

P. Description of supplements for Vermont

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont

+
+
+

Use this table to view the code and definitions of State Living Arrangement Variations.

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living (except Chittenden County) – This OS code applies to several situations + including:

+ +
    +
  • +
    +
    •
    +
    +

    Recipients who are not living in the household of another;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients who are not in a residential or custodial care situation;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients who are under age 18 and live with a parent;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients who reside in a private Title XIX facility where Medicaid is not paying + more than 50 percent of the cost of care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients who are under age 18 in a private medical facility where private health + insurance is paying more than 50% of their care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients who are under age 18 in a private medical facility where a combination + of Medicaid and a private health insurance policy pays or is expected to pay over + 50 percent of the cost of their care. For information regarding the $30 payment limit + see second and third bullets in SI 00520.011C.1.b.; and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients who reside throughout a month in a publicly operated emergency shelter.

    +
    +
    +
  • +
+
+

B

+
+

Independent Living in Chittenden County – Apply this code to all recipients living + in situations described in “A” above except restricted to residents of Chittenden + County.

+
+

C

+
+

Licensed Residential Care Home or Assisted Living Residence with Assistive Community + Care Services (Level III) – Recipients residing in Level III facilities identified + by the State. To determine if the facility meets the requirements for OS code C, refer + to the Division + of Licensing and Protection for Vermont Community Care + Facilities.

+
+

E

+
+

Living in the Household of Another – Apply this OS code to recipients who live in + the household of another and receive support and maintenance from them (subject to + the Federal one-third reduction provisions).

+
+

G

+
+

Licensed Residential Care Home or Therapeutic Community Residence (Level IV) – Apply + this OS code to recipients residing in Level IV facilities identified by the State. + To determine if a facility meets the requirements for OS code G, refer to the Division + of Licensing and Protection for Vermont Community Care + Facilities. website http://www.dlp.vermont.gov/resident-list.

+
+

H

+
+

Custodial Care: Family Home – Apply this OS code to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    Live in another's home,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Pay room and board to that home owner, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Receive one or more of the services outlined under the custodial care definition (below).

    +
    +
    +
  • +
+ +

In order to qualify as a home under this arrangement, these services must be provided + to two persons or less by a resident of the home.

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) H. To qualify these programs must meet the requirements stated above.

+ +

Custodial care means providing basic room and board, plus personal services such as:

+ +
    +
  • +
    +
    •
    +
    +

    Help with feeding,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Dressing,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Bathing,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Moving about under normal circumstances,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients.

    +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care.

+
+

I

+
+

Effective 07/01/87, the State elected Federal administration of an optional State + supplementary payment to residents in Title XIX facilities. This includes children + under the age of 18 for whom Medicaid alone pays or is expected to pay over 50 percent + of the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+
+
+
+
+
+

2. Coding and monthly payment levels

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + 01/01/12.

+
+
+

a. Individual

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County)

+
+

698.00

+
+

52.04

+
+

750.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

698.00

+
+

52.04

+
+

750.04

+
+

 

+
+

C

+
+

All

+
+

698.00

+
+

48.38

+
+

746.38

+
+

 

+
+

G

+
+

All

+
+

698.00

+
+

223.94

+
+

921.94

+
+

 

+
+

H

+
+

All

+
+

698.00

+
+

98.69

+
+

796.69

+
+

B

+
+

E

+
+

All

+
+

465.34

+
+

39.30

+
+

504.64

+
+

C

+
+

A

+
+

All (Except Chittenden County)

+
+

698.00

+
+

52.04

+
+

750.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

698.00

+
+

52.04

+
+

750.04

+
+

D

+
+

A or B2

+
+

Children Private Insurance

+
+

30.001

+
+

52.04

+
+

82.04

+
+

 

+
+

I

+
+

All

+
+

30.002

+
+

17.66

+
+

47.66

+
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All(Except Chittenden County)

+
+

1048.00

+
+

98.88

+
+

1146.88

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

1048.00

+
+

98.88

+
+

1146.88

+
+

 

+
+

C

+
+

All

+
+

1048.00

+
+

96.77

+
+

1144.77

+
+

 

+
+

G

+
+

All

+
+

1048.00

+
+

562.06

+
+

1610.06

+
+

 

+
+

H

+
+

All

+
+

1048.00

+
+

332.82

+
+

1380.82

+
+

B

+
+

E

+
+

All

+
+

698.671

+
+

48.31

+
+

746.98

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

35.33

+
+

95.33

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

Q. Procedure for documenting optional state category determination

+
+
+
+
+

1. General documentation requirements for initial claims, pre-effectuation reviews, and + redeterminations

+
+
+

No additional documentation is required unless you have reason to question the situation.

+
+
+
+
+

2. General documentation requirements for all other claims events

+
+
+

Unless you have reason to question the situation, document the individual's statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact).

+
+
+
+
+

3. Questionable situations

+
+
+

In questionable situations, review any available evidence that supports the individual’s + allegation of their optional state supplement category. Contact other persons with + knowledge of the individual’s living situation, if necessary (e.g. landlord, homeowner, + facility manager). Document the file per GN 00301.285 through GN 00301.289.

+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415044
SI 01415.044 - Federally Administered Optional Supplementary Payment Programs for 01/12 Payment Levels - 08/06/2012
+Batch run: 05/27/2026
+Rev:08/06/2012
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html new file mode 100644 index 00000000..4f06c30b --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2013.html @@ -0,0 +1,11805 @@ + + +SSA - POMS: SI 01415.045 - Federally Administered Optional Supplementary Payment Programs for 01/13 Payment Levels - 09/24/2013 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 79 (08-24)

+

SI 01415.045 Federally Administered Optional Supplementary Payment Programs for 01/13 Payment Levels

+ + +
+
+

CITATIONS:

+
+
+ +
Social Security Act as amended in 1973, Section + 1616; Social + Security Amendments of 1972, Section + 301;
+ +
Public Law 93-66, Section 212
+
+
+
+
+

A. List of States participating in the Federally Administered Optional Supplementary + Payment program

+
+
+

The following states participate in Federally Administered Optional Supplementary + Payment Programs:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+
+

Reference

+
+

California

+
+

SI 01415.045B

+
+

Delaware

+
+

SI 01415.045C

+
+

District of Columbia

+
+

SI 01415.045D

+
+

Hawaii

+
+

SI 01415.045E

+
+

Iowa

+
+

SI 01415.045F

+
+

Michigan

+
+

SI 01415.045G

+
+

Montana

+
+

SI 01415.045H

+
+

Nevada

+
+

SI 01415.045I

+
+

New Jersey

+
+

SI 01415.045J

+
+

New York

+
+

SI 01415.045K

+
+

Pennsylvania

+
+

SI 01415.045L

+
+

Rhode Island

+
+

SI 01415.045M

+
+

Utah

+
+

SI 01415.045N

+
+

Vermont

+
+

SI 01415.045O

+
+
+
+
+ +
+
+

B. Description of supplements for California

+
+
+
+
+

1. Definitions of State living arrangement variations for California

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Use OS code A for independent living with cooking facilities for an eligible individual + or couple who meets one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    lives in their own household, as defined for Federal living arrangement A purposes, + and has cooking and food storage facilities or is provided meals as part of the living + arrangement;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    is a blind child under age 18 living in the household of a parent, or parents, or + is a disabled child age 18 or over who meets sharing criteria and is living in the + household of a parent or parents;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    is a blind recipient who lives in an independent living arrangement with or without + cooking and food storage facilities; or

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX.

    +
    +
    +
  10. +
+
+

B

+
+

Apply OS code B for Non-medical Out-of-Home Care (NMOHC) when an individual or couple + needs non-medical care or supervision in the following living arrangement situations:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Children (under age 18)

    + +
      +
    1. +
      +
      a. 
      +
      +

      blind child residing in a State licensed NMOHC facility; or

      +
      +
      +
    2. +
    3. +
      +
      b. 
      +
      +

      blind child residing in the home of a relative who is not a parent and not a legal + guardian; or

      +
      +
      +
    4. +
    5. +
      +
      c. 
      +
      +

      disabled child residing in a State licensed NMOHC facility; or

      +
      +
      +
    6. +
    7. +
      +
      d. 
      +
      +

      disabled child residing in the home of a legal guardian who is not a relative; or

      +
      +
      +
    8. +
    9. +
      +
      e. 
      +
      +

      disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

      +
      +
      +
    10. +
    11. +
      +
      f. 
      +
      +

      blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”).

      +
      +
      +
    12. +
    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Adults (age 18 and over)

    +
    +
    +
  4. +
+ +
    +
  1. +
    +
    a. 
    +
    +

    aged, blind or disabled individual or couple is determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    aged, blind, or disabled individual is determined to be in FLA A and resides in a + State licensed NMOHC facility; or

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    aged, blind or disabled individual is determined to be in FLA A and resides in a family + home certified by a Family Home Agency under State law.

    +
    +
    +
  6. +
+ +

For California optional supplement (OS) purposes, a relative is defined as a

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-sibling

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    +
    +
    +
  • +
+
+

C

+
+

Independent Living Without Cooking Facilities

+ +

Apply OS code C to aged or disabled individuals or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement.

    +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS C.

+ +

An individual or couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    1. 
    +
    +

    immediate living quarters do not have cooking and food storage facilities that the + individual or couple or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + have access for preparing meals.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparing + meals.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis).

    +
    +
    +
  10. +
+ +

“Adequate” cooking and food storage facilities exist when an individual or couple has access + to:

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.)

    + +

    or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”)

    + +

    or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove or a one-burner hotplate with a temperature control.

    +
    +
    +
  • +
+ +

Eligibility for OS C begins in the month the recipient applies for this supplement + rate provided they have been without cooking and food storage facilities throughout + the month.

+ +

NOTE: For purposes of OS C, “throughout a month” does not mean the recipient must lack adequate cooking or food storage facilities from the + very first moment of the month. The recipient need only lack them from some time on + the first day of the month.

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + has ceased.

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact.

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available.

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind or aged or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment.

+
+

D

+
+

Living in the Household of Another

+ +

Apply OS code D when an eligible individual or couple is living in the household of + another and receives food and shelter from that person. Most individuals or couples who are subject to a one-third + reduction of their Federal SSI payments are eligible for OS D because the criteria + for this supplement level are the same as for charging the one-third reduction. However, + when the eligible individual or couple lives in the home of a relative (other than + a spouse) and needs care and supervision, you must obtain certification for non-medical + out-of-home care (OS F) from the county welfare office since this is the highest categorical + supplement that an individual or couple can qualify.

+
+

E

+
+

Disabled Child Under Age 18

+ +

Apply OS code E to a disabled (not blind) child under age 18 who resides with a parent + or relative by blood or marriage.

+ +

NOTE: Only FLA A and C are compatible with OS E. If the Value of the One Third Reduction + (VTR) applies, see code G.

+
+

F

+
+

Non-medical Out-of-Home Care Living in the Household of Another

+ +

OS code F applies whenever an eligible individual or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code B payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200.

+
+

G

+
+

Disabled Child Under Age 18 Living in the Household of Another

+ +

OS code G applies to a disabled (not blind) child under age 18, who resides with a + parent or relative by blood or marriage, and is determined to receive the Federal code B payment for living in the household of + another person. For the one-third reduction provision, see SI 00835.200.

+
+

J

+
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code J to an eligible recipient who is a patient + in a medical facility where Title XIX pays more than 50 percent of the costs. Also + apply OS State code J to supplement Section 1619 cases.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Apply OS code Z to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter.

+ +

For periods prior to July 1, 1987, apply OS code Z to an eligible recipient who is + a patient in a medical facility where Title XIX pays more than 50 percent of the costs.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for California

+
+
+

The following charts display the coding and monthly payment levels for California + effective 01/01/2013.

+
+
+

a. Individual payment levels or California

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

710.00

+
+

156.40

+
+

866.40

+
+

 

+
+

 

+
+

Blind

+
+

710.00

+
+

211.40

+
+

921.40

+
+

 

+
+

 

+
+

Disabled

+
+

710.00

+
+

156.40

+
+

866.40

+
+

 

+
+

B

+
+

All

+
+

710.00

+
+

412.00

+
+

1122.00

+
+

 

+
+

C

+
+

Aged

+
+

710.00

+
+

240.40

+
+

950.40

+
+

 

+
+

 

+
+

Disabled

+
+

710.00

+
+

240.40

+
+

950.40

+
+

 

+
+

E

+
+

Disabled

+
+

710.00

+
+

63.40

+
+

773.40

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

0.00

+
+

710.00

+
+

B

+
+

D

+
+

Aged

+
+

473.341

+
+

159.83

+
+

633.17

+
+

 

+
+

 

+
+

Blind

+
+

473.341

+
+

214.83

+
+

688.17

+
+

 

+
+

 

+
+

Disabled

+
+

473.341

+
+

159.83

+
+

633.17

+
+

 

+
+

F

+
+

All

+
+

473.341

+
+

407.00

+
+

880.34

+
+

 

+
+

G

+
+

Disabled

+
+

473.341

+
+

66.83

+
+

540.17

+
+

C

+
+

A

+
+

Blind

+
+

710.00

+
+

211.40

+
+

921.40

+
+

 

+
+

E

+
+

Disabled

+
+

710.00

+
+

63.40

+
+

773.40

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

0.

+
+

710.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1066.00

+
+

396.20

+
+

1462.20

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1066.00

+
+

543.20

+
+

1609.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1066.00

+
+

396.20

+
+

1462.20

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1066.00

+
+

487.20

+
+

1553.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1066.00

+
+

396.20

+
+

1462.20

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1066.00

+
+

487.20

+
+

1553.20

+
+

 

+
+

B

+
+

All

+
+

1066.00

+
+

1178.00

+
+

2244.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1066.00

+
+

564.20

+
+

1630.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1066.00

+
+

564.20

+
+

1630.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1066.00

+
+

564.20

+
+

1630.20

+
+

 

+
+

Z

+
+

All

+
+

1066.00

+
+

0.00

+
+

1066.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

710.671

+
+

401.33

+
+

1112.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

710.671

+
+

548.33

+
+

1259.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

710.671

+
+

401.33

+
+

1112.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

710.671

+
+

492.33

+
+

1203.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

710.671

+
+

401.33

+
+

1112.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

710.671

+
+

492.33

+
+

1203.00

+
+

 

+
+

F

+
+

All

+
+

710.671

+
+

1045.66

+
+

1756.33

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR).

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + To be eligible for OS code A, the State must provide documentation that a recipient + is a resident of a certified Adult Residential Care Facility, Assisted Living Facility, + or Adult Foster Care Home.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use code Y to indicate that a recipient is eligible for an optional supplement, but + has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Use OS code Z for any recipient who is not included in OS categories A or Y.

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code A.

+ +

For more information on Optional State Supplement codes see SM 01301.535

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + 01/01/13.

+
+
+

a. Individual payment levels for Delaware

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

710.00

+
+

140.00

+
+

850.00

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

0.

+
+

710.00

+
+

B

+
+

Z

+
+

All

+
+

473.34

+
+

0.

+
+

473.34

+
+

C

+
+

Z

+
+

All

+
+

710.00

+
+

0.

+
+

710.00

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Delaware

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1066.00

+
+

448.00

+
+

1514.00

+
+

 

+
+

Z

+
+

All

+
+

1066.00

+
+

0.

+
+

1066.00

+
+

B

+
+

Z

+
+

All

+
+

710.67

+
+

0.

+
+

710.67

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Foster Care Home with 50 or Fewer Residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents

+
+

B

+
+

Adult Foster Care Home with More than 50 Residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents.

+
+

G

+
+

Apply OS code “G” to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective 01/01/13.

+
+
+

a. Individual payment levels for the District of Columbia

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

710.00

+
+

585.00

+
+

1295.00

+
+

 

+
+

B

+
+

All

+
+

710.00

+
+

695.00

+
+

1405.00

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

0.

+
+

710.00

+
+

B

+
+

Z

+
+

All

+
+

473.341

+
+

0.

+
+

473.34

+
+

C

+
+

Z

+
+

All

+
+

710.00

+
+

0.

+
+

710.00

+
+

D

+
+

G

+
+

All

+
+

30.002

+
+

40.00

+
+

70.00

+
+
+

1Not the FBR; the amount represents the FBR less the VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for the District of Columbia

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Code

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1066.00

+
+

1524.00

+
+

2590.00

+
+

 

+
+

B

+
+

All

+
+

1066.00

+
+

1744.00

+
+

2810.00

+
+

 

+
+

Z

+
+

All

+
+

1066.00

+
+

0.

+
+

1066.00

+
+

B

+
+

Z

+
+

All

+
+

710.671

+
+

0.

+
+

710.67

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

80.00

+
+

140.00

+
+
+

1Not the FBR; the amount represents the FBR less the VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

B

+
+

Living in a Community Care or Foster Care Home

+ +

Apply OS code B to recipients who are both over age 18 and live in a State approved + Care or Foster Care Home.

+
+

D

+
+

Living in a Certified Medical Facility

+ +

Use OS code D for an eligible individual living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care.

+
+

H

+
+

Domiciliary Care I (Maximum of five residents)

+ +

Use OS code H for an eligible recipient (including a child) or couple living in a + domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities.

+
+

I

+
+

Domiciliary Care II

+ +

OS Code I is the same as code H except the facility provides care for six or more + residents.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because they are living in the following situations:

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility which is not certified under + Title XIX; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    +
    +
    +
  • +
+
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + 01/01/13.

+
+
+

a. Individual payments levels for Hawaii

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A 

+
+

B

+
+

All

+
+

710.00

+
+

651.90

+
+

1361.90

+
+

 

+
+

H

+
+

All

+
+

710.00

+
+

651.90

+
+

1361.90

+
+

 

+
+

I

+
+

All

+
+

710.00

+
+

759.90

+
+

1469.90

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

0.

+
+

710.00

+
+

B

+
+

Z

+
+

All

+
+

473.34

+
+

0.

+
+

473.34

+
+

D

+
+

D

+
+

All

+
+

30.001

+
+

20.00

+
+

50.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Hawaii

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

B

+
+

All

+
+

1066.00

+
+

1640.80

+
+

2706.80

+
+

 

+
+

H

+
+

All

+
+

1066.00

+
+

1640.80

+
+

2706.80

+
+

 

+
+

I

+
+

All

+
+

1066.00

+
+

1856.80

+
+

2922.80

+
+

 

+
+

Z

+
+

All

+
+

1066.00

+
+

0.

+
+

1066.00

+
+

B

+
+

Z

+
+

All

+
+

710.67

+
+

0.

+
+

710.67

+
+

D

+
+

D

+
+

All

+
+

60.001

+
+

40.00

+
+

100.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living in Own Household (Blind Only)

+ +

Apply OS code “A” only to an eligible blind recipient and the blind member of a couple who:

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code A is also compatible with Federal + codes A and C.

    +
    +
    +
  • +
+ +

OS code A is the proper code to use with an “intervening” Federal code A.

+ +

For optional State supplement codes, see SM 01301.535.

+
+

B

+
+

Living in the Household of Another (Blind Only)

+ +

OS Code B is only for an eligible blind recipient and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation.

+
+

C

+
+

Living with a Dependent Person

+ +

Use OS Code C for an eligible recipient or each member of an eligible couple in Federal + living arrangement A or C who has an

+ +
    +
  • +
    +
    •
    +
    +

    ineligible spouse, parent, child, or adult child living in the home with them, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services.

    +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement.

+
+

D

+
+

Living in a Family Life or Boarding Home

+ +

Use OS Code D for an eligible recipient or each member of an eligible couple in Federal + living arrangement A who resides in a family life home or boarding home licensed by + the State Department of Health or certified by the State Department of Human Services

+
+

H

+
+

Living with a Dependent Person

+ +

Use OS Code H for an eligible recipient or each member of an eligible couple in Federal + living arrangement B who has an

+ +
    +
  • +
    +
    •
    +
    +

    ineligible spouse, parent, child, or adult child living in the home with them, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services.

    +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement.

+
+

G

+
+

Use OS Code G to indicate that no supplement is payable to a recipient living in a + Title XIX facility and Title XIX pays more than 50 percent of the cost of care. However, + a Federal D living arrangement is not appropriate because the recipient did not meet + the “throughout a month” requirement at the initial claims input.

+
+

I

+
+

Living in a Family Life or Boarding Home-Eligible individual or each member of an + eligible couple in FLA B, who resides in a family life home or boarding home licensed + by the State Department of Health, or certified by the State Department of Human Services.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Use OS code Z to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care.

    +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs:

+ +
    +
  1. +
    +
    1. 
    +
    +

    “In-Home Health Related Care”;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    “Residential Care”; and

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    “Supplement for Medicare and Medicaid Eligible.”

    +
    +
    +
  6. +
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid.

+
+
+
+
+

2. Coding and monthly payment levels for Iowa

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + 01/01/13.

+
+
+

a. Individual payment levels for Iowa

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind

+
+

710.00

+
+

22.00

+
+

732.00

+
+

 

+
+

C

+
+

Aged

+
+

710.00

+
+

364.00

+
+

1074.00

+
+

 

+
+

 

+
+

Blind

+
+

710.00

+
+

386.00

+
+

1096.00

+
+

 

+
+

 

+
+

Disabled

+
+

710.00

+
+

364.00

+
+

1074.00

+
+

 

+
+

D

+
+

Aged

+
+

710.00

+
+

142.00

+
+

852.00

+
+

 

+
+

 

+
+

Blind

+
+

710.00

+
+

164.00

+
+

874.00

+
+

 

+
+

 

+
+

Disabled

+
+

710.00

+
+

142.00

+
+

852.00

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

0.00

+
+

710.00

+
+

B

+
+

B

+
+

Blind

+
+

473.341

+
+

22.00

+
+

495.34

+
+

 

+
+

H

+
+

Aged

+
+

473.341

+
+

364.00

+
+

837.34

+
+

 

+
+

 

+
+

Blind

+
+

473.341

+
+

386.00

+
+

859.34

+
+

 

+
+

 

+
+

Disabled

+
+

473.341

+
+

364.00

+
+

837.34

+
+

 

+
+

I

+
+

Aged

+
+

473.341

+
+

142.00

+
+

615.34

+
+

 

+
+

I

+
+

Disabled

+
+

473.341

+
+

142.00

+
+

615.34

+
+

 

+
+

I

+
+

Blind

+
+

473.341

+
+

164.00

+
+

637.34

+
+

 

+
+

Z

+
+

All

+
+

473.341

+
+

0.00

+
+

473.34

+
+

C

+
+

A

+
+

Blind

+
+

710.00

+
+

22.00

+
+

732.00

+
+

 

+
+

C

+
+

Blind

+
+

710.00

+
+

386.00

+
+

1096.00

+
+

 

+
+

 

+
+

Disabled

+
+

710.00

+
+

364.00

+
+

1074.00

+
+

 

+
+

Z

+
+

Disabled

+
+

710.00

+
+

0.00

+
+

710.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: State-administered programs for calendar year 2013 include:

+
    +
  • +
    +
    •
    +
    +

    individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    individuals receiving a supplement for Medicare and Medicaid Eligible receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind/Blind

+
+

1066.00

+
+

44.00

+
+

1110.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

1066.00

+
+

22.00

+
+

1088.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1066.00

+
+

22.00

+
+

1088.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1066.00

+
+

364.00

+
+

1430.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1066.00

+
+

408.00

+
+

1474.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1066.00

+
+

364.00

+
+

1430.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1066.00

+
+

386.00

+
+

1452.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1066.00

+
+

364.00

+
+

1430.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1066.00

+
+

386.00

+
+

1452.00

+
+

 

+
+

D

+
+

Aged/Aged

+
+

1066.00

+
+

658.00

+
+

1724.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1066.00

+
+

702.00

+
+

1768.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1066.00

+
+

658.00

+
+

1724.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1066.00

+
+

680.00

+
+

1746.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1066.00

+
+

658.00

+
+

1724.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1066.00

+
+

680.00

+
+

1746.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

1066.00

+
+

0.00

+
+

1066.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1066.00

+
+

0.00

+
+

1066.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1066.00

+
+

0.00

+
+

1066.00

+
+

B

+
+

B

+
+

Blind/Blind

+
+

710.671

+
+

44.00

+
+

754.67

+
+

 

+
+

 

+
+

Blind/Aged

+
+

710.671

+
+

22.00

+
+

732.67

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

710.671

+
+

22.00

+
+

732.67

+
+

 

+
+

H

+
+

Aged/Aged

+
+

710.671

+
+

364.00

+
+

1074.67

+
+

 

+
+

 

+
+

Blind/Blind

+
+

710.671

+
+

408.00

+
+

1118.67

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

710.671

+
+

364.00

+
+

1074.67

+
+

 

+
+

 

+
+

Aged/Blind

+
+

710.671

+
+

386.00

+
+

1096.67

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

710.671

+
+

364.00

+
+

1074.67

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

710.671

+
+

386.00

+
+

1096.67

+
+

 

+
+

I

+
+

Aged/Aged

+
+

710.671

+
+

658.00

+
+

1368.67

+
+

 

+
+

 

+
+

Blind/Blind

+
+

710.671

+
+

702.00

+
+

1412.67

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

710.671

+
+

658.00

+
+

1368.67

+
+

 

+
+

 

+
+

Aged/Blind

+
+

710.671

+
+

680.00

+
+

1390.67

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

710.671

+
+

658.00

+
+

1368.67

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

710.671

+
+

680.00

+
+

1390.67

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

710.671

+
+

0.00

+
+

710.67

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

710.671

+
+

0.00

+
+

710.67

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

710.671

+
+

0.00

+
+

710.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: State-administered programs for calendar year 2013 include:

+
    +
  • +
    +
    •
    +
    +

    recipients receiving “Residential Care” receive payment based on a per diem rate plus + a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. Treat members of a couple as individuals.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients receiving a supplement for Medicare and Medicaid receive a $1 monthly payment.

    +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Domiciliary Care

+ +

Use OS code D for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care.

+
+

E

+
+

Personal Care

+ +

Apply OS code E to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies which recipients are residents requiring this level of care. Such care + situations include, but are not limited to, licensed homes for the aged.

+
+

F

+
+

Home for the Aged

+ +

Apply OS code F for residents in Homes for the Aged. The State provides SSA with a + list of these non-medical facilities for the aged and certifies which recipients are + residents who require this level of care.

+
+

G

+
+

Independent Living with an EP

+ +

OS code G applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18 .

+
+

H

+
+

Living in the Household of Another with an EP

+ +

OS code H applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18.

+
+

I

+
+

Effective 01/01/88, OS code I applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + 01/01/13.

+
+
+

a. Individual payment levels for Michigan

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

710.00

+
+

87.00

+
+

797.00

+
+

 

+
+

E

+
+

All

+
+

710.00

+
+

157.50

+
+

867.50

+
+

 

+
+

F

+
+

All

+
+

710.00

+
+

179.30

+
+

889.30

+
+

 

+
+

G

+
+

All

+
+

1066.001

+
+

14.00

+
+

1080.00

+
+

B

+
+

H

+
+

All

+
+

710.672

+
+

9.33

+
+

720.00

+
+

D

+
+

I

+
+

All

+
+

  30.003

+
+

7.00

+
+

37.00

+
+

 

+
+

Z

+
+

All

+
+

30.00

+
+

0.

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Michigan

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

1066.00

+
+

528.00

+
+

1594.00

+
+

 

+
+

E

+
+

All

+
+

1066.00

+
+

669.00

+
+

1735.00

+
+

 

+
+

F

+
+

All

+
+

1066.00

+
+

712.60

+
+

1778.60

+
+

 

+
+

G

+
+

All

+
+

1422.001

+
+

21.00

+
+

1443.00

+
+

B

+
+

H

+
+

All

+
+

948.00

+
+

14.00

+
+

962.00

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

14.00

+
+

74.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

G

+
+

State-Certified Personal Care

+
+

H

+
+

State-Certified Residence in Group Home for Mentally Disabled

+
+

I

+
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+
+

J

+
+

State-Certified Residence for Child and Adult Foster Care

+
+

K

+
+

State-Certified Transitional Living for Developmentally Disabled

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – Includes all individuals and couples not certified in State + codes G, H, I, J, or K.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + 01/01/13.

+
+
+

a. Individual payment levels for Montana

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

710.00

+
+

94.00

+
+

804.00

+
+

 

+
+

H

+
+

All

+
+

710.00

+
+

94.00

+
+

804.00

+
+

 

+
+

I

+
+

All

+
+

710.00

+
+

94.00

+
+

804.00

+
+

 

+
+

J

+
+

All

+
+

710.00

+
+

52.75

+
+

762.75

+
+

 

+
+

K

+
+

All

+
+

710.00

+
+

26.00

+
+

736.00

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

0.00

+
+

710.00

+
+

B

+
+

Z

+
+

All

+
+

474.341

+
+

0.00

+
+

474.34

+
+

C

+
+

Z

+
+

All

+
+

710.00

+
+

0.00

+
+

710.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Montana

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

1066.00

+
+

193.00

+
+

1259.00

+
+

 

+
+

H

+
+

All

+
+

1066.00

+
+

193.00

+
+

1259.00

+
+

 

+
+

I

+
+

All

+
+

1066.00

+
+

193.00

+
+

1259.00

+
+

 

+
+

J

+
+

All

+
+

1066.00

+
+

110.50

+
+

1176.50

+
+

 

+
+

K

+
+

All

+
+

1066.00

+
+

57.00

+
+

1123.00

+
+

 

+
+

Z

+
+

All

+
+

1066.00

+
+

0.00

+
+

1066.00

+
+

B

+
+

Z

+
+

All

+
+

710.671

+
+

0.00

+
+

710.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living or Living in Parental Household

+ +

Use OS code A for an aged or blind eligible recipient who meets one of the following + situations:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes;

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household.

    +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. For Optional State Supplement codes, see + SM 01301.535.

+
+

B

+
+

Living in the Household of Another

+ +

Use OS code B for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject to a one-third + reduction (VTR) of their Federal SSI payment are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B.

+
+

C

+
+

Domiciliary Care

+ +

Apply OS code C to aged or blind recipients who the State has certified live in a + private non-medical facility or, a residential facility serving 16 or fewer persons, + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor.

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

Apply “No Supplement” code Y to the following recipients:

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible individual or disabled member of eligible couple;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible individual or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible individual or member of eligible couple who is patient in a private medical + facility which is not certified under Title XIX; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    +
    +
    +
  • +
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + 01/01/13.

+
+
+

a. Individual payment levels for Nevada

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

710.00

+
+

36.40

+
+

746.40

+
+

 

+
+

 

+
+

Blind

+
+

710.00

+
+

109.30

+
+

819.30

+
+

 

+
+

C

+
+

Aged

+
+

710.00

+
+

391.00

+
+

1101.00

+
+

 

+
+

 

+
+

Blind

+
+

710.00

+
+

391.00

+
+

1101.00

+
+

 

+
+

Z

+
+

Disabled

+
+

710.00

+
+

0.00

+
+

710.00

+
+

B

+
+

B

+
+

Aged

+
+

473.341

+
+

24.27

+
+

497.61

+
+

 

+
+

 

+
+

Blind

+
+

473.34

+
+

213.96

+
+

687.30

+
+

 

+
+

Z

+
+

Disabled

+
+

473.34

+
+

0.00

+
+

473.34

+
+

C

+
+

A

+
+

Blind

+
+

710.00

+
+

109.30

+
+

819.30

+
+

 

+
+

Z

+
+

Disabled

+
+

710.00

+
+

0.00

+
+

710.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Nevada

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1066.00

+
+

74.46

+
+

1140.46

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1066.00

+
+

374.60

+
+

1440.60

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1066.00

+
+

224.53

+
+

1290.53

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1066.00

+
+

37.23

+
+

1103.23

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1066.00

+
+

187.30

+
+

1253.30

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1066.00

+
+

881.00

+
+

1947.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1066.00

+
+

881.00

+
+

1947.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1066.00

+
+

881.00

+
+

1947.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1066.00

+
+

440.50

+
+

1506.50

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1066.00

+
+

440.50

+
+

1506.50

+
+

 

+
+

Z

+
+

Disabled

+
+

1066.00

+
+

0.00

+
+

1066.00

+
+

B

+
+

B

+
+

Aged/Aged

+
+

710.67

+
+

49.64

+
+

760.31

+
+

 

+
+

 

+
+

Blind/Blind

+
+

710.67

+
+

531.94

+
+

1242.61

+
+

 

+
+

 

+
+

Aged/Blind

+
+

710.67

+
+

290.79

+
+

1001.46

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

710.67

+
+

24.82

+
+

735.49

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

710.67

+
+

265.97

+
+

976.64

+
+

 

+
+

Z

+
+

Disabled

+
+

710.67

+
+

0.00

+
+

710.67

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Congregate Care

+ +

Apply OS code A to recipients in Federal living arrangement A. The living arrangement + includes the following:

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services:

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients living in Assisted Living Residences or Comprehensive Personal Care Homes + (CPCH) that are licensed by the Department of Health and Senior Services.

    +
    +
    +
  • +
+
+

B

+
+

Living Alone or with Others

+ +

Use OS code B for recipients whose Federal living arrangements are A or C and who + do not meet the requirements defined in other supplementation categories.

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + A to be in optional supplement B unless they are residing in a residential health + care facility or living alone with an ineligible spouse.

+ +

Likewise, any child meeting the criteria for a Federal code C is automatically entitled + to optional supplement B.

+ +

This category includes, but is not limited to, those recipients who are in one of + the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    living physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    placed in a Transitional Residency Program by the Division of Mental Health and Hospitals, + Department of Human Services.

    +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to use with an “intervening” Federal + code A. For State Supplement codes, see SM 01301.535.

+ +

Use OS code B to address Section 1619 cases.

+
+

C

+
+

Living Alone with an Ineligible Spouse

+ +

Use OS code C when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes i.e., a spouse, either by marriage or holding + out who is either not eligible for SSI or who chooses not to apply. If other + persons, even minor children, are present in the household, you cannot apply this + OS + code.

+ +

However, it is possible that a claimant and the ineligible spouse live with others + and allege that they are a separate “household” by virtue of the fact that they eat + their meals out or have separate purchase and preparation of food. In this instance, + you may consider an optional supplement C as long as no other person is considered + part of the “household.” There is no couple counterpart in this category.

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS “C.”

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS “B.”

+
+

D

+
+

Living in the Household of Another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes.

+
+

I

+
+

Licensed Residential Health Care Facilities (RHCF)

+ +

Apply OS code I to recipients living in the following:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Assisted Living Residence;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “Free standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to 1/1/06.

    +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence + at a facility listed in the New Jersey Congregate Care Directory .

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. + Pay residents of the Assisted Living Resident (ALR, or CPCH section of a multipurpose + facility) at the OS “A” rate. Nursing home residents are in living arrangement (D/G) + if Medicaid pays more than 50 percent of the cost of care.

+
+

G

+
+

Apply OS code G effective 09/01/88, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Apply OS code Z to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Residing throughout a month in publicly operated emergency shelters.

    +
    +
    +
  • +
+ +

You can also apply OS code Z to cases that were FLA D prior to 01/1988, or effective + 12/01/96, to children residing in public or private facilities where private health + insurance paid for their care. For determination of applicability of $30 payment limit, + see SI 00520.011.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for New Jersey

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective 01/01/13.

+
+
+

a. Individual payment levels for New Jersey

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
FBR +

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

710.00

+
+

150.05

+
+

860.05

+
+

 

+
+

B

+
+

All

+
+

710.00

+
+

31.25

+
+

741.25

+
+

 

+
+

C

+
+

Individual

+
+

710.00

+
+

153.00

+
+

863.00

+
+

 

+
+

 

+
+

w/EP

+
+

1066.001

+
+

25.36

+
+

1091.36

+
+

 

+
+

I

+
+

All

+
+

710.00

+
+

210.05

+
+

920.05

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

0.00

+
+

710.00

+
+

B

+
+

D

+
+

All

+
+

473.342

+
+

44.31

+
+

517.65

+
+

C

+
+

B

+
+

All

+
+

710.00

+
+

31.25

+
+

741.25

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

10.00

+
+

40.00

+
+

 

+
+

Z

+
+

All

+
+

30.00

+
+

0.

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for New Jersey

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

A

+
+

A

+
+

All

+
+

1066.00

+
+

618.36

+
+

 

+
+

B

+
+

All

+
+

1066.00

+
+

25.36

+
+

 

+
+

I

+
+

All

+
+

1066.00

+
+

738.36

+
+

 

+
+

Z

+
+

All

+
+

1066.00

+
+

  0.00

+
+

B

+
+

D

+
+

All

+
+

710.671

+
+

93.09

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

20.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for New York

+
+
+
+
+

1. Definitions of State living arrangement variations for New York

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone

+ +

Apply OS code A to recipients living in one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    live physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    pay a fixed, pre-established flat fee for both room and board in a commercial establishment;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    lives with others but takes all meals outside the dwelling;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    lives with others but separately prepares or has someone separately prepare their + food. Occasional preparation of meals in common does not preclude a finding of separate + preparation;

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    receive a fixed, pre-established flat fee for room and board from all others in the dwelling;

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    live with only a foster child, or a homemaker authorized by the local Department of + Social Services (DSS), or a family care recipient placed by the Office of Mental Health + (OMH) or Office for People with Developmental Disabilities (OPWDD) or local DSS; or

    +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    does not have a permanent living arrangement (i.e., transient or street person) and + is not with a spouse or a child for whom they have primary responsibility.

    +
    +
    +
  14. +
+
+

B

+
+

Living with Others

+ +

Apply OS code B to recipients living in one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    resides in a dwelling with others and prepares food in common with at least one other + person in the dwelling.

    + +

    NOTE: Consider a recipient living with an ineligible spouse to be living with others despite + any separate preparation. The same is true if a recipient lives with a child for whom + they have primary responsibility (except if the child is a foster child)

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    is a child who does not meet the criteria for OS C or OS D (below);

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    lives in a religious community and room and board are provided in full or in part + by the religious community; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    does not have a permanent living arrangement (i.e., transient or street person), but + is with an ineligible spouse or child for whom they have primary responsibility.

    +
    +
    +
  8. +
+
+

C

+
+

Congregate Care Level I

+ +

Apply OS code C to recipients placed in a

+ +
    +
  • +
    +
    •
    +
    +

    family type home certified by New York State (NYS) Office of Children and Family Services + and supervised by a local DSS.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    family care home certified by OMH or OPWDD.

    +
    +
    +
  • +
+
+

D

+
+

Congregate Care Level II

+ +

Apply OS code D to a recipient who is a resident of a licensed Level II care facility.

+ +

These supportive living facilities include:

+ +
    +
  • +
    +
    •
    +
    +

    residences for adults certified by the NYS Department of Health;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    privately operated facilities certified by the NYS OMH;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    privately operated facilities certified by NYS OMH and OPWDD; and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    privately operated facilities certified by Office of Alcoholism and Substance Abuse + Services.

    +
    +
    +
  • +
+
+

E

+
+

Congregate Care Level III and Enhanced Residential Care

+ +

Apply OS code E to recipients residing in a licensed level III care facility (including + a recipient over age 18 who still meets the definition of a child per SI 00501.010).

+ +

Level III care facilities include:

+ +
    +
  • +
    +
    •
    +
    +

    adult homes and enriched housing programs certified by the NYS Department of Health; + or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Schools for the Mentally Retarded, the NYS Office for People with Developmental Disabilities + must certify that these residential facilities provide academic, vocational, recreational, + and social skills programs. Although sometimes called schools, they often do not meet + the Federal definition of schools.

    +
    +
    +
  • +
+ +

NOTE: Do not apply OS code E to a situation in which a child, who is receiving SSI, resides + in a Level III facility. Apply OS Code B for those recipients.

+
+

F

+
+

Living in the Household of Another

+ +

Apply OS code F to pay recipients who are FLA B.

+
+

G

+
+

Apply OS code G effective 01/01/88, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. SSA + and the state agreed to terminate Federal administration effective 09/30/03 and the + State began administering this payment 10/01/03.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use code Y to indicate that a recipient is eligible for an optional supplement, but + has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Apply OS code Z to recipients in FLA A or D who meet one of the following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    in a licensed medical facility where Medicaid is paying less than 50 percent of the + cost of care;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    in a publicly operated community residence which serves 16 or fewer residents;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    in a publicly operated emergency shelter (PESH) throughout a month;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    qualifies under the special provisions for institutionalized 1619 eligibles described + in SI 00520.130 ;

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    is in FLA-D effective 10/01/03; or

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    is a child, under age 18; whose stay in a public or private facility was paid by private + health insurance (applies prior to 12/1/96). For determination of applicability of + $30 payment limit see SI 00520.011.

    +
    +
    +
  12. +
+
+
+
+
+
+
+

2. Coding and monthly payment levels for New York

+
+
+

The following charts display the coding and monthly payment levels for New York effective + 01/01/13.

+
+
+

a. Individual payment levels for New York

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

710.00

+
+

87.00

+
+

797.00

+
+

 

+
+

B

+
+

All

+
+

710.00

+
+

23.00

+
+

733.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

710.00

+
+

266.48

+
+

976.48

+
+

 

+
+

 

+
+

All other counties

+
+

710.00

+
+

228.48

+
+

938.48

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

710.00

+
+

435.00

+
+

1145.00

+
+

 

+
+

 

+
+

All other counties

+
+

710.00

+
+

405.00

+
+

1115.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

710.00

+
+

694.00

+
+

1404.00

+
+

 

+
+

 

+
+

All other counties

+
+

710.00

+
+

694.00

+
+

1404.00

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

  0.00

+
+

710.00

+
+

B

+
+

F

+
+

All

+
+

473.342

+
+

23.00

+
+

496.34

+
+

D

+
+

Z

+
+

All

+
+

30.003

+
+

0.004

+
+

30.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for New York

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1066.00

+
+

104.00

+
+

1170.00

+
+

 

+
+

B

+
+

All

+
+

1066.00

+
+

46.00

+
+

1112.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

1066.00

+
+

886.96

+
+

1952.96

+
+

 

+
+

 

+
+

All other counties

+
+

1066.00

+
+

810.96

+
+

1876.96

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

1066.00

+
+

1224.00

+
+

2290.00

+
+

 

+
+

 

+
+

All other counties

+
+

1066.00

+
+

1164.00

+
+

2230.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

1066.00

+
+

1742.00

+
+

2808.00

+
+

 

+
+

 

+
+

All other counties

+
+

1066.00

+
+

1742.00

+
+

2808.00

+
+

 

+
+

Z

+
+

All

+
+

1066.00

+
+

0.00

+
+

1066.00

+
+

B

+
+

F

+
+

All

+
+

710.672

+
+

46.00

+
+

756.67

+
+

D

+
+

Z

+
+

All

+
+

60.003

+
+

0.004

+
+

60.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Pennsylvania

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

C

+
+

Living with an Essential Person (EP)

+ +

Apply OS code C to recipients who are not living in the household of another or in + a foster care home for adults and who have one or more EP’s as defined under the Federal + rules.

+
+

D

+
+

Living in the Household of Another with an EP

+ +

Apply OS code D to recipients who live in the household of another and have one or + more EP’s as defined under the Federal rules.

+
+

G

+
+

Living in a Domiciliary Care Facility

+ +

Apply OS code G to adult persons (age 18 and over) certified by the State to be residing + in non-medical residential care facilities.

+
+

H

+
+

Living in a Personal Care Boarding Home (PCBH)

+ +

Apply OS code H to Adult Persons (age 18 and over) certified by the State to be residing + in non-medical residential care facilities.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use code Y to indicate that a recipient is eligible for an optional supplement, but + has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

OS code Z includes all recipients who are residing in a medical facility in which + Title XIX is paying more than 50 percent of the cost of care and recipients in FLA-A + or FLA-B who receive a State-administered supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective 01/01/13.

+
+
+

a. Individual payment levels for Pennsylvania

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

C

+
+

All

+
+

1066.001

+
+

43.70

+
+

1109.70

+
+

 

+
+

G

+
+

All

+
+

710.00

+
+

434.30

+
+

1144.30

+
+

 

+
+

H

+
+

All

+
+

710.00

+
+

439.30

+
+

1149.30

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

0.

+
+

710.00

+
+

B

+
+

Z

+
+

All

+
+

473.342

+
+

0.00

+
+

473.34

+
+

 

+
+

D

+
+

All

+
+

710.673

+
+

43.70

+
+

754.37

+
+

C

+
+

Z

+
+

All

+
+

710.00

+
+

0.00

+
+

710.00

+
+

D

+
+

Z

+
+

All

+
+

30.004

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Pennsylvania

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

C

+
+

All

+
+

1422.001

+
+

68.05

+
+

1490.05

+
+

 

+
+

G

+
+

All

+
+

1066.00

+
+

947.40

+
+

2013.40

+
+

 

+
+

H

+
+

All

+
+

1066.00

+
+

957.40

+
+

2023.40

+
+

 

+
+

Z

+
+

All

+
+

1066.00

+
+

0.

+
+

1066.00

+
+

B 

+
+

D

+
+

All

+
+

948.002

+
+

68.05

+
+

1016.05

+
+

B

+
+

Z

+
+

All

+
+

710.673

+
+

0.00

+
+

710.67

+
+

D

+
+

Z

+
+

All

+
+

60.004

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR.

+

3Not the FBR; the amount represents the FBR less VTR.

+

4Not the FBR; the amount represents a payment cap to recipients

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individuals in the month following the + month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010.

+
+
+
+
+
+
+ +
+
+

M. Description of supplements for Rhode Island

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Residential Care or Assisted Living

+ +

Apply OS code D to recipients only.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No State Supplement payable

+ +

Code Z means the State of Rhode Island does not pay a supplement unless the recipient + resides in a Licensed Adult Care Facility (“Residential Care or Assisted Living”) + as described in category “D”.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective 01/01/13.

+

Individual payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

710.00

+
+

332.00

+
+

1042.00

+
+

 

+
+

Z

+
+

All

+
+

710.00

+
+

0.

+
+

710.00

+
+
+
+
+
+
+ +
+
+

N. Description of supplements for Utah

+
+
+
+
+

1. Definitions of State living arrangement variations for Utah

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone or With Others

+ +

Apply OS code A to recipients who are in Federal codes A and C.

+
+

B

+
+

Living in the Household of Another

+ +

Apply OS code B to recipients who are “living in the household of another” for Federal + purposes. Children under age 18 are included in this living arrangement variation.

+
+

Z

+
+

No Supplement Cases

+ +

Apply OS code Z to all recipients who are not included in OS codes A or B.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Utah

+
+
+

The following charts display the coding and monthly payment levels for Utah effective + 01/01/13.

+
+
+

a. Individual payment levels for Utah

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Level

+
+

A,C

+
+

Z

+
+

All

+
+

710.00

+
+

0.00

+
+

710.00

+
+

B

+
+

B

+
+

All

+
+

473.341

+
+

3.13

+
+

476.47

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1 Not the FBR, the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Utah

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1066.00

+
+

4.60

+
+

1070.60

+
+

B

+
+

B

+
+

All

+
+

710.671

+
+

9.73

+
+

720.40

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1 Not the FBR, the amount represents the FBR less VTR.

+

2 Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

O. Description of supplements for Vermont

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont

+
+
+

Use this table to view the code and definitions of State Living Arrangement Variations.

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living (except Chittenden County)

+ +

Apply OS code A to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50% of their care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    +
    +
    +
  • +
+
+

B

+
+

Independent Living in Chittenden County

+ +

Apply OS code B to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County.

+
+

C

+
+

Licensed Residential Care Home or Assisted Living Residence with Assistive Community + Care Services (Level III)

+ +

Apply OS code C to recipients residing in Level III facilities identified by the State. + To determine if the facility meets the requirements for OS code C, refer to the Vermont + State website http://www.dlp.vermont.gov/resident-list.

+
+

E

+
+

Living in the Household of Another

+ +

Apply OS code E to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions).

+
+

G

+
+

Licensed Residential Care Home or Therapeutic Community Residence (Level IV)

+ +

Apply OS code G to recipients residing in Level IV facilities identified by the State. + To determine if a facility meets the requirements for OS code G, refer to the Vermont + State website http://www.dlp.vermont.gov/resident-list

+
+

H

+
+

Custodial Care: Family Home

+ +

Apply OS code H to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition (below).

    +
    +
    +
  • +
+ +

In order to qualify as a home under this arrangement, a resident of the home must + provide these services to two persons or less.

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) H. To qualify these programs must meet the requirements stated above.

+ +

Custodial care means providing basic room and board, plus personal services such as:

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients.

    +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care.

+
+

I

+
+

Apply OS code I effective 07/01/87, when the State elected Federal administration + of an optional State supplementary payment to residents in Title XIX facilities. This + includes children under the age of 18 for whom Medicaid alone pays or is expected + to pay over 50 percent of the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use this OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + 01/01/13.

+
+
+

a. Individual payment levels for Vermont

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County)

+
+

710.00

+
+

52.04

+
+

762.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

710.00

+
+

52.04

+
+

762.04

+
+

 

+
+

C

+
+

All

+
+

710.00

+
+

48.38

+
+

758.38

+
+

 

+
+

G

+
+

All

+
+

710.00

+
+

223.94

+
+

933.94

+
+

 

+
+

H

+
+

All

+
+

710.00

+
+

98.69

+
+

808.69

+
+

B

+
+

E

+
+

All

+
+

473.34

+
+

39.30

+
+

512.64

+
+

C

+
+

A

+
+

All (Except Chittenden County)

+
+

710.00

+
+

52.04

+
+

762.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

710.00

+
+

52.04

+
+

762.04

+
+

D

+
+

A or B2

+
+

Children Private Insurance

+
+

30.001

+
+

52.04

+
+

82.04

+
+

 

+
+

I

+
+

All

+
+

30.002

+
+

17.66

+
+

47.66

+
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Vermont

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All(Except Chittenden County)

+
+

1066.00

+
+

98.88

+
+

1164.88

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

1066.00

+
+

98.88

+
+

1164.88

+
+

 

+
+

C

+
+

All

+
+

1066.00

+
+

96.77

+
+

1162.77

+
+

 

+
+

G

+
+

All

+
+

1066.00

+
+

562.06

+
+

1628.06

+
+

 

+
+

H

+
+

All

+
+

1066.00

+
+

332.82

+
+

1398.82

+
+

B

+
+

E

+
+

All

+
+

710.671

+
+

48.31

+
+

758.98

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

35.33

+
+

95.33

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

P. Procedure for documenting optional state category determination

+
+
+
+
+

1. General documentation requirements for initial claims, pre-effectuation reviews, and + redeterminations

+
+
+

No additional documentation is required unless you have reason to question the situation.

+
+
+
+
+

2. General documentation requirements for all other claims events

+
+
+

Unless you have reason to question the situation, document the individual's statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact).

+
+
+
+
+

3. Questionable situations regarding optional state supplements

+
+
+

In questionable situations, review any available evidence that supports the individual’s + allegation of their optional state supplement category. Contact other persons with + knowledge of the individual’s living situation, if necessary (e.g. landlord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289.

+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415045
SI 01415.045 - Federally Administered Optional Supplementary Payment Programs for 01/13 Payment Levels - 09/24/2013
+Batch run: 05/27/2026
+Rev:09/24/2013
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html new file mode 100644 index 00000000..656090f3 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2014.html @@ -0,0 +1,11502 @@ + + +SSA - POMS: SI 01415.046 - Federally Administered Optional Supplementary Payment Programs for 01/14 Payment Levels - 05/14/2014 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 90 (08-24)

+

SI 01415.046 Federally Administered Optional Supplementary Payment Programs for 01/14 Payment Levels

+ + +
+
+

CITATIONS:

+
+
+ +
Social Security Act as amended in 1973, Section 1616 ; Social Security Amendments of 1972, Section 301;
+ + +
+
+
+
+

A. List of States participating in the Federally Administered Optional Supplementary + Payment program

+
+
+

The following states participate in Federally Administered Optional Supplementary + Payment Programs:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+
+

Reference

+
+

California

+
+

SI 01415.046B

+
+

Delaware

+
+

SI 01415.046C

+
+

District of Columbia

+
+

SI 01415.046D

+
+

Hawaii

+
+

SI 01415.046E

+
+

Iowa

+
+

SI 01415.046F

+
+

Michigan

+
+

SI 01415.046G

+
+

Montana

+
+

SI 01415.046H

+
+

Nevada

+
+

SI 01415.046I

+
+

New Jersey

+
+

SI 01415.046J

+
+

New York

+ +

(effective 10/01/14, New York began self-administering all categories)

+
+

SI 01415.046K

+
+

Pennsylvania

+
+

SI 01415.046L

+
+

Rhode Island

+
+

SI 01415.046M

+
+

Vermont

+
+

SI 01415.046N

+
+
+
+
+ +
+
+

B. Description of supplements for California

+
+
+
+
+

1. Definitions of State living arrangement variations for California

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Use OS code A for independent living with cooking facilities for an eligible individual + or couple who meets one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    lives in their own household, as defined for Federal living arrangement (FLA) A purposes, + and has cooking and food storage facilities or is provided meals as part of the living + arrangement;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    is a blind child under age 18 living in the household of a parent, or parents, or + is a disabled child age 18 or over who meets sharing criteria and is living in the + household of a parent or parents;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    is a blind recipient who lives in an independent living arrangement with or without + cooking and food storage facilities; or

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX.

    +
    +
    +
  10. +
+
+

B

+
+

Apply OS code B for Non-medical Out-of-Home Care (NMOHC) when an individual or couple + needs non-medical care or supervision in the following living arrangement situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Children (under age 18)

    + +
      +
    • +
      +
      •
      +
      +

      blind child residing in a State licensed NMOHC facility; or

      +
      +
      +
    • +
    • +
      +
      •
      +
      +

      blind child residing in the home of a relative who is not a parent and not a legal + guardian; or

      +
      +
      +
    • +
    • +
      +
      •
      +
      +

      disabled child residing in a State licensed NMOHC facility; or

      +
      +
      +
    • +
    • +
      +
      •
      +
      +

      disabled child residing in the home of a legal guardian who is not a relative; or

      +
      +
      +
    • +
    • +
      +
      •
      +
      +

      disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

      +
      +
      +
    • +
    • +
      +
      •
      +
      +

      blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”).

      +
      +
      +
    • +
    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Adults (age 18 and over)

    + +
      +
    • +
      +
      •
      +
      +

      aged, blind or disabled individual or couple is determined to be in FLA A and resides + in the home of a relative, legal conservator or guardian; or

      +
      +
      +
    • +
    • +
      +
      •
      +
      +

      aged, blind, or disabled individual is determined to be in FLA A and resides in a + State licensed NMOHC facility; or

      +
      +
      +
    • +
    • +
      +
      •
      +
      +

      aged, blind or disabled individual is determined to be in FLA A and resides in a family + home certified by a Family Home Agency under State law.

      +
      +
      +
    • +
    +
    +
    +
  4. +
+ +

For California optional supplement (OS) purposes, a relative is defined as a

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-sibling

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    +
    +
    +
  • +
+
+

C

+
+

Independent Living Without Cooking Facilities

+ +

Apply OS code C to aged or disabled individuals or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement.

    +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS C.

+ +

An individual or couple qualifies for OS C if any of the following situations exists:

+ +
    +
  1. +
    +
    1. 
    +
    +

    immediate living quarters do not have cooking and food storage facilities that the + individual or couple or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis.

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities which are outside the immediate + living quarters) for the purpose of preparing meals or having them prepared on their + behalf.

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + have access for preparing meals.

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparing + meals.

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis).

    +
    +
    +
  10. +
+ +

“Adequate” cooking and food storage facilities exist when an individual or couple has access + to:

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.)

    + +

    or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”)

    + +

    or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove or a one-burner hotplate with a temperature control.

    +
    +
    +
  • +
+ +

Eligibility for OS C begins in the month the recipient applies for this supplement + rate provided they have been without cooking and food storage facilities throughout + the month.

+ +

NOTE: For purposes of OS C, “throughout a month” does not mean the recipient must lack adequate cooking or food storage facilities from the + very first moment of the month. The recipient need only lack them from some time on + the first day of the month.

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + has ceased.

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact.

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available.

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind or aged or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment.

+
+

D

+
+

Living in the Household of Another

+ +

Apply OS code D when an eligible individual or couple is living in the household of + another and receives food and shelter from that person. Most individuals or couples who are subject to a one-third + reduction of their Federal SSI payments are eligible for OS D because the criteria + for this supplement level are the same as for charging the one-third reduction. However, + when the eligible individual or couple lives in the home of a relative (other than + a spouse) and needs care and supervision, you must obtain certification for non-medical + out-of-home care (OS F) from the county welfare office since this is the highest categorical + supplement that an individual or couple can qualify.

+
+

E

+
+

Disabled Child Under Age 18

+ +

Apply OS code E to a disabled (not blind) child under age 18 who resides with a parent + or relative by blood or marriage.

+ +

NOTE: Only FLA A and C are compatible with OS E. If the Value of the One Third Reduction + (VTR) applies, see code G.

+
+

F

+
+

Non-medical Out-of-Home Care Living in the Household of Another

+ +

OS code F applies whenever an eligible individual or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code B payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200.

+
+

G

+
+

Disabled Child Under Age 18 Living in the Household of Another

+ +

OS code G applies to a disabled (not blind) child under age 18, who resides with a + parent or relative by blood or marriage, and is determined to receive the Federal code B payment for living in the household of + another person. For the one-third reduction provision, see SI 00835.200.

+
+

J

+
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code J to an eligible recipient who is a patient + in a medical facility where Title XIX pays more than 50 percent of the costs. Also + apply OS State code J to supplement Section 1619 cases.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Apply OS code Z to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter.

+ +

For periods prior to July 1, 1987, apply OS code Z to an eligible recipient who is + a patient in a medical facility where Title XIX pays more than 50 percent of the costs.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for California

+
+
+

The following charts display the coding and monthly payment levels for California + effective 01/01/2014.

+
+
+

a. Individual payment levels or California

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

721.00

+
+

156.40

+
+

877.40

+
+

 

+
+

 

+
+

Blind

+
+

721.00

+
+

211.40

+
+

932.40

+
+

 

+
+

 

+
+

Disabled

+
+

721.00

+
+

156.40

+
+

877.40

+
+

 

+
+

B

+
+

All

+
+

721.00

+
+

412.00

+
+

1133.00

+
+

 

+
+

C

+
+

Aged

+
+

721.00

+
+

240.40

+
+

961.40

+
+

 

+
+

 

+
+

Disabled

+
+

721.00

+
+

240.40

+
+

961.40

+
+

 

+
+

E

+
+

Disabled

+
+

721.00

+
+

63.40

+
+

784.40

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

0.00

+
+

721.00

+
+

B

+
+

D

+
+

Aged

+
+

480.671

+
+

159.83

+
+

640.50

+
+

 

+
+

 

+
+

Blind

+
+

480.671

+
+

214.83

+
+

695.50

+
+

 

+
+

 

+
+

Disabled

+
+

480.671

+
+

159.83

+
+

640.50

+
+

 

+
+

F

+
+

All

+
+

480.671

+
+

407.00

+
+

887.67

+
+

 

+
+

G

+
+

Disabled

+
+

480.671

+
+

66.83

+
+

547.50

+
+

C

+
+

A

+
+

Blind

+
+

721.00

+
+

211.40

+
+

932.40

+
+

 

+
+

E

+
+

Disabled

+
+

721.00

+
+

63.40

+
+

784.40

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

0.

+
+

721.00

+
+

D

+
+

J

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1082.00

+
+

396.20

+
+

1478.20

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1082.00

+
+

543.20

+
+

1625.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1082.00

+
+

396.20

+
+

1478.20

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1082.00

+
+

487.20

+
+

1569.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1082.00

+
+

396.20

+
+

1478.20

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1082.00

+
+

487.20

+
+

1569.20

+
+

 

+
+

B

+
+

All

+
+

1082.00

+
+

1184.00

+
+

2266.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1082.00

+
+

564.20

+
+

1646.20

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1082.00

+
+

564.20

+
+

1646.20

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1082.00

+
+

564.20

+
+

1646.20

+
+

 

+
+

Z

+
+

All

+
+

1082.00

+
+

0.00

+
+

1082.00

+
+

B

+
+

D

+
+

Aged/Aged

+
+

721.341

+
+

401.33

+
+

1122.67

+
+

 

+
+

 

+
+

Blind/Blind

+
+

721.341

+
+

548.33

+
+

1269.67

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

721.341

+
+

401.33

+
+

1122.67

+
+

 

+
+

 

+
+

Aged/Blind

+
+

721.341

+
+

492.33

+
+

1213.67

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

721.341

+
+

401.33

+
+

1122.67

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

721.341

+
+

492.33

+
+

1213.67

+
+

 

+
+

F

+
+

All

+
+

721.341

+
+

1045.66

+
+

1767.00

+
+

D

+
+

J

+
+

All

+
+

60.002

+
+

40.00

+
+

100.00

+
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR).

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Residential Care Facility, Assisted Living Facility, or Adult Foster Care Home + To be eligible for OS code A, the State must provide documentation that a recipient + is a resident of a certified Adult Residential Care Facility, Assisted Living Facility, + or Adult Foster Care Home.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use code Y to indicate that a recipient is eligible for an optional supplement, but + has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Use OS code Z for any recipient who is not included in OS categories A or Y.

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code A.

+ +

For more information on Optional State Supplement codes see SM 01301.535

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + 01/01/14.

+
+
+

a. Individual payment levels for Delaware

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

721.00

+
+

140.00

+
+

861.00

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

0.

+
+

721.00

+
+

B

+
+

Z

+
+

All

+
+

480.67

+
+

0.

+
+

480.67

+
+

C

+
+

Z

+
+

All

+
+

721.00

+
+

0.

+
+

721.00

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Delaware

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1082.00

+
+

448.00

+
+

1530.00

+
+

 

+
+

Z

+
+

All

+
+

1082.00

+
+

0.

+
+

1082.00

+
+

B

+
+

Z

+
+

All

+
+

721.34

+
+

0.

+
+

721.34

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult Foster Care Home with 50 or Fewer Residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents.

+
+

B

+
+

Adult Foster Care Home with More than 50 Residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents.

+
+

G

+
+

Apply OS code “G” to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective 01/01/14.

+
+
+

a. Individual payment levels for the District of Columbia

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

721.00

+
+

585.00

+
+

1306.00

+
+

 

+
+

B

+
+

All

+
+

721.00

+
+

695.00

+
+

1416.00

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

0.

+
+

721.00

+
+

B

+
+

Z

+
+

All

+
+

480.671

+
+

0.

+
+

480.67

+
+

C

+
+

Z

+
+

All

+
+

721.00

+
+

0.

+
+

721.00

+
+

D

+
+

G

+
+

All

+
+

30.002

+
+

40.00

+
+

70.00

+
+
+

1Not the FBR; the amount represents the FBR less the VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for the District of Columbia

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Code

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1082.00

+
+

1530.00

+
+

2612.00

+
+

 

+
+

B

+
+

All

+
+

1082.00

+
+

1750.00

+
+

2832.00

+
+

 

+
+

Z

+
+

All

+
+

1082.00

+
+

0.

+
+

1082.00

+
+

B

+
+

Z

+
+

All

+
+

721.341

+
+

0.

+
+

721.34

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

80.00

+
+

140.00

+
+
+

1Not the FBR; the amount represents the FBR less the VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

B

+
+

Living in a Community Care or Foster Care Home

+ +

Apply OS code B to recipients who are both over age 18 and live in a State approved + Care or Foster Care Home.

+
+

D

+
+

Living in a Certified Medical Facility

+ +

Use OS code D for an eligible individual living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care.

+
+

H

+
+

Domiciliary Care I (Maximum of five residents)

+ +

Use OS code H for an eligible recipient (including a child) or couple living in a + domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities.

+
+

I

+
+

Domiciliary Care II

+ +

OS Code I is the same as code H except the facility provides care for six or more + residents.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations:

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility which is not certified under + Title XIX; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    +
    +
    +
  • +
+
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + 01/01/14.

+
+
+

a. Individual payments levels for Hawaii

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A 

+
+

B

+
+

All

+
+

721.00

+
+

651.90

+
+

1372.90

+
+

 

+
+

H

+
+

All

+
+

721.00

+
+

651.90

+
+

1372.90

+
+

 

+
+

I

+
+

All

+
+

721.00

+
+

759.90

+
+

1480.90

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

0.

+
+

721.00

+
+

B

+
+

Z

+
+

All

+
+

480.67

+
+

0.

+
+

480.67

+
+

D

+
+

D

+
+

All

+
+

30.001

+
+

20.00

+
+

50.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Hawaii

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

B

+
+

All

+
+

1082.00

+
+

1640.80

+
+

2722.80

+
+

 

+
+

H

+
+

All

+
+

1082.00

+
+

1640.80

+
+

2722.80

+
+

 

+
+

I

+
+

All

+
+

1082.00

+
+

1856.80

+
+

2938.80

+
+

 

+
+

Z

+
+

All

+
+

1082.00

+
+

0.

+
+

1082.00

+
+

B

+
+

Z

+
+

All

+
+

721.34

+
+

0.

+
+

721.34

+
+

D

+
+

D

+
+

All

+
+

60.001

+
+

40.00

+
+

100.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living in Own Household (Blind Only)

+ +

Apply OS code “A” only to an eligible blind recipient and the blind member of a couple who:

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code A is also compatible with Federal + codes A and C.

    +
    +
    +
  • +
+ +

OS code A is the proper code to use with an “intervening” Federal code A.

+ +

For optional State supplement codes, see SM 01301.535.

+
+

B

+
+

Living in the Household of Another (Blind Only)

+ +

OS Code B is only for an eligible blind recipient and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation.

+
+

C

+
+

Living with a Dependent Person

+ +

Use OS Code C for an eligible recipient or each member of an eligible couple in Federal + living arrangement A or C who has an

+ +
    +
  • +
    +
    •
    +
    +

    ineligible spouse, parent, child, or adult child living in the home with them, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services.

    +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement.

+
+

D

+
+

Living in a Family Life or Boarding Home

+ +

Use OS Code D for an eligible recipient or each member of an eligible couple in Federal + living arrangement A who resides in a family life home or boarding home licensed by + the State Department of Health or certified by the State Department of Human Services.

+
+

H

+
+

Living with a Dependent Person

+ +

Use OS Code H for an eligible recipient or each member of an eligible couple in Federal + living arrangement B who has an

+ +
    +
  • +
    +
    •
    +
    +

    ineligible spouse, parent, child, or adult child living in the home with them, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services.

    +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement.

+
+

G

+
+

Use OS Code G to indicate that no supplement is payable to a recipient living in a + Title XIX facility and Title XIX pays more than 50 percent of the cost of care. However, + a Federal D living arrangement is not appropriate because the recipient did not meet + the “throughout a month” requirement at the initial claims input.

+
+

I

+
+

Living in a Family Life or Boarding Home-Eligible individual or each member of an + eligible couple in FLA B, who resides in a family life home or boarding home licensed + by the State Department of Health, or certified by the State Department of Human Services.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Use OS code Z to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care.

    +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs:

+ +
    +
  1. +
    +
    1. 
    +
    +

    “In-Home Health Related Care”;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    “Residential Care”; and

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    “Supplement for Medicare and Medicaid Eligible.”

    +
    +
    +
  6. +
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each individual in + addition to the FBR and EP increment and must be force paid.

+
+
+
+
+

2. Coding and monthly payment levels for Iowa

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + 01/01/14.

+
+
+

a. Individual payment levels for Iowa

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind

+
+

721.00

+
+

22.00

+
+

743.00

+
+

 

+
+

C

+
+

Aged

+
+

721.00

+
+

370.00

+
+

1091.00

+
+

 

+
+

 

+
+

Blind

+
+

721.00

+
+

392.00

+
+

1113.00

+
+

 

+
+

 

+
+

Disabled

+
+

721.00

+
+

370.00

+
+

1091.00

+
+

 

+
+

D

+
+

Aged

+
+

721.00

+
+

142.00

+
+

863.00

+
+

 

+
+

 

+
+

Blind

+
+

721.00

+
+

164.00

+
+

885.00

+
+

 

+
+

 

+
+

Disabled

+
+

721.00

+
+

142.00

+
+

863.00

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

0.00

+
+

721.00

+
+

B

+
+

B

+
+

Blind

+
+

480.671

+
+

22.00

+
+

502.67

+
+

 

+
+

H

+
+

Aged

+
+

480.671

+
+

370.00

+
+

850.67

+
+

 

+
+

 

+
+

Blind

+
+

480.671

+
+

392.00

+
+

872.67

+
+

 

+
+

 

+
+

Disabled

+
+

480.671

+
+

370.00

+
+

850.67

+
+

 

+
+

I

+
+

Aged

+
+

480.671

+
+

142.00

+
+

622.67

+
+

 

+
+

I

+
+

Disabled

+
+

480.671

+
+

142.00

+
+

622.67

+
+

 

+
+

I

+
+

Blind

+
+

480.671

+
+

164.00

+
+

644.67

+
+

 

+
+

Z

+
+

All

+
+

480.671

+
+

0.00

+
+

480.67

+
+

C

+
+

A

+
+

Blind

+
+

721.00

+
+

22.00

+
+

743.00

+
+

 

+
+

C

+
+

Blind

+
+

721.00

+
+

392.00

+
+

1113.00

+
+

 

+
+

 

+
+

Disabled

+
+

721.00

+
+

370.00

+
+

1091.00

+
+

 

+
+

Z

+
+

Disabled

+
+

721.00

+
+

0.00

+
+

721.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: State-administered programs for calendar year 2014 include:

+
    +
  • +
    +
    •
    +
    +

    individuals receiving “Residential Care” receive payment based on a per diem rate + plus a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    individuals receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    individuals receiving a supplement for Medicare and Medicaid Eligible receive a $1 + monthly payment.

    +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind/Blind

+
+

1082.00

+
+

44.00

+
+

1126.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

1082.00

+
+

22.00

+
+

1104.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1066.00

+
+

22.00

+
+

1088.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1082.00

+
+

370.00

+
+

1452.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1082.00

+
+

414.00

+
+

1496.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1082.00

+
+

370.00

+
+

1452.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1082.00

+
+

392.00

+
+

1474.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1082.00

+
+

370.00

+
+

1452.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1082.00

+
+

392.00

+
+

1474.00

+
+

 

+
+

D

+
+

Aged/Aged

+
+

1082.00

+
+

664.00

+
+

1746.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1082.00

+
+

708.00

+
+

1790.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1082.00

+
+

664.00

+
+

1746.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1082.00

+
+

686.00

+
+

1768.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1082.00

+
+

664.00

+
+

1746.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1082.00

+
+

686.00

+
+

1768.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

1082.00

+
+

0.00

+
+

1082.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1082.00

+
+

0.00

+
+

1082.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1082.00

+
+

0.00

+
+

1082.00

+
+

B

+
+

B

+
+

Blind/Blind

+
+

721.341

+
+

44.00

+
+

765.34

+
+

 

+
+

 

+
+

Blind/Aged

+
+

721.341

+
+

22.00

+
+

743.34

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

721.341

+
+

22.00

+
+

743.34

+
+

 

+
+

H

+
+

Aged/Aged

+
+

721.341

+
+

370.00

+
+

1091.34

+
+

 

+
+

 

+
+

Blind/Blind

+
+

721.341

+
+

414.00

+
+

1135.34

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

721.341

+
+

370.00

+
+

1091.34

+
+

 

+
+

 

+
+

Aged/Blind

+
+

721.341

+
+

392.00

+
+

1113.34

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

721.341

+
+

370.00

+
+

1091.34

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

721.341

+
+

392.00

+
+

1113.34

+
+

 

+
+

I

+
+

Aged/Aged

+
+

721.341

+
+

664.00

+
+

1385.34

+
+

 

+
+

 

+
+

Blind/Blind

+
+

721.341

+
+

708.00

+
+

1429.34

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

721.341

+
+

664.00

+
+

1385.34

+
+

 

+
+

 

+
+

Aged/Blind

+
+

721.341

+
+

686.00

+
+

1407.34

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

721.341

+
+

664.00

+
+

1385.34

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

721.341

+
+

686.00

+
+

1407.34

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

721.341

+
+

0.00

+
+

721.34

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

721.341

+
+

0.00

+
+

721.34

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

721.341

+
+

0.00

+
+

721.34

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: State-administered programs for calendar year 2014 include:

+
    +
  • +
    +
    •
    +
    +

    recipients receiving “Residential Care” receive payment based on a per diem rate plus + a monthly personal allowance.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. Treat members of a couple as individuals.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients receiving a supplement for Medicare and Medicaid receive a $1 monthly payment.

    +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Domiciliary Care

+ +

Use OS code D for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + which recipients are residents requiring this level of care.

+
+

E

+
+

Personal Care

+ +

Apply OS code E to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies which recipients are residents requiring this level of care. Such care + situations include, but are not limited to, licensed homes for the aged.

+
+

F

+
+

Home for the Aged

+ +

Apply OS code F for residents in Homes for the Aged. The State provides SSA with a + list of these non-medical facilities for the aged and certifies which recipients are + residents who require this level of care.

+
+

G

+
+

Independent Living with an EP

+ +

OS code G applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18.

+
+

H

+
+

Living in the Household of Another with an EP

+ +

OS code H applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18.

+
+

I

+
+

Effective 01/01/88, OS code I applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + 01/01/14.

+
+
+

a. Individual payment levels for Michigan

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

721.00

+
+

87.00

+
+

808.00

+
+

 

+
+

E

+
+

All

+
+

721.00

+
+

157.50

+
+

878.50

+
+

 

+
+

F

+
+

All

+
+

721.00

+
+

179.30

+
+

900.30

+
+

 

+
+

G

+
+

All

+
+

1082.001

+
+

14.00

+
+

1096.00

+
+

B

+
+

H

+
+

All

+
+

721.342

+
+

9.33

+
+

730.67

+
+

D

+
+

I

+
+

All

+
+

  30.003

+
+

7.00

+
+

37.00

+
+

 

+
+

Z

+
+

All

+
+

30.00

+
+

0.

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Michigan

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

1082.00

+
+

534.00

+
+

1616.00

+
+

 

+
+

E

+
+

All

+
+

1082.00

+
+

675.00

+
+

1757.00

+
+

 

+
+

F

+
+

All

+
+

1082.00

+
+

718.60

+
+

1800.60

+
+

 

+
+

G

+
+

All

+
+

1443.001

+
+

21.00

+
+

1464.00

+
+

B

+
+

H

+
+

All

+
+

962.00

+
+

14.00

+
+

976.00

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

14.00

+
+

74.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

G

+
+

State-Certified Personal Care

+
+

H

+
+

State-Certified Residence in Group Home for Mentally Disabled

+
+

I

+
+

State-Certified Residence in Group Home for Physically or Developmentally Disabled

+
+

J

+
+

State-Certified Residence for Child and Adult Foster Care

+
+

K

+
+

State-Certified Transitional Living for Developmentally Disabled

+
+

Y

+
+

Optional Supplementation Waived – Use this code to indicate that a recipient is eligible + for an optional supplement, but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases – Includes all individuals and couples not certified in State + codes G, H, I, J, or K.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + 01/01/14.

+
+
+

a. Individual payment levels for Montana

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

721.00

+
+

94.00

+
+

815.00

+
+

 

+
+

H

+
+

All

+
+

721.00

+
+

94.00

+
+

815.00

+
+

 

+
+

I

+
+

All

+
+

721.00

+
+

94.00

+
+

815.00

+
+

 

+
+

J

+
+

All

+
+

721.00

+
+

52.75

+
+

773.75

+
+

 

+
+

K

+
+

All

+
+

721.00

+
+

26.00

+
+

747.00

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

0.00

+
+

721.00

+
+

B

+
+

Z

+
+

All

+
+

480.671

+
+

0.00

+
+

480.67

+
+

C

+
+

Z

+
+

All

+
+

721.00

+
+

0.00

+
+

721.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Montana

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

1082.00

+
+

193.00

+
+

1275.00

+
+

 

+
+

H

+
+

All

+
+

1082.00

+
+

193.00

+
+

1275.00

+
+

 

+
+

I

+
+

All

+
+

1082.00

+
+

193.00

+
+

1275.00

+
+

 

+
+

J

+
+

All

+
+

1082.00

+
+

110.50

+
+

1192.50

+
+

 

+
+

K

+
+

All

+
+

1082.00

+
+

57.00

+
+

1139.00

+
+

 

+
+

Z

+
+

All

+
+

1082.00

+
+

0.00

+
+

1082.00

+
+

B

+
+

Z

+
+

All

+
+

721.341

+
+

0.00

+
+

721.34

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living or Living in Parental Household

+ +

Use OS code A for an aged or blind eligible recipient who meets one of the following + situations:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes;

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for individuals who qualify as a “protected + child”) living in a parent's household.

    +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code A. For Optional State Supplement codes, see + SM 01301.535.

+
+

B

+
+

Living in the Household of Another

+ +

Use OS code B for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject to a one-third + reduction (VTR) of their Federal SSI payment are eligible for optional supplement + B because the criteria for this supplement level are the same as for Federal code + B.

+
+

C

+
+

Domiciliary Care

+ +

Apply OS code C to aged or blind recipients who the State has certified live in a + private non-medical facility or, a residential facility serving 16 or fewer persons, + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor.

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

Apply “No Supplement” code Y to the following recipients:

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible individual or disabled member of eligible couple;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible individual or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible individual or member of eligible couple who is patient in a private medical + facility which is not certified under Title XIX; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    +
    +
    +
  • +
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + 01/01/14.

+
+
+

a. Individual payment levels for Nevada

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

721.00

+
+

36.40

+
+

757.40

+
+

 

+
+

 

+
+

Blind

+
+

721.00

+
+

109.30

+
+

830.30

+
+

 

+
+

C

+
+

Aged

+
+

721.00

+
+

391.00

+
+

1112.00

+
+

 

+
+

 

+
+

Blind

+
+

721.00

+
+

391.00

+
+

1112.00

+
+

 

+
+

Z

+
+

Disabled

+
+

721.00

+
+

0.00

+
+

721.00

+
+

B

+
+

B

+
+

Aged

+
+

480.671

+
+

24.27

+
+

504.94

+
+

 

+
+

 

+
+

Blind

+
+

480.67

+
+

213.96

+
+

694.63

+
+

 

+
+

Z

+
+

Disabled

+
+

480.67

+
+

0.00

+
+

480.67

+
+

C

+
+

A

+
+

Blind

+
+

721.00

+
+

109.30

+
+

830.30

+
+

 

+
+

Z

+
+

Disabled

+
+

721.00

+
+

0.00

+
+

721.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Nevada

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1082.00

+
+

74.46

+
+

1156.46

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1082.00

+
+

374.60

+
+

1456.60

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1082.00

+
+

224.53

+
+

1306.53

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1082.00

+
+

37.23

+
+

1119.23

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1082.00

+
+

187.30

+
+

1269.30

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1082.00

+
+

881.00

+
+

1963.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1082.00

+
+

881.00

+
+

1963.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1082.00

+
+

881.00

+
+

1963.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1082.00

+
+

440.50

+
+

1522.50

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1082.00

+
+

440.50

+
+

1522.50

+
+

 

+
+

Z

+
+

Disabled

+
+

1082.00

+
+

0.00

+
+

1082.00

+
+

B

+
+

B

+
+

Aged/Aged

+
+

721.34

+
+

49.64

+
+

770.98

+
+

 

+
+

 

+
+

Blind/Blind

+
+

721.34

+
+

531.94

+
+

1253.28

+
+

 

+
+

 

+
+

Aged/Blind

+
+

721.34

+
+

290.79

+
+

1012.13

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

721.34

+
+

24.82

+
+

746.16

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

721.34

+
+

265.97

+
+

987.31

+
+

 

+
+

Z

+
+

Disabled

+
+

721.34

+
+

0.00

+
+

721.34

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Congregate Care

+ +

Apply OS code A to recipients in Federal living arrangement A. The living arrangement + includes the following:

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services:

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients living in Assisted Living Residences or Comprehensive Personal Care Homes + (CPCH) that are licensed by the Department of Health and Senior Services.

    +
    +
    +
  • +
+
+

B

+
+

Living Alone or with Others

+ +

Use OS code B for recipients whose Federal living arrangements are A or C and who + do not meet the requirements defined in other supplementation categories.

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + A to be in optional supplement B unless they are residing in a residential health + care facility or living alone with an ineligible spouse.

+ +

Likewise, any child meeting the criteria for a Federal code C is automatically entitled + to optional supplement B.

+ +

This category includes, but is not limited to, those recipients who are in one of + the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    living physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    living with others in a private dwelling, but meeting some criteria for Federal living + arrangement A; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    placed in a Transitional Residency Program by the Division of Mental Health and Hospitals, + Department of Human Services.

    +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to use with an “intervening” Federal + code A. For State Supplement codes, see SM 01301.535.

+ +

Use OS code B to address Section 1619 cases.

+
+

C

+
+

Living Alone with an Ineligible Spouse

+ +

Use OS code C when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes i.e., a spouse, either by marriage or holding + out who is either not eligible for SSI or who chooses not to apply. If other persons, + even minor children, are present in the household, you cannot apply this OS + code.

+ +

However, it is possible that a claimant and the ineligible spouse live with others + and allege that they are a separate “household” by virtue of the fact that they eat + their meals out or have separate purchase and preparation of food. In this instance, + you may consider an optional supplement C as long as no other person is considered + part of the “household.” There is no couple counterpart in this category.

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS “C.”

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS “B.”

+
+

D

+
+

Living in the Household of Another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes.

+
+

I

+
+

Licensed Residential Health Care Facilities (RHCF)

+ +

Apply OS code I to recipients living in the following:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Assisted Living Residence;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “Free standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to 1/1/06.

    +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence + at a facility listed in the New Jersey Congregate Care Directory .

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS “I” rate. + Pay residents of the Assisted Living Resident (ALR, or CPCH section of a multipurpose + facility) at the OS “A” rate. Nursing home residents are in living arrangement (D/G) + if Medicaid pays more than 50 percent of the cost of care.

+
+

G

+
+

Apply OS code G effective 09/01/88, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Apply OS code Z to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Residing throughout a month in publicly operated emergency shelters.

    +
    +
    +
  • +
+ +

You can also apply OS code Z to cases that were FLA D prior to 01/1988, or effective + 12/01/96, to children residing in public or private facilities where private health + insurance paid for their care. For determination of applicability of $30 payment limit, + see SI 00520.011.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for New Jersey

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective 01/01/14.

+
+
+

a. Individual payment levels for New Jersey

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

721.00

+
+

150.05

+
+

871.05

+
+

 

+
+

B

+
+

All

+
+

721.00

+
+

31.25

+
+

752.25

+
+

 

+
+

C

+
+

Individual

+
+

721.00

+
+

153.00

+
+

874.00

+
+

 

+
+

 

+
+

w/EP

+
+

1082.001

+
+

25.36

+
+

1107.36

+
+

 

+
+

I

+
+

All

+
+

721.00

+
+

210.05

+
+

931.05

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

0.00

+
+

721.00

+
+

B

+
+

D

+
+

All

+
+

480.672

+
+

44.31

+
+

524.98

+
+

C

+
+

B

+
+

All

+
+

721.00

+
+

31.25

+
+

752.25

+
+

D

+
+

G

+
+

All

+
+

30.003

+
+

10.00

+
+

40.00

+
+

 

+
+

Z

+
+

All

+
+

30.00

+
+

0.

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for New Jersey

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

 

+
+

A

+
+

A

+
+

All

+
+

1082.00

+
+

618.36

+
+

1700.36

+
+

 

+
+

 

+
+

B

+
+

All

+
+

1082.00

+
+

25.36

+
+

1107.36

+
+

 

+
+

 

+
+

I

+
+

All

+
+

1082.00

+
+

738.36

+
+

1820.36

+
+

 

+
+

 

+
+

Z

+
+

All

+
+

1082.00

+
+

  0.00

+
+

1082.00

+
+

 

+
+

B

+
+

D

+
+

All

+
+

721.341

+
+

93.09

+
+

814.43

+
+

 

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

20.00

+
+

80.00

+
+

 

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for New York

+
+
+
+
+

1. Definitions of State living arrangement variations for New York

+
+
+

IMPORTANT: Effective 10/01/14, New York began self-administering all categories

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living Alone

+ +

Apply OS code A to a recipient living in one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    lives physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    pays a fixed, pre-established flat fee for both room and board in a commercial establishment. + This includes the "flat fee" household arrangement described in SI 00835.120A. It also includes cases where the individual/couple resides in an institution that + meets no other OSS criteria (e.g., not licensed as a congregate care facility and + not a public emergency shelter).;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    lives with others but takes all meals outside the dwelling;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    lives with others but separately prepares or has someone separately prepare their + food. Occasional preparation of meals in common does not preclude a finding of separate + preparation;

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    receives a fixed, pre-established flat fee for room and board from all others in the dwelling;

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    lives with only a foster child, or a homemaker authorized by the local Department + of Social Services (DSS), or a family care recipient placed by the Office of Mental + Health (OMH) or Office for People with Developmental Disabilities (OPWDD) or local + DSS; or

    +
    +
    +
  12. +
  13. +
    +
    7. 
    +
    +

    does not have a permanent living arrangement (i.e., transient or street person) and + is not with a spouse or a child for whom they have primary responsibility.

    +
    +
    +
  14. +
+
+

B

+
+

Living with Others

+ +

Apply OS code B to recipients living in one of the following situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    resides in a dwelling with others and prepares food in common with at least one other + person in the dwelling.

    + +

    NOTE: Consider a recipient living with an ineligible spouse to be living with others despite + any separate preparation. The same is true if a recipient lives with a child for whom + they have primary responsibility (except if the child is a foster child).

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    is a child who does not meet the criteria for OS C or OS D (below);

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    lives in a religious community and room and board are provided in full or in part + by the religious community; or

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    does not have a permanent living arrangement (i.e., transient or street person), but + is with an ineligible spouse or child for whom they have primary responsibility.

    +
    +
    +
  8. +
+
+

C

+
+

Congregate Care Level I

+ +

Apply OS code C to recipients placed in a

+ +
    +
  • +
    +
    •
    +
    +

    family type home certified by New York State (NYS) Office of Children and Family Services + and supervised by a local DSS.

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    family care home certified by OMH or OPWDD.

    +
    +
    +
  • +
+
+

D

+
+

Congregate Care Level II

+ +

Apply OS code D to a recipient who is a resident of a licensed Level II care facility.

+ +

These supportive living facilities include:

+ +
    +
  • +
    +
    •
    +
    +

    residences for adults certified by the NYS Department of Health;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    privately operated facilities certified by the NYS OMH;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    privately operated facilities certified by NYS OMH and OPWDD; and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    privately operated facilities certified by Office of Alcoholism and Substance Abuse + Services.

    +
    +
    +
  • +
+
+

E

+
+

Congregate Care Level III and Enhanced Residential Care

+ +

Apply OS code E to recipients residing in a licensed level III care facility (including + a recipient over age 18 who still meets the definition of a child per SI 00501.010).

+ +

Level III care facilities include:

+ +
    +
  • +
    +
    •
    +
    +

    adult homes and enriched housing programs certified by the NYS Department of Health; + or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Schools for the Mentally Retarded, the NYS Office for People with Developmental Disabilities + must certify that these residential facilities provide academic, vocational, recreational, + and social skills programs. Although sometimes called schools, they often do not meet + the Federal definition of schools.

    +
    +
    +
  • +
+ +

NOTE: Do not apply OS code E to a situation in which a child, who is receiving SSI, resides + in a Level III facility. Apply OS Code B for those recipients.

+
+

F

+
+

Living in the Household of Another

+ +

Apply OS code F to pay recipients who are FLA B.

+
+

G

+
+

Apply OS code G effective 01/01/88, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. SSA + and the state agreed to terminate Federal administration effective 09/30/03 and the + State began administering this payment 10/01/03.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use code Y to indicate that a recipient is eligible for an optional supplement, but + has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

Apply OS code Z to recipients in FLA A or D who meet one of the following:

+ +
    +
  1. +
    +
    1. 
    +
    +

    in a licensed medical facility where Medicaid is paying less than 50 percent of the + cost of care;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    in a publicly operated community residence which serves 16 or fewer residents;

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    in a publicly operated emergency shelter (PESH) throughout a month;

    +
    +
    +
  6. +
  7. +
    +
    4. 
    +
    +

    qualifies under the special provisions for institutionalized 1619 eligibles described + in SI 00520.130 ;

    +
    +
    +
  8. +
  9. +
    +
    5. 
    +
    +

    is in FLA-D effective 10/01/03; or

    +
    +
    +
  10. +
  11. +
    +
    6. 
    +
    +

    is a child, under age 18; whose stay in a public or private facility was paid by private + health insurance (applies prior to 12/1/96). For determination of applicability of + $30 payment limit, see SI 00520.011.

    +
    +
    +
  12. +
+
+
+
+
+
+
+

2. Coding and monthly payment levels for New York

+
+
+

The following charts display the coding and monthly payment levels for New York effective + 01/01/14.

+
+
+

a. Individual payment levels for New York

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

721.00

+
+

87.00

+
+

808.00

+
+

 

+
+

B

+
+

All

+
+

721.00

+
+

23.00

+
+

744.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

721.00

+
+

266.48

+
+

987.48

+
+

 

+
+

 

+
+

All other counties

+
+

721.00

+
+

228.48

+
+

949.48

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

721.00

+
+

435.00

+
+

1156.00

+
+

 

+
+

 

+
+

All other counties

+
+

721.00

+
+

405.00

+
+

1126.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

721.00

+
+

694.00

+
+

1415.00

+
+

 

+
+

 

+
+

All other counties

+
+

721.00

+
+

694.00

+
+

1415.00

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

  0.00

+
+

721.00

+
+

B

+
+

F

+
+

All

+
+

480.672

+
+

23.00

+
+

503.67

+
+

D

+
+

Z

+
+

All

+
+

30.003

+
+

0.004

+
+

30.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for New York

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A,C

+
+

A

+
+

All

+
+

1082.00

+
+

104.00

+
+

1186.00

+
+

 

+
+

B

+
+

All

+
+

1082.00

+
+

46.00

+
+

1128.00

+
+

 

+
+

C

+
+

NY City and selected counties1

+
+

1082.00

+
+

892.96

+
+

1974.96

+
+

 

+
+

 

+
+

All other counties

+
+

1082.00

+
+

816.96

+
+

1898.96

+
+

 

+
+

D

+
+

NY City and selected counties1

+
+

1082.00

+
+

1230.00

+
+

2312.00

+
+

 

+
+

 

+
+

All other counties

+
+

1082.00

+
+

1170.00

+
+

2252.00

+
+

 

+
+

E

+
+

NY City and selected counties1

+
+

1082.00

+
+

1748.00

+
+

2830.00

+
+

 

+
+

 

+
+

All other counties

+
+

1082.00

+
+

1748.00

+
+

2830.00

+
+

 

+
+

Z

+
+

All

+
+

1082.00

+
+

0.00

+
+

1082.00

+
+

B

+
+

F

+
+

All

+
+

721.342

+
+

46.00

+
+

767.34

+
+

D

+
+

Z

+
+

All

+
+

60.003

+
+

0.004

+
+

60.00

+
+
+

1Includes and applies to: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, + Suffolk, and Westchester counties effective 01/01/07.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

4New York administers a supplement of $25 to some recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Pennsylvania

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

C

+
+

Living with an Essential Person (EP)

+ +

Apply OS code C to recipients who are not living in the household of another or in + a foster care home for adults and who have one or more EP’s as defined under the Federal + rules.

+
+

D

+
+

Living in the Household of Another with an EP

+ +

Apply OS code D to recipients who live in the household of another and have one or + more EP’s as defined under the Federal rules.

+
+

G

+
+

Living in a Domiciliary Care Facility

+ +

Apply OS code G to adult persons (age 18 and over) certified by the State to be residing + in non-medical residential care facilities.

+
+

H

+
+

Living in a Personal Care Boarding Home (PCBH)

+ +

Apply OS code H to Adult Persons (age 18 and over) certified by the State to be residing + in non-medical residential care facilities.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use code Y to indicate that a recipient is eligible for an optional supplement, but + has waived their right to receive such.

+
+

Z

+
+

No Supplement Cases

+ +

OS code Z includes all recipients who are residing in a medical facility in which + Title XIX is paying more than 50 percent of the cost of care and recipients in FLA-A + or FLA-B who receive a State-administered supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective 01/01/14.

+
+
+

a. Individual payment levels for Pennsylvania

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

C

+
+

All

+
+

1082.001

+
+

43.70

+
+

1125.70

+
+

 

+
+

G

+
+

All

+
+

721.00

+
+

434.30

+
+

1155.30

+
+

 

+
+

H

+
+

All

+
+

721.00

+
+

439.30

+
+

1160.30

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

0.

+
+

721.00

+
+

B

+
+

Z

+
+

All

+
+

480.672

+
+

0.00

+
+

480.67

+
+

 

+
+

D

+
+

All

+
+

721.343

+
+

43.70

+
+

765.05

+
+

C

+
+

Z

+
+

All

+
+

721.00

+
+

0.00

+
+

721.00

+
+

D

+
+

Z

+
+

All

+
+

30.004

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Pennsylvania

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

 A

+
+

C

+
+

All

+
+

1443.001

+
+

68.05

+
+

1511.05

+
+

 

+
+

G

+
+

All

+
+

1082.00

+
+

947.40

+
+

2029.40

+
+

 

+
+

H

+
+

All

+
+

1082.00

+
+

957.40

+
+

2039.40

+
+

 

+
+

Z

+
+

All

+
+

1082.00

+
+

0.

+
+

1082.00

+
+

B 

+
+

D

+
+

All

+
+

962.002

+
+

68.05

+
+

1030.05

+
+

B

+
+

Z

+
+

All

+
+

721.343

+
+

0.00

+
+

721.34

+
+

D

+
+

Z

+
+

All

+
+

60.004

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR.

+

3Not the FBR; the amount represents the FBR less VTR.

+

4Not the FBR; the amount represents a payment cap to recipients

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individuals in the month following the + month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010.

+
+
+
+
+
+
+ +
+
+

M. Description of supplements for Rhode Island

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Residential Care or Assisted Living

+ +

Apply OS code D to recipients only.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No State Supplement payable

+ +

Code Z means the State of Rhode Island does not pay a supplement unless the recipient + resides in a Licensed Adult Care Facility (“Residential Care or Assisted Living”) + as described in category “D”.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective 01/01/14.

+

Individual payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

721.00

+
+

332.00

+
+

1053.00

+
+

 

+
+

Z

+
+

All

+
+

721.00

+
+

0.

+
+

721.00

+
+
+
+
+
+
+ +
+
+

N. Description of supplements for Vermont

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont

+
+
+

Use this table to view the code and definitions of State Living Arrangement Variations.

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent Living (except Chittenden County)

+ +

Apply OS code A to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50 percent of their care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    +
    +
    +
  • +
+
+

B

+
+

Independent Living in Chittenden County

+ +

Apply OS code B to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County.

+
+

C

+
+

Licensed Residential Care Home or Assisted Living Residence with Assistive Community + Care Services (Level III)

+ +

Apply OS code C to recipients residing in Level III facilities identified by the State. + To determine if the facility meets the requirements for OS code C, refer to the Division of Licensing and Protection forVermont State website (http://www.dlp.vermont.gov/resident-list).

+
+

E

+
+

Living in the Household of Another

+ +

Apply OS code E to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions).

+
+

G

+
+

Licensed Residential Care Home or Therapeutic Community Residence (Level IV)

+ +

Apply OS code G to recipients residing in Level IV facilities identified by the State. + Apply OS code G to recipients residing in Level IV facilities identified by the State. + To determine if a facility meets the requirements for OS code G, refer to the Division of Licensing and Protection for Vermont State website (http://www.dlp.vermont.gov/resident-list).

+
+

H

+
+

Custodial Care: Family Home

+ +

Apply OS code H to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition (below).

    +
    +
    +
  • +
+ +

In order to qualify as a home under this arrangement, a resident of the home must + provide these services to two persons or less.

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) H. To qualify these programs must meet the requirements stated above.

+ +

Custodial care means providing basic room and board, plus personal services such as:

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients.

    +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care.

+
+

I

+
+

Apply OS code I effective 07/01/87, when the State elected Federal administration + of an optional State supplementary payment to residents in Title XIX facilities. This + includes children under the age of 18 for whom Medicaid alone pays or is expected + to pay over 50 percent of the cost of care for that month.

+
+

Y

+
+

Optional Supplementation Waived

+ +

Use this OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + 01/01/14.

+
+
+

a. Individual payment levels for Vermont

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County)

+
+

721.00

+
+

52.04

+
+

773.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

710.00

+
+

52.04

+
+

773.04

+
+

 

+
+

C

+
+

All

+
+

721.00

+
+

48.38

+
+

769.38

+
+

 

+
+

G

+
+

All

+
+

721.00

+
+

223.94

+
+

944.94

+
+

 

+
+

H

+
+

All

+
+

721.00

+
+

98.69

+
+

819.69

+
+

B

+
+

E

+
+

All

+
+

480.67

+
+

39.30

+
+

519.97

+
+

C

+
+

A

+
+

All (Except Chittenden County)

+
+

721.00

+
+

52.04

+
+

773.04

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

721.00

+
+

52.04

+
+

773.04

+
+

D

+
+

A or B2

+
+

Children Private Insurance

+
+

30.001

+
+

52.04

+
+

82.04

+
+

 

+
+

I

+
+

All

+
+

30.002

+
+

17.66

+
+

47.66

+
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Vermont

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All(Except Chittenden County)

+
+

1082.00

+
+

98.88

+
+

1180.88

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

1082.00

+
+

98.88

+
+

1180.88

+
+

 

+
+

C

+
+

All

+
+

1082.00

+
+

96.77

+
+

1178.77

+
+

 

+
+

G

+
+

All

+
+

1082.00

+
+

562.06

+
+

1644.06

+
+

 

+
+

H

+
+

All

+
+

1082.00

+
+

332.82

+
+

1414.82

+
+

B

+
+

E

+
+

All

+
+

721.671

+
+

48.31

+
+

769.98

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

35.33

+
+

95.33

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

O. Procedure for documenting optional state category determination

+
+
+
+
+

1. General documentation requirements for initial claims, pre-effectuation reviews, and + redeterminations

+
+
+

No additional documentation is required unless you have reason to question the situation.

+
+
+
+
+

2. General documentation requirements for all other claims events

+
+
+

Unless you have reason to question the situation, document the individual's statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact).

+
+
+
+
+

3. Questionable situations regarding optional state supplements

+
+
+

In questionable situations, review any available evidence that supports the individual’s + allegation of their optional state supplement category. Contact other persons with + knowledge of the individual’s living situation, if necessary (e.g. landlord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289.

+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415046
SI 01415.046 - Federally Administered Optional Supplementary Payment Programs for 01/14 Payment Levels - 05/14/2014
+Batch run: 05/27/2026
+Rev:05/14/2014
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html new file mode 100644 index 00000000..403c06bb --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2015.html @@ -0,0 +1,12830 @@ + + +SSA - POMS: SI 01415.047 - Federally Administered Optional Supplementary Payment Programs for 01/15 Payment Levels - 08/08/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 73 (08-24)

+

SI 01415.047 Federally Administered Optional Supplementary Payment Programs for 01/15 Payment Levels +

+ + +
+
+

CITATIONS:

+
+
+ +
Social Security Act as amended in 1973, Section + 1616; Social + Security Amendments of 1972, Section 301; Public + Law 93-66, Section 212 +
+ +
+
+
+
+

A. List of States participating in the Federally Administered Optional Supplementary + Payment program +

+
+
+

The following states participate in Federally Administered Optional Supplementary + Payment Programs. +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+ +
+

Reference

+ +
+

California

+ +
+

SI 01415.047B

+ +
+

Delaware

+ +
+

SI 01415.047C

+ +
+

District of Columbia

+ +
+

SI 01415.047D

+ +
+

Hawaii

+ +
+

SI 01415.047E

+ +
+

Iowa

+ +
+

SI 01415.047F

+ +
+

Michigan

+ +
+

SI 01415.047G

+ +
+

Montana

+ +
+

SI 01415.047H

+ +
+

Nevada

+ +
+

SI 01415.047I

+ +
+

New Jersey

+ +
+

SI 01415.047J

+ +
+

Pennsylvania

+ +
+

SI 01415.047K

+ +
+

Rhode Island

+ +
+

SI 01415.047L

+ +
+

Vermont

+ +
+

SI 01415.047M

+ +
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Use optional supplement (OS) code A for independent living with cooking facilities for an eligible recipient or couple who meet one of the following situations. +

+ +
    +
  • +
    +
    •
    +
    +

    Live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Apply OS code “B” for non-medical out-of-home care (NMOHC) when a recipient or couple needs non-medical care or supervision in the following + living arrangement situations. +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    Blind child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Blind child residing in the home of a relative who is not a parent and not a legal + guardian; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +
    +
  • +
    +
    •
    +
    +

    Aged, blind, or disabled recipient or couple is determined to be in FLA “A” and resides + in the home of a relative, legal conservator, or guardian; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Aged, blind, or disabled recipient is determined to be in FLA “A” and resides in a + State licensed NMOHC facility; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Aged, blind, or disabled recipient is determined to be in FLA “A” and resides in a + family home certified by a family home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
+

C

+ +
+

Independent living without cooking facilities

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement. +

    + +
    +
    +
  • +
+ +

Transients are also eligible for OS “C”, as defined in SI 00835.060. +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists.

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities, which are outside the + immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + have access for preparing meals. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for preparing + meals. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has access + to the following. +

+ +
    +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.) +

    + +

    or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”) +

    + +

    or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +

NOTE: For purposes of OS “C,” “throughout a month” does not mean the recipient must lack adequate cooking or food storage facilities from the + very first moment of the month. The recipient need only lack them from some time on + the first day of the month. +

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment. +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. Most recipient or couples who are subject to a one-third + reduction of their Federal SSI payments are eligible for OS “D” because the criteria + for this supplement level are the same as for charging the one-third reduction. However, + when the eligible recipient or couple lives in the home of a relative (other than + a spouse) and needs care and supervision, you must obtain certification for non-medical + out-of-home care (OS “F”) from the county welfare office since this is the highest + categorical supplement that a recipient or couple can qualify. +

+ +
+

E

+ +
+

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +

NOTE: Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third reduction + (VTR) applies, see code “G.” +

+ +
+

F

+ +
+

Non-medical out-of-home care living in the household of another

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
+

G

+ +
+

Disabled child under 18 Living in the of another

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal code “B” payment for living in the household + of another person. For the one-third reduction provision, see SI 00835.200. +

+ +
+

J

+ +
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective 01/01/2015. +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

Federal Benefit Rate (FBR)

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

733.00

+ +
+

156.40

+ +
+

889.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

733.00

+ +
+

211.40

+ +
+

944.40

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

733.00

+ +
+

156.40

+ +
+

889.40

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

733.00

+ +
+

412.00

+ +
+

1145.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

733.00

+ +
+

240.40

+ +
+

973.40

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

733.00

+ +
+

240.40

+ +
+

973.40

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

733.00

+ +
+

63.40

+ +
+

796.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

488.671

+ +
+

159.83

+ +
+

648.50

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

488.671

+ +
+

214.83

+ +
+

703.50

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

488.671

+ +
+

159.83

+ +
+

648.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

488.671

+ +
+

407.00

+ +
+

895.67

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

488.671

+ +
+

66.83

+ +
+

555.50

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

733.00

+ +
+

211.40

+ +
+

944.40

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

733.00

+ +
+

63.40

+ +
+

796.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.

+ +
+

733.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1100.00

+ +
+

396.20

+ +
+

1496.20

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1100.00

+ +
+

543.20

+ +
+

1643.20

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1100.00

+ +
+

396.20

+ +
+

1496.20

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1100.00

+ +
+

487.20

+ +
+

1587.20

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1100.00

+ +
+

396.20

+ +
+

1496.20

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1100.00

+ +
+

487.20

+ +
+

1587.20

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1100.00

+ +
+

1190.00

+ +
+

2290.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1100.00

+ +
+

564.20

+ +
+

1664.20

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1100.00

+ +
+

564.20

+ +
+

1664.20

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1100.00

+ +
+

564.20

+ +
+

1664.20

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

733.341

+ +
+

401.33

+ +
+

1134.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

733.341

+ +
+

548.33

+ +
+

1281.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

733.341

+ +
+

401.33

+ +
+

1134.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

733.341

+ +
+

492.33

+ +
+

1225.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

733.341

+ +
+

401.33

+ +
+

1134.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

733.341

+ +
+

492.33

+ +
+

1225.67

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

733.341

+ +
+

1045.66

+ +
+

1779.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult residential care facility, assisted living facility, or adult foster care home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + 01/01/15. +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

733.00

+ +
+

140.00

+ +
+

873.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

488.67

+ +
+

0.00

+ +
+

488.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1100.00

+ +
+

448.00

+ +
+

1548.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

733.34

+ +
+

0.00

+ +
+

733.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult foster care home with 50 or fewer residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents.

+ +
+

B

+ +
+

Adult foster care home with more than 50 residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective 01/01/15. +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

733.00

+ +
+

585.00

+ +
+

1318.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

733.00

+ +
+

695.00

+ +
+

1428.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

488.671

+ +
+

0.00

+ +
+

488.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Code

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1100.00

+ +
+

1536.00

+ +
+

2636.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1100.00

+ +
+

1756.00

+ +
+

2856.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

733.341

+ +
+

0.00

+ +
+

733.34

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +
+

Living in a community care or foster care home

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +
+

Domiciliary care I (maximum of five residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations. +

+ +
    +
  • +
    +
    •
    +
    +

    Recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipient is a patient in a private medical facility that is not certified under Title + XIX; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + 01/01/15. +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +
+

B

+ +
+

All

+ +
+

733.00

+ +
+

651.90

+ +
+

1384.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

733.00

+ +
+

651.90

+ +
+

1384.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

733.00

+ +
+

759.90

+ +
+

1492.90

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

488.67

+ +
+

0.00

+ +
+

488.67

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

30.001

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

B

+ +
+

All

+ +
+

1100.00

+ +
+

1640.80

+ +
+

2740.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1100.00

+ +
+

1640.80

+ +
+

2740.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1100.00

+ +
+

1856.80

+ +
+

2956.80

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

733.34

+ +
+

0.00

+ +
+

733.34

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

60.001

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +
+

Living in the household of another (blind only)

+ +

OS code “B” is only for an eligible blind recipient and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C” who has an: +

+ +
    +
  • +
    +
    •
    +
    +

    ineligible spouse, parent, child, or adult child living in the home with them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +
+

Living with a dependent person

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B” who has an: +

+ +
    +
  • +
    +
    •
    +
    +

    ineligible spouse, parent, child, or adult child living in the home with them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

G

+ +
+

Use OS code “G” to indicate that no supplement is payable to a recipient living in a Title XIX facility and Title XIX pays more than 50 percent of + the cost of care. However, a Federal “D” living arrangement is not appropriate because the recipient + did not meet the “throughout a month” requirement at the initial claims input. +

+ +
+

I

+ +
+

Living in a family life or boarding home-eligible recipient or each member of an eligible couple in FLA “B,” who resides in + a family life home or boarding home licensed by the State Department of Health, or + certified by the State Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs: +

+ +
    +
  • +
    +
    •
    +
    +

    In-home health related care;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residential care; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  • +
+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + 01/01/15. +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

733.00

+ +
+

22.00

+ +
+

755.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

733.00

+ +
+

377.00

+ +
+

1110.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

733.00

+ +
+

399.00

+ +
+

1132.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

733.00

+ +
+

377.00

+ +
+

1110.00

+ +
+

 

+ +
+

D

+ +
+

Aged

+ +
+

733.00

+ +
+

142.00

+ +
+

875.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

733.00

+ +
+

164.00

+ +
+

897.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

733.00

+ +
+

142.00

+ +
+

875.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

488.671

+ +
+

22.00

+ +
+

510.67

+ +
+

 

+ +
+

H

+ +
+

Aged

+ +
+

488.671

+ +
+

377.00

+ +
+

865.67

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

488.671

+ +
+

399.00

+ +
+

887.67

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

488.671

+ +
+

377.00

+ +
+

865.67

+ +
+

 

+ +
+

I

+ +
+

Aged

+ +
+

488.671

+ +
+

142.00

+ +
+

630.67

+ +
+

 

+ +
+

I

+ +
+

Disabled

+ +
+

488.671

+ +
+

142.00

+ +
+

630.67

+ +
+

 

+ +
+

I

+ +
+

Blind

+ +
+

488.671

+ +
+

164.00

+ +
+

652.67

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

488.671

+ +
+

0.00

+ +
+

488.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

733.00

+ +
+

22.00

+ +
+

755.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

733.00

+ +
+

399.00

+ +
+

1132.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

733.00

+ +
+

377.00

+ +
+

1110.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include: +

+
    +
  • +
    +
    •
    +
    +

    Recipients receiving “Residential Care” receive payment based on a per diem rate plus + a monthly personal allowance. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients receiving a supplement for Medicare and Medicaid receive a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

1100.00

+ +
+

44.00

+ +
+

1144.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

1100.00

+ +
+

22.00

+ +
+

1122.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1100.00

+ +
+

22.00

+ +
+

1122.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1100.00

+ +
+

377.00

+ +
+

1477.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1100.00

+ +
+

421.00

+ +
+

1521.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1100.00

+ +
+

377.00

+ +
+

1477.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1100.00

+ +
+

399.00

+ +
+

1499.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1100.00

+ +
+

377.00

+ +
+

1477.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1100.00

+ +
+

399.00

+ +
+

1499.00

+ +
+

 

+ +
+

D

+ +
+

Aged/Aged

+ +
+

1100.00

+ +
+

670.00

+ +
+

1770.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1100.00

+ +
+

714.00

+ +
+

1814.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1100.00

+ +
+

670.00

+ +
+

1770.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1100.00

+ +
+

692.00

+ +
+

1792.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1100.00

+ +
+

670.00

+ +
+

1770.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1100.00

+ +
+

692.00

+ +
+

1792.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

733.341

+ +
+

44.00

+ +
+

777.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

733.341

+ +
+

22.00

+ +
+

755.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

733.341

+ +
+

22.00

+ +
+

755.34

+ +
+

 

+ +
+

H

+ +
+

Aged/Aged

+ +
+

733.341

+ +
+

377.00

+ +
+

1110.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

733.341

+ +
+

421.00

+ +
+

1154.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

733.341

+ +
+

377.00

+ +
+

1110.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

733.341

+ +
+

399.00

+ +
+

1132.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

733.341

+ +
+

377.00

+ +
+

1110.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

733.341

+ +
+

399.00

+ +
+

1132.34

+ +
+

 

+ +
+

I

+ +
+

Aged/Aged

+ +
+

733.341

+ +
+

670.00

+ +
+

1403.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

733.341

+ +
+

714.00

+ +
+

1447.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

733.341

+ +
+

670.00

+ +
+

1403.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

733.341

+ +
+

692.00

+ +
+

1425.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

733.341

+ +
+

670.00

+ +
+

1403.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

733.341

+ +
+

692.00

+ +
+

1425.34

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

733.341

+ +
+

0.00

+ +
+

733.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

733.341

+ +
+

0.00

+ +
+

733.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

733.341

+ +
+

0.00

+ +
+

733.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include: +

+
    +
  • +
    +
    •
    +
    +

    Recipients receiving “Residential Care” receive payment based on a per diem rate plus + a monthly personal allowance. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients receiving “In-Home Health Care” receive a payment based on actual cost + of in-home health care plus basic Federal benefits. Treat members of a couple as individuals. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients receiving a supplement for Medicare and Medicaid receive a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

G

+ +
+

Independent living with an EP

+ +

OS code “G” applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18. +

+ +
+

H

+ +
+

Living in the household of another with an EP

+ +

OS code “H” applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18. +

+ +
+

I

+ +
+

Effective 01/01/88, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + 01/01/15. +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

733.00

+ +
+

87.00

+ +
+

820.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

733.00

+ +
+

157.50

+ +
+

890.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

733.00

+ +
+

179.30

+ +
+

912.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1100.001

+ +
+

14.00

+ +
+

1114.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

733.342

+ +
+

9.33

+ +
+

742.67

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

  30.003

+ +
+

7.00

+ +
+

37.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

1100.00

+ +
+

540.00

+ +
+

1640.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

1100.00

+ +
+

681.00

+ +
+

1781.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

1100.00

+ +
+

724.60

+ +
+

1824.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1467.001

+ +
+

21.00

+ +
+

1488.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

978.00

+ +
+

14.00

+ +
+

992.00

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care

+ +
+

H

+ +
+

State-certified residence in group home for mentally disabled

+ +
+

I

+ +
+

State-certified residence in group home for physically or developmentally disabled

+ +
+

J

+ +
+

State-certified residence for child and adult foster care

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + 01/01/15. +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

733.00

+ +
+

94.00

+ +
+

827.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

733.00

+ +
+

94.00

+ +
+

827.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

733.00

+ +
+

94.00

+ +
+

827.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

733.00

+ +
+

52.75

+ +
+

785.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

733.00

+ +
+

26.00

+ +
+

759.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

488.671

+ +
+

0.00

+ +
+

488.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

1100.00

+ +
+

193.00

+ +
+

1293.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1100.00

+ +
+

193.00

+ +
+

1293.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1100.00

+ +
+

193.00

+ +
+

1293.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

1100.00

+ +
+

110.50

+ +
+

1210.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

1100.00

+ +
+

57.00

+ +
+

1157.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

733.341

+ +
+

0.00

+ +
+

733.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living or living in parental household

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations. +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Used with an “intervening” Federal code “A.” For optional State supplement codes, + see SM 01301.535. +

+ +
+

B

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject to a one-third + reduction (VTR) of their Federal SSI payment are eligible for optional supplement + “B” because the criteria for this supplement level are the same as for Federal code + “B.” +

+ +
+

C

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live in a private non-medical facility or, a residential facility serving 16 or fewer + persons that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Apply “No Supplement” code “Y” to the following recipients. +

+ +
    +
  • +
    +
    •
    +
    +

    Disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + 01/01/15. +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

733.00

+ +
+

36.40

+ +
+

769.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

733.00

+ +
+

109.30

+ +
+

842.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

733.00

+ +
+

391.00

+ +
+

1124.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

733.00

+ +
+

391.00

+ +
+

1124.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

488.671

+ +
+

24.27

+ +
+

512.94

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

488.6

+ +
+

213.96

+ +
+

702.63

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

488.67

+ +
+

0.00

+ +
+

488.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

733.00

+ +
+

109.30

+ +
+

842.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1100.00

+ +
+

74.46

+ +
+

1174.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1100.00

+ +
+

374.60

+ +
+

1474.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1100.00

+ +
+

224.53

+ +
+

1324.53

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1100.00

+ +
+

37.23

+ +
+

1137.23

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1100.00

+ +
+

187.30

+ +
+

1287.30

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1100.00

+ +
+

881.00

+ +
+

1981.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1100.00

+ +
+

881.00

+ +
+

1981.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1100.00

+ +
+

881.00

+ +
+

1981.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1100.00

+ +
+

440.50

+ +
+

1540.50

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1100.00

+ +
+

440.50

+ +
+

1540.50

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

733.34

+ +
+

49.64

+ +
+

782.98

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

733.34

+ +
+

531.94

+ +
+

1265.28

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

733.34

+ +
+

290.79

+ +
+

1024.13

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

733.34

+ +
+

24.82

+ +
+

758.16

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

733.34

+ +
+

265.97

+ +
+

999.31

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

733.34

+ +
+

0.00

+ +
+

733.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    Recipients in residential facilities who are under the supervision of the Department + of Human Services: +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Living alone or with others

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations. +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or +

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +
+

Living alone with an ineligible spouse

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If + other persons, even minor children, are present in the household, you cannot apply + this OS + code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +
+

Living in the of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +
+

Licensed residential health care facilities (RHCF)

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to 01/01/06. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence + at a facility listed in the New Jersey Congregate Care Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Apply OS code “G” effective 09/01/88, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to 01/1988, or effective + 12/01/96, to children residing in public or private facilities where private health + insurance paid for their care. For determination of applicability of $30 payment limit, + see SI 00520.011. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective 01/01/15. +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

733.00

+ +
+

150.05

+ +
+

883.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

733.00

+ +
+

31.25

+ +
+

764.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

733.00

+ +
+

153.00

+ +
+

886.00

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

1100.001

+ +
+

25.36

+ +
+

1125.36

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

733.00

+ +
+

210.05

+ +
+

943.05

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

488.672

+ +
+

44.31

+ +
+

532.98

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

733.00

+ +
+

31.25

+ +
+

764.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

10.00

+ +
+

40.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1100.00

+ +
+

618.36

+ +
+

1718.36

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1100.00

+ +
+

25.36

+ +
+

1125.36

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1100.00

+ +
+

738.36

+ +
+

1838.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

733.341

+ +
+

93.09

+ +
+

826.43

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

20.00

+ +
+

80.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +
+

Living in the household of another with an EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a personal care boarding home (PCBH)

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective 01/01/15. +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

C

+ +
+

All

+ +
+

1100.001

+ +
+

43.70

+ +
+

1143.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

733.00

+ +
+

434.30

+ +
+

1167.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

733.00

+ +
+

439.30

+ +
+

1172.30

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

488.672

+ +
+

0.00

+ +
+

488.67

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

733.343

+ +
+

43.70

+ +
+

777.04

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

C

+ +
+

All

+ +
+

1467.001

+ +
+

68.05

+ +
+

1535.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1100.00

+ +
+

947.40

+ +
+

2047.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1100.00

+ +
+

957.40

+ +
+

2057.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1100.00

+ +
+

0.00

+ +
+

1100.00

+ +
+

B 

+ +
+

D

+ +
+

All

+ +
+

978.002

+ +
+

68.05

+ +
+

1046.05

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

733.343

+ +
+

0.00

+ +
+

733.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients +

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility (“residential care or assisted + living”) s described in category “D”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective 01/01/15. +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

733.00

+ +
+

332.00

+ +
+

1065.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

733.00

+ +
+

0.00

+ +
+

733.00

+ +
+
+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations.

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living (except Chittenden County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50 percent of their care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +
+

Licensed residential care home or assisted living residence with assistive community + care services (Level III)

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of Licensing and Protection for Vermont State websitehttp://www.dlp.vermont.gov/resident-list. +

+ +
+

E

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +
+

Licensed residential care home or therapeutic community residence (Level IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of Licensing and Protection for Vermont State website http://www.dlp.vermont.gov/resident-list

+ +
+

H

+ +
+

Custodial care: family home

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition (below).

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the requirements stated above. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +
+

Apply OS code “I” effective 07/01/87, when the State elected Federal administration of an optional State supplementary payment to + residents in Title XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays or is expected + to pay over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + 01/01/15. +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

733.00

+ +
+

52.04

+ +
+

785.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

733.00

+ +
+

52.04

+ +
+

785.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

733.00

+ +
+

48.38

+ +
+

781.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

733.00

+ +
+

223.94

+ +
+

956.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

733.00

+ +
+

98.69

+ +
+

831.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

488.67

+ +
+

39.30

+ +
+

527.97

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

733.00

+ +
+

52.04

+ +
+

785.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

733.00

+ +
+

52.04

+ +
+

785.04

+ +
+

D

+ +
+

A or B2

+ +
+

Children Private Insurance

+ +
+

30.001

+ +
+

52.04

+ +
+

82.04

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

17.66

+ +
+

47.66

+ +
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All(Except Chittenden County)

+ +
+

1100.00

+ +
+

98.88

+ +
+

1198.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

1100.00

+ +
+

98.88

+ +
+

1198.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1100.00

+ +
+

96.77

+ +
+

1196.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1100.00

+ +
+

562.06

+ +
+

1662.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1100.00

+ +
+

332.82

+ +
+

1432.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

733.341

+ +
+

48.31

+ +
+

781.65

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

35.33

+ +
+

95.33

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. General documentation requirements for initial claims, pre-effectuation reviews, and + redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. General documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of their optional State supplement category. Contact other persons with + knowledge of the recipient’s living situation, if necessary (e.g., landlord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289. +

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415047
SI 01415.047 - Federally Administered Optional Supplementary Payment Programs for 01/15 Payment Levels - 08/08/2024
+Batch run: 02/19/2025
+Rev:08/08/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html new file mode 100644 index 00000000..46091603 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2016.html @@ -0,0 +1,15920 @@ + + +SSA - POMS: SI 01415.048 - Federally Administered Optional Supplementary Payment Programs for January 2016 Payment Levels - 08/09/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 76 (08-24)

+

SI 01415.048 Federally Administered Optional Supplementary Payment Programs for January 2016 Payment + Levels +

+ + +
+
+

CITATIONS:

+
+
+ +
Social Security Act as amended in 1973, Section + 1616; + Social Security Amendments of 1972, Section + 301; Public Law 93-66, Section + 212 + +
+ +
+
+
+
+

A. List of States participating in the federally administered optional supplementary + payment program +

+
+
+

The following states participate in federally administered optional supplementary + payment programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+ +

 

+ +
+

Reference

+ +

 

+ +
+

California

+ +

 

+ +
+

SI 01415.048B

+ +

 

+ +
+

Delaware

+ +

 

+ +
+

SI 01415.048C

+ +

 

+ +
+

District of Columbia

+ +

 

+ +
+

SI 01415.048D

+ +

 

+ +
+

Hawaii

+ +

 

+ +
+

SI 01415.048E

+ +

 

+ +
+

Iowa

+ +

 

+ +
+

SI 01415.048F

+ +

 

+ +
+

Michigan

+ +

 

+ +
+

SI 01415.048G

+ +

 

+ +
+

Montana

+ +

 

+ +
+

SI 01415.048H

+ +

 

+ +
+

Nevada

+ +

 

+ +
+

SI 01415.048I

+ +

 

+ +
+

New Jersey

+ +

 

+ +
+

SI 01415.048J

+ +

 

+ +
+

Pennsylvania

+ +

 

+ +
+

SI 01415.048K

+ +

 

+ +
+

Rhode Island

+ +

 

+ +
+

SI 01415.048L

+ +

 

+ +
+

Vermont

+ +

 

+ +
+

SI 01415.048M

+ +

 

+ +
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +
+

Use optional supplement (OS) code “A” for independent living with cooking facilities for an eligible recipient or couple who meet one of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
+

B

+ +

 

+ +
+

Apply OS code “B” for non-medical out-of-home care (NMOHC) when a recipient or couple needs non-medical care or supervision in the following + living arrangement situations: +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA “A” and resides in the home of a relative, legal + conservator, or guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a family home certified by a family + home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
+

C

+ +

 

+ +
+

Independent living without cooking facilities

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement. +

    + +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS “C.” +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities, which are outside the + immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + can access for preparing meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for + preparing meals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has access to + the following: +

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove, or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +

NOTE: For purposes of OS “C,” “throughout a month” does not mean the recipient must lack + adequate cooking or food storage facilities from the very first moment of the month. + The recipient need only lack them from some time on the first day of the month. +

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment. +

+ +
+

D

+ +

 

+ +
+

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. Most recipient or couples + who are subject to a one-third reduction of their Federal SSI payments are eligible + for OS “D” because the criteria for this supplement level are the same as for charging + the one-third reduction. However, when the eligible recipient or couple lives in the + home of a relative (other than a spouse) and needs care and supervision, you must + obtain certification for non-medical out-of-home care (OS “F”) from the county welfare + office since this is the highest categorical supplement that a recipient or couple + can qualify. +

+ +
+

E

+ +

 

+ +
+

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +

NOTE: Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third reduction + (VTR) applies, see code “G.” +

+ +
+

F

+ +

 

+ +
+

Non-medical out-of-home care living in the household of another

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
+

G

+ +

 

+ +
+

Disabled child under 18 living in the of another

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal + code “B” payment for living in the household of another person. For the one-third + reduction provision, see SI 00835.200. +

+ +
+

J

+ +

 

+ +
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
+

Y

+ +

 

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +

 

+ +
+

Z

+ +

 

+ +
+

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2015: +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +

 

+ +
+

State OS Code

+ +

 

+ +
+

Category

+ +

 

+ +
+

Federal Benefit Rate (FBR)

+ +

 

+ +
+

State Supplement Level

+ +

 

+ +
+

Total Payment Levels

+ +

 

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

Aged

+ +

 

+ +
+

733.00

+ +

 

+ +
+

156.40

+ +

 

+ +
+

889.40

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind

+ +

 

+ +
+

733.00

+ +

 

+ +
+

211.40

+ +

 

+ +
+

944.40

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.00

+ +

 

+ +
+

156.40

+ +

 

+ +
+

889.40

+ +

 

+ +
+

 

+ +

 

+ +
+

B

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

412.00

+ +

 

+ +
+

1145.00

+ +

 

+ +
+

 

+ +

 

+ +
+

C

+ +

 

+ +
+

Aged

+ +

 

+ +
+

733.00

+ +

 

+ +
+

240.40

+ +

 

+ +
+

973.40

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.00

+ +

 

+ +
+

240.40

+ +

 

+ +
+

973.40

+ +

 

+ +
+

 

+ +

 

+ +
+

E

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.00

+ +

 

+ +
+

63.40

+ +

 

+ +
+

796.40

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

B

+ +

 

+ +
+

D

+ +

 

+ +
+

Aged

+ +

 

+ +
+

488.671

+ +

 

+ +
+

159.83

+ +

 

+ +
+

648.50

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind

+ +

 

+ +
+

488.671

+ +

 

+ +
+

214.83

+ +

 

+ +
+

703.50

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

488.671

+ +

 

+ +
+

159.83

+ +

 

+ +
+

648.50

+ +

 

+ +
+

 

+ +

 

+ +
+

F

+ +

 

+ +
+

All

+ +

 

+ +
+

488.671

+ +

 

+ +
+

407.00

+ +

 

+ +
+

895.67

+ +

 

+ +
+

 

+ +

 

+ +
+

G

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

488.671

+ +

 

+ +
+

66.83

+ +

 

+ +
+

555.50

+ +

 

+ +
+

C

+ +

 

+ +
+

A

+ +

 

+ +
+

Blind

+ +

 

+ +
+

733.00

+ +

 

+ +
+

211.40

+ +

 

+ +
+

944.40

+ +

 

+ +
+

 

+ +

 

+ +
+

E

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.00

+ +

 

+ +
+

63.40

+ +

 

+ +
+

796.40

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.

+ +

 

+ +
+

733.00

+ +

 

+ +
+

D

+ +

 

+ +
+

J

+ +

 

+ +
+

All

+ +

 

+ +
+

30.002

+ +

 

+ +
+

20.00

+ +

 

+ +
+

50.00

+ +

 

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

396.20

+ +

 

+ +
+

1496.20

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

543.20

+ +

 

+ +
+

1643.20

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

396.20

+ +

 

+ +
+

1496.20

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

487.20

+ +

 

+ +
+

1587.20

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

396.20

+ +

 

+ +
+

1496.20

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

487.20

+ +

 

+ +
+

1587.20

+ +

 

+ +
+

 

+ +

 

+ +
+

B

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

1190.00

+ +

 

+ +
+

2290.00

+ +

 

+ +
+

 

+ +

 

+ +
+

C

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

564.20

+ +

 

+ +
+

1664.20

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

564.20

+ +

 

+ +
+

1664.20

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

564.20

+ +

 

+ +
+

1664.20

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

B

+ +

 

+ +
+

D

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

733.341

+ +

 

+ +
+

401.33

+ +

 

+ +
+

1134.67

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

733.341

+ +

 

+ +
+

548.33

+ +

 

+ +
+

1281.67

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

401.33

+ +

 

+ +
+

1134.67

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Blind

+ +

 

+ +
+

733.341

+ +

 

+ +
+

492.33

+ +

 

+ +
+

1225.67

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

401.33

+ +

 

+ +
+

1134.67

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

492.33

+ +

 

+ +
+

1225.67

+ +

 

+ +
+

 

+ +

 

+ +
+

F

+ +

 

+ +
+

All

+ +

 

+ +
+

733.341

+ +

 

+ +
+

1045.66

+ +

 

+ +
+

1779.00

+ +

 

+ +
+

D

+ +

 

+ +
+

J

+ +

 

+ +
+

All

+ +

 

+ +
+

60.002

+ +

 

+ +
+

40.00

+ +

 

+ +
+

100.00

+ +

 

+ +
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +
+

Adult residential care facility, assisted living facility, or adult foster care home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +

 

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +

 

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2015: +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

140.00

+ +

 

+ +
+

873.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

B

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

488.67

+ +

 

+ +
+

0.00

+ +

 

+ +
+

488.67

+ +

 

+ +
+

C

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

D

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

30.001

+ +

 

+ +
+

0.00

+ +

 

+ +
+

30.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

448.00

+ +

 

+ +
+

1548.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

B

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.34

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.34

+ +

 

+ +
+

D

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

60.001

+ +

 

+ +
+

0.00

+ +

 

+ +
+

60.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +
+

Adult foster care home with 50 or fewer residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents. +

+ +
+

B

+ +

 

+ +
+

Adult foster care home with more than 50 residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX facilities. +

+ +
+

Y

+ +

 

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +

 

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2016: +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

600.00

+ +

 

+ +
+

1333.00

+ +

 

+ +
+

 

+ +

 

+ +
+

B

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

710.00

+ +

 

+ +
+

1443.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

B

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

488.671

+ +

 

+ +
+

0.00

+ +

 

+ +
+

488.67

+ +

 

+ +
+

C

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

D

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

30.002

+ +

 

+ +
+

40.00

+ +

 

+ +
+

70.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Code

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

1566.00

+ +

 

+ +
+

2666.00

+ +

 

+ +
+

 

+ +

 

+ +
+

B

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

1786.00

+ +

 

+ +
+

2886.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

B

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.341

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.34

+ +

 

+ +
+

D

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

60.002

+ +

 

+ +
+

80.00

+ +

 

+ +
+

140.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +

 

+ +
+

Living in a community care or foster care home

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +

 

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +

 

+ +
+

Domiciliary care I (maximum of five residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +

 

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +

 

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +

 

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2015: +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +

 

+ +
+

B

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

651.90

+ +

 

+ +
+

1384.90

+ +

 

+ +
+

 

+ +

 

+ +
+

H

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

651.90

+ +

 

+ +
+

1384.90

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

759.90

+ +

 

+ +
+

1492.90

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

B

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

488.67

+ +

 

+ +
+

0.00

+ +

 

+ +
+

488.67

+ +

 

+ +
+

D

+ +

 

+ +
+

D

+ +

 

+ +
+

All

+ +

 

+ +
+

30.001

+ +

 

+ +
+

20.00

+ +

 

+ +
+

50.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +

 

+ +
+

B

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

1640.80

+ +

 

+ +
+

2740.80

+ +

 

+ +
+

 

+ +

 

+ +
+

H

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

1640.80

+ +

 

+ +
+

2740.80

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

1856.80

+ +

 

+ +
+

2956.80

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

B

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.34

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.34

+ +

 

+ +
+

D

+ +

 

+ +
+

D

+ +

 

+ +
+

All

+ +

 

+ +
+

60.001

+ +

 

+ +
+

40.00

+ +

 

+ +
+

100.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +

 

+ +
+

Definition

+ +

 

+ +
+

A

+ +

 

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple + who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +

 

+ +
+

Living in the household of another (blind only)

+ +

OS code “B” is only for an eligible blind recipient and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +

 

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +

 

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +

 

+ +
+

Living with a dependent person

+ +

 

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

G

+ +

 

+ +
+

Use OS code “G” to indicate that no supplement is payable to a recipient living in a Title XIX facility and Title XIX pays more than 50 percent + of the cost of care. However, a Federal “D” living arrangement is not appropriate because the recipient + did not meet the “throughout a month” requirement at the initial claims input. +

+ +
+

I

+ +

 

+ +
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA “B,” who resides + in a family life home or boarding home licensed by the State Department of Health, + or certified by the State Department of Human Services. +

+ +
+

Y

+ +

 

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +

 

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  6. +
+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2015: +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

Blind

+ +

 

+ +
+

733.00

+ +

 

+ +
+

22.00

+ +

 

+ +
+

755.00

+ +

 

+ +
+

 

+ +

 

+ +
+

C

+ +

 

+ +
+

Aged

+ +

 

+ +
+

733.00

+ +

 

+ +
+

377.00

+ +

 

+ +
+

1110.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind

+ +

 

+ +
+

733.00

+ +

 

+ +
+

399.00

+ +

 

+ +
+

1132.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.00

+ +

 

+ +
+

377.00

+ +

 

+ +
+

1110.00

+ +

 

+ +
+

 

+ +

 

+ +
+

D

+ +

 

+ +
+

Aged

+ +

 

+ +
+

733.00

+ +

 

+ +
+

142.00

+ +

 

+ +
+

875.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind

+ +

 

+ +
+

733.00

+ +

 

+ +
+

164.00

+ +

 

+ +
+

897.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.00

+ +

 

+ +
+

142.00

+ +

 

+ +
+

875.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

B

+ +

 

+ +
+

B

+ +

 

+ +
+

Blind

+ +

 

+ +
+

488.671

+ +

 

+ +
+

22.00

+ +

 

+ +
+

510.67

+ +

 

+ +
+

 

+ +

 

+ +
+

H

+ +

 

+ +
+

Aged

+ +

 

+ +
+

488.671

+ +

 

+ +
+

377.00

+ +

 

+ +
+

865.67

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind

+ +

 

+ +
+

488.671

+ +

 

+ +
+

399.00

+ +

 

+ +
+

887.67

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

488.671

+ +

 

+ +
+

377.00

+ +

 

+ +
+

865.67

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

Aged

+ +

 

+ +
+

488.671

+ +

 

+ +
+

142.00

+ +

 

+ +
+

630.67

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

488.671

+ +

 

+ +
+

142.00

+ +

 

+ +
+

630.67

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

Blind

+ +

 

+ +
+

488.671

+ +

 

+ +
+

164.00

+ +

 

+ +
+

652.67

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

488.671

+ +

 

+ +
+

0.00

+ +

 

+ +
+

488.67

+ +

 

+ +
+

C

+ +

 

+ +
+

A

+ +

 

+ +
+

Blind

+ +

 

+ +
+

733.00

+ +

 

+ +
+

22.00

+ +

 

+ +
+

755.00

+ +

 

+ +
+

 

+ +

 

+ +
+

C

+ +

 

+ +
+

Blind

+ +

 

+ +
+

733.00

+ +

 

+ +
+

399.00

+ +

 

+ +
+

1132.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.00

+ +

 

+ +
+

377.00

+ +

 

+ +
+

1110.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

D

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

30.002

+ +

 

+ +
+

0.00

+ +

 

+ +
+

30.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

44.00

+ +

 

+ +
+

1144.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Aged

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

22.00

+ +

 

+ +
+

1122.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

22.00

+ +

 

+ +
+

1122.00

+ +

 

+ +
+

 

+ +

 

+ +
+

C

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

377.00

+ +

 

+ +
+

1477.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

421.00

+ +

 

+ +
+

1521.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

377.00

+ +

 

+ +
+

1477.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

399.00

+ +

 

+ +
+

1499.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

377.00

+ +

 

+ +
+

1477.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

399.00

+ +

 

+ +
+

1499.00

+ +

 

+ +
+

 

+ +

 

+ +
+

D

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

670.00

+ +

 

+ +
+

1770.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

714.00

+ +

 

+ +
+

1814.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

670.00

+ +

 

+ +
+

1770.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

692.00

+ +

 

+ +
+

1792.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

670.00

+ +

 

+ +
+

1770.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

692.00

+ +

 

+ +
+

1792.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

B

+ +

 

+ +
+

B

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

733.341

+ +

 

+ +
+

44.00

+ +

 

+ +
+

777.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Aged

+ +

 

+ +
+

733.341

+ +

 

+ +
+

22.00

+ +

 

+ +
+

755.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

22.00

+ +

 

+ +
+

755.34

+ +

 

+ +
+

 

+ +

 

+ +
+

H

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

733.341

+ +

 

+ +
+

377.00

+ +

 

+ +
+

1110.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

733.341

+ +

 

+ +
+

421.00

+ +

 

+ +
+

1154.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

377.00

+ +

 

+ +
+

1110.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Blind

+ +

 

+ +
+

733.341

+ +

 

+ +
+

399.00

+ +

 

+ +
+

1132.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

377.00

+ +

 

+ +
+

1110.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

399.00

+ +

 

+ +
+

1132.34

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

733.341

+ +

 

+ +
+

670.00

+ +

 

+ +
+

1403.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

733.341

+ +

 

+ +
+

714.00

+ +

 

+ +
+

1447.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

670.00

+ +

 

+ +
+

1403.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Blind

+ +

 

+ +
+

733.341

+ +

 

+ +
+

692.00

+ +

 

+ +
+

1425.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

670.00

+ +

 

+ +
+

1403.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

692.00

+ +

 

+ +
+

1425.34

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

733.341

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Disabled/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.34

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Disabled

+ +

 

+ +
+

733.341

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.34

+ +

 

+ +
+

D

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

60.002

+ +

 

+ +
+

0.00

+ +

 

+ +
+

60.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +

 

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +

 

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +

 

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

G

+ +

 

+ +
+

Independent living with an EP

+ +

OS code “G” applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18. +

+ +
+

H

+ +

 

+ +
+

Living in the household of another with an EP OS code “H” applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18. +

+ +
+

I

+ +

 

+ +
+

Effective January 1, 1988, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +

 

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +

 

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2015: +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

D

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

87.00

+ +

 

+ +
+

820.00

+ +

 

+ +
+

 

+ +

 

+ +
+

E

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

157.50

+ +

 

+ +
+

890.50

+ +

 

+ +
+

 

+ +

 

+ +
+

F

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

179.30

+ +

 

+ +
+

912.30

+ +

 

+ +
+

 

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.001

+ +

 

+ +
+

14.00

+ +

 

+ +
+

1114.00

+ +

 

+ +
+

B

+ +

 

+ +
+

H

+ +

 

+ +
+

All

+ +

 

+ +
+

733.342

+ +

 

+ +
+

9.33

+ +

 

+ +
+

742.67

+ +

 

+ +
+

D

+ +

 

+ +
+

I

+ +

 

+ +
+

All

+ +

 

+ +
+

30.003

+ +

 

+ +
+

7.00

+ +

 

+ +
+

37.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

30.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

30.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

D

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

540.00

+ +

 

+ +
+

1640.00

+ +

 

+ +
+

 

+ +

 

+ +
+

E

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

681.00

+ +

 

+ +
+

1781.00

+ +

 

+ +
+

 

+ +

 

+ +
+

F

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

724.60

+ +

 

+ +
+

1824.60

+ +

 

+ +
+

 

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

1467.001

+ +

 

+ +
+

21.00

+ +

 

+ +
+

1488.00

+ +

 

+ +
+

B

+ +

 

+ +
+

H

+ +

 

+ +
+

All

+ +

 

+ +
+

978.00

+ +

 

+ +
+

14.00

+ +

 

+ +
+

992.00

+ +

 

+ +
+

D

+ +

 

+ +
+

I

+ +

 

+ +
+

All

+ +

 

+ +
+

60.002

+ +

 

+ +
+

14.00

+ +

 

+ +
+

74.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care.

+ +
+

H

+ +
+

State-certified residence in-group home for mentally disabled.

+ +
+

I

+ +
+

State-certified residence in-group home for physically or developmentally disabled.

+ +
+

J

+ +
+

State-certified residence for child and adult foster care.

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled.

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2015: +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

94.00

+ +

 

+ +
+

827.00

+ +

 

+ +
+

 

+ +

 

+ +
+

H

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

94.00

+ +

 

+ +
+

827.00

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

94.00

+ +

 

+ +
+

827.00

+ +

 

+ +
+

 

+ +

 

+ +
+

J

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

52.75

+ +

 

+ +
+

785.75

+ +

 

+ +
+

 

+ +

 

+ +
+

K

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

26.00

+ +

 

+ +
+

759.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

B

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

488.671

+ +

 

+ +
+

0.00

+ +

 

+ +
+

488.67

+ +

 

+ +
+

C

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

D

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

30.002

+ +

 

+ +
+

0.00

+ +

 

+ +
+

30.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

193.00

+ +

 

+ +
+

1293.00

+ +

 

+ +
+

 

+ +

 

+ +
+

H

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

193.00

+ +

 

+ +
+

1293.00

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

193.00

+ +

 

+ +
+

1293.00

+ +

 

+ +
+

 

+ +

 

+ +
+

J

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

110.50

+ +

 

+ +
+

1210.50

+ +

 

+ +
+

 

+ +

 

+ +
+

K

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

57.00

+ +

 

+ +
+

1157.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

B

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.341

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.34

+ +

 

+ +
+

D

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

60.002

+ +

 

+ +
+

0.00

+ +

 

+ +
+

60.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +
+

Independent living or living in parental household

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code “A.” For optional State supplement codes, see + SM 01301.535. +

+ +
+

B

+ +

 

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement “B” because the criteria for this supplement level are the same as for + Federal code “B.” +

+ +
+

C

+ +

 

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live + in a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +

 

+ +
+

Apply “No Supplement” code “Y” to the following recipients: +

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2015: +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

Aged

+ +

 

+ +
+

733.00

+ +

 

+ +
+

36.40

+ +

 

+ +
+

769.40

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind

+ +

 

+ +
+

733.00

+ +

 

+ +
+

109.30

+ +

 

+ +
+

842.30

+ +

 

+ +
+

 

+ +

 

+ +
+

C

+ +

 

+ +
+

Aged

+ +

 

+ +
+

733.00

+ +

 

+ +
+

391.00

+ +

 

+ +
+

1124.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind

+ +

 

+ +
+

733.00

+ +

 

+ +
+

391.00

+ +

 

+ +
+

1124.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

B

+ +

 

+ +
+

B

+ +

 

+ +
+

Aged

+ +

 

+ +
+

488.671

+ +

 

+ +
+

24.27

+ +

 

+ +
+

512.94

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind

+ +

 

+ +
+

488.6

+ +

 

+ +
+

213.96

+ +

 

+ +
+

702.63

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

488.67

+ +

 

+ +
+

0.00

+ +

 

+ +
+

488.67

+ +

 

+ +
+

C

+ +

 

+ +
+

A

+ +

 

+ +
+

Blind

+ +

 

+ +
+

733.00

+ +

 

+ +
+

109.30

+ +

 

+ +
+

842.30

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

D

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

30.002

+ +

 

+ +
+

0.00

+ +

 

+ +
+

30.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

74.46

+ +

 

+ +
+

1174.46

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

374.60

+ +

 

+ +
+

1474.60

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

224.53

+ +

 

+ +
+

1324.53

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/

+ +

Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

37.23

+ +

 

+ +
+

1137.23

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/

+ +

Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

187.30

+ +

 

+ +
+

1287.30

+ +

 

+ +
+

 

+ +

 

+ +
+

C

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

881.00

+ +

 

+ +
+

1981.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

881.00

+ +

 

+ +
+

1981.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Blind

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

881.00

+ +

 

+ +
+

1981.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/

+ +

Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

440.50

+ +

 

+ +
+

1540.50

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/

+ +

Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

440.50

+ +

 

+ +
+

1540.50

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

B

+ +

 

+ +
+

B

+ +

 

+ +
+

Aged/Aged

+ +

 

+ +
+

733.34

+ +

 

+ +
+

49.64

+ +

 

+ +
+

782.98

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/Blind

+ +

 

+ +
+

733.34

+ +

 

+ +
+

531.94

+ +

 

+ +
+

1265.28

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/Blind

+ +

 

+ +
+

733.34

+ +

 

+ +
+

290.79

+ +

 

+ +
+

1024.13

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Aged/

+ +

Disabled

+ +

 

+ +
+

733.34

+ +

 

+ +
+

24.82

+ +

 

+ +
+

758.16

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

Blind/

+ +

Disabled

+ +

 

+ +
+

733.34

+ +

 

+ +
+

265.97

+ +

 

+ +
+

999.31

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

Disabled

+ +

 

+ +
+

733.34

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.34

+ +

 

+ +
+

D

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

60.002

+ +

 

+ +
+

0.00

+ +

 

+ +
+

60.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +

 

+ +
+

Living alone or with others

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +

 

+ +
+

Living alone with an ineligible spouse

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If other persons, even minor children, are present in the household, + you cannot apply this OS code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +

 

+ +
+

Living in the of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +

 

+ +
+

Licensed residential health care facilities (RHCF)

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to January 1, 2006. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey Congregate Care Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +

 

+ +
+

Apply OS code “G” effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +

 

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +

 

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or + effective December 1, 1996, to children residing in public or private facilities where + private health insurance paid for their care. For determination of applicability of + $30 payment limit, see SI 00520.011. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2015: +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

150.05

+ +

 

+ +
+

883.05

+ +

 

+ +
+

 

+ +

 

+ +
+

B

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

31.25

+ +

 

+ +
+

764.25

+ +

 

+ +
+

 

+ +

 

+ +
+

C

+ +

 

+ +
+

Individual

+ +

 

+ +
+

733.00

+ +

 

+ +
+

153.00

+ +

 

+ +
+

886.00

+ +

 

+ +
+

 

+ +

 

+ +
+

 

+ +

 

+ +
+

w/EP

+ +

 

+ +
+

1100.001

+ +

 

+ +
+

25.36

+ +

 

+ +
+

1125.36

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

210.05

+ +

 

+ +
+

943.05

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

B

+ +

 

+ +
+

D

+ +

 

+ +
+

All

+ +

 

+ +
+

488.672

+ +

 

+ +
+

44.31

+ +

 

+ +
+

532.98

+ +

 

+ +
+

C

+ +

 

+ +
+

B

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

31.25

+ +

 

+ +
+

764.25

+ +

 

+ +
+

D

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

30.003

+ +

 

+ +
+

10.00

+ +

 

+ +
+

40.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

30.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

30.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

618.36

+ +

 

+ +
+

1718.36

+ +

 

+ +
+

 

+ +

 

+ +
+

B

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

25.36

+ +

 

+ +
+

1125.36

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

738.36

+ +

 

+ +
+

1838.36

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

B

+ +

 

+ +
+

D

+ +

 

+ +
+

All

+ +

 

+ +
+

733.341

+ +

 

+ +
+

93.09

+ +

 

+ +
+

826.43

+ +

 

+ +
+

D

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

60.002

+ +

 

+ +
+

20.00

+ +

 

+ +
+

80.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +

 

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +

 

+ +
+

Living in the household of another with an EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +

 

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +

 

+ +
+

Living in a personal care boarding home (PCBH)

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +

 

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +

 

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2015: +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

C

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.001

+ +

 

+ +
+

43.70

+ +

 

+ +
+

1143.70

+ +

 

+ +
+

 

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

434.30

+ +

 

+ +
+

1167.30

+ +

 

+ +
+

 

+ +

 

+ +
+

H

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

439.30

+ +

 

+ +
+

1172.30

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

B

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

488.672

+ +

 

+ +
+

0.00

+ +

 

+ +
+

488.67

+ +

 

+ +
+

 

+ +

 

+ +
+

D

+ +

 

+ +
+

All

+ +

 

+ +
+

733.343

+ +

 

+ +
+

43.70

+ +

 

+ +
+

777.04

+ +

 

+ +
+

C

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+

D

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

30.004

+ +

 

+ +
+

0.00

+ +

 

+ +
+

30.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +

 

+ +
+

C

+ +

 

+ +
+

All

+ +

 

+ +
+

1467.001

+ +

 

+ +
+

68.05

+ +

 

+ +
+

1535.05

+ +

 

+ +
+

 

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

947.40

+ +

 

+ +
+

2047.40

+ +

 

+ +
+

 

+ +

 

+ +
+

H

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

957.40

+ +

 

+ +
+

2057.40

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

B 

+ +

 

+ +
+

D

+ +

 

+ +
+

All

+ +

 

+ +
+

978.002

+ +

 

+ +
+

68.05

+ +

 

+ +
+

1046.05

+ +

 

+ +
+

B

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.343

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.34

+ +

 

+ +
+

D

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

60.004

+ +

 

+ +
+

0.00

+ +

 

+ +
+

60.00

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients +

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +

 

+ +
+

D

+ +

 

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities as certified by the Rhode Island Department of Human Services. +

+ +
+

F

+ +

 

+ +
+

Advanced Care

+ +

Apply OS code “F” only to recipients living in a licensed adult community supportive + living residence and receiving advanced care as certified by the Rhode Island Executive + Office of Health and Human Services. +

+ +
+

Y

+ +

 

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +

 

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category “D” or “F”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2016: +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

D

+ +

 

+ +

F

+ +

 

+ +
+

All

+ +

 

+ +

All

+ +

 

+ +
+

733.00

+ +

 

+ +

733.00

+ +

 

+ +
+

332.00

+ +

 

+ +

797.00

+ +

 

+ +
+

1065.00

+ +

 

+ +

1,530.00

+ +

 

+ +
+

 

+ +

 

+ +
+

Z

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

0.00

+ +

 

+ +
+

733.00

+ +

 

+ +
+
+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +
+

Independent living (except Chittenden County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50 percent of their care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +

 

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +

 

+ +
+

Licensed residential care home or assisted living residence with assistive community + care services (Level III)

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of Licensing and Protection for Vermont State. Use this website link: http://www.dlp.vermont.gov/resident-list. +

+ +
+

E

+ +

 

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +

 

+ +
+

Licensed residential care home or therapeutic community residence (Level IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of Licensing and Protection for Vermont State. Use this website link: http://www.dlp.vermont.gov/resident-list

+ +
+

H

+ +

 

+ +
+

Custodial care: family home +

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the above requirements. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +

 

+ +
+

Apply OS code “I” effective July 1, 1987, when the State elected Federal administration of an optional State supplementary payment to + residents in Title XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +

 

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2015: +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

All (Except Chittenden County)

+ +

 

+ +
+

733.00

+ +

 

+ +
+

52.04

+ +

 

+ +
+

785.04

+ +

 

+ +
+

 

+ +

 

+ +
+

B

+ +

 

+ +
+

All (Restricted to Chittenden County)

+ +

 

+ +
+

733.00

+ +

 

+ +
+

52.04

+ +

 

+ +
+

785.04

+ +

 

+ +
+

 

+ +

 

+ +
+

C

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

48.38

+ +

 

+ +
+

781.38

+ +

 

+ +
+

 

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

223.94

+ +

 

+ +
+

956.94

+ +

 

+ +
+

 

+ +

 

+ +
+

H

+ +

 

+ +
+

All

+ +

 

+ +
+

733.00

+ +

 

+ +
+

98.69

+ +

 

+ +
+

831.69

+ +

 

+ +
+

B

+ +

 

+ +
+

E

+ +

 

+ +
+

All

+ +

 

+ +
+

488.67

+ +

 

+ +
+

39.30

+ +

 

+ +
+

527.97

+ +

 

+ +
+

C

+ +

 

+ +
+

A

+ +

 

+ +
+

All (Except Chittenden County)

+ +

 

+ +
+

733.00

+ +

 

+ +
+

52.04

+ +

 

+ +
+

785.04

+ +

 

+ +
+

 

+ +

 

+ +
+

B

+ +

 

+ +
+

All (Restricted to Chittenden County)

+ +

 

+ +
+

733.00

+ +

 

+ +
+

52.04

+ +

 

+ +
+

785.04

+ +

 

+ +
+

D

+ +

 

+ +
+

A or B2

+ +

 

+ +
+

Children Private Insurance

+ +

 

+ +
+

30.001

+ +

 

+ +
+

52.04

+ +

 

+ +
+

82.04

+ +

 

+ +
+

 

+ +

 

+ +
+

I

+ +

 

+ +
+

All

+ +

 

+ +
+

30.002

+ +

 

+ +
+

17.66

+ +

 

+ +
+

47.66

+ +

 

+ +
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +

 

+ +
+

A

+ +

 

+ +
+

All(Except Chittenden County)

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

98.88

+ +

 

+ +
+

1198.88

+ +

 

+ +
+

 

+ +

 

+ +
+

B

+ +

 

+ +
+

All (Restricted to Chittenden County)

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

98.88

+ +

 

+ +
+

1198.88

+ +

 

+ +
+

 

+ +

 

+ +
+

C

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

96.77

+ +

 

+ +
+

1196.77

+ +

 

+ +
+

 

+ +

 

+ +
+

G

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

562.06

+ +

 

+ +
+

1662.06

+ +

 

+ +
+

 

+ +

 

+ +
+

H

+ +

 

+ +
+

All

+ +

 

+ +
+

1100.00

+ +

 

+ +
+

332.82

+ +

 

+ +
+

1432.82

+ +

 

+ +
+

B

+ +

 

+ +
+

E

+ +

 

+ +
+

All

+ +

 

+ +
+

733.341

+ +

 

+ +
+

48.31

+ +

 

+ +
+

781.65

+ +

 

+ +
+

D

+ +

 

+ +
+

I

+ +

 

+ +
+

All

+ +

 

+ +
+

60.002

+ +

 

+ +
+

35.33

+ +

 

+ +
+

95.33

+ +

 

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of their optional State supplement category. Contact other persons with + knowledge of the recipient’s living situation, if necessary (land lord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289. +

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415048
SI 01415.048 - Federally Administered Optional Supplementary Payment Programs for January 2016 Payment Levels - 08/09/2024
+Batch run: 02/19/2025
+Rev:08/09/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html new file mode 100644 index 00000000..0f4bba7f --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2017.html @@ -0,0 +1,12279 @@ + + +SSA - POMS: SI 01415.049 - Federally Administered Optional Supplementary Payment Programs for January 2017 Payment Levels - 08/08/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 75 (08-24)

+

SI 01415.049 Federally Administered Optional Supplementary Payment Programs for January 2017 Payment + Levels +

+ + +

Citations: + Social Security Act as amended in 1973, Section + 1616; Social Security Amendments of 1972, Section 301; Public Law 93-66, + Section 212 +

+ +
+
+

A. List of States participating in the federally administered optional supplementary + payment program +

+
+
+

The following states participate in federally administered optional supplementary + payment programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+ +
+

Reference

+ +
+

California

+ +
+

SI 01415.049B

+ +
+

Delaware

+ +
+

SI 01415.049C

+ +
+

District of Columbia

+ +
+

SI 01415.049D

+ +
+

Hawaii

+ +
+

SI 01415.049E

+ +
+

Iowa

+ +
+

SI 01415.049F

+ +
+

Michigan

+ +
+

SI 01415.049G

+ +
+

Montana

+ +
+

SI 01415.049H

+ +
+

Nevada

+ +
+

SI 01415.049I

+ +
+

New Jersey

+ +
+

SI 01415.049J

+ +
+

Pennsylvania

+ +
+

SI 01415.049K

+ +
+

Rhode Island

+ +
+

SI 01415.049L

+ +
+

Vermont

+ +
+

SI 01415.049M

+ +
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +

 

+ +
+

Use optional supplement (OS) code “A” for independent living with cooking facilities for an eligible recipient or couple who meet one of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
+

B

+ +

 

+ +

 

+ +
+

Apply OS code “B” for non-medical out-of-home care (NMOHC) when a recipient or couple needs non-medical care or supervision in the following + living arrangement situations: +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. + McMahon decision); or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA “A” and resides in the home of a relative, legal + conservator, or guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a State licensed NMOHC facility; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a family home certified by a family + home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
+

C

+ +

 

+ +

 

+ +
+

Independent living without cooking facilities

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement. +

    + +
    +
    +
  • +
+ +

Transients are also eligible for OS “C”, as defined in SI 00835.060. +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities, which are outside the + immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + can access for preparing meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for + preparing meals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has access to + the following: +

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove, or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +

NOTE: For purposes of OS “C,” “throughout a month” does not mean the recipient must lack + adequate cooking or food storage facilities from the very first moment of the month. + The recipient need only lack them from some time on the first day of the month. +

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment. +

+ +
+

D

+ +

 

+ +

 

+ +
+

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. +

+ +

Most recipient or couples who are subject to a one-third reduction of their Federal + SSI payments are eligible for OS “D” because the criteria for this supplement level + are the same as for charging the one-third reduction. +

+ +

However, when the eligible recipient or couple lives in the home of a relative (other + than a spouse) and needs care and supervision, you must obtain certification for non-medical + out-of-home care (OS “F”) from the county welfare office since this is the highest + categorical supplement that a recipient or couple can qualify. +

+ +
+

E

+ +
+

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +

NOTE: Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third reduction + (VTR) applies, see code “G.” +

+ +
+

F

+ +
+

Non-medical out-of-home care living in the household of another

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
+

G

+ +
+

Disabled child under 18 living in the of another

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal + code “B” payment for living in the household of another person. For the one-third + reduction provision, see SI 00835.200. +

+ +
+

J

+ +
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2017: +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

Federal Benefit Rate (FBR)

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

735.00

+ +
+

160.72

+ +
+

895.72

+ +
​​ +

Blind

+ +
+

735.00

+ +
+

217.23

+ +
+

952.23

+ +
​​ +

Disabled

+ +
+

735.00

+ +
+

160.72

+ +
+

895.72

+ +
​ +

B

+ +
+

All

+ +
+

735.00

+ +
+

423.37

+ +
+

1158.37

+ +
​ +

C

+ +
+

Aged

+ +
+

735.00

+ +
+

247.04

+ +
+

982.04

+ +
​ +

 

+ +
+

Disabled

+ +
+

735.00

+ +
+

247.04

+ +
+

982.04

+ +
​ +

E

+ +
+

Disabled

+ +
+

735.00

+ +
+

65.15

+ +
+

800.15

+ +
​ +

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

490.001

+ +
+

164.24

+ +
+

654.24

+ +
​​ +

Blind

+ +
+

490.001

+ +
+

220.76

+ +
+

710.76

+ +
​​ +

Disabled

+ +
+

490.001

+ +
+

164.24

+ +
+

654.24

+ +
​ +

F

+ +
+

All

+ +
+

490.001

+ +
+

418.23

+ +
+

908.23

+ +
​ +

G

+ +
+

Disabled

+ +
+

490.001

+ +
+

68.67

+ +
+

558.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

735.00

+ +
+

217.23

+ +
+

952.23

+ +
​ +

E

+ +
+

Disabled

+ +
+

735.00

+ +
+

65.15

+ +
+

800.15

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

21.00

+ +
+

51.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1103.00

+ +
+

407.14

+ +
+

1510.14

+ +
​​ +

Blind/Blind

+ +
+

1103.00

+ +
+

558.19

+ +
+

1661.19

+ +
​​ +

Disabled/Disabled

+ +
+

1103.00

+ +
+

407.14

+ +
+

1510.14

+ +
​​ +

Aged/Blind

+ +
+

1103.00

+ +
+

500.65

+ +
+

1603.65

+ +
​​ +

Aged/Disabled

+ +
+

1103.00

+ +
+

407.14

+ +
+

1510.14

+ +
​​ +

Blind/Disabled

+ +
+

1103.00

+ +
+

500.65

+ +
+

1603.65

+ +
​ +

B

+ +
+

All

+ +
+

1103.00

+ +
+

1213.74

+ +
+

2316.74

+ +
​ +

C

+ +
+

Aged/Aged

+ +
+

1103.00

+ +
+

579.77

+ +
+

1682.77

+ +
​​ +

Disabled/Disabled

+ +
+

1103.00

+ +
+

579.77

+ +
+

1682.77

+ +
​​ +

Aged/Disabled

+ +
+

1103.00

+ +
+

579.77

+ +
+

1682.77

+ +
​ +

Z

+ +
+

All

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

 

+ +

735.341

+ +
+

412.41

+ +
+

1147.75

+ +
​​ +

Blind/Blind

+ +
+

735.341

+ +
+

563.46

+ +
+

1298.80

+ +
​​ +

Disabled/Disabled

+ +
+

735.341

+ +
+

412.41

+ +
+

1147.75

+ +
​​ +

Aged/Blind

+ +
+

735.341

+ +
+

505.92

+ +
+

1241.26

+ +
​​ +

Aged/Disabled

+ +
+

735.341

+ +
+

412.41

+ +
+

1147.75

+ +
​ +

 

+ +
+

Blind/Disabled

+ +
+

735.341

+ +
+

505.92

+ +
+

1241.26

+ +
​ +

F

+ +
+

All

+ +
+

735.341

+ +
+

1074.52

+ +
+

1809.86

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

42.00

+ +
+

102.00

+ +
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult residential care facility, assisted living facility, or adult foster care + home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2017: +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

735.00

+ +
+

140.00

+ +
+

875.00

+ +
​ +

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

490.00

+ +
+

0.00

+ +
+

490.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1103.00

+ +
+

448.00

+ +
+

1551.00

+ +
​ +

Z

+ +
+

All

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

735.34

+ +
+

0.00

+ +
+

735.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult foster care home with 50 or fewer residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult foster care home with more than 50 residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more + than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2017: +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

735.00

+ +
+

640.00

+ +
+

1375.00

+ +
​ +

B

+ +
+

All

+ +
+

735.00

+ +
+

750.00

+ +
+

1485.00

+ +
​ +

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

490.001

+ +
+

0.00

+ +
+

490.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1103.00

+ +
+

1636.00

+ +
+

2739.00

+ +
​ +

B

+ +
+

All

+ +
+

1103.00

+ +
+

1856.00

+ +
+

2959.00

+ +
​ +

Z

+ +
+

All

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

735.341

+ +
+

0.00

+ +
+

735.34

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

 

+ +

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +
+

Living in a community care or foster care home

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +
+

Domiciliary care I (maximum of five residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +
+

Optional supplementation + waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2017: +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +
+

B

+ +
+

All

+ +
+

735.00

+ +
+

651.90

+ +
+

1386.90

+ +
​ +

H

+ +
+

All

+ +
+

735.00

+ +
+

651.90

+ +
+

1386.90

+ +
​ +

I

+ +
+

All

+ +
+

735.00

+ +
+

759.90

+ +
+

1494.90

+ +
​ +

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

490.00

+ +
+

0.00

+ +
+

490.00

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

30.001

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

B

+ +
+

All

+ +
+

1103.00

+ +
+

1640.80

+ +
+

2743.80

+ +
​ +

H

+ +
+

All

+ +
+

1103.00

+ +
+

1640.80

+ +
+

2743.80

+ +
​ +

I

+ +
+

All

+ +
+

1103.00

+ +
+

1856.80

+ +
+

2959.80

+ +
​ +

Z

+ +
+

All

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

735.34

+ +
+

0.00

+ +
+

735.34

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

60.001

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple + who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +
+

Living in the household of another (blind only)

+ +

OS code “B” is only for an eligible blind recipient and the blind member of a + couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +
+

Living with a dependent person

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

G

+ +
+

Use OS code “G” to indicate that no supplement is payable to a recipient living in a Title XIX facility and Title XIX pays more than 50 percent + of the cost of care. However, a Federal “D” living arrangement is not appropriate because the recipient + did not meet the “throughout a month” requirement at the initial claims input. +

+ +
+

I

+ +
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA “B,” who resides + in a family life home or boarding home licensed by the State Department of Health, + or certified by the State Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  6. +
+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2017: +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

735.00

+ +
+

22.00

+ +
+

757.00

+ +
​ +

C

+ +
+

Aged

+ +
+

735.00

+ +
+

379.00

+ +
+

1114.00

+ +
​​ +

Blind

+ +
+

735.00

+ +
+

401.00

+ +
+

1136.00

+ +
​​ +

Disabled

+ +
+

735.00

+ +
+

379.00

+ +
+

1114.00

+ +
​ +

D

+ +
+

Aged

+ +
+

735.00

+ +
+

142.00

+ +
+

877.00

+ +
​​ +

Blind

+ +
+

735.00

+ +
+

164.00

+ +
+

899.00

+ +
​​ +

Disabled

+ +
+

735.00

+ +
+

142.00

+ +
+

877.00

+ +
​ +

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

490.001

+ +
+

22.00

+ +
+

512.00

+ +
​ +

H

+ +
+

Aged

+ +
+

490.001

+ +
+

379.00

+ +
+

869.00

+ +
​ +

 

+ +
+

Blind

+ +
+

490.001

+ +
+

401.00

+ +
+

891.00

+ +
​​ +

Disabled

+ +
+

490.001

+ +
+

379.00

+ +
+

869.00

+ +
​ +

I

+ +
+

Aged

+ +
+

490.001

+ +
+

142.00

+ +
+

632.00

+ +
​ +

I

+ +
+

Disabled

+ +
+

490.001

+ +
+

142.00

+ +
+

632.00

+ +
​ +

I

+ +
+

Blind

+ +
+

490.001

+ +
+

164.00

+ +
+

654.00

+ +
​ +

Z

+ +
+

All

+ +
+

490.001

+ +
+

0.00

+ +
+

490.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

735.00

+ +
+

22.00

+ +
+

757.00

+ +
​ +

C

+ +
+

Blind

+ +
+

735.00

+ +
+

401.00

+ +
+

1136.00

+ +
​​ +

Disabled

+ +
+

735.00

+ +
+

379.00

+ +
+

1114.00

+ +
​ +

Z

+ +
+

Disabled

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

1103.00

+ +
+

44.00

+ +
+

1147.00

+ +
​​ +

Blind/Aged

+ +
+

1103.00

+ +
+

44.00

+ +
+

1147.00

+ +
​ +

 

+ +
+

Blind/Disabled

+ +
+

1103.00

+ +
+

44.00

+ +
+

1147.00

+ +
​ +

C

+ +
+

Aged/Aged

+ +
+

1103.00

+ +
+

379.00

+ +
+

1482.00

+ +
​​ +

Blind/Blind

+ +
+

1103.00

+ +
+

423.00

+ +
+

1526.00

+ +
​​ +

Disabled/Disabled

+ +
+

1103.00

+ +
+

379.00

+ +
+

1482.00

+ +
​​ +

Aged/Blind

+ +
+

1103.00

+ +
+

423.00

+ +
+

1526.00

+ +
​​ +

Aged/Disabled

+ +
+

1103.00

+ +
+

379.00

+ +
+

1482.00

+ +
​ +

 

+ +
+

Blind/Disabled

+ +
+

1103.00

+ +
+

423.00

+ +
+

1526.00

+ +
​ +

D

+ +
+

Aged/Aged

+ +
+

1103.00

+ +
+

671.00

+ +
+

1774.00

+ +
​​ +

Blind/Blind

+ +
+

1103.00

+ +
+

715.00

+ +
+

1818.00

+ +
​​ +

Disabled/Disabled

+ +
+

1103.00

+ +
+

671.00

+ +
+

1774.00

+ +
​​ +

Aged/Blind

+ +
+

1103.00

+ +
+

715.00

+ +
+

1818.00

+ +
​​ +

Aged/Disabled

+ +
+

1103.00

+ +
+

671.00

+ +
+

1774.00

+ +
​​ +

Blind/Disabled

+ +
+

1103.00

+ +
+

715.00

+ +
+

1818.00

+ +
​ +

Z

+ +
+

Aged/Aged

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
​​ +

Disabled/Disabled

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
​​ +

Aged/Disabled

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

735.341

+ +
+

44.00

+ +
+

779.34

+ +
​​ +

Blind/Aged

+ +
+

735.341

+ +
+

44.00

+ +
+

779.34

+ +
​​ +

Blind/Disabled

+ +
+

735.341

+ +
+

44.00

+ +
+

779.34

+ +
​ +

H

+ +
+

Aged/Aged

+ +
+

735.341

+ +
+

379.00

+ +
+

1114.34

+ +
​​ +

Blind/Blind

+ +
+

735.341

+ +
+

423.00

+ +
+

1158.34

+ +
​​ +

Disabled/Disabled

+ +
+

735.341

+ +
+

379.00

+ +
+

1114.34

+ +
​​ +

Aged/Blind

+ +
+

735.341

+ +
+

423.00

+ +
+

1158.34

+ +
​​ +

Aged/Disabled

+ +
+

735.341

+ +
+

379.00

+ +
+

1114.34

+ +
​​ +

Blind/Disabled

+ +
+

735.341

+ +
+

423.00

+ +
+

1158.34

+ +
​ +

I

+ +
+

Aged/Aged

+ +
+

735.341

+ +
+

671.00

+ +
+

1406.34

+ +
​​ +

Blind/Blind

+ +

 

+ +

 

+ +
+

735.341

+ +
+

715.00

+ +
+

1450.34

+ +
​ +

 

+ +
+

Disabled/Disabled

+ +
+

735.341

+ +
+

671.00

+ +
+

1406.34

+ +
​​ +

Aged/Blind

+ +
+

 

+ +

735.341

+ +
+

715.00

+ +
+

1450.34

+ +
​​ +

Aged/Disabled

+ +
+

735.341

+ +
+

671.00

+ +
+

1406.34

+ +
​​ +

Blind/Disabled

+ +
+

735.341

+ +
+

715.00

+ +
+

1450.34

+ +
​ +

Z

+ +
+

Aged/Aged

+ +
+

735.341

+ +
+

0.00

+ +
+

735.34

+ +
​​ +

Disabled/Disabled

+ +
+

735.341

+ +
+

0.00

+ +
+

735.34

+ +
​​ +

Aged/Disabled

+ +
+

735.341

+ +
+

0.00

+ +
+

735.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

G

+ +
+

Independent living with an EP

+ +

OS code “G” applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18. +

+ +
+

H

+ +
+

Living in the household of another with an EP OS code “H” applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18. +

+ +
+

I

+ +
+

Effective January 1, 1988, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2017: +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

735.00

+ +
+

87.00

+ +
+

822.00

+ +
​ +

E

+ +
+

All

+ +
+

735.00

+ +
+

157.50

+ +
+

892.50

+ +
​ +

F

+ +
+

All

+ +
+

735.00

+ +
+

179.30

+ +
+

914.30

+ +
​ +

G

+ +
+

All

+ +
+

1103.001

+ +
+

14.00

+ +
+

1117.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

7

+ +

735.342

+ +
+

9.33

+ +
+

744.67

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.003

+ +
+

7.00

+ +
+

37.00

+ +
​ +

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

1103.00

+ +
+

541.00

+ +
+

1644.00

+ +
​ +

E

+ +
+

All

+ +
+

1103.00

+ +
+

682.00

+ +
+

1785.00

+ +
​ +

F

+ +
+

All

+ +
+

1103.00

+ +
+

725.60

+ +
+

1828.60

+ +
​ +

G

+ +
+

All

+ +
+

 

+ +

1471.001

+ +
+

21.00

+ +
+

1492.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

980.66

+ +
+

14.00

+ +
+

994.66

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care.

+ +
+

H

+ +
+

State-certified residence in-group home for mentally disabled.

+ +
+

I

+ +
+

State-certified residence in-group home for physically or developmentally disabled.

+ +
+

J

+ +
+

State-certified residence for child and adult foster care.

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled.

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2017: +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

735.00

+ +
+

94.00

+ +
+

829.00

+ +
​ +

H

+ +
+

All

+ +
+

735.00

+ +
+

94.00

+ +
+

829.00

+ +
​ +

I

+ +
+

All

+ +
+

735.00

+ +
+

94.00

+ +
+

829.00

+ +
​ +

J

+ +
+

All

+ +
+

735.00

+ +
+

52.75

+ +
+

787.75

+ +
​ +

K

+ +
+

All

+ +
+

735.00

+ +
+

26.00

+ +
+

761.00

+ +
​ +

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

490.001

+ +
+

0.00

+ +
+

490.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

1103.00

+ +
+

193.00

+ +
+

1296.00

+ +
​ +

H

+ +
+

All

+ +
+

1103.00

+ +
+

193.00

+ +
+

1296.00

+ +
​ +

I

+ +
+

All

+ +
+

1103.00

+ +
+

193.00

+ +
+

1296.00

+ +
​ +

J

+ +
+

All

+ +
+

1103.00

+ +
+

110.50

+ +
+

1213.50

+ +
​ +

K

+ +
+

All

+ +
+

1103.00

+ +
+

57.00

+ +
+

1160.00

+ +
​ +

Z

+ +
+

All

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

 

+ +

735.341

+ +
+

0.00

+ +
+

735.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living or living in parental household

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in his or her own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code “A.” For optional State supplement codes, see + SM 01301.535. +

+ +
+

B

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement “B” because the criteria for this supplement level are the same as for + Federal code “B.” +

+ +
+

C

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live + in a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Apply “No Supplement” code “Y” to the following recipients: +

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2017: +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

735.00

+ +
+

36.40

+ +
+

771.40

+ +
​​ +

Blind

+ +
+

735.00

+ +
+

109.30

+ +
+

844.30

+ +
​ +

C

+ +
+

Aged

+ +
+

735.00

+ +
+

391.00

+ +
+

1126.00

+ +
​​ +

Blind

+ +
+

735.00

+ +
+

391.00

+ +
+

1126.00

+ +
​ +

Z

+ +
+

Disabled

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

 

+ +

490.001

+ +
+

24.27

+ +
+

514.27

+ +
​​ +

Blind

+ +
+

 

+ +

490.00

+ +
+

213.96

+ +
+

703.96

+ +
​ +

Z

+ +
+

Disabled

+ +
+

490.00

+ +
+

0.00

+ +
+

490.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

735.00

+ +
+

109.30

+ +
+

844.30

+ +
​ +

Z

+ +
+

Disabled

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1103.00

+ +
+

74.46

+ +
+

1177.46

+ +
​​ +

Blind/Blind

+ +
+

1103.00

+ +
+

374.60

+ +
+

1477.60

+ +
​​ +

Aged/Blind

+ +
+

1103.00

+ +
+

374.60

+ +
+

1477.60

+ +
​​ +

Aged/

+ +

 

+ +

Disabled

+ +
+

1103.00

+ +
+

74.46

+ +
+

1177.46

+ +
​​ +

Blind/

+ +

 

+ +

Disabled

+ +
+

1103.00

+ +
+

374.60

+ +
+

1477.60

+ +
​ +

C

+ +
+

Aged/Aged

+ +
+

1103.00

+ +
+

881.00

+ +
+

1984.00

+ +
​​ +

Blind/Blind

+ +
+

1103.00

+ +
+

881.00

+ +
+

1984.00

+ +
​​ +

Aged/Blind

+ +
+

1103.00

+ +
+

881.00

+ +
+

1984.00

+ +
​​ +

Aged/

+ +

 

+ +

Disabled

+ +
+

1103.00

+ +
+

881.00

+ +
+

1984.00

+ +
​​ +

Blind/

+ +

 

+ +

Disabled

+ +
+

1103.00

+ +
+

881.00

+ +
+

1984.00

+ +
​ +

Z

+ +
+

Disabled

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

735.34

+ +
+

49.64

+ +
+

784.98

+ +
​​ +

Blind/Blind

+ +
+

735.34

+ +
+

531.94

+ +
+

1267.28

+ +
​​ +

Aged/Blind

+ +
+

735.34

+ +
+

531.94

+ +
+

1267.28

+ +
​​ +

Aged/

+ +

 

+ +

Disabled

+ +
+

735.34

+ +
+

49.64

+ +
+

784.98

+ +
​​ +

Blind/

+ +

 

+ +

Disabled

+ +
+

735.34

+ +
+

531.94

+ +
+

1267.28

+ +
​ +

Z

+ +
+

Disabled

+ +
+

735.34

+ +
+

0.00

+ +
+

735.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Living alone or with others

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +
+

Living alone with an ineligible spouse

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If + other persons, even minor children, are present in the household, you cannot apply + this OS + code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +
+

Living in the of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +

 

+ +

 

+ +
+

Licensed residential health care facilities (RHCF)

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to January 1, 2006. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey Congregate Care + Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Apply OS code “G” effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or + effective December 1, 1996, to children residing in public or private facilities where + private health insurance paid for their care. For determination of applicability of + $30 payment limit, see SI 00520.011. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2017: +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

735.00

+ +
+

150.05

+ +
+

885.05

+ +
​ +

B

+ +
+

All

+ +
+

735.00

+ +
+

31.25

+ +
+

766.25

+ +
​ +

C

+ +
+

Individual

+ +
+

735.00

+ +
+

153.00

+ +
+

888.00

+ +
​​ +

w/EP

+ +
+

1103.001

+ +
+

25.36

+ +
+

1128.36

+ +
​ +

I

+ +
+

All

+ +
+

735.00

+ +
+

210.05

+ +
+

945.05

+ +
​ +

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

490.002

+ +
+

44.31

+ +
+

534.31

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

735.00

+ +
+

31.25

+ +
+

766.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

10.00

+ +
+

40.00

+ +
​ +

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1103.00

+ +
+

618.36

+ +
+

1721.36

+ +
​ +

B

+ +
+

All

+ +
+

1103.00

+ +
+

25.36

+ +
+

1128.36

+ +
​ +

I

+ +
+

All

+ +
+

1103.00

+ +
+

738.36

+ +
+

1841.36

+ +
​ +

Z

+ +
+

All

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

 

+ +

735.341

+ +
+

93.09

+ +
+

828.43

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

20.00

+ +
+

80.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +
+

Living in the household of another with an EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a personal care boarding home (PCBH)

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2017: +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

C

+ +
+

All

+ +
+

1103.001

+ +
+

43.70

+ +
+

1146.70

+ +
​ +

G

+ +
+

All

+ +
+

735.00

+ +
+

434.30

+ +
+

1169.30

+ +
​ +

H

+ +
+

All

+ +
+

735.00

+ +
+

439.30

+ +
+

1174.30

+ +
​ +

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +

 

+ +
+

 

+ +

490.002

+ +
+

0.00

+ +
+

490.00

+ +
​ +

D

+ +
+

All

+ +
+

 

+ +

735.343

+ +
+

43.70

+ +
+

779.04

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

C

+ +
+

All

+ +
+

1471.001

+ +
+

68.05

+ +
+

1539.05

+ +
​ +

G

+ +
+

All

+ +
+

1103.00

+ +
+

947.40

+ +
+

2050.40

+ +
​ +

H

+ +
+

All

+ +
+

1103.00

+ +
+

957.40

+ +
+

2060.40

+ +
​ +

Z

+ +
+

All

+ +
+

1103.00

+ +
+

0.00

+ +
+

1103.00

+ +
+

B 

+ +
+

D

+ +
+

All

+ +
+

 

+ +

980.662

+ +
+

68.05

+ +
+

1048.71

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

 

+ +

735.343

+ +
+

0.00

+ +
+

735.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients +

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities as certified by the Rhode Island Department of Human Services. +

+ +
+

F

+ +
+

Advanced Care

+ +

Apply OS code “F” only to recipients living in a licensed adult community supportive + living residence and receiving advanced care as certified by the Rhode Island Executive + Office of Health and Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category “D” or “F”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2017: +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +

 

+ +

 

+ +

 

+ +

F

+ +
+

All

+ +

 

+ +

 

+ +

 

+ +

All

+ +
+

735.00

+ +

 

+ +

 

+ +

735.00

+ +
+

332.00

+ +

 

+ +

 

+ +

 

+ +

797.00

+ +
+

1067.00

+ +

 

+ +

 

+ +

1532.00

+ +
​ +

Z

+ +
+

All

+ +
+

735.00

+ +
+

0.00

+ +
+

735.00

+ +
+
+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living (except Chittenden County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50 percent of their care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +
+

Licensed residential care home or assisted living residence with assistive community + care services (Level III)

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of Licensing and + Protection for Vermont State. Use this website link: http://www.dlp.vermont.gov/resident-list. +

+ +
+

E

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +
+

Licensed residential care home or therapeutic community residence (Level + IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of Licensing and Protection for + Vermont State. Use this website link: http://www.dlp.vermont.gov/resident-list

+ +
+

H

+ +
+

Custodial care: family home +

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the above requirements. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +
+

Apply OS code “I” effective July 1, 1987, when the State elected Federal administration of an optional State supplementary payment to + residents in Title XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2017: +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

735.00

+ +
+

52.04

+ +
+

787.04

+ +
​ +

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

735.00

+ +
+

52.04

+ +
+

787.04

+ +
​ +

C

+ +
+

All

+ +
+

735.00

+ +
+

48.38

+ +
+

783.38

+ +
​ +

G

+ +
+

All

+ +
+

735.00

+ +
+

223.94

+ +
+

958.94

+ +
​ +

H

+ +
+

All

+ +
+

735.00

+ +
+

98.69

+ +
+

833.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

490.00

+ +
+

39.30

+ +
+

529.30

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

735.00

+ +
+

52.04

+ +
+

787.04

+ +
​ +

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

735.00

+ +
+

52.04

+ +
+

787.04

+ +
+

D

+ +
+

A or B2

+ +
+

Children Private Insurance

+ +
+

30.001

+ +
+

52.04

+ +
+

82.04

+ +
​ +

I

+ +
+

All

+ +
+

30.002

+ +
+

17.66

+ +
+

47.66

+ +
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All(Except Chittenden County)

+ +
+

1103.00

+ +
+

98.88

+ +
+

1201.88

+ +
​ +

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

1103.00

+ +
+

98.88

+ +
+

1201.88

+ +
​ +

C

+ +
+

All

+ +
+

1103.00

+ +
+

96.77

+ +
+

1199.77

+ +
​ +

G

+ +
+

All

+ +
+

1103.00

+ +
+

562.06

+ +
+

1665.06

+ +
​ +

H

+ +
+

All

+ +
+

1103.00

+ +
+

332.82

+ +
+

1435.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

 

+ +

735.341

+ +
+

48.31

+ +
+

783.65

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

35.33

+ +
+

95.33

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of their optional State supplement category. +

+

If necessary, contact other persons with knowledge of the recipient’s living situation + (land lord, homeowner, facility manager). Document the file per the instructions on + recording evidence in GN 00301.285 through GN 00301.289. +

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415049
SI 01415.049 - Federally Administered Optional Supplementary Payment Programs for January 2017 Payment Levels - 08/08/2024
+Batch run: 02/19/2025
+Rev:08/08/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html new file mode 100644 index 00000000..e258f798 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2018.html @@ -0,0 +1,12731 @@ + + +SSA - POMS: SI 01415.050 - Federally Administered Optional Supplementary Payment Programs for January 2018 Payment Levels - 08/13/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 83 (08-24)

+

SI 01415.050 Federally Administered Optional Supplementary Payment Programs for January 2018 Payment + Levels +

+ + +
+
+

CITATIONS:

+
+
+ Social Security Act as amended in 1973, +
Section 1616 ; Social Security Amendments of 1972, Section 301
+ +
Public Law 93-66, Section 212
+ +
+
+
+
+

A. List of States participating in the federally administered optional supplementary + payment program +

+
+
+

The following states participate in federally administered optional supplementary + payment programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+ +
+

Reference

+ +
+

California

+ +
+

SI 01415.050B

+ +
+

Delaware

+ +
+

SI 01415.050C

+ +
+

District of Columbia

+ +
+

SI 01415.050D

+ +
+

Hawaii

+ +
+

SI 01415.050E

+ +
+

Iowa

+ +
+

SI 01415.050F

+ +
+

Michigan

+ +
+

SI 01415.050G

+ +
+

Montana

+ +
+

SI 01415.050H

+ +
+

Nevada

+ +
+

SI 01415.050I

+ +
+

New Jersey

+ +
+

SI 01415.050J

+ +
+

Pennsylvania

+ +
+

SI 01415.050K

+ +
+

Rhode Island

+ +
+

SI 01415.050L

+ +
+

Vermont

+ +
+

SI 01415.050M

+ +
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Use optional supplement (OS) code “A” for independent living with cooking facilities for an eligible recipient or couple who meet one of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
+

B

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Apply OS code “B” for non-medical out-of-home care (NMOHC) when a recipient or couple needs non-medical care or supervision in the following + living arrangement situations: +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA “A” and resides in the home of a relative, legal + conservator, or guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a family home certified by a family + home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
+

C

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Independent living without cooking facilities

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement. +

    + +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS “C.” +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities, which are outside the + immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + can access for preparing meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for + preparing meals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

 

+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has access to + the following: +

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove, or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +

NOTE: For purposes of OS “C,” “throughout a month” does not mean the recipient must lack + adequate cooking or food storage facilities from the very first moment of the month. + The recipient need only lack them from some time on the first day of the month. +

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment. +

+ +
+

D

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. Most recipient or couples + who are subject to a one-third reduction of their Federal SSI payments are eligible + for OS “D” because the criteria for this supplement level are the same as for charging + the one-third reduction. However, when the eligible recipient or couple lives in the + home of a relative (other than a spouse) and needs care and supervision, you must + obtain certification for non-medical out-of-home care (OS “F”) from the county welfare + office since this is the highest categorical supplement that a recipient or couple + can qualify. +

+ +
+

E

+ +
+

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +

NOTE: Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third reduction + (VTR) applies, see code “G.” +

+ +
+

F

+ +
+

Non-medical out-of-home care living in the household of another

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
+

G

+ +
+

Disabled child under 18 living in the of another

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal + code “B” payment for living in the household of another person. For the one-third + reduction provision, see SI 00835.200. +

+ +
+

J

+ +
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2018: +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

Federal Benefit Rate (FBR)

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

750.00

+ +
+

160.72

+ +
+

910.72

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

750.00

+ +
+

217.23

+ +
+

967.23

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

750.00

+ +
+

160.72

+ +
+

910.72

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

750.00

+ +
+

423.37

+ +
+

1173.37

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

750.00

+ +
+

247.04

+ +
+

997.04

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

750.00

+ +
+

247.04

+ +
+

997.04

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

750.00

+ +
+

65.15

+ +
+

815.15

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

500.001

+ +
+

164.24

+ +
+

664.24

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

500.001

+ +
+

220.76

+ +
+

720.76

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

500.001

+ +
+

164.24

+ +
+

664.24

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

500.001

+ +
+

418.23

+ +
+

918.23

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

500.001

+ +
+

68.67

+ +
+

568.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

750.00

+ +
+

217.23

+ +
+

967.23

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

750.00

+ +
+

65.15

+ +
+

815.15

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

21.00

+ +
+

51.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1125.00

+ +
+

407.14

+ +
+

1532.14

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1125.00

+ +
+

558.19

+ +
+

1683.19

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1125.00

+ +
+

407.14

+ +
+

1532.14

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1125.00

+ +
+

500.65

+ +
+

1625.65

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1125.00

+ +
+

407.14

+ +
+

1532.14

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1125.00

+ +
+

500.65

+ +
+

1625.65

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1125.00

+ +
+

1221.74

+ +
+

2346.74

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1125.00

+ +
+

579.77

+ +
+

1704.77

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1125.00

+ +
+

579.77

+ +
+

1704.77

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1125.00

+ +
+

579.77

+ +
+

1704.77

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

750.001

+ +
+

412.41

+ +
+

1162.41

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

750.001

+ +
+

563.46

+ +
+

1313.46

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

750.001

+ +
+

412.41

+ +
+

1162.41

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

750.001

+ +
+

505.92

+ +
+

1255.92

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

750.001

+ +
+

412.41

+ +
+

1162.41

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

750.001

+ +
+

505.92

+ +
+

1255.92

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

750.001

+ +
+

1074.52

+ +
+

1824.52

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

42.00

+ +
+

102.00

+ +
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult residential care facility, assisted living facility, or adult foster care home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2018: +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

750.00

+ +
+

140.00

+ +
+

890.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1125.00

+ +
+

448.00

+ +
+

1573.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult foster care home with 50 or fewer residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult foster care home with more than 50 residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2018: +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

750.00

+ +
+

640.00

+ +
+

1390.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

750.00

+ +
+

750.00

+ +
+

1500.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

500.001

+ +
+

0.00

+ +
+

500.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1125.00

+ +
+

1636.00

+ +
+

2761.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1125.00

+ +
+

1856.00

+ +
+

2981.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

700.001

+ +
+

0.00

+ +
+

700.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +
+

Living in a community care or foster care home

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +
+

Domiciliary care I (maximum of five residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2018: +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +
+

B

+ +
+

All

+ +
+

750.00

+ +
+

651.90

+ +
+

1401.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

750.00

+ +
+

651.90

+ +
+

1401.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

750.00

+ +
+

759.90

+ +
+

1509.90

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

30.001

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

B

+ +
+

All

+ +
+

1125.00

+ +
+

1640.80

+ +
+

2765.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1125.00

+ +
+

1640.80

+ +
+

2765.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1125.00

+ +
+

1856.80

+ +
+

2981.80

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

60.001

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple + who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +
+

Living in the household of another (blind only)

+ +

OS code “B” is only for an eligible blind recipient and the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +
+

Living with a dependent person

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

G

+ +
+

Use OS code “G” to indicate that no supplement is payable to a recipient living in a Title XIX facility and Title XIX pays more than 50 percent + of the cost of care. However, a Federal “D” living arrangement is not appropriate because the recipient + did not meet the “throughout a month” requirement at the initial claims input. +

+ +
+

I

+ +
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA “B,” who resides + in a family life home or boarding home licensed by the State Department of Health, + or certified by the State Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  6. +
+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2018: +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

750.00

+ +
+

22.00

+ +
+

772.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

750.00

+ +
+

387.00

+ +
+

1137.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

750.00

+ +
+

409.00

+ +
+

1159.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

750.00

+ +
+

387.00

+ +
+

1137.00

+ +
+

 

+ +
+

D

+ +
+

Aged

+ +
+

750.00

+ +
+

142.00

+ +
+

892.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

750.00

+ +
+

164.00

+ +
+

914.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

750.00

+ +
+

142.00

+ +
+

892.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

500.001

+ +
+

22.00

+ +
+

522.00

+ +
+

 

+ +
+

H

+ +
+

Aged

+ +
+

500.001

+ +
+

387.00

+ +
+

887.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

500.001

+ +
+

409.00

+ +
+

909.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

500.001

+ +
+

387.00

+ +
+

887.00

+ +
+

 

+ +
+

I

+ +
+

Aged

+ +
+

500.001

+ +
+

142.00

+ +
+

642.00

+ +
+

 

+ +
+

I

+ +
+

Disabled

+ +
+

500.001

+ +
+

142.00

+ +
+

642.00

+ +
+

 

+ +
+

I

+ +
+

Blind

+ +
+

500.001

+ +
+

164.00

+ +
+

664.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

500.001

+ +
+

0.00

+ +
+

500.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

750.00

+ +
+

22.00

+ +
+

772.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

750.00

+ +
+

409.00

+ +
+

1159.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

750.00

+ +
+

387.00

+ +
+

1137.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

1125.00

+ +
+

44.00

+ +
+

1169.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

1125.00

+ +
+

44.00

+ +
+

1169.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1125.00

+ +
+

44.00

+ +
+

1169.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1125.00

+ +
+

387.00

+ +
+

1512.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1125.00

+ +
+

431.00

+ +
+

1556.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1125.00

+ +
+

387.00

+ +
+

1512.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1125.00

+ +
+

431.00

+ +
+

1556.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1125.00

+ +
+

387.00

+ +
+

1512.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1125.00

+ +
+

431.00

+ +
+

1556.00

+ +
+

 

+ +
+

D

+ +
+

Aged/Aged

+ +
+

1125.00

+ +
+

679.00

+ +
+

1804.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1125.00

+ +
+

723.00

+ +
+

1848.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1125.00

+ +
+

679.00

+ +
+

1804.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1125.00

+ +
+

723.00

+ +
+

1848.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1125.00

+ +
+

679.00

+ +
+

1804.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1125.00

+ +
+

723.00

+ +
+

1848.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

750.001

+ +
+

44.00

+ +
+

794.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

750.001

+ +
+

44.00

+ +
+

794.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

750.001

+ +
+

44.00

+ +
+

794.00

+ +
+

 

+ +
+

H

+ +
+

Aged/Aged

+ +
+

750.001

+ +
+

387.00

+ +
+

1137.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

750.001

+ +
+

431.00

+ +
+

1181.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

750.001

+ +
+

387.00

+ +
+

1137.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

750.001

+ +
+

431.00

+ +
+

1181.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

750.001

+ +
+

387.00

+ +
+

1137.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

750.001

+ +
+

431.00

+ +
+

1181.00

+ +
+

 

+ +
+

I

+ +
+

Aged/Aged

+ +
+

750.001

+ +
+

679.00

+ +
+

1429.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

750.001

+ +
+

723.00

+ +
+

1473.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

750.001

+ +
+

679.00

+ +
+

1429.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

750.001

+ +
+

723.00

+ +
+

1473.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

750.001

+ +
+

679.00

+ +
+

1429.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

750.001

+ +
+

723.00

+ +
+

1473.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

750.001

+ +
+

0.00

+ +
+

750.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

750.001

+ +
+

0.00

+ +
+

750.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

750.001

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

G

+ +
+

Independent living with an EP

+ +

OS code “G” applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18. +

+ +
+

H

+ +
+

Living in the household of another with an EP OS code “H” applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18. +

+ +
+

I

+ +
+

Effective January 1, 1988, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2018: +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

750.00

+ +
+

87.00

+ +
+

837.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

750.00

+ +
+

157.50

+ +
+

907.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

750.00

+ +
+

179.30

+ +
+

929.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1126.001

+ +
+

14.00

+ +
+

1140.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

750.672

+ +
+

9.33

+ +
+

760.00

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.003

+ +
+

7.00

+ +
+

37.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

1125.00

+ +
+

549.00

+ +
+

1674.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

1125.00

+ +
+

690.00

+ +
+

1815.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

1125.00

+ +
+

733.60

+ +
+

1858.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1501.001

+ +
+

21.00

+ +
+

1522.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

1125.671

+ +
+

14.00

+ +
+

1139.67

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care.

+ +
+

H

+ +
+

State-certified residence in-group home for mentally disabled.

+ +
+

I

+ +
+

State-certified residence in-group home for physically or developmentally disabled.

+ +
+

J

+ +
+

State-certified residence for child and adult foster care.

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled.

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2018: +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

750.00

+ +
+

94.00

+ +
+

844.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

750.00

+ +
+

94.00

+ +
+

844.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

750.00

+ +
+

94.00

+ +
+

844.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

750.00

+ +
+

52.75

+ +
+

802.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

750.00

+ +
+

26.00

+ +
+

776.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

500.001

+ +
+

0.00

+ +
+

500.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

1125.00

+ +
+

193.00

+ +
+

1318.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1125.00

+ +
+

193.00

+ +
+

1318.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1125.00

+ +
+

193.00

+ +
+

1318.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

1125.00

+ +
+

110.50

+ +
+

1235.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

1125.00

+ +
+

57.00

+ +
+

1182.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

750.001

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living or living in parental household

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code “A.” For optional State supplement codes, see + SM 01301.535. +

+ +
+

B

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement “B” because the criteria for this supplement level are the same as for + Federal code “B.” +

+ +
+

C

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live + in a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Apply “No Supplement” code “Y” to the following recipients: +

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2018: +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

750.00

+ +
+

36.40

+ +
+

786.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

750.00

+ +
+

109.30

+ +
+

859.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

750.00

+ +
+

391.00

+ +
+

1141.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

750.00

+ +
+

391.00

+ +
+

1141.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

500.001

+ +
+

24.27

+ +
+

524.27

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

500.00

+ +
+

213.96

+ +
+

713.96

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

500.00

+ +
+

0.00

+ +
+

500.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

750.00

+ +
+

109.30

+ +
+

859.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1125.00

+ +
+

74.46

+ +
+

1199.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1125.00

+ +
+

374.60

+ +
+

1499.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1125.00

+ +
+

374.60

+ +
+

1499.60

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1125.00

+ +
+

74.46

+ +
+

1199.46

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1125.00

+ +
+

374.60

+ +
+

1499.60

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1125.00

+ +
+

881.00

+ +
+

2006.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1125.00

+ +
+

881.00

+ +
+

2006.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1125.00

+ +
+

881.00

+ +
+

2006.00

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1125.00

+ +
+

881.00

+ +
+

2006.00

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1125.00

+ +
+

881.00

+ +
+

2006.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

750.00

+ +
+

49.64

+ +
+

799.64

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

750.00

+ +
+

531.94

+ +
+

1281.94

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

750.00

+ +
+

531.94

+ +
+

1281.94

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

750.00

+ +
+

49.64

+ +
+

799.64

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

750.00

+ +
+

531.94

+ +
+

1281.94

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Living alone or with others

+ +

 

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +
+

Living alone with an ineligible spouse

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If other persons, even minor + children, are present in the household, you cannot apply this OS code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Licensed residential health care facilities (RHCF)

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to January 1, 2006. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey Congregate Care Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Apply OS code “G” effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or + effective December 1, 1996, to children residing in public or private facilities where + private health insurance paid for their care. For determination of applicability of + $30 payment limit, see SI 00520.011. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2018: +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

750.00

+ +
+

150.05

+ +
+

900.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

750.00

+ +
+

31.25

+ +
+

781.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

750.00

+ +
+

153.00

+ +
+

903.00

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

1126.001

+ +
+

25.36

+ +
+

1151.36

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

750.00

+ +
+

210.05

+ +
+

960.05

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

500.002

+ +
+

44.31

+ +
+

544.31

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

750.00

+ +
+

31.25

+ +
+

781.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

10.00

+ +
+

40.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1125.00

+ +
+

618.36

+ +
+

1743.36

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1125.00

+ +
+

25.36

+ +
+

1150.36

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1125.00

+ +
+

738.36

+ +
+

1863.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

750.001

+ +
+

93.09

+ +
+

843.09

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

20.00

+ +
+

80.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +
+

Living in the household of another with an EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a personal care boarding home (PCBH)

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2018: +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

C

+ +
+

All

+ +
+

1126.001

+ +
+

43.70

+ +
+

1169.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

750.00

+ +
+

434.30

+ +
+

1184.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

750.00

+ +
+

439.30

+ +
+

1189.30

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +

 

+ +
+

500.002

+ +
+

0.00

+ +
+

500.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

750.673

+ +
+

43.70

+ +
+

794.37

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

C

+ +
+

All

+ +
+

1501.001

+ +
+

68.05

+ +
+

1569.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1125.00

+ +
+

947.40

+ +
+

2072.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1125.00

+ +
+

957.40

+ +
+

2082.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1125.00

+ +
+

0.00

+ +
+

1125.00

+ +
+

B 

+ +
+

D

+ +
+

All

+ +
+

1000.672

+ +
+

68.05

+ +
+

1068.72

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

750.003

+ +
+

0.00

+ +
+

750.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients +

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities as certified by the Rhode Island Department of Human Services. +

+ +
+

F

+ +
+

Advanced Care

+ +

Apply OS code “F” only to recipients living in a licensed adult community supportive + living residence and receiving advanced care as certified by the Rhode Island Executive + Office of Health and Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category “D” or “F”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2018: +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +

 

+ +

F

+ +
+

All

+ +

 

+ +

All

+ +
+

750.00

+ +

 

+ +

750.00

+ +
+

332.00

+ +

 

+ +

797.00

+ +
+

1082.00

+ +

 

+ +

1547.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

750.00

+ +
+

0.00

+ +
+

750.00

+ +
+
+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living (except Chittenden County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50 percent of their care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +
+

Licensed residential care home or assisted living residence with assistive community + care services (Level III)

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of Licensing and Protection for Vermont State. Use this website link: http://www.dlp.vermont.gov/resident-list. +

+ +
+

E

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +
+

Licensed residential care home or therapeutic community residence (Level IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of Licensing and Protection for Vermont State. Use this website link: http://www.dlp.vermont.gov/resident-list

+ +
+

H

+ +
+

Custodial care: family home +

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the above requirements. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +
+

Apply OS code “I” effective July 1, 1987, when the State elected Federal administration of an optional State supplementary payment to + residents in Title XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2018: +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

750.00

+ +
+

52.04

+ +
+

802.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

750.00

+ +
+

52.04

+ +
+

802.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

750.00

+ +
+

48.38

+ +
+

798.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

750.00

+ +
+

223.94

+ +
+

973.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

750.00

+ +
+

98.69

+ +
+

848.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

500.00

+ +
+

39.30

+ +
+

539.30

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

750.00

+ +
+

52.04

+ +
+

802.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

750.00

+ +
+

52.04

+ +
+

802.04

+ +
+

D

+ +
+

A or B2

+ +
+

Children Private Insurance

+ +
+

30.001

+ +
+

52.04

+ +
+

82.04

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

17.66

+ +
+

47.66

+ +
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All(Except Chittenden County)

+ +
+

1125.00

+ +
+

98.88

+ +
+

1223.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

1125.00

+ +
+

98.88

+ +
+

1223.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1125.00

+ +
+

96.77

+ +
+

1221.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1125.00

+ +
+

562.06

+ +
+

1687.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1125.00

+ +
+

332.82

+ +
+

1457.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

750.001

+ +
+

48.31

+ +
+

798.31

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

35.33

+ +
+

95.33

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of their optional State supplement category. Contact other persons with + knowledge of the recipient’s living situation, if necessary (land lord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289. +

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415050
SI 01415.050 - Federally Administered Optional Supplementary Payment Programs for January 2018 Payment Levels - 08/13/2024
+Batch run: 02/19/2025
+Rev:08/13/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html new file mode 100644 index 00000000..40925eaa --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2019.html @@ -0,0 +1,12749 @@ + + +SSA - POMS: SI 01415.051 - Federally Administered Optional Supplementary Payment Programs for January 2019 - 08/13/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 84 (08-24)

+

SI 01415.051 Federally Administered Optional Supplementary Payment Programs for January 2019 +

+ + +
+
+

CITATIONS:

+
+
Social Security Act as amended in 1973, +
Section 1616 ; Social Security Amendments of 1972, Section 301
+ +
Public Law 93-66, + Section 212 +
+ +
+
+
+
+

A. List of States participating in the federally administered optional supplementary + payment program +

+
+
+

The following states participate in federally administered optional supplementary + payment programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+ +
+

Reference

+ +
+

California

+ +
+

SI 01415.051B

+ +
+

Delaware

+ +
+

SI 01415.051C

+ +
+

District of Columbia

+ +
+

SI 01415.051D

+ +
+

Hawaii

+ +
+

SI 01415.051E

+ +
+

Iowa

+ +
+

SI 01415.051F

+ +
+

Michigan

+ +
+

SI 01415.051G

+ +
+

Montana

+ +
+

SI 01415.051H

+ +
+

Nevada

+ +
+

SI 01415.051I

+ +
+

New Jersey

+ +
+

SI 01415.051J

+ +
+

Pennsylvania

+ +
+

SI 01415.051K

+ +
+

Rhode Island

+ +
+

SI 01415.051L

+ +
+

Vermont

+ +
+

SI 01415.051M

+ +
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Use optional supplement (OS) code “A” for independent + living with cooking facilities for an eligible recipient or couple who meet one of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
+

B

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Apply OS code “B” for non-medical out-of-home care + (NMOHC) when a recipient or couple needs non-medical care or supervision in the following + living arrangement situations: +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. McMahon + decision); or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA “A” and resides in the home of a relative, legal + conservator, or guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a family home certified by a family + home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-sibling

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
+

C

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Independent living without cooking facilities +

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement. +

    + +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS “C.” +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities, which are outside the + immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + can access for preparing meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for + preparing meals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has access to + the following: +

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove, or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +

NOTE: For purposes of OS “C,” “throughout a month” does not mean the recipient must lack + adequate cooking or food storage facilities from the very first moment of the month. + The recipient need only lack them from some time on the first day of the month. +

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment. +

+ +
+

D

+ +

 

+ +

 

+ +
+

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. Most recipient or couples + who are subject to a one-third reduction of their Federal SSI payments are eligible + for OS “D” because the criteria for this supplement level are the same as for charging + the one-third reduction. However, when the eligible recipient or couple lives in the + home of a relative (other than a spouse) and needs care and supervision, you must + obtain certification for non-medical out-of-home care (OS “F”) from the county welfare + office since this is the highest categorical supplement that a recipient or couple + can qualify. +

+ +
+

E

+ +
+

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +

NOTE: Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third reduction + (VTR) applies, see code “G.” +

+ +
+

F

+ +
+

Non-medical out-of-home care living in the household of + another

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
+

G

+ +
+

Disabled child under 18 living in the of another +

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal + code “B” payment for living in the household of another person. For the one-third + reduction provision, see SI 00835.200. +

+ +
+

J

+ +
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2019: +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

Federal Benefit Rate (FBR)

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

771.00

+ +
+

160.72

+ +
+

931.72

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

771.00

+ +
+

217.23

+ +
+

988.23

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

771.00

+ +
+

160.72

+ +
+

931.72

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

771.00

+ +
+

423.37

+ +
+

1194.37

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

771.00

+ +
+

247.04

+ +
+

1018.04

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

771.00

+ +
+

247.04

+ +
+

1018.04

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

771.00

+ +
+

65.15

+ +
+

836.15

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

514.001

+ +
+

164.24

+ +
+

678.24

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

514.001

+ +
+

220.76

+ +
+

734.76

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

514.001

+ +
+

164.24

+ +
+

678.24

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

514.001

+ +
+

418.23

+ +
+

932.23

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

514.001

+ +
+

68.67

+ +
+

582.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

771.00

+ +
+

217.23

+ +
+

988.23

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

771.00

+ +
+

65.15

+ +
+

836.15

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

21.00

+ +
+

51.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1157.00

+ +
+

407.14

+ +
+

1564.14

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1157.00

+ +
+

558.19

+ +
+

1715.19

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1157.00

+ +
+

407.14

+ +
+

1564.14

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1157.00

+ +
+

500.65

+ +
+

1657.65

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

112557.00

+ +
+

407.14

+ +
+

1564.14

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1157.00

+ +
+

500.65

+ +
+

1657.65

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1157.00

+ +
+

1231.74

+ +
+

2388.74

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1157.00

+ +
+

579.77

+ +
+

1736.77

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1157.00

+ +
+

579.77

+ +
+

1736.77

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1157.00

+ +
+

579.77

+ +
+

1736.77

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

771.341

+ +
+

412.41

+ +
+

1183.75

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

771.341

+ +
+

563.46

+ +
+

1334.80

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

771.341

+ +
+

412.41

+ +
+

1183.75

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

771.341

+ +
+

505.92

+ +
+

1277.26

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

771.341

+ +
+

412.41

+ +
+

1183.75

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

771.341

+ +
+

505.92

+ +
+

1277.26

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

771.341

+ +
+

1074.52

+ +
+

1845.86

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

42.00

+ +
+

102.00

+ +
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult residential care facility, assisted living + facility, or adult foster care home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2019: +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

771.00

+ +
+

140.00

+ +
+

911.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

514.00

+ +
+

0.00

+ +
+

514.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1157.00

+ +
+

448.00

+ +
+

1605.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

77134

+ +
+

0.00

+ +
+

771.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult foster care home with 50 or fewer residents +

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult foster care home with more than 50 residents +

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX + facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2019: +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

771.00

+ +
+

640.00

+ +
+

1411.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

771.00

+ +
+

750.00

+ +
+

1521.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

514.001

+ +
+

0.00

+ +
+

514.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1157.00

+ +
+

1636.00

+ +
+

2793.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1157.00

+ +
+

1856.00

+ +
+

3013.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

771.341

+ +
+

0.00

+ +
+

771.34

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +
+

Living in a community care or foster care home +

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +
+

Domiciliary care I (maximum of five + residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2019: +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +
+

B

+ +
+

All

+ +
+

771.00

+ +
+

651.90

+ +
+

1422.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

771.00

+ +
+

651.90

+ +
+

1422.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

771.00

+ +
+

759.90

+ +
+

1530.90

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

514.00

+ +
+

0.00

+ +
+

514.00

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

30.001

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

B

+ +
+

All

+ +
+

1157.00

+ +
+

1640.80

+ +
+

2797.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1157.00

+ +
+

1640.80

+ +
+

2797.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1157.00

+ +
+

1856.80

+ +
+

3013.80

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

771.34

+ +
+

0.00

+ +
+

771.34

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

60.001

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple + who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +
+

Living in the household of another (blind only) +

+ +

OS code “B” is only for an eligible blind recipient and + the blind member of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +
+

Living with a dependent person

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

G

+ +
+

Use OS code “G” to indicate that no supplement is payable to a recipient living in a Title XIX facility and Title + XIX pays more than 50 percent of the cost of care. However, a Federal “D” living arrangement is not appropriate because the recipient + did not meet the “throughout a month” requirement at the initial claims input. +

+ +
+

I

+ +
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA “B,” who resides + in a family life home or boarding home licensed by the State Department of Health, + or certified by the State Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  6. +
+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2019: +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

771.00

+ +
+

22.00

+ +
+

793.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

771.00

+ +
+

398.00

+ +
+

1169.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

771.00

+ +
+

420.00

+ +
+

1191.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

771.00

+ +
+

398.00

+ +
+

1169.00

+ +
+

 

+ +
+

D

+ +
+

Aged

+ +
+

771.00

+ +
+

142.00

+ +
+

913.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

771.00

+ +
+

164.00

+ +
+

935.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

771.00

+ +
+

142.00

+ +
+

913.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

514.001

+ +
+

22.00

+ +
+

536.00

+ +
+

 

+ +
+

H

+ +
+

Aged

+ +
+

514.001

+ +
+

398.00

+ +
+

912.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

514.001

+ +
+

420.00

+ +
+

934.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

514.001

+ +
+

398.00

+ +
+

912.00

+ +
+

 

+ +
+

I

+ +
+

Aged

+ +
+

514.001

+ +
+

142.00

+ +
+

656.00

+ +
+

 

+ +
+

I

+ +
+

Disabled

+ +
+

514.001

+ +
+

142.00

+ +
+

656.00

+ +
+

 

+ +
+

I

+ +
+

Blind

+ +
+

514.001

+ +
+

164.00

+ +
+

678.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

514.001

+ +
+

0.00

+ +
+

514.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

771.00

+ +
+

22.00

+ +
+

793.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

771.00

+ +
+

420.00

+ +
+

1191.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

771.00

+ +
+

398.00

+ +
+

1169.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

1157.00

+ +
+

44.00

+ +
+

1201.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

1157.00

+ +
+

44.00

+ +
+

1201.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1157.00

+ +
+

44.00

+ +
+

1201.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1157.00

+ +
+

398.00

+ +
+

1555.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1157.00

+ +
+

442.00

+ +
+

1599.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1157.00

+ +
+

398.00

+ +
+

1555.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1157.00

+ +
+

442.00

+ +
+

1599.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1157.00

+ +
+

398.00

+ +
+

1555.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1157.00

+ +
+

442.00

+ +
+

1599.00

+ +
+

 

+ +
+

D

+ +
+

Aged/Aged

+ +
+

1157.00

+ +
+

689.00

+ +
+

1846.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1157.00

+ +
+

733.00

+ +
+

1890.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1157.00

+ +
+

689.00

+ +
+

1846.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1157.00

+ +
+

733.00

+ +
+

1890.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1157.00

+ +
+

689.00

+ +
+

1846.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1157.00

+ +
+

733.00

+ +
+

1890.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

771.341

+ +
+

44.00

+ +
+

815.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

771.341

+ +
+

44.00

+ +
+

815.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

771.341

+ +
+

44.00

+ +
+

815.34

+ +
+

 

+ +
+

H

+ +
+

Aged/Aged

+ +
+

771.341

+ +
+

398.00

+ +
+

1169.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

771.341

+ +
+

442.00

+ +
+

1213.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

771.341

+ +
+

398.00

+ +
+

1169.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

771.341

+ +
+

442.00

+ +
+

1213.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

771.341

+ +
+

398.00

+ +
+

1169.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

771.341

+ +
+

442.00

+ +
+

1213.34

+ +
+

 

+ +
+

I

+ +
+

Aged/Aged

+ +
+

771.341

+ +
+

689.00

+ +
+

1460.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

771.341

+ +
+

733.00

+ +
+

1504.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

771.341

+ +
+

689.00

+ +
+

1460.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

771.341

+ +
+

733.00

+ +
+

1504.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

771.341

+ +
+

689.00

+ +
+

1460.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

771.341

+ +
+

733.00

+ +
+

1504.34

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

771.341

+ +
+

0.00

+ +
+

771.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

771.341

+ +
+

0.00

+ +
+

771.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

771.341

+ +
+

0.00

+ +
+

771.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

G

+ +
+

Independent living with an EP

+ +

OS code “G” applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18. +

+ +
+

H

+ +
+

Living in the household of another with an EP OS code “H” applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18. +

+ +
+

I

+ +
+

Effective January 1, 1988, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2019: +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

771.00

+ +
+

87.00

+ +
+

858.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

771.00

+ +
+

157.50

+ +
+

928.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

771.00

+ +
+

179.30

+ +
+

950.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1157.001

+ +
+

14.00

+ +
+

1171.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

514.002

+ +
+

9.33

+ +
+

523.33

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.003

+ +
+

7.00

+ +
+

37.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

1157.00

+ +
+

559.00

+ +
+

1716.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

1157.00

+ +
+

700.00

+ +
+

1857.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

1157.00

+ +
+

743.60

+ +
+

1900.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1543.001

+ +
+

21.00

+ +
+

1564.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

771.341

+ +
+

14.00

+ +
+

785.34

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care.

+ +
+

H

+ +
+

State-certified residence in-group home for mentally disabled.

+ +
+

I

+ +
+

State-certified residence in-group home for physically or developmentally disabled.

+ +
+

J

+ +
+

State-certified residence for child and adult foster care.

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled.

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2019: +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

771.00

+ +
+

94.00

+ +
+

865.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

771.00

+ +
+

94.00

+ +
+

865.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

771.00

+ +
+

94.00

+ +
+

865.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

771.00

+ +
+

52.75

+ +
+

823.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

771.00

+ +
+

26.00

+ +
+

797.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

514.001

+ +
+

0.00

+ +
+

514.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

1157.00

+ +
+

193.00

+ +
+

1350.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1157.00

+ +
+

193.00

+ +
+

1350.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1157.00

+ +
+

193.00

+ +
+

1350.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

1157.00

+ +
+

110.50

+ +
+

1267.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

1157.00

+ +
+

57.00

+ +
+

1214.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

771.341

+ +
+

0.00

+ +
+

771.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living or living in parental household +

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code “A.” For optional State supplement codes, see + SM 01301.535. +

+ +
+

B

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement “B” because the criteria for this supplement level are the same as for + Federal code “B.” +

+ +
+

C

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live + in a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Apply “No Supplement” code “Y” to the following recipients: +

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2019: +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

771.00

+ +
+

36.40

+ +
+

807.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

771.00

+ +
+

109.30

+ +
+

880.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

771.00

+ +
+

391.00

+ +
+

1162.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

771.00

+ +
+

391.00

+ +
+

1162.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

514.001

+ +
+

24.27

+ +
+

538.27

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

514.00

+ +
+

213.96

+ +
+

727.96

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

514.00

+ +
+

0.00

+ +
+

514.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

771.00

+ +
+

109.30

+ +
+

880.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1157.00

+ +
+

74.46

+ +
+

1231.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1157.00

+ +
+

374.60

+ +
+

1531.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1157.00

+ +
+

374.60

+ +
+

1531.60

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1157.00

+ +
+

74.46

+ +
+

1231.46

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1157.00

+ +
+

374.60

+ +
+

1531.60

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1157.00

+ +
+

881.00

+ +
+

2038.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1157.00

+ +
+

881.00

+ +
+

2038.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1157.00

+ +
+

881.00

+ +
+

2038.00

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1157.00

+ +
+

881.00

+ +
+

2038.00

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1157.00

+ +
+

881.00

+ +
+

2038.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

771.34

+ +
+

49.64

+ +
+

820.98

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

771.34

+ +
+

531.94

+ +
+

1303.28

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

771.34

+ +
+

531.94

+ +
+

1303.28

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

771.34

+ +
+

49.64

+ +
+

820.98

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

771.34

+ +
+

531.94

+ +
+

1303.28

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

771.34

+ +
+

0.00

+ +
+

771.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Living alone or with others

+ +

 

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +
+

Living alone with an ineligible spouse +

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If + other persons, even minor children, are present in the household, you cannot apply + this OS + code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Licensed residential health care facilities (RHCF) +

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to January 1, 2006. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey + Congregate Care Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Apply OS code “G” effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or + effective December 1, 1996, to children residing in public or private facilities where + private health insurance paid for their care. For determination of applicability of + $30 payment limit, see SI 00520.011. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2019: +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

771.00

+ +
+

150.05

+ +
+

921.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

771.00

+ +
+

31.25

+ +
+

802.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

771.00

+ +
+

153.00

+ +
+

924.00

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

1157.001

+ +
+

25.36

+ +
+

1182.36

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

771.00

+ +
+

210.05

+ +
+

981.05

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

514.002

+ +
+

44.31

+ +
+

558.31

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

771.00

+ +
+

31.25

+ +
+

802.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

20.00

+ +
+

50.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1157.00

+ +
+

618.36

+ +
+

1775.36

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1157.00

+ +
+

25.36

+ +
+

1182.36

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1157.00

+ +
+

738.36

+ +
+

1895.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

771.341

+ +
+

93.09

+ +
+

864.43

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +
+

Living in the household of another with an + EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a personal care boarding home (PCBH) +

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2019: +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

C

+ +
+

All

+ +
+

1157.001

+ +
+

43.70

+ +
+

1200.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

771.00

+ +
+

434.30

+ +
+

1205.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

771.00

+ +
+

439.30

+ +
+

1210.30

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +

 

+ +
+

514.002

+ +
+

0.00

+ +
+

514.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

771.343

+ +
+

43.70

+ +
+

815.04

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

C

+ +
+

All

+ +
+

1543.001

+ +
+

68.05

+ +
+

1611.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1157.00

+ +
+

947.40

+ +
+

2104.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1157.00

+ +
+

957.40

+ +
+

2114.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1157.00

+ +
+

0.00

+ +
+

1157.00

+ +
+

B 

+ +
+

D

+ +
+

All

+ +
+

1057.342

+ +
+

68.05

+ +
+

1225.39

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

771.343

+ +
+

0.00

+ +
+

771.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients +

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities as certified by the Rhode Island Department of Human Services. +

+ +
+

F

+ +
+

Advanced Care

+ +

Apply OS code “F” only to recipients living in a licensed adult community supportive + living residence and receiving advanced care as certified by the Rhode Island Executive + Office of Health and Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category “D” or “F”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2019: +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +

 

+ +

F

+ +
+

All

+ +

 

+ +

All

+ +
+

771.00

+ +

 

+ +

771.00

+ +
+

332.00

+ +

 

+ +

797.00

+ +
+

1103.00

+ +

 

+ +

1568.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

771.00

+ +
+

0.00

+ +
+

771.00

+ +
+
+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living (except Chittenden + County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50 percent of their care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +
+

Licensed residential care home or assisted living + residence with assistive community care services (Level III) +

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of Licensing and Protection for Vermont + State. Use this website link:: https://dail.vermont.gov/sites/dail/files//documents/Assisted_living_regs_final_2003.pdf . +

+ +
+

E

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +
+

Licensed residential care home or therapeutic community + residence (Level IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of Licensing and Protection for Vermont + State. Use this website link: https://dlp.vermont.gov/sites/dlp/files/documents/Residential-Care-Home-Directory2.pdf

+ +
+

H

+ +
+

Custodial care: family home +

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the above requirements. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +
+

Apply OS code “I” effective July 1, 1987, when the State + elected Federal administration of an optional State + supplementary payment to residents in Title XIX + facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2019: +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

771.00

+ +
+

52.04

+ +
+

823.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

771.00

+ +
+

52.04

+ +
+

823.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

771.00

+ +
+

48.38

+ +
+

819.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

771.00

+ +
+

223.94

+ +
+

994.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

771.00

+ +
+

98.69

+ +
+

869.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

514.00

+ +
+

39.30

+ +
+

553.30

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

771.00

+ +
+

52.04

+ +
+

823.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

771.00

+ +
+

52.04

+ +
+

823.04

+ +
+

D

+ +
+

A or B2

+ +
+

Children Private Insurance

+ +
+

30.001

+ +
+

52.04

+ +
+

82.04

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

17.66

+ +
+

47.66

+ +
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All(Except Chittenden County)

+ +
+

1157.00

+ +
+

98.88

+ +
+

1255.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

1157.00

+ +
+

98.88

+ +
+

1255.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1157.00

+ +
+

96.77

+ +
+

1253.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1157.00

+ +
+

562.06

+ +
+

1719.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1157.00

+ +
+

332.82

+ +
+

1489.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

771.341

+ +
+

48.31

+ +
+

819.65

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

35.33

+ +
+

95.33

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of their optional State supplement category. Contact other persons with + knowledge of the recipient’s living situation, if necessary (land lord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289. +

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415051
SI 01415.051 - Federally Administered Optional Supplementary Payment Programs for January 2019 - 08/13/2024
+Batch run: 02/19/2025
+Rev:08/13/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html new file mode 100644 index 00000000..f4553820 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2020.html @@ -0,0 +1,12839 @@ + + +SSA - POMS: SI 01415.052 - Federally Administered Optional Supplementary Payment Programs for January 2020 - 08/15/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 85 (08-24)

+

SI 01415.052 Federally Administered Optional Supplementary Payment Programs for January 2020 +

+ + +
+
+

CITATIONS:

+
+
Social Security Act as amended in 1973, +
Section + 1616; Social + Security Amendments of 1972, Section + 301
+ +
Public Law 93-66, Section + 212 +
+ +
+
+
+
+

A. List of States participating in the federally administered optional supplementary + payment program +

+
+
+

The following states participate in federally administered optional supplementary + payment programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+ +
+

Reference

+ +
+

California

+ +
+

SI 01415.052B

+ +
+

Delaware

+ +
+

SI 01415.052C

+ +
+

District of Columbia

+ +
+

SI 01415.052D

+ +
+

Hawaii

+ +
+

SI 01415.052E

+ +
+

Iowa

+ +
+

SI 01415.052F

+ +
+

Michigan

+ +
+

SI 01415.052G

+ +
+

Montana

+ +
+

SI 01415.052H

+ +
+

Nevada

+ +
+

SI 01415.052I

+ +
+

New Jersey

+ +
+

SI 01415.052J

+ +
+

Pennsylvania

+ +
+

SI 01415.052K

+ +
+

Rhode Island

+ +
+

SI 01415.052L

+ +
+

Vermont

+ +
+

SI 01415.052M

+ +
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Use optional supplement (OS) code “A” for independent + living with cooking facilities for an eligible recipient or couple who meet one of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
+

B

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Apply OS code “B” for non-medical out-of-home care + (NMOHC) when a recipient or couple needs non-medical care or supervision in the following + living arrangement situations: +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. McMahon + decision); or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA “A” and resides in the home of a relative, legal + conservator, or guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a family home certified by a family + home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
+

C

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Independent living without cooking facilities

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement. +

    + +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS “C.” +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities, which are outside the + immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + can access for preparing meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for + preparing meals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has access to + the following: +

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove, or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +
+
+

NOTE: 

+
+
+ +

For purposes of OS “C,” “throughout a month” does not mean the recipient must lack + adequate cooking or food storage facilities from the very first moment of the month. + The recipient need only lack them from some time on the first day of the month. +

+ +
+
+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment. +

+ +
+

D

+ +

 

+ +

 

+ +
+

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. Most recipient or couples + who are subject to a one-third reduction of their Federal SSI payments are eligible + for OS “D” because the criteria for this supplement level are the same as for charging + the one-third reduction. However, when the eligible recipient or couple lives in the + home of a relative (other than a spouse) and needs care and supervision, you must + obtain certification for non-medical out-of-home care (OS “F”) from the county welfare + office since this is the highest categorical supplement that a recipient or couple + can qualify. +

+ +
+

E

+ +
+

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +
+
+

NOTE: 

+
+
+ +

Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third reduction + (VTR) applies, see code “G.” +

+ +
+
+ +
+

F

+ +
+

Non-medical out-of-home care living in the household of + another

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
+

G

+ +
+

Disabled child under 18 living in the of another +

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal + code “B” payment for living in the household of another person. For the one-third + reduction provision, see SI 00835.200. +

+ +
+

J

+ +
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2020: +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

Federal Benefit Rate (FBR)

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

783.00

+ +
+

160.72

+ +
+

943.72

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

783.00

+ +
+

217.23

+ +
+

1000.23

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

783.00

+ +
+

160.72

+ +
+

943.72

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

783.00

+ +
+

423.37

+ +
+

1206.37

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

783.00

+ +
+

247.04

+ +
+

1030.04

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

783.00

+ +
+

247.04

+ +
+

1030.04

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

783.00

+ +
+

65.15

+ +
+

848.15

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

522.001

+ +
+

164.24

+ +
+

686.24

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

522.001

+ +
+

220.76

+ +
+

742.76

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

522.001

+ +
+

164.24

+ +
+

686.24

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

522.001

+ +
+

418.23

+ +
+

940.23

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

522.001

+ +
+

68.67

+ +
+

590.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

783.00

+ +
+

217.23

+ +
+

1000.23

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

783.00

+ +
+

65.15

+ +
+

848.15

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

21.00

+ +
+

51.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+

NOTE: 

+
+
+ +

California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+ +
+
+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1175.00

+ +
+

407.14

+ +
+

1582.14

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1175.00

+ +
+

558.19

+ +
+

1733.19

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1175.00

+ +
+

407.14

+ +
+

1582.14

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1175.00

+ +
+

500.65

+ +
+

1675.65

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1175.00

+ +
+

407.14

+ +
+

1582.14

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1175.00

+ +
+

500.65

+ +
+

1675.65

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1175.00

+ +
+

1237.74

+ +
+

2412.74

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1175.00

+ +
+

579.77

+ +
+

1754.77

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1175.00

+ +
+

579.77

+ +
+

1754.77

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1175.00

+ +
+

579.77

+ +
+

1754.77

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

783.341

+ +
+

412.41

+ +
+

1195.75

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

783.341

+ +
+

563.46

+ +
+

1346.80

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

783.341

+ +
+

412.41

+ +
+

1195.75

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

783.341

+ +
+

505.92

+ +
+

1289.26

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

783.341

+ +
+

412.41

+ +
+

1195.75

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

783.341

+ +
+

505.92

+ +
+

1289.26

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

783.341

+ +
+

1074.52

+ +
+

1857.86

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

42.00

+ +
+

102.00

+ +
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult residential care facility, assisted living + facility, or adult foster care home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2020: +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

783.00

+ +
+

140.00

+ +
+

923.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

522.00

+ +
+

0.00

+ +
+

522.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1175.00

+ +
+

448.00

+ +
+

1623.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

783.34

+ +
+

0.00

+ +
+

783.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult foster care home with 50 or fewer residents +

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult foster care home with more than 50 residents +

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX + facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2020: +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

783.00

+ +
+

640.00

+ +
+

1423.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

783.00

+ +
+

750.00

+ +
+

1533.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

522.001

+ +
+

0.00

+ +
+

522.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1175.00

+ +
+

1636.00

+ +
+

2811.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1175.00

+ +
+

1856.00

+ +
+

3031.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

783.341

+ +
+

0.00

+ +
+

783.34

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +
+

Living in a community care or foster care home +

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +
+

Domiciliary care I (maximum of five + residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2020: +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +
+

B

+ +
+

All

+ +
+

783.00

+ +
+

651.90

+ +
+

1434.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

783.00

+ +
+

651.90

+ +
+

1434.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

783.00

+ +
+

759.90

+ +
+

1542.90

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

522.00

+ +
+

0.00

+ +
+

522.00

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

30.001

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

B

+ +
+

All

+ +
+

1175.00

+ +
+

1640.80

+ +
+

2815.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1175.00

+ +
+

1640.80

+ +
+

2815.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1175.00

+ +
+

1856.80

+ +
+

3031.80

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

783.34

+ +
+

0.00

+ +
+

783.34

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

60.001

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple + who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +
+

Living in the household of another (blind only)

+ +

OS code “B” is only for an eligible blind recipient and the blind member of a + couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +
+

Living with a dependent person

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

G

+ +
+

Use OS code “G” to indicate that no supplement is payable to a recipient living in a + Title XIX facility and Title XIX pays more than 50 percent of the cost of care. However, a Federal “D” living arrangement is not appropriate because the recipient + did not meet the “throughout a month” requirement at the initial claims input. +

+ +
+

I

+ +
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA “B,” who resides + in a family life home or boarding home licensed by the State Department of Health, + or certified by the State Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +
+
+

NOTE: 

+
+
+ +

The State Department of Human Services administers three optional supplementation + programs: +

+ +
+
+ +

 

+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  6. +
+ +
+
+
+
+

NOTE: 

+
+
+ +

Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+ +
+
+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2020: +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

783.00

+ +
+

22.00

+ +
+

805.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

783.00

+ +
+

405.00

+ +
+

1188.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

783.00

+ +
+

427.00

+ +
+

1210.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

783.00

+ +
+

405.00

+ +
+

1188.00

+ +
+

 

+ +
+

D

+ +
+

Aged

+ +
+

783.00

+ +
+

142.00

+ +
+

925.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

783.00

+ +
+

164.00

+ +
+

947.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

783.00

+ +
+

142.00

+ +
+

925.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

522.001

+ +
+

22.00

+ +
+

544.00

+ +
+

 

+ +
+

H

+ +
+

Aged

+ +
+

522.001

+ +
+

405.00

+ +
+

927.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

522.001

+ +
+

427.00

+ +
+

949.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

522.001

+ +
+

405.00

+ +
+

927.00

+ +
+

 

+ +
+

I

+ +
+

Aged

+ +
+

522.001

+ +
+

142.00

+ +
+

664.00

+ +
+

 

+ +
+

I

+ +
+

Disabled

+ +
+

522.001

+ +
+

142.00

+ +
+

664.00

+ +
+

 

+ +
+

I

+ +
+

Blind

+ +
+

522.001

+ +
+

164.00

+ +
+

686.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

522.001

+ +
+

0.00

+ +
+

522.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

783.00

+ +
+

22.00

+ +
+

805.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

783.00

+ +
+

427.00

+ +
+

1210.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

783.00

+ +
+

405.00

+ +
+

1188.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+

NOTE: 

+
+
+ +

State-administered programs for calendar year 2015 include recipients receiving:

+ +
+
+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

1175.00

+ +
+

44.00

+ +
+

1219.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

1175.00

+ +
+

44.00

+ +
+

1219.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1175.00

+ +
+

44.00

+ +
+

1219.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1175.00

+ +
+

405.00

+ +
+

1580.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1175.00

+ +
+

449.00

+ +
+

1624.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1175.00

+ +
+

405.00

+ +
+

1580.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1175.00

+ +
+

449.00

+ +
+

1624.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1175.00

+ +
+

405.00

+ +
+

1580.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1175.00

+ +
+

449.00

+ +
+

1624.00

+ +
+

 

+ +
+

D

+ +
+

Aged/Aged

+ +
+

1175.00

+ +
+

695.00

+ +
+

1870.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1175.00

+ +
+

739.00

+ +
+

1914.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1175.00

+ +
+

695.00

+ +
+

1870.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1175.00

+ +
+

739.00

+ +
+

1914.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1175.00

+ +
+

695.00

+ +
+

1870.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1175.00

+ +
+

739.00

+ +
+

1914.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

783.341

+ +
+

44.00

+ +
+

827.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

783.341

+ +
+

44.00

+ +
+

827.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

783.341

+ +
+

44.00

+ +
+

827.34

+ +
+

 

+ +
+

H

+ +
+

Aged/Aged

+ +
+

783.341

+ +
+

405.00

+ +
+

1188.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

783.341

+ +
+

449.00

+ +
+

1232.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

783.341

+ +
+

405.00

+ +
+

1188.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

783.341

+ +
+

449.00

+ +
+

1232.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

783.341

+ +
+

405.00

+ +
+

1188.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

783.341

+ +
+

449.00

+ +
+

1232.34

+ +
+

 

+ +
+

I

+ +
+

Aged/Aged

+ +
+

783.341

+ +
+

695.00

+ +
+

1478.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

783.341

+ +
+

739.00

+ +
+

1522.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

783.341

+ +
+

695.00

+ +
+

1478.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

783.341

+ +
+

739.00

+ +
+

1522.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

783.341

+ +
+

695.00

+ +
+

1478.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

783.341

+ +
+

739.00

+ +
+

1522.34

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

783.341

+ +
+

0.00

+ +
+

783.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

783.341

+ +
+

0.00

+ +
+

783.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

783.341

+ +
+

0.00

+ +
+

783.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+

NOTE: 

+
+
+ +

State-administered programs for calendar year 2015 include recipients receiving:

+ +
+
+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

G

+ +
+

Independent living with an EP

+ +

OS code “G” applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18. +

+ +
+

H

+ +
+

Living in the household of another with an EP OS code “H” applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18. +

+ +
+

I

+ +
+

Effective January 1, 1988, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2020: +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

783.00

+ +
+

87.00

+ +
+

870.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

783.00

+ +
+

157.50

+ +
+

940.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

783.00

+ +
+

179.30

+ +
+

962.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1175.001

+ +
+

14.00

+ +
+

1189.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

522.002

+ +
+

9.33

+ +
+

531.33

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.003

+ +
+

7.00

+ +
+

37.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

1175.00

+ +
+

565.00

+ +
+

1740.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

1175.00

+ +
+

706.00

+ +
+

1881.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

1175.00

+ +
+

749.60

+ +
+

1924.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1567.001

+ +
+

21.00

+ +
+

1588.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

783.341

+ +
+

13.96

+ +
+

797.30

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care.

+ +
+

H

+ +
+

State-certified residence in-group home for mentally disabled.

+ +
+

I

+ +
+

State-certified residence in-group home for physically or developmentally disabled.

+ +
+

J

+ +
+

State-certified residence for child and adult foster care.

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled.

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2020: +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

783.00

+ +
+

94.00

+ +
+

877.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

783.00

+ +
+

94.00

+ +
+

877.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

783.00

+ +
+

94.00

+ +
+

877.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

783.00

+ +
+

52.75

+ +
+

835.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

783.00

+ +
+

26.00

+ +
+

809.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

522.001

+ +
+

0.00

+ +
+

522.00

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

1175.00

+ +
+

193.00

+ +
+

1368.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1175.00

+ +
+

193.00

+ +
+

1368.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1175.00

+ +
+

193.00

+ +
+

1368.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

1175.00

+ +
+

110.50

+ +
+

1285.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

1175.00

+ +
+

57.00

+ +
+

1232.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

783.341

+ +
+

0.00

+ +
+

783.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living or living in parental household

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code “A.” For optional State supplement codes, see + SM 01301.535. +

+ +
+

B

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement “B” because the criteria for this supplement level are the same as for + Federal code “B.” +

+ +
+

C

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live + in a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Apply “No Supplement” code “Y” to the following recipients: +

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+
+
+

NOTE: 

+
+
+ +

Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2020: +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

783.00

+ +
+

36.40

+ +
+

819.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

783.00

+ +
+

109.30

+ +
+

892.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

783.00

+ +
+

391.00

+ +
+

1174.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

783.00

+ +
+

391.00

+ +
+

1174.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

522.001

+ +
+

24.27

+ +
+

546.27

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

522.00

+ +
+

213.96

+ +
+

735.96

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

522.00

+ +
+

0.00

+ +
+

522.00

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

783.00

+ +
+

109.30

+ +
+

892.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1175.00

+ +
+

74.46

+ +
+

1249.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1175.00

+ +
+

374.60

+ +
+

1549.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1175.00

+ +
+

374.60

+ +
+

1549.60

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1175.00

+ +
+

74.46

+ +
+

1249.46

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1175.00

+ +
+

374.60

+ +
+

1549.60

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1175.00

+ +
+

881.00

+ +
+

2056.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1175.00

+ +
+

881.00

+ +
+

2056.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1175.00

+ +
+

881.00

+ +
+

2056.00

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1175.00

+ +
+

881.00

+ +
+

2056.00

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1175.00

+ +
+

881.00

+ +
+

2056.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

783.34

+ +
+

49.64

+ +
+

832.98

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

783.34

+ +
+

531.94

+ +
+

1315.28

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

783.34

+ +
+

531.94

+ +
+

1315.28

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

783.34

+ +
+

49.64

+ +
+

832.98

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

783.34

+ +
+

531.94

+ +
+

1315.28

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

783.34

+ +
+

0.00

+ +
+

783.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Living alone or with others

+ +

 

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +
+

Living alone with an ineligible spouse +

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If + other persons, even minor children, are present in the household, you cannot apply + this OS + code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Licensed residential health care facilities (RHCF) +

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to January 1, 2006. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey + Congregate Care Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Apply OS code “G” effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or + effective December 1, 1996, to children residing in public or private facilities where + private health insurance paid for their care. For determination of applicability of + $30 payment limit, see SI 00520.011. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2020: +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

783.00

+ +
+

150.05

+ +
+

933.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

783.00

+ +
+

31.25

+ +
+

814.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

783.00

+ +
+

153.00

+ +
+

936.00

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

1175.001

+ +
+

25.36

+ +
+

1200.36

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

783.00

+ +
+

210.05

+ +
+

993.05

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

522.002

+ +
+

44.31

+ +
+

566.31

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

783.00

+ +
+

31.25

+ +
+

814.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

20.00

+ +
+

50.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1175.00

+ +
+

618.36

+ +
+

1793.36

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1175.00

+ +
+

25.36

+ +
+

1200.36

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1175.00

+ +
+

738.36

+ +
+

1913.36

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

783.341

+ +
+

93.09

+ +
+

876.43

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +
+

Living in the household of another with an + EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a personal care boarding home (PCBH) +

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2020: +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

C

+ +
+

All

+ +
+

1175.001

+ +
+

43.70

+ +
+

1218.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

783.00

+ +
+

434.30

+ +
+

1217.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

783.00

+ +
+

439.30

+ +
+

1222.30

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +

 

+ +
+

522.002

+ +
+

0.00

+ +
+

522.00

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

783.343

+ +
+

43.70

+ +
+

827.04

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

C

+ +
+

All

+ +
+

1567.001

+ +
+

68.05

+ +
+

1635.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1175.00

+ +
+

947.40

+ +
+

2122.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1175.00

+ +
+

957.40

+ +
+

2132.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1175.00

+ +
+

0.00

+ +
+

1175.00

+ +
+

B 

+ +
+

D

+ +
+

All

+ +
+

1044.662

+ +
+

68.05

+ +
+

1112.71

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

783.343

+ +
+

0.00

+ +
+

783.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients +

+
+
+

NOTE: 

+
+
+ +

Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+ +
+
+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities as certified by the Rhode Island Department of Human Services. +

+ +
+

F

+ +
+

Advanced Care

+ +

Apply OS code “F” only to recipients living in a licensed adult community supportive + living residence and receiving advanced care as certified by the Rhode Island Executive + Office of Health and Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category “D” or “F”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2020: +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +

 

+ +

F

+ +
+

All

+ +

 

+ +

All

+ +
+

783.00

+ +

 

+ +

783.00

+ +
+

332.00

+ +

 

+ +

797.00

+ +
+

1115.00

+ +

 

+ +

1580.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

783.00

+ +
+

0.00

+ +
+

783.00

+ +
+
+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living (except Chittenden + County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50 percent of their care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +
+

Licensed residential care home or assisted living + residence with assistive community care services (Level III) +

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of Licensing and Protection for Vermont + State. Use this website link:: https://dail.vermont.gov/sites/dail/files//documents/Assisted_living_regs_final_2003.pdf . +

+ +
+

E

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +
+

Licensed residential care home or therapeutic community + residence (Level IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of Licensing and Protection for Vermont + State. Use this website link: https://dlp.vermont.gov/sites/dlp/files/documents/Residential-Care-Home-Directory2.pdf

+ +
+

H

+ +
+

Custodial care: family home +

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the above requirements. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +
+

Apply OS code “I” effective July 1, 1987, when the State + elected Federal administration of an optional State + supplementary payment to residents in Title XIX + facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2020: +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

783.00

+ +
+

52.04

+ +
+

835.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

783.00

+ +
+

52.04

+ +
+

835.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

783.00

+ +
+

48.38

+ +
+

831.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

783.00

+ +
+

223.94

+ +
+

1006.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

783.00

+ +
+

98.69

+ +
+

881.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

522.00

+ +
+

39.30

+ +
+

561.30

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

783.00

+ +
+

52.04

+ +
+

835.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

783.00

+ +
+

52.04

+ +
+

835.04

+ +
+

D

+ +
+

A or B2

+ +
+

Children Private Insurance

+ +
+

30.001

+ +
+

52.04

+ +
+

82.04

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

42.66

+ +
+

72.66

+ +
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All(Except Chittenden County)

+ +
+

1175.00

+ +
+

98.88

+ +
+

1273.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

1175.00

+ +
+

98.88

+ +
+

1273.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1175.00

+ +
+

96.77

+ +
+

1271.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1175.00

+ +
+

562.06

+ +
+

1737.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1175.00

+ +
+

332.82

+ +
+

1507.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

783.341

+ +
+

48.31

+ +
+

831.65

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

85.32

+ +
+

145.32

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of their optional State supplement category. Contact other persons with + knowledge of the recipient’s living situation, if necessary (land lord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289. +

+

 

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415052
SI 01415.052 - Federally Administered Optional Supplementary Payment Programs for January 2020 - 08/15/2024
+Batch run: 02/19/2025
+Rev:08/15/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html new file mode 100644 index 00000000..68bbf3ff --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2021.html @@ -0,0 +1,12723 @@ + + +SSA - POMS: SI 01415.053 - Federally Administered Optional Supplementary Payment Programs for January 2021 - 08/19/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 87 (08-24)

+

SI 01415.053 Federally Administered Optional Supplementary Payment Programs for January 2021 +

+ + +
+
+

CITATIONS:

+
+
Social Security Act as amended in 1973, +
Section + 1616; Social + Security Amendments of 1972, Section + 301
+ +
Public Law 93-66, Section + 212 +
+ +
+
+
+
+

A. List of States participating in the federally administered optional supplementary + payment program +

+
+
+

The following states participate in federally administered optional supplementary + payment programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+ +
+

Reference

+ +
+

California

+ +
+

SI 01415.053B

+ +
+

Delaware

+ +
+

SI 01415.053C

+ +
+

District of Columbia

+ +
+

SI 01415.053D

+ +
+

Hawaii

+ +
+

SI 01415.053E

+ +
+

Iowa

+ +
+

SI 01415.053F

+ +
+

Michigan

+ +
+

SI 01415.053G

+ +
+

Montana

+ +
+

SI 01415.053H

+ +
+

Nevada

+ +
+

SI 01415.053I

+ +
+

New Jersey

+ +
+

SI 01415.053J

+ +
+

Pennsylvania

+ +
+

SI 01415.053K

+ +
+

Rhode Island

+ +
+

SI 01415.053L

+ +
+

Vermont

+ +
+

SI 01415.053M

+ +
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Use optional supplement (OS) code “A” for independent living with cooking facilities + for an eligible recipient or couple who meet one of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Apply OS code “B” for non-medical out-of-home care (NMOHC) when a recipient or couple needs non-medical care or supervision in the following + living arrangement situations: +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. + McMahon decision); or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA “A” and resides in the home of a relative, legal + conservator, or guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a State licensed NMOHC facility; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a family home certified by a family + home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
+

C

+ +
+

Independent living without cooking facilities

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement. +

    + +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS “C.” +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities, which are outside the + immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + can access for preparing meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for + preparing meals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has access to + the following: +

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove, or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +

NOTE: For purposes of OS “C,” “throughout a month” does not mean the recipient must lack + adequate cooking or food storage facilities from the very first moment of the month. + The recipient need only lack them from some time on the first day of the month. +

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment. +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. Most recipient or couples + who are subject to a one-third reduction of their Federal SSI payments are eligible + for OS “D” because the criteria for this supplement level are the same as for charging + the one-third reduction. However, when the eligible recipient or couple lives in the + home of a relative (other than a spouse) and needs care and supervision, you must + obtain certification for non-medical out-of-home care (OS “F”) from the county welfare + office since this is the highest categorical supplement that a recipient or couple + can qualify. +

+ +
+

E

+ +
+

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +

NOTE: Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third reduction + (VTR) applies, see code “G.” +

+ +
+

F

+ +
+

Non-medical out-of-home care living in the household of another

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
+

G

+ +
+

Disabled child under 18 living in the of another

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal + code “B” payment for living in the household of another person. For the one-third + reduction provision, see SI 00835.200. +

+ +
+

J

+ +
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2021: +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

Federal Benefit Rate (FBR)

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

794.00

+ +
+

160.72

+ +
+

954.72

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

794.00

+ +
+

217.23

+ +
+

1011.23

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

794.00

+ +
+

160.72

+ +
+

954.72

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

794.00

+ +
+

423.37

+ +
+

1217.37

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

794.00

+ +
+

247.04

+ +
+

1041.04

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

794.00

+ +
+

247.04

+ +
+

1041.04

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

794.00

+ +
+

65.15

+ +
+

859.15

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

529.341

+ +
+

164.24

+ +
+

693.58

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

529.341

+ +
+

220.76

+ +
+

750.10

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

529.341

+ +
+

164.24

+ +
+

693.58

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

529.341

+ +
+

418.23

+ +
+

947.57

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

529.341

+ +
+

68.67

+ +
+

598.01

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

794.00

+ +
+

217.23

+ +
+

1011.23

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

794.00

+ +
+

65.15

+ +
+

859.15

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

21.00

+ +
+

51.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1191.00

+ +
+

407.14

+ +
+

1598.14

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1191.00

+ +
+

558.19

+ +
+

1749.19

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1191.00

+ +
+

407.14

+ +
+

1598.14

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1191.00

+ +
+

500.65

+ +
+

1691.65

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1191.00

+ +
+

407.14

+ +
+

1598.14

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1191.00

+ +
+

500.65

+ +
+

1691.65

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1191.00

+ +
+

1237.74

+ +
+

2428.74

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1191.00

+ +
+

579.77

+ +
+

1770.77

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1191.00

+ +
+

579.77

+ +
+

1770.77

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1191.00

+ +
+

579.77

+ +
+

1770.77

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

794.001

+ +
+

412.41

+ +
+

1206.41

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

794.001

+ +
+

563.46

+ +
+

1357.46

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

794.001

+ +
+

412.41

+ +
+

1206.41

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

794.001

+ +
+

505.92

+ +
+

1299.92

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

794.001

+ +
+

412.41

+ +
+

1206.41

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

794.001

+ +
+

505.92

+ +
+

1299.92

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

794.001

+ +
+

1074.52

+ +
+

1868.52

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

42.00

+ +
+

102.00

+ +
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult residential care facility, assisted living facility, or adult foster care + home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2021: +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

794.00

+ +
+

140.00

+ +
+

934.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

529.34

+ +
+

0.00

+ +
+

529.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1191.00

+ +
+

448.00

+ +
+

1639.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult foster care home with 50 or fewer residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult foster care home with more than 50 residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more + than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2021: +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

794.00

+ +
+

640.00

+ +
+

1434.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

794.00

+ +
+

750.00

+ +
+

1544.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

529.341

+ +
+

0.00

+ +
+

529.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1191.00

+ +
+

1636.00

+ +
+

2827.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1191.00

+ +
+

1856.00

+ +
+

3047.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

794.001

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +
+

Living in a community care or foster care home

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +
+

Domiciliary care I (maximum of five residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2021: +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +
+

B

+ +
+

All

+ +
+

794.00

+ +
+

651.90

+ +
+

1445.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

794.00

+ +
+

651.90

+ +
+

1445.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

794.00

+ +
+

759.90

+ +
+

1553.90

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

529.34

+ +
+

0.00

+ +
+

529.34

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

30.001

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

B

+ +
+

All

+ +
+

1191.00

+ +
+

1640.80

+ +
+

2831.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1191.00

+ +
+

1640.80

+ +
+

2831.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1191.00

+ +
+

1856.80

+ +
+

3047.80

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

60.001

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple + who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +
+

Living in the household of another (blind only)

+ +

OS code “B” is only for an eligible blind recipient and the blind member of a + couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +
+

Living with a dependent person

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

G

+ +
+

Use OS code “G” to indicate that no supplement is payable to a recipient living in a + Title XIX facility and Title XIX pays more than 50 percent of the cost of care. However, a Federal “D” living arrangement is not appropriate because the recipient + did not meet the “throughout a month” requirement at the initial claims input. +

+ +
+

I

+ +
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA “B,” who resides + in a family life home or boarding home licensed by the State Department of Health, + or certified by the State Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  6. +
+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2021: +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

794.00

+ +
+

22.00

+ +
+

816.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

794.00

+ +
+

411.00

+ +
+

1205.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

794.00

+ +
+

433.00

+ +
+

1227.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

794.00

+ +
+

411.00

+ +
+

1205.00

+ +
+

 

+ +
+

D

+ +
+

Aged

+ +
+

794.00

+ +
+

142.00

+ +
+

936.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

794.00

+ +
+

164.00

+ +
+

958.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

794.00

+ +
+

142.00

+ +
+

936.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

529.341

+ +
+

22.00

+ +
+

551.34

+ +
+

 

+ +
+

H

+ +
+

Aged

+ +
+

529.341

+ +
+

411.00

+ +
+

940.34

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

529.341

+ +
+

433.00

+ +
+

962.34

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

529.341

+ +
+

411.00

+ +
+

940.34

+ +
+

 

+ +
+

I

+ +
+

Aged

+ +
+

529.341

+ +
+

142.00

+ +
+

671.34

+ +
+

 

+ +
+

I

+ +
+

Disabled

+ +
+

529.341

+ +
+

142.00

+ +
+

671.34

+ +
+

 

+ +
+

I

+ +
+

Blind

+ +
+

529.341

+ +
+

164.00

+ +
+

693.34

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

529.341

+ +
+

0.00

+ +
+

529.34

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

794.00

+ +
+

22.00

+ +
+

816.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

794.00

+ +
+

433.00

+ +
+

1227.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

794.00

+ +
+

411.00

+ +
+

1205.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

1191.00

+ +
+

44.00

+ +
+

1235.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

1191.00

+ +
+

44.00

+ +
+

1235.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1191.00

+ +
+

44.00

+ +
+

1235.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1191.00

+ +
+

411.00

+ +
+

1602.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1191.00

+ +
+

455.00

+ +
+

1646.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1191.00

+ +
+

411.00

+ +
+

1602.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1191.00

+ +
+

455.00

+ +
+

1646.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1191.00

+ +
+

411.00

+ +
+

1602.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1191.00

+ +
+

455.00

+ +
+

1646.00

+ +
+

 

+ +
+

D

+ +
+

Aged/Aged

+ +
+

1191.00

+ +
+

701.00

+ +
+

1892.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1191.00

+ +
+

745.00

+ +
+

1936.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1191.00

+ +
+

701.00

+ +
+

1892.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1191.00

+ +
+

745.00

+ +
+

1936.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1191.00

+ +
+

701.00

+ +
+

1892.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1191.00

+ +
+

745.00

+ +
+

1936.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

794.001

+ +
+

44.00

+ +
+

838.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

794.001

+ +
+

44.00

+ +
+

838.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

794.001

+ +
+

44.00

+ +
+

838.00

+ +
+

 

+ +
+

H

+ +
+

Aged/Aged

+ +
+

794.001

+ +
+

411.00

+ +
+

1205.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

794.001

+ +
+

455.00

+ +
+

1249.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

794.001

+ +
+

411.00

+ +
+

1205.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

794.001

+ +
+

455.00

+ +
+

1249.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

794.001

+ +
+

411.00

+ +
+

1205.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

794.001

+ +
+

455.00

+ +
+

1249.00

+ +
+

 

+ +
+

I

+ +
+

Aged/Aged

+ +
+

794.001

+ +
+

701.00

+ +
+

1495.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

794.001

+ +
+

745.00

+ +
+

1539.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

794.001

+ +
+

701.00

+ +
+

1495.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

794.001

+ +
+

745.00

+ +
+

1539.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

794.001

+ +
+

701.00

+ +
+

1495.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

794.001

+ +
+

745.00

+ +
+

1539.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

794.001

+ +
+

0.00

+ +
+

794.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

794.001

+ +
+

0.00

+ +
+

794.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

794.001

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

G

+ +
+

Independent living with an EP

+ +

OS code “G” applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18. +

+ +
+

H

+ +
+

Living in the household of another with an EP OS code “H” applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18. +

+ +
+

I

+ +
+

Effective January 1, 1988, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2021: +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

794.00

+ +
+

87.00

+ +
+

881.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

794.00

+ +
+

157.50

+ +
+

951.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

794.00

+ +
+

179.30

+ +
+

973.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1191.001

+ +
+

14.00

+ +
+

1205.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

529.342

+ +
+

9.33

+ +
+

538.67

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.003

+ +
+

7.00

+ +
+

37.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

1191.00

+ +
+

571.00

+ +
+

1762.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

1191.00

+ +
+

712.00

+ +
+

1903.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

1191.00

+ +
+

755.60

+ +
+

1946.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1588.001

+ +
+

21.00

+ +
+

1609.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

794.001

+ +
+

13.96

+ +
+

807.96

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care.

+ +
+

H

+ +
+

State-certified residence in-group home for mentally disabled.

+ +
+

I

+ +
+

State-certified residence in-group home for physically or developmentally disabled.

+ +
+

J

+ +
+

State-certified residence for child and adult foster care.

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled.

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2021: +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

794.00

+ +
+

94.00

+ +
+

888.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

794.00

+ +
+

94.00

+ +
+

888.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

794.00

+ +
+

94.00

+ +
+

888.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

794.00

+ +
+

52.75

+ +
+

846.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

794.00

+ +
+

26.00

+ +
+

820.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

529.341

+ +
+

0.00

+ +
+

529.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

1191.00

+ +
+

193.00

+ +
+

1384.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1191.00

+ +
+

193.00

+ +
+

1384.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1191.00

+ +
+

193.00

+ +
+

1384.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

1191.00

+ +
+

110.50

+ +
+

1301.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

1191.00

+ +
+

57.00

+ +
+

1248.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

794.001

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living or living in parental household

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code “A.” For optional State supplement codes, see + SM 01301.535. +

+ +
+

B

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement “B” because the criteria for this supplement level are the same as for + Federal code “B.” +

+ +
+

C

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live + in a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Apply “No Supplement” code “Y” to the following recipients: +

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2021: +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

794.00

+ +
+

36.40

+ +
+

830.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

794.00

+ +
+

109.30

+ +
+

903.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

794.00

+ +
+

391.00

+ +
+

1185.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

794.00

+ +
+

391.00

+ +
+

1185.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

529.341

+ +
+

24.27

+ +
+

553.61

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

529.34

+ +
+

213.96

+ +
+

743.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

529.34

+ +
+

0.00

+ +
+

529.34

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

794.00

+ +
+

109.30

+ +
+

903.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1191.00

+ +
+

74.46

+ +
+

1265.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1191.00

+ +
+

374.60

+ +
+

1565.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1191.00

+ +
+

374.60

+ +
+

1565.60

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1161.00

+ +
+

74.46

+ +
+

1265.46

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1191.00

+ +
+

374.60

+ +
+

1565.60

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1191.00

+ +
+

881.00

+ +
+

2072.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1191.00

+ +
+

881.00

+ +
+

2072.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1191.00

+ +
+

881.00

+ +
+

2072.00

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1191.00

+ +
+

881.00

+ +
+

2072.00

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1191.00

+ +
+

881.00

+ +
+

2072.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

794.00

+ +
+

49.64

+ +
+

843.64

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

794.00

+ +
+

531.94

+ +
+

1325.94

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

794.00

+ +
+

531.94

+ +
+

1325.94

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

794.00

+ +
+

49.64

+ +
+

843.64

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

794.00

+ +
+

531.94

+ +
+

1325.94

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Living alone or with others

+ +

 

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +
+

Living alone with an ineligible spouse +

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If + other persons, even minor children, are present in the household, you cannot apply + this OS + code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Licensed residential health care facilities (RHCF)

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to January 1, 2006. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey Congregate Care + Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Apply OS code “G” effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or + effective December 1, 1996, to children residing in public or private facilities where + private health insurance paid for their care. For determination of applicability of + $30 payment limit, see SI 00520.011. +

+ +
+
+

NOTE: All State Supplement payments, except for medicaid facilities, include a Lifeline + payment which is a utility assistance program for older people and people with disabilities + that offers an annual benefit amount for individuals who receive SSI. +

+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2021: +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

794.00

+ +
+

150.05

+ +
+

944.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

794.00

+ +
+

31.25

+ +
+

825.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

794.00

+ +
+

152.99

+ +
+

946.99

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

1191.001

+ +
+

25.35

+ +
+

1216.35

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

794.00

+ +
+

210.05

+ +
+

1004.05

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

529.342

+ +
+

44.31

+ +
+

573.65

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

794.00

+ +
+

31.25

+ +
+

825.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

20.00

+ +
+

50.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1191.00

+ +
+

618.35

+ +
+

1809.351

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1191.00

+ +
+

25.35

+ +
+

1216.351

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1191.00

+ +
+

738.35

+ +
+

1929.351

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

794.002

+ +
+

93.08

+ +
+

887.08

+ 1
+

D

+ +
+

G

+ +
+

All

+ +
+

60.003

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1This amount is the total of the federal payment, the state supplement amount, and + the lifeline payment. When added together and divided in half for each member of the + couple, the result includes a half penny. The total is rounded up to accommodate system + processing. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +
+

Living in the household of another with an EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a personal care boarding home (PCBH)

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2021: +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

C

+ +
+

All

+ +
+

1191.001

+ +
+

43.70

+ +
+

1234.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

794.00

+ +
+

434.30

+ +
+

1228.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

794.00

+ +
+

439.30

+ +
+

1233.30

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +

 

+ +
+

529.342

+ +
+

0.00

+ +
+

529.34

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

794.003

+ +
+

43.70

+ +
+

837.70

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

C

+ +
+

All

+ +
+

1588.001

+ +
+

68.05

+ +
+

1656.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1191.00

+ +
+

947.40

+ +
+

2138.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1191.00

+ +
+

957.40

+ +
+

2148.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1191.00

+ +
+

0.00

+ +
+

1191.00

+ +
+

B 

+ +
+

D

+ +
+

All

+ +
+

1058.672

+ +
+

68.05

+ +
+

1126.72

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

794.003

+ +
+

0.00

+ +
+

794.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients +

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities as certified by the Rhode Island Department of Human Services. +

+ +
+

F

+ +
+

Advanced Care

+ +

Apply OS code “F” only to recipients living in a licensed adult community supportive + living residence and receiving advanced care as certified by the Rhode Island Executive + Office of Health and Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category “D” or “F”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2021: +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +

 

+ +

F

+ +
+

All

+ +

 

+ +

All

+ +
+

794.00

+ +

 

+ +

794.00

+ +
+

332.00

+ +

 

+ +

797.00*

+ +
+

1126.00

+ +

 

+ +

1591.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+
+

* Effective 11/1/2021 RI no longer pays OS F.

+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living (except Chittenden County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50 percent of their care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +
+

Licensed residential care home or assisted living residence with assistive community + care services (Level III)

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of Licensing and + Protection for Vermont State. Use this website link:: https://dail.vermont.gov/sites/dail/files//documents/Assisted_living_regs_final_2003.pdf . +

+ +
+

E

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +
+

Licensed residential care home or therapeutic community residence (Level + IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of Licensing and Protection for + Vermont State. Use this website link: https://dlp.vermont.gov/sites/dlp/files/documents/Residential-Care-Home-Directory2.pdf

+ +
+

H

+ +
+

Custodial care: family home +

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the above requirements. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +
+

Apply OS code “I” effective July 1, 1987, when the State elected Federal administration + of an optional State supplementary payment to residents in Title XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2021: +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

794.00

+ +
+

52.04

+ +
+

846.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

794.00

+ +
+

52.04

+ +
+

846.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

794.00

+ +
+

48.38

+ +
+

842.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

794.00

+ +
+

223.94

+ +
+

1017.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

794.00

+ +
+

98.69

+ +
+

892.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

529.34

+ +
+

39.30

+ +
+

568.64

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

794.00

+ +
+

52.04

+ +
+

846.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

794.00

+ +
+

52.04

+ +
+

846.04

+ +
+

D

+ +
+

A or B2

+ +
+

Children Private Insurance

+ +
+

30.001

+ +
+

52.04

+ +
+

82.04

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

42.66

+ +
+

72.66

+ +
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All(Except Chittenden County)

+ +
+

1191.00

+ +
+

98.88

+ +
+

1289.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

1191.00

+ +
+

98.88

+ +
+

1289.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1191.00

+ +
+

96.77

+ +
+

1287.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1191.00

+ +
+

562.06

+ +
+

1753.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1191.00

+ +
+

332.82

+ +
+

1523.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

794.001

+ +
+

48.31

+ +
+

842.31

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

85.32

+ +
+

145.32

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of their optional State supplement category. Contact other persons with + knowledge of the recipient’s living situation, if necessary (land lord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289. +

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415053
SI 01415.053 - Federally Administered Optional Supplementary Payment Programs for January 2021 - 08/19/2024
+Batch run: 02/19/2025
+Rev:08/19/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html new file mode 100644 index 00000000..6009f0b4 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2022.html @@ -0,0 +1,12768 @@ + + +SSA - POMS: SI 01415.054 - Federally Administered Optional Supplementary Payment Programs for January 2022 - 08/12/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 80 (08-24)

+

SI 01415.054 Federally Administered Optional Supplementary Payment Programs for January 2022 +

+ + +
+
+

CITATIONS:

+
+
Social Security Act as amended in 1973, +
Section 1616; Social Security Amendments of 1972, Section 301
+ +
Public Law 93-66, Section + 212 +
+ +
+
+
+
+

A. List of States participating in the federally administered optional supplementary + payment program +

+
+
+

The following states participate in federally administered optional supplementary + payment programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+ +
+

Reference

+ +
+

California

+ +
+

SI 01415.054B

+ +
+

Delaware

+ +
+

SI 01415.054C

+ +
+

District of Columbia

+ +
+

SI 01415.054D

+ +
+

Hawaii

+ +
+

SI 01415.054E

+ +
+

Iowa

+ +
+

SI 01415.054F

+ +
+

Michigan

+ +
+

SI 01415.054G

+ +
+

Montana

+ +
+

SI 01415.054H

+ +
+

Nevada

+ +
+

SI 01415.054I

+ +
+

New Jersey

+ +
+

SI 01415.054J

+ +
+

Pennsylvania

+ +
+

SI 01415.054K

+ +
+

Rhode Island

+ +
+

SI 01415.054L

+ +
+

Vermont

+ +
+

SI 01415.054M

+ +
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Use optional supplement (OS) code “A” for independent living with + cooking facilities for an eligible recipient or couple who meet one of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Apply OS code “B” for non-medical out-of-home care (NMOHC) when a recipient or couple needs non-medical care or supervision in the following + living arrangement situations: +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. McMahon decision); or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA “A” and resides in the home of a relative, legal + conservator, or guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a family home certified by a family + home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
+

C

+ +
+

Independent living without cooking facilities

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement. +

    + +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS “C.” +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities, which are outside the + immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + can access for preparing meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for + preparing meals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has access to + the following: +

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove, or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +
+
+

NOTE: For purposes of OS “C,” “throughout a month” does not mean the recipient must lack + adequate cooking or food storage facilities from the very first moment of the month. + The recipient need only lack them from some time on the first day of the month. +

+ +
+
+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment. +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. Most recipient or couples + who are subject to a one-third reduction of their Federal SSI payments are eligible + for OS “D” because the criteria for this supplement level are the same as for charging + the one-third reduction. However, when the eligible recipient or couple lives in the + home of a relative (other than a spouse) and needs care and supervision, you must + obtain certification for non-medical out-of-home care (OS “F”) from the county welfare + office since this is the highest categorical supplement that a recipient or couple + can qualify. +

+ +
+

E

+ +
+

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +
+
+

NOTE: Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third reduction + (VTR) applies, see code “G.” +

+ +
+
+ +
+

F

+ +
+

Non-medical out-of-home care living in the household of another +

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
+

G

+ +
+

Disabled child under 18 living in the of another

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal + code “B” payment for living in the household of another person. For the one-third + reduction provision, see SI 00835.200. +

+ +
+

J

+ +
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2022: +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

Federal Benefit Rate (FBR)

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

841.00

+ +
+

199.21

+ +
+

1040.21

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

841.00

+ +
+

269.26

+ +
+

1110.26

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

841.00

+ +
+

199.21

+ +
+

1040.21

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

841.00

+ +
+

524.77

+ +
+

1365.77

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

841.00

+ +
+

306.20

+ +
+

1147.20

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

841.00

+ +
+

306.20

+ +
+

1147.20

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

841.00

+ +
+

80.75

+ +
+

921.75

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

560.671

+ +
+

203.58

+ +
+

764.25

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

560.671

+ +
+

273.63

+ +
+

834.30

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

560.671

+ +
+

203.58

+ +
+

764.25

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

560.671

+ +
+

518.40

+ +
+

1079.07

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

560.671

+ +
+

85.12

+ +
+

645.79

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

841.00

+ +
+

269.26

+ +
+

1110.26

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

841.00

+ +
+

80.75

+ +
+

921.75

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

26.00

+ +
+

56.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+ +
+
+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1261.00

+ +
+

504.64

+ +
+

1765.64

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1261.00

+ +
+

691.88

+ +
+

1952.88

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1261.00

+ +
+

504.64

+ +
+

1765.64

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1261.00

+ +
+

620.55

+ +
+

1881.55

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1261.00

+ +
+

504.64

+ +
+

1765.64

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1261.00

+ +
+

620.55

+ +
+

1881.55

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1261.00

+ +
+

1470.54

+ +
+

2731.54

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1261.00

+ +
+

718.63

+ +
+

1979.63

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1261.00

+ +
+

718.63

+ +
+

1979.63

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1261.00

+ +
+

718.63

+ +
+

1979.63

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

840.671

+ +
+

511.18

+ +
+

1351.85

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

840.671

+ +
+

698.41

+ +
+

1539.08

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

840.671

+ +
+

511.18

+ +
+

1351.85

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

840.671

+ +
+

627.09

+ +
+

1467.76

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

840.671

+ +
+

511.18

+ +
+

1351.85

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

840.671

+ +
+

627.09

+ +
+

1467.76

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

840.671

+ +
+

1331.87

+ +
+

2172.54

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

52.00

+ +
+

112.00

+ +
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult residential care facility, assisted living facility, or adult + foster care home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2022: +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

841.00

+ +
+

140.00

+ +
+

981.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

560.67

+ +
+

0.00

+ +
+

560.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1261.00

+ +
+

448.00

+ +
+

1709.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

840.67

+ +
+

0.00

+ +
+

840.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult foster care home with 50 or fewer residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult foster care home with more than 50 residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2022: +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

841.00

+ +
+

640.00

+ +
+

1481.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

841.00

+ +
+

750.00

+ +
+

1591.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

560.671

+ +
+

0.00

+ +
+

560.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

40.00

+ +
+

70.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1261.00

+ +
+

1636.00

+ +
+

2897.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1261.00

+ +
+

1856.00

+ +
+

3117.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

840.671

+ +
+

0.00

+ +
+

840.67

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

80.00

+ +
+

140.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +
+

Living in a community care or foster care home

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +
+

Domiciliary care I (maximum of five residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2022: +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +
+

B

+ +
+

All

+ +
+

841.00

+ +
+

651.90

+ +
+

1492.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

841.00

+ +
+

651.90

+ +
+

1492.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

841.00

+ +
+

759.90

+ +
+

1600.90

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

560.67

+ +
+

0.00

+ +
+

560.67

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

30.001

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

B

+ +
+

All

+ +
+

1261.00

+ +
+

1640.80

+ +
+

2901.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1261.00

+ +
+

1640.80

+ +
+

2901.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1261.00

+ +
+

1856.80

+ +
+

3117.80

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1.261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

840.67

+ +
+

0.00

+ +
+

840.67

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

60.001

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple + who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +
+

Living in the household of another (blind only)

+ +

OS code “B” is only for an eligible blind recipient and the blind member of a + couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +
+

Living with a dependent person

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

G

+ +
+

Use OS code “G” to indicate that no supplement is payable to a recipient living in a + Title XIX facility and Title XIX pays more than 50 percent of the cost of care. However, a Federal “D” living arrangement is not appropriate because the recipient + did not meet the “throughout a month” requirement at the initial claims input. +

+ +
+

I

+ +
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA “B,” who resides + in a family life home or boarding home licensed by the State Department of Health, + or certified by the State Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +
+
+

NOTE: The State Department of Human Services administers three optional supplementation + programs: +

+ +
+
+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  6. +
+ +
+
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+ +
+
+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2022: +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

841.00

+ +
+

22.00

+ +
+

863.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

841.00

+ +
+

436.00

+ +
+

1277.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

841.00

+ +
+

458.00

+ +
+

1299.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

841.00

+ +
+

436.00

+ +
+

1277.00

+ +
+

 

+ +
+

D

+ +
+

Aged

+ +
+

841.00

+ +
+

142.00

+ +
+

983.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

841.00

+ +
+

164.00

+ +
+

1005.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

841.00

+ +
+

142.00

+ +
+

983.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

560.671

+ +
+

22.00

+ +
+

582.67

+ +
+

 

+ +
+

H

+ +
+

Aged

+ +
+

560.671

+ +
+

436.00

+ +
+

996.67

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

560.671

+ +
+

458.00

+ +
+

1018.67

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

560.671

+ +
+

436.00

+ +
+

996.67

+ +
+

 

+ +
+

I

+ +
+

Aged

+ +
+

560.671

+ +
+

142.00

+ +
+

702.67

+ +
+

 

+ +
+

I

+ +
+

Disabled

+ +
+

560.671

+ +
+

142.00

+ +
+

702.67

+ +
+

 

+ +
+

I

+ +
+

Blind

+ +
+

560.671

+ +
+

164.00

+ +
+

724.67

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

560.671

+ +
+

0.00

+ +
+

560.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

841.00

+ +
+

22.00

+ +
+

863.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

841.00

+ +
+

458.00

+ +
+

1299.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

841.00

+ +
+

436.00

+ +
+

1277.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+ +
+
+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

1261.00

+ +
+

44.00

+ +
+

1305.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

1261.00

+ +
+

44.00

+ +
+

1305.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1261.00

+ +
+

44.00

+ +
+

1305.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1261.00

+ +
+

436.00

+ +
+

1697.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1261.00

+ +
+

480.00

+ +
+

1741.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1261.00

+ +
+

436.00

+ +
+

1697.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1261.00

+ +
+

480.00

+ +
+

1741.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1261.00

+ +
+

436.00

+ +
+

1697.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1261.00

+ +
+

480.00

+ +
+

1741.00

+ +
+

 

+ +
+

D

+ +
+

Aged/Aged

+ +
+

1261.00

+ +
+

725.00

+ +
+

1986.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1261.00

+ +
+

769.00

+ +
+

2030.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1261.00

+ +
+

725.00

+ +
+

1986.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1261.00

+ +
+

769.00

+ +
+

2030.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1261.00

+ +
+

725.00

+ +
+

1986.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1261.00

+ +
+

769.00

+ +
+

2030.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

1261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

840.671

+ +
+

44.00

+ +
+

884.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

860.671

+ +
+

44.00

+ +
+

884.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

860.671

+ +
+

44.00

+ +
+

884.67

+ +
+

 

+ +
+

H

+ +
+

Aged/Aged

+ +
+

840.671

+ +
+

436.00

+ +
+

1276.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

840.671

+ +
+

480.00

+ +
+

1320.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

840.671

+ +
+

436.00

+ +
+

1276.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

840.671

+ +
+

480.00

+ +
+

1320.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

840.671

+ +
+

436.00

+ +
+

1276.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

840.671

+ +
+

480.00

+ +
+

1320.67

+ +
+

 

+ +
+

I

+ +
+

Aged/Aged

+ +
+

840.671

+ +
+

725.00

+ +
+

1565.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

840.671

+ +
+

769.00

+ +
+

1609.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

840.671

+ +
+

725.00

+ +
+

1565.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

840.671

+ +
+

769.00

+ +
+

1609.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

840.671

+ +
+

725.00

+ +
+

1565.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

840.671

+ +
+

769.00

+ +
+

1609.67

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

840.671

+ +
+

0.00

+ +
+

840.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

840.671

+ +
+

0.00

+ +
+

840.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

840.671

+ +
+

0.00

+ +
+

840.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+ +
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

G

+ +
+

Independent living with an EP

+ +

OS code “G” applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18. +

+ +
+

H

+ +
+

Living in the household of another with an EP OS code “H” applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18. +

+ +
+

I

+ +
+

Effective January 1, 1988, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2022: +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

841.00

+ +
+

87.00

+ +
+

928.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

841.00

+ +
+

157.50

+ +
+

998.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

841.00

+ +
+

179.30

+ +
+

1020.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1262.001

+ +
+

14.00

+ +
+

1276.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

560.672

+ +
+

9.33

+ +
+

570.00

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.003

+ +
+

7.00

+ +
+

37.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

1261.00

+ +
+

571.00

+ +
+

1832.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

1261.00

+ +
+

712.00

+ +
+

1973.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

1261.00

+ +
+

755.60

+ +
+

2016.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1682.341

+ +
+

21.00

+ +
+

1703.34

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

840.671

+ +
+

13.96

+ +
+

854.63

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care.

+ +
+

H

+ +
+

State-certified residence in-group home for mentally disabled.

+ +
+

I

+ +
+

State-certified residence in-group home for physically or developmentally disabled.

+ +
+

J

+ +
+

State-certified residence for child and adult foster care.

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled.

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2022: +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

841.00

+ +
+

94.00

+ +
+

935.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

841.00

+ +
+

94.00

+ +
+

935.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

841.00

+ +
+

94.00

+ +
+

935.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

841.00

+ +
+

52.75

+ +
+

893.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

841.00

+ +
+

26.00

+ +
+

867.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

560.671

+ +
+

0.00

+ +
+

560.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

1261.00

+ +
+

193.00

+ +
+

1454.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1261.00

+ +
+

193.00

+ +
+

1454.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1261.00

+ +
+

193.00

+ +
+

1454.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

1261.00

+ +
+

110.50

+ +
+

1371.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

1261.00

+ +
+

57.00

+ +
+

1318.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

840.671

+ +
+

0.00

+ +
+

840.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living or living in parental household

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code “A.” For optional State supplement codes, see + SM 01301.535. +

+ +
+

B

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement “B” because the criteria for this supplement level are the same as for + Federal code “B.” +

+ +
+

C

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live + in a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Apply “No Supplement” code “Y” to the following recipients: +

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2022: +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

841.00

+ +
+

36.40

+ +
+

877.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

841.00

+ +
+

109.30

+ +
+

950.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

841.00

+ +
+

391.00

+ +
+

1232.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

841.00

+ +
+

391.00

+ +
+

1232.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

560.671

+ +
+

24.27

+ +
+

584.94

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

560.67

+ +
+

213.96

+ +
+

774.63

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

560.67

+ +
+

0.00

+ +
+

560.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

841.00

+ +
+

109.30

+ +
+

950.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1261.00

+ +
+

74.46

+ +
+

1335.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1261.00

+ +
+

374.60

+ +
+

1635.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1261.00

+ +
+

374.60

+ +
+

1635.60

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1261.00

+ +
+

74.46

+ +
+

1335.46

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1261.00

+ +
+

374.60

+ +
+

1635.60

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1261.00

+ +
+

881.00

+ +
+

2142.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1261.00

+ +
+

881.00

+ +
+

2142.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1261.00

+ +
+

881.00

+ +
+

2142.00

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1261.00

+ +
+

881.00

+ +
+

2142.00

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1261.00

+ +
+

881.00

+ +
+

2142.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

1261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

840.67

+ +
+

49.64

+ +
+

890.31

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

840.67

+ +
+

531.94

+ +
+

1372.61

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

840.67

+ +
+

531.94

+ +
+

1372.61

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

840.67

+ +
+

49.64

+ +
+

890.31

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

840.67

+ +
+

531.94

+ +
+

1372.61

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

840.67

+ +
+

0.00

+ +
+

840.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Living alone or with others

+ +

 

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +
+

Living alone with an ineligible spouse

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If other persons, even minor + children, are present in the household, you cannot apply this OS code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Licensed residential health care facilities (RHCF)

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to January 1, 2006. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey Congregate Care + Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Apply OS code “G” effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or + effective December 1, 1996, to children residing in public or private facilities where + private health insurance paid for their care. For determination of applicability of + $30 payment limit, see SI 00520.011. +

+ +
+
+
+
+

NOTE: All State Supplement payments, except for medicaid facilities, include a Lifeline + payment which is a utility assistance program for older people and people with disabilities + that offers an annual benefit amount for individuals who receive SSI. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2022: +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

841.00

+ +
+

150.05

+ +
+

991.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

841.00

+ +
+

31.25

+ +
+

872.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

841.00

+ +
+

152.99

+ +
+

993.99

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

1262.001

+ +
+

25.35

+ +
+

1287.35

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

841.00

+ +
+

210.05

+ +
+

1051.05

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

560.672

+ +
+

44.31

+ +
+

604.98

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

841.00

+ +
+

31.25

+ +
+

872.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

20.00

+ +
+

50.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1261.00

+ +
+

618.35

+ +
+

1879.351

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1261.00

+ +
+

25.35

+ +
+

1286.351

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1261.00

+ +
+

738.35

+ +
+

1999.351

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

840.672

+ +
+

93.08

+ +
+

933.751

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.003

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1This amount is the total of the federal payment, the state supplement amount, and + the lifeline payment. When added together and divided in half for each member of the + couple, the result includes a half penny. The total is rounded up to accommodate system + processing. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +
+

Living in the household of another with an EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a personal care boarding home (PCBH)

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2022: +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

C

+ +
+

All

+ +
+

1262.001

+ +
+

43.70

+ +
+

1305.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

841.00

+ +
+

434.30

+ +
+

1275.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

841.00

+ +
+

439.30

+ +
+

1280.30

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +

 

+ +
+

560.672

+ +
+

0.00

+ +
+

560.67

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

841.343

+ +
+

43.70

+ +
+

885.04

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

841.00

+ +
+

0.00

+ +
+

841.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

C

+ +
+

All

+ +
+

1682.001

+ +
+

68.05

+ +
+

1750.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1261.00

+ +
+

947.40

+ +
+

2208.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1261.00

+ +
+

957.40

+ +
+

2218.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1261.00

+ +
+

0.00

+ +
+

1261.00

+ +
+

B 

+ +
+

D

+ +
+

All

+ +
+

1121.342

+ +
+

68.05

+ +
+

1189.39

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

840.673

+ +
+

0.00

+ +
+

840.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients +

+
+
+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+ +
+
+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities as certified by the Rhode Island Department of Human Services. +

+ +
+

F

+ +
+

Advanced Care

+ +

Apply OS code “F” only to recipients living in a licensed adult community supportive + living residence and receiving advanced care as certified by the Rhode Island Executive + Office of Health and Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category “D” or “F”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2022: +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +

 

+ +

 

+ +
+

All

+ +

 

+ +

 

+ +
+

841.00

+ +

 

+ +

 

+ +
+

332.00

+ +

 

+ +

 

+ +
+

1173.00

+ +

 

+ +

 

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

794.00

+ +
+

0.00

+ +
+

794.00

+ +
+
+

 

+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living (except Chittenden County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50 percent of their care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +
+

Licensed residential care home or assisted living residence with + assistive community care services (Level III)

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of Licensing and + Protection for Vermont State. Use this website link:: https://dail.vermont.gov/sites/dail/files//documents/Assisted_living_regs_final_2003.pdf . +

+ +
+

E

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +
+

Licensed residential care home or therapeutic community residence (Level + IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of Licensing and + Protection for Vermont State. Use this website link: https://dlp.vermont.gov/sites/dlp/files/documents/Residential-Care-Home-Directory2.pdf

+ +
+

H

+ +
+

Custodial care: family home +

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the above requirements. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +
+

Apply OS code “I” effective July 1, 1987, when the State elected Federal + administration of an optional State supplementary payment to residents in Title + XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2022: +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

841.00

+ +
+

52.04

+ +
+

893.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

841.00

+ +
+

52.04

+ +
+

893.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

841.00

+ +
+

48.38

+ +
+

889.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

841.00

+ +
+

223.94

+ +
+

1064.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

841.00

+ +
+

98.69

+ +
+

939.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

560.67

+ +
+

39.30

+ +
+

599.97

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

841.00

+ +
+

52.04

+ +
+

893.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

841.00

+ +
+

52.04

+ +
+

893.04

+ +
+

D

+ +
+

A or B2

+ +
+

Children Private Insurance

+ +
+

30.001

+ +
+

52.04

+ +
+

82.04

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

42.66

+ +
+

72.66

+ +
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All(Except Chittenden County)

+ +
+

1261.00

+ +
+

98.88

+ +
+

1359.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

1261.00

+ +
+

98.88

+ +
+

1359.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1261.00

+ +
+

96.77

+ +
+

1357.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1261.00

+ +
+

562.06

+ +
+

1823.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1261.00

+ +
+

332.82

+ +
+

1593.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

840.671

+ +
+

48.31

+ +
+

888.98

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

85.32

+ +
+

145.32

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of their optional State supplement category. Contact other persons with + knowledge of the recipient’s living situation, if necessary (land lord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289. +

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415054
SI 01415.054 - Federally Administered Optional Supplementary Payment Programs for January 2022 - 08/12/2024
+Batch run: 02/19/2025
+Rev:08/12/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html new file mode 100644 index 00000000..a36252b8 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2023.html @@ -0,0 +1,12773 @@ + + +SSA - POMS: SI 01415.055 - Federally Administered Optional Supplemental Payment Programs for January 2023 - 08/15/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 86 (08-24)

+

SI 01415.055 Federally Administered Optional Supplemental Payment Programs for January 2023 +

+ + +
+
+

CITATIONS:

+
+
Social Security Act as amended in 1973, +
Section 1616 ; Social Security Amendments of 1972, Section 301
+ +
Public Law 93-66, Section + 212 +
+
+
+
+
+

A. List of States participating in the federally administered optional supplementary + payment program +

+
+
+

The following states participate in federally administered optional supplementary + payment programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

State

+ +
+

Reference

+ +
+

California

+ +
+

SI 01415.055B

+ +
+

Delaware

+ +
+

SI 01415.055C

+ +
+

District of Columbia

+ +
+

SI 01415.055D

+ +
+

Hawaii

+ +
+

SI 01415.055E

+ +
+

Iowa

+ +
+

SI 01415.055F

+ +
+

Michigan

+ +
+

SI 01415.055G

+ +
+

Montana

+ +
+

SI 01415.055H

+ +
+

Nevada

+ +
+

SI 01415.055I

+ +
+

New Jersey

+ +
+

SI 01415.055J

+ +
+

Pennsylvania

+ +
+

SI 01415.055K

+ +
+

Rhode Island

+ +
+

SI 01415.055L

+ +
+

Vermont

+ +
+

SI 01415.055M

+ +
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Use optional supplement (OS) code “A” for independent living with cooking facilities + for an eligible recipient or couple who meet one of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Apply OS code “B” for non-medical out-of-home care (NMOHC) when a recipient or couple needs non-medical care or supervision in the following + living arrangement situations: +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. + McMahon decision); or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA “A” and resides in the home of a relative, legal + conservator, or guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a State licensed NMOHC facility; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a family home certified by a family + home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
+

C

+ +
+

Independent living without cooking facilities

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living arrangement. +

    + +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS “C.” +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the living + arrangement (including cooking and food storage facilities, which are outside the + immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking and food storage facilities that they + can access for preparing meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence for + preparing meals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have meals prepared and provided as part of the living + arrangement (for example, the Supplemental Security Income (SSI) recipient’s arrangement + with the facility is to purchase only shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has access to + the following: +

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with at least two working burners. (Do not consider + the capacity of the refrigerator or icebox when making this determination. Also, do + not consider an ice chest to be adequate storage.); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with separate temperature controls, or two one-burner + hotplates with temperature controls. (Do not consider hotplates without temperature + controls used for warming food as “adequate cooking facilities.”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning microwave oven in combination with at + least one working burner on a stove, or a one-burner hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +
+
+

NOTE: For purposes of OS “C,” “throughout a month” does not mean the recipient must lack + adequate cooking or food storage facilities from the very first moment of the month. + The recipient need only lack them from some time on the first day of the month. +

+ +
+
+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled member of the couple. This living + arrangement requires force due payment. +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. Most recipient or couples + who are subject to a one-third reduction of their Federal SSI payments are eligible + for OS “D” because the criteria for this supplement level are the same as for charging + the one-third reduction. However, when the eligible recipient or couple lives in the + home of a relative (other than a spouse) and needs care and supervision, you must + obtain certification for non-medical out-of-home care (OS “F”) from the county welfare + office since this is the highest categorical supplement that a recipient or couple + can qualify. +

+ +
+

E

+ +
+

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +
+
+

NOTE: Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third reduction + (VTR) applies, see code “G.” +

+ +
+
+ +
+

F

+ +
+

Non-medical out-of-home care living in the household of another

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
+

G

+ +
+

Disabled child under 18 living in the of another

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal + code “B” payment for living in the household of another person. For the one-third + reduction provision, see SI 00835.200. +

+ +
+

J

+ +
+

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2023: +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

Federal Benefit Rate (FBR)

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

914.00

+ +
+

219.73

+ +
+

1133.73

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

914.00

+ +
+

297.00

+ +
+

1211.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

914.00

+ +
+

219.73

+ +
+

1133.73

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

914.00

+ +
+

578.82

+ +
+

1492.82

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

914.00

+ +
+

337.74

+ +
+

1251.74

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

914.00

+ +
+

337.74

+ +
+

1251.74

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

914.00

+ +
+

89.07

+ +
+

1003.07

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

B

+ +
+

D

+ +
+

Aged

+ +
+

609.341

+ +
+

224.55

+ +
+

833.89

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

609.341

+ +
+

301.82

+ +
+

911.16

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

609.341

+ +
+

224.55

+ +
+

833.89

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

609.341

+ +
+

571.80

+ +
+

1181.14

+ +
+

 

+ +
+

G

+ +
+

Disabled

+ +
+

914.001

+ +
+

93.89

+ +
+

1003.14

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

914.00

+ +
+

297.00

+ +
+

1211.00

+ +
+

 

+ +
+

E

+ +
+

Disabled

+ +
+

914.00

+ +
+

89.07

+ +
+

1003.07

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

30.002

+ +
+

29.00

+ +
+

59.00

+ +
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+

NOTE: California is a concurrent category State and permits SSI recipients to receive the + highest categorical supplement for which they can qualify. For more information on + multi-category eligibility, see SI 00501.300B.3.

+ +
+
+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1371.00

+ +
+

556.62

+ +
+

1927.62

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1371.00

+ +
+

763.14

+ +
+

2134.14

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1371.00

+ +
+

556.62

+ +
+

1927.62

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1371.00

+ +
+

684.47

+ +
+

2055.47

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1371.00

+ +
+

556.62

+ +
+

1927.62

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1371.00

+ +
+

684.47

+ +
+

2055.47

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1371.00

+ +
+

1614.564

+ +
+

2984.64

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1371.00

+ +
+

792.65

+ +
+

2163.65

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1371.00

+ +
+

792.65

+ +
+

2163.65

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1371.00

+ +
+

792.65

+ +
+

2163.65

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

B

+ +
+

D

+ +
+

Aged/Aged

+ +
+

914.001

+ +
+

563.83

+ +
+

1477.83

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

914.001

+ +
+

770.35

+ +
+

1684.35

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

914.001

+ +
+

563.83

+ +
+

1477.83

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

914.001

+ +
+

691.68

+ +
+

1605.68

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

914.001

+ +
+

563.83

+ +
+

1477.83

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

914.001

+ +
+

691.68

+ +
+

1605.68

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

914.001

+ +
+

1469.05

+ +
+

2383.05

+ +
+

D

+ +
+

J

+ +
+

All

+ +
+

60.002

+ +
+

57.00

+ +
+

117.00

+ +
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult residential care facility, assisted living facility, or adult foster care + home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2023: +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

914.00

+ +
+

140.00

+ +
+

1054.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

609.34

+ +
+

0.00

+ +
+

609.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1371.00

+ +
+

448.00

+ +
+

1819.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult foster care home with 50 or fewer residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult foster care home with more than 50 residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more + than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2023: +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

914.00

+ +
+

640.00

+ +
+

1554.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

914.00

+ +
+

750.00

+ +
+

1664.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

609.341

+ +
+

0.00

+ +
+

609.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

70.00

+ +
+

100.003

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

3Effective 2/2023. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1371.00

+ +
+

1636.00

+ +
+

3007.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1371.00

+ +
+

1856.00

+ +
+

3227.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

914.001

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

140.00

+ +
+

200.003

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

3Effective 2/2023. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +
+

Living in a community care or foster care home

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +
+

Domiciliary care I (maximum of five residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2023: +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +
+

B

+ +
+

All

+ +
+

914.00

+ +
+

651.90

+ +
+

1565.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

914.00

+ +
+

651.90

+ +
+

1565.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

914.00

+ +
+

759.90

+ +
+

1673.90

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

609.34

+ +
+

0.00

+ +
+

609.34

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

30.001

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

B

+ +
+

All

+ +
+

1371.00

+ +
+

1640.80

+ +
+

3001.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1371.00

+ +
+

1640.80

+ +
+

3001.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1371.00

+ +
+

1856.80

+ +
+

3227.80

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1.371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

60.001

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple + who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +
+

Living in the household of another (blind only)

+ +

OS code “B” is only for an eligible blind recipient and the blind member of a + couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +
+

Living with a dependent person

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

G

+ +
+

Use OS code “G” to indicate that no supplement is payable to a recipient living in a + Title XIX facility and Title XIX pays more than 50 percent of the cost of care. However, a Federal “D” living arrangement is not appropriate because the recipient + did not meet the “throughout a month” requirement at the initial claims input. +

+ +
+

I

+ +
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA “B,” who resides + in a family life home or boarding home licensed by the State Department of Health, + or certified by the State Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +
+
+

NOTE: The State Department of Human Services administers three optional supplementation + programs: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  6. +
+ +
+
+ +
+
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+ +
+
+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2023: +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

914.00

+ +
+

22.00

+ +
+

936.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

914.00

+ +
+

474.00

+ +
+

1388.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

914.00

+ +
+

496.00

+ +
+

1410.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

914.00

+ +
+

474.00

+ +
+

1388.00

+ +
+

 

+ +
+

D

+ +
+

Aged

+ +
+

914.00

+ +
+

142.00

+ +
+

1056.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

914.00

+ +
+

164.00

+ +
+

1078.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

914.00

+ +
+

142.00

+ +
+

1056.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

609.341

+ +
+

22.00

+ +
+

631.34

+ +
+

 

+ +
+

H

+ +
+

Aged

+ +
+

609.341

+ +
+

474.00

+ +
+

1083.34

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

609.341

+ +
+

496.00

+ +
+

1105.34

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

609.341

+ +
+

474.00

+ +
+

1083.34

+ +
+

 

+ +
+

I

+ +
+

Aged

+ +
+

609.341

+ +
+

142.00

+ +
+

751.34

+ +
+

 

+ +
+

I

+ +
+

Disabled

+ +
+

609.341

+ +
+

142.00

+ +
+

751.34

+ +
+

 

+ +
+

I

+ +
+

Blind

+ +
+

609.341

+ +
+

164.00

+ +
+

733.34

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

609.341

+ +
+

0.00

+ +
+

609.34

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

914.00

+ +
+

22.00

+ +
+

936.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

914.00

+ +
+

496.00

+ +
+

1410.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

914.00

+ +
+

474.00

+ +
+

1388.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+ +
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

1371.00

+ +
+

44.00

+ +
+

1415.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

1371.00

+ +
+

44.00

+ +
+

1415.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1371.00

+ +
+

44.00

+ +
+

1415.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1371.00

+ +
+

474.00

+ +
+

1845.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1371.00

+ +
+

518.00

+ +
+

1889.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1371.00

+ +
+

474.00

+ +
+

1845.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1371.00

+ +
+

518.00

+ +
+

1889.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1371.00

+ +
+

474.00

+ +
+

1845.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1371.00

+ +
+

518.00

+ +
+

1889.00

+ +
+

 

+ +
+

D

+ +
+

Aged/Aged

+ +
+

1371.00

+ +
+

761.00

+ +
+

2132.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1371.00

+ +
+

805.00

+ +
+

2176.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1371.00

+ +
+

761.00

+ +
+

2132.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1371.00

+ +
+

805.00

+ +
+

2176.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1371.00

+ +
+

761.00

+ +
+

2132.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1371.00

+ +
+

805.00

+ +
+

2176.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

1371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

914.001

+ +
+

44.00

+ +
+

958.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

914.001

+ +
+

44.00

+ +
+

958.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

914.001

+ +
+

44.00

+ +
+

958.00

+ +
+

 

+ +
+

H

+ +
+

Aged/Aged

+ +
+

914.001

+ +
+

474.00

+ +
+

1388.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

914.001

+ +
+

518.00

+ +
+

1432.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

914.001

+ +
+

474.00

+ +
+

1388.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

914.001

+ +
+

518.00

+ +
+

1432.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

914.001

+ +
+

474.00

+ +
+

1388.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

914.001

+ +
+

518.00

+ +
+

1432.00

+ +
+

 

+ +
+

I

+ +
+

Aged/Aged

+ +
+

914.001

+ +
+

761.00

+ +
+

1675.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

914.001

+ +
+

805.00

+ +
+

1719.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

914.001

+ +
+

761.00

+ +
+

1675.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

914.001

+ +
+

805.00

+ +
+

1719.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

914.001

+ +
+

761.00

+ +
+

1675.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

914.001

+ +
+

805.00

+ +
+

1719.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

914.001

+ +
+

0.00

+ +
+

914.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

914.001

+ +
+

0.00

+ +
+

914.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

914.001

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+

NOTE: State-administered programs for calendar year 2015 include recipients receiving: +

+ +
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

G

+ +
+

Independent living with an EP

+ +

OS code “G” applies to recipients with an essential person who are not living in the + household of another. Exclude from this category children under age 18. +

+ +
+

H

+ +
+

Living in the household of another with an EP OS code “H” applies to recipients with an EP who are living in the household of another + for Federal purposes. Exclude from this category children under age 18. +

+ +
+

I

+ +
+

Effective January 1, 1988, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2023: +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

914.00

+ +
+

87.00

+ +
+

1001.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

914.00

+ +
+

157.50

+ +
+

1071.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

914.00

+ +
+

179.30

+ +
+

1093.30

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1372.001

+ +
+

14.00

+ +
+

1386.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

914.672

+ +
+

9.33

+ +
+

924.00

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.003

+ +
+

7.00

+ +
+

37.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

1371.00

+ +
+

631.00

+ +
+

2002.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

1371.00

+ +
+

772.00

+ +
+

2143.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

1371.00

+ +
+

815.60

+ +
+

2186.60

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1829.001

+ +
+

21.00

+ +
+

1850.00

+ +
+

B

+ +
+

H

+ +
+

All

+ +
+

914.001

+ +
+

13.96

+ +
+

924.96

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care.

+ +
+

H

+ +
+

State-certified residence in-group home for mentally disabled.

+ +
+

I

+ +
+

State-certified residence in-group home for physically or developmentally disabled.

+ +
+

J

+ +
+

State-certified residence for child and adult foster care.

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled.

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2023: +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

914.00

+ +
+

94.00

+ +
+

1008.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

914.00

+ +
+

94.00

+ +
+

1008.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

914.00

+ +
+

94.00

+ +
+

1008.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

914.00

+ +
+

52.75

+ +
+

966.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

914.00

+ +
+

26.00

+ +
+

940.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

609.341

+ +
+

0.00

+ +
+

609.34

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

1371.00

+ +
+

193.00

+ +
+

1564.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1371.00

+ +
+

193.00

+ +
+

1564.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1371.00

+ +
+

193.00

+ +
+

1564.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

1371.00

+ +
+

110.50

+ +
+

1481.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

1371.00

+ +
+

57.00

+ +
+

1428.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

914.001

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living or living in parental household

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code “A.” For optional State supplement codes, see + SM 01301.535. +

+ +
+

B

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement “B” because the criteria for this supplement level are the same as for + Federal code “B.” +

+ +
+

C

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live + in a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Apply “No Supplement” code “Y” to the following recipients: +

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2023: +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

914.00

+ +
+

36.40

+ +
+

950.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

914.00

+ +
+

109.30

+ +
+

1023.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

914.00

+ +
+

391.00

+ +
+

1305.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

914.00

+ +
+

391.00

+ +
+

1305.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

609.341

+ +
+

24.27

+ +
+

633.61

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

609.34

+ +
+

213.96

+ +
+

823.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

609.34

+ +
+

0.00

+ +
+

609.34

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

914.00

+ +
+

109.30

+ +
+

1023.30

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1371.00

+ +
+

74.46

+ +
+

1445.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1371.00

+ +
+

374.60

+ +
+

1745.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1371.00

+ +
+

374.60

+ +
+

1745.60

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1371.00

+ +
+

74.46

+ +
+

1445.46

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1371.00

+ +
+

374.60

+ +
+

1745.60

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1371.00

+ +
+

881.00

+ +
+

2252.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1371.00

+ +
+

881.00

+ +
+

2252.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1371.00

+ +
+

881.00

+ +
+

2252.00

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1371.00

+ +
+

881.00

+ +
+

2252.00

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1371.00

+ +
+

881.00

+ +
+

2252.00

+ +

 

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

1371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

914.00

+ +
+

49.64

+ +
+

963.64

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

914.00

+ +
+

531.94

+ +
+

1445.94

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

914.00

+ +
+

531.94

+ +
+

1445.94

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

914.00

+ +
+

49.64

+ +
+

963.64

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

914.00

+ +
+

531.94

+ +
+

1445.94

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Living alone or with others

+ +

 

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +
+

Living alone with an ineligible spouse

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If + other persons, even minor children, are present in the household, you cannot apply + this OS + code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Licensed residential health care facilities (RHCF)

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to January 1, 2006. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey Congregate Care + Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Apply OS code “G” effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or + effective December 1, 1996, to children residing in public or private facilities where + private health insurance paid for their care. For determination of applicability of + $30 payment limit, see SI 00520.011. +

+ +
+
+
+
+

NOTE: All State Supplement payments, except for medicaid facilities, include a Lifeline + payment which is a utility assistance program for older people and people with disabilities + that offers an annual benefit amount for individuals who receive SSI. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2023: +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

914.00

+ +
+

150.05

+ +
+

1064.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

914.00

+ +
+

31.25

+ +
+

945.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

914.00

+ +
+

152.99

+ +
+

1066.99

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

1372.001

+ +
+

25.35

+ +
+

1396.35

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

914.00

+ +
+

210.05

+ +
+

1124.05

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

609.342

+ +
+

44.31

+ +
+

653.65

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

914.00

+ +
+

31.25

+ +
+

945.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

20.00

+ +
+

50.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1371.00

+ +
+

618.35

+ +
+

1989.351

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1371.00

+ +
+

25.35

+ +
+

1396.351

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1371.00

+ +
+

738.35

+ +
+

2109.351

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

914.002

+ +
+

93.08

+ +
+

1007.081

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.003

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1This amount is the total of the federal payment, the state supplement amount, and + the lifeline payment. When added together and divided in half for each member of the + couple, the result includes a half penny. The total is rounded up to accommodate system + processing. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +
+

Living in the household of another with an EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a personal care boarding home (PCBH)

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2023: +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

C

+ +
+

All

+ +
+

1372.001

+ +
+

43.70

+ +
+

1415.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

914.00

+ +
+

634.30

+ +
+

1548.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

914.00

+ +
+

639.30

+ +
+

1553.30

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +

 

+ +
+

609.342

+ +
+

0.00

+ +
+

609.34

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

914.673

+ +
+

43.70

+ +
+

958.37

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

C

+ +
+

All

+ +
+

1829.001

+ +
+

68.05

+ +
+

1897.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1371.00

+ +
+

1347.40

+ +
+

2718.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1371.00

+ +
+

1357.40

+ +
+

2728.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1371.00

+ +
+

0.00

+ +
+

1371.00

+ +
+

B 

+ +
+

D

+ +
+

All

+ +
+

1372.002

+ +
+

68.05

+ +
+

1440.05

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

914.003

+ +
+

0.00

+ +
+

914.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients +

+
+
+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+ +
+
+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities as certified by the Rhode Island Department of Human Services. +

+ +
+

F

+ +
+

Advanced Care

+ +

Apply OS code “F” only to recipients living in a licensed adult community supportive + living residence and receiving advanced care as certified by the Rhode Island Executive + Office of Health and Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category “D” or “F”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2023: +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +

 

+ +

 

+ +
+

All

+ +

 

+ +

 

+ +
+

914.00

+ +

 

+ +

 

+ +
+

332.00

+ +

 

+ +

 

+ +
+

1246.00

+ +

 

+ +

 

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

914.00

+ +
+

0.00

+ +
+

914.00

+ +
+
+

 

+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living (except Chittenden County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where private health insurance is paying + more than 50 percent of their care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 in a private medical facility where a combination of Medicaid and + a private health insurance policy pays or is expected to pay over 50 percent of the + cost of their care. For information regarding the $30 payment limit, see in SI 00520.011C.1.; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +
+

Licensed residential care home or assisted living residence with assistive community + care services (Level III)

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of Licensing and + Protection for Vermont State. Use this website link:: https://dail.vermont.gov/sites/dail/files//documents/Assisted_living_regs_final_2003.pdf . +

+ +
+

E

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +
+

Licensed residential care home or therapeutic community residence (Level + IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of Licensing and Protection for + Vermont State. Use this website link: https://dlp.vermont.gov/sites/dlp/files/documents/Residential-Care-Home-Directory2.pdf

+ +
+

H

+ +
+

Custodial care: family home +

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the above requirements. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +
+

Apply OS code “I” effective July 1, 1987, when the State elected Federal administration + of an optional State supplementary payment to residents in Title XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2023: +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

914.00

+ +
+

52.04

+ +
+

966.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

914.00

+ +
+

52.04

+ +
+

966.04

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

914.00

+ +
+

48.38

+ +
+

962.38

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

914.00

+ +
+

223.94

+ +
+

1137.94

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

914.00

+ +
+

98.69

+ +
+

1012.69

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

609.34

+ +
+

39.30

+ +
+

648.64

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

914.00

+ +
+

52.04

+ +
+

966.04

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

914.00

+ +
+

52.04

+ +
+

966.04

+ +
+

D

+ +
+

A or B2

+ +
+

Children Private Insurance

+ +
+

30.001

+ +
+

52.04

+ +
+

82.04

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

30.002

+ +
+

42.66

+ +
+

72.66

+ +
+
+

1State OS code A or B applies to children under the age of 18 who are in Federal living + arrangement D because of private health insurance payments. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All(Except Chittenden County)

+ +
+

1371.00

+ +
+

98.88

+ +
+

1469.88

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

1371.00

+ +
+

98.88

+ +
+

1469.88

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1371.00

+ +
+

96.77

+ +
+

1467.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1371.00

+ +
+

562.06

+ +
+

1993.06

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1371.00

+ +
+

332.82

+ +
+

1703.82

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

914.001

+ +
+

48.31

+ +
+

962.31

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

85.32

+ +
+

145.32

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of optional State supplement category. Contact other persons with knowledge + of the recipient’s living situation, if necessary (land lord, homeowner, facility + manager). Document the file per the instructions on recording evidence in GN 00301.285 through GN 00301.289

+

 

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415055
SI 01415.055 - Federally Administered Optional Supplemental Payment Programs for January 2023 - 08/15/2024
+Batch run: 02/19/2025
+Rev:08/15/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html new file mode 100644 index 00000000..2c1c73e3 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2024.html @@ -0,0 +1,11684 @@ + + +SSA - POMS: SI 01415.056 - Federally Administered Optional Supplementary Payment Programs for January 2024 - 08/26/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 89 (08-24)

+

SI 01415.056 Federally Administered Optional Supplementary Payment Programs for January 2024 +

+ + +

CITATIONS:

+ +

Social Security Act as amended in 1973, Section 1616 ; Social Security Amendments + of 1972, Section 301;Public Law + 93-66, Section 212

+ +

 

+ +
+
+

A. List of States participating in the federally administered optional supplementary + payment program +

+
+
+

The following states participate in federally administered optional supplementary + payment programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
StateReference
CaliforniaSI 01415.056B
DelawareSI 01415.056C
District of ColumbiaSI 01415.056D
HawaiiSI 01415.056E
IowaSI 01415.056F
MichiganSI 01415.056G
MontanaSI 01415.056H
NevadaSI 01415.056I
New JerseySI 01415.056J
PennsylvaniaSI 01415.056K
Rhode IslandSI 01415.056L
VermontSI 01415.056M
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
A +

Use optional supplement (OS) code “A” for independent living with cooking facilities + for an eligible recipient or couple who meet one of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
B +

Apply OS code “B” for non-medical out-of-home care (NMOHC) when a recipient or couple + needs non-medical care or supervision in the following living arrangement situations: +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. McMahon + decision); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA “A” and resides in the home of a relative, legal + conservator, or guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a family home certified by a family + home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
C +

Independent living without cooking facilities

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living + arrangement. +

    + +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS “C.” +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the + living arrangement (including cooking and food storage facilities, which are outside + the immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking + and food storage facilities that they can access for preparing meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence + for preparing meals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have + meals prepared and provided as part of the living arrangement (for example, the Supplemental + Security Income (SSI) recipient’s arrangement with the facility is to purchase only + shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has + access to the following: +

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with + at least two working burners. (Do not consider the capacity of the refrigerator or + icebox when making this determination. Also, do not consider an ice chest to be adequate + storage.); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with + separate temperature controls, or two one-burner hotplates with temperature controls. + (Do not consider hotplates without temperature controls used for warming food as “adequate + cooking facilities.”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning + microwave oven in combination with at least one working burner on a stove, or a one-burner + hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +

NOTE: For purposes of OS “C,” “throughout a month” does not mean the recipient must + lack adequate cooking or food storage facilities from the very first moment of the + month. The recipient need only lack them from some time on the first day of the month. +

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must + receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled + member of the couple. This living arrangement requires force due payment. +

+ +
D +

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. Most recipient or couples + who are subject to a one-third reduction of their Federal SSI payments are eligible + for OS “D” because the criteria for this supplement level are the same as for charging + the one-third reduction. However, when the eligible recipient or couple lives in the + home of a relative (other than a spouse) and needs care and supervision, you must + obtain certification for non-medical out-of-home care (OS “F”) from the county welfare + office since this is the highest categorical supplement that a recipient or couple + can qualify. +

+ +
E +

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +

NOTE: Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third + reduction (VTR) applies, see code “G.” +

+ +
F +

Non-medical out-of-home care living in the household of another

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
G +

Disabled child under 18 living in the abode of another

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal + code “B” payment for living in the household of another person. For the one-third + reduction provision, see SI 00835.200. +

+ +
J +

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
Y +

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +
Z +

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2024: +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFederal Benefit Rate (FBR)State Supplement LevelTotal Payment Levels
AAAged943.00239.941182.94
​​Blind943.00324.321267.32
​​Disabled943.00239.941182.94
​BAll943.00632.071575.07
​CAged943.00368.811311.81
​​Disabled943.00368.811311.81
​EDisabled943.0097.271040.27
​ZAll943.000.00943.00
BDAged628.671245.20873.87
​​Blind628.671329.58958.25
​​Disabled628.671245.20873.87
​FAll628.671624.401253.07
​GDisabled628.671102.53731.20
CABlind943.00324.321267.32
​EDisabled943.0097.271040.27
​ZAll943.000.00943.00
DJAll30.00232.0062.00
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: California is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. For more information + on multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState Supplement LevelTotal Payment Levels
AAAged/Aged1415.00607.832022.83
​​Blind/Blind1415.00833.352248.35
​​Disabled/Disabled1415.00607.832022.83
​​Aged/Blind1415.00747.442162.44
​​Aged/Disabled1415.00607.832022.83
​​Blind/Disabled1415.00747.442162.44
​BAll1415.001735.143150.14
​CAged/Aged1415.00865.572280.57
​​Disabled/Disabled1415.00865.572280.57
​​Aged/Disabled1415.00865.572280.57
​ZAll1415.000.001415.00
BDAged/Aged943.341615.701559.04
​​Blind/Blind943.341841.221784.56
​​Disabled/Disabled943.341615.701559.04
​​Aged/Blind943.341755.311698.65
​​Aged/Disabled943.341615.701559.04
​​Blind/Disabled943.341755.311698.65
​FAll943.3411604.202547.54
DJAll60.00264.00124.00
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult residential care facility, assisted living facility, or adult + foster care home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2024: +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

943.00

+ +
+

140.00

+ +
+

1083.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

628.67

+ +
+

0.00

+ +
+

628.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1415.00

+ +
+

448.00

+ +
+

1863.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1415.00

+ +
+

0.00

+ +
+

1415.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

943.34

+ +
+

0.00

+ +
+

943.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult foster care home with 50 or fewer residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult foster care home with more than 50 residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2024: +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

943.00

+ +
+

674.16

+ +
+

1617.16

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

943.00

+ +
+

784.16

+ +
+

1727.16

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

628.671

+ +
+

0.00

+ +
+

628.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

73.20

+ +
+

103.20

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1415.00

+ +
+

1704.32

+ +
+

3119.32

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1415.00

+ +
+

1924.32

+ +
+

3339.32

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1415.00

+ +
+

0.00

+ +
+

1415.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

943.341

+ +
+

0.00

+ +
+

943.34

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

146.40

+ +
+

206.40

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +
+

Living in a community care or foster care home

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +
+

Domiciliary care I (maximum of five residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2024: +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +
+

B

+ +
+

All

+ +
+

943.00

+ +
+

651.90

+ +
+

1594.90

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

943.00

+ +
+

651.90

+ +
+

1594.90

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

943.00

+ +
+

759.90

+ +
+

1702.90

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

628.67

+ +
+

0.00

+ +
+

628.67

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

30.001

+ +
+

20.00

+ +
+

50.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

B

+ +
+

All

+ +
+

1415.00

+ +
+

1640.80

+ +
+

3055.80

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1415.00

+ +
+

1640.80

+ +
+

3055.80

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1415.00

+ +
+

1856.80

+ +
+

3271.80

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1415.00

+ +
+

0.00

+ +
+

1415.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

943.34

+ +
+

0.00

+ +
+

943.34

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

60.001

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple + who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +
+

Living in the household of another (blind only)

+ +

OS code “B” is only for an eligible blind recipient and the blind member + of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +
+

Living with a dependent person

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

I

+ +
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA “B,” who resides + in a family life home or boarding home licensed by the State Department of Health, + or certified by the State Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  6. +
+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2024: +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

943.00

+ +
+

22.00

+ +
+

965.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

943.00

+ +
+

490.00

+ +
+

1433.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

943.00

+ +
+

512.00

+ +
+

1455.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

943.00

+ +
+

490.00

+ +
+

1433.00

+ +
+

 

+ +
+

D

+ +
+

Aged

+ +
+

943.00

+ +
+

142.00

+ +
+

1085.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

943.00

+ +
+

164.00

+ +
+

1107.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

943.00

+ +
+

142.00

+ +
+

1085.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

628.671

+ +
+

22.00

+ +
+

650.67

+ +
+

 

+ +
+

H

+ +
+

Aged

+ +
+

628.671

+ +
+

490.00

+ +
+

1118.67

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

628.671

+ +
+

512.00

+ +
+

1140.67

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

628.671

+ +
+

490.00

+ +
+

1118.67

+ +
+

 

+ +
+

I

+ +
+

Aged

+ +
+

628.671

+ +
+

142.00

+ +
+

770.67

+ +
+

 

+ +
+

I

+ +
+

Disabled

+ +
+

628.671

+ +
+

142.00

+ +
+

770.67

+ +
+

 

+ +
+

I

+ +
+

Blind

+ +
+

628.671

+ +
+

164.00

+ +
+

792.67

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

628.671

+ +
+

0.00

+ +
+

628.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

943.00

+ +
+

22.00

+ +
+

965.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

943.00

+ +
+

512.00

+ +
+

1455.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

943.00

+ +
+

490.00

+ +
+

1433.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

1415.00

+ +
+

44.00

+ +
+

1459.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

1415.00

+ +
+

22.00

+ +
+

1437.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1415.00

+ +
+

22.00

+ +
+

1437.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1415.00

+ +
+

490.00

+ +
+

1905.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1415.00

+ +
+

534.00

+ +
+

1949.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1415.00

+ +
+

490.00

+ +
+

1905.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1415.00

+ +
+

512.00

+ +
+

1927.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1415.00

+ +
+

490.00

+ +
+

1905.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1415.00

+ +
+

512.00

+ +
+

1927.00

+ +
+

 

+ +
+

D

+ +
+

Aged/Aged

+ +
+

1415.00

+ +
+

775.00

+ +
+

2190.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1415.00

+ +
+

819.00

+ +
+

2234.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1415.00

+ +
+

775.00

+ +
+

2190.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1415.00

+ +
+

797.00

+ +
+

2212.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1415.00

+ +
+

775.00

+ +
+

2190.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1415.00

+ +
+

797.00

+ +
+

2212.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

1415.00

+ +
+

0.00

+ +
+

1415.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1415.00

+ +
+

0.00

+ +
+

1415.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1415.00

+ +
+

0.00

+ +
+

1415.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

943.341

+ +
+

44.00

+ +
+

987.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

943.341

+ +
+

22.00

+ +
+

965.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

943.341

+ +
+

22.00

+ +
+

965.34

+ +
+

 

+ +
+

H

+ +
+

Aged/Aged

+ +
+

943.341

+ +
+

490.00

+ +
+

1433.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

943.341

+ +
+

534.00

+ +
+

1477.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

943.341

+ +
+

490.00

+ +
+

1433.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

943.341

+ +
+

512.00

+ +
+

1455.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

943.341

+ +
+

490.00

+ +
+

1433.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

943.341

+ +
+

512.00

+ +
+

1455.34

+ +
+

 

+ +
+

I

+ +
+

Aged/Aged

+ +
+

943.341

+ +
+

775.00

+ +
+

1718.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

943.341

+ +
+

819.00

+ +
+

1762.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

943.341

+ +
+

775.00

+ +
+

1718.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

943.341

+ +
+

797.00

+ +
+

1740.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

943.341

+ +
+

775.00

+ +
+

1718.34

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

943.341

+ +
+

797.00

+ +
+

1740.34

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

943.341

+ +
+

0.00

+ +
+

943.34

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

943.341

+ +
+

0.00

+ +
+

943.34

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

943.341

+ +
+

0.00

+ +
+

943.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

I

+ +
+

Effective January 1, 1988, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2024: +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

943.00

+ +
+

87.00

+ +
+

1030.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

943.00

+ +
+

157.50

+ +
+

1100.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

943.00

+ +
+

179.30

+ +
+

1122.30

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.001

+ +
+

7.00

+ +
+

37.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

1415.00

+ +
+

645.00

+ +
+

2060.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

1415.00

+ +
+

786.00

+ +
+

2201.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

1415.00

+ +
+

829.60

+ +
+

2244.60

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.001

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care.

+ +
+

H

+ +
+

State-certified residence in-group home for mentally disabled.

+ +
+

I

+ +
+

State-certified residence in-group home for physically or developmentally disabled.

+ +
+

J

+ +
+

State-certified residence for child and adult foster care.

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled.

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2024: +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

943.00

+ +
+

94.00

+ +
+

1037.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

943.00

+ +
+

94.00

+ +
+

1037.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

943.00

+ +
+

94.00

+ +
+

1037.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

943.00

+ +
+

52.75

+ +
+

995.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

943.00

+ +
+

26.00

+ +
+

969.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

628.671

+ +
+

0.00

+ +
+

628.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

1415.00

+ +
+

193.00

+ +
+

1608.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1415.00

+ +
+

193.00

+ +
+

1608.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1415.00

+ +
+

193.00

+ +
+

1608.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

1415.00

+ +
+

110.50

+ +
+

1525.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

1415.00

+ +
+

57.00

+ +
+

1472.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1415.00

+ +
+

0.00

+ +
+

1415.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

943.341

+ +
+

0.00

+ +
+

943.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living or living in parental household

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code “A.” For optional State supplement codes, see + SM 01301.535. +

+ +
+

B

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement “B” because the criteria for this supplement level are the same as for + Federal code “B.” +

+ +
+

C

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live + in a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Apply “No Supplement” code “Y” to the following recipients: +

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2024: +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

943.00

+ +
+

36.40

+ +
+

979.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

943.00

+ +
+

109.30

+ +
+

1052.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

943.00

+ +
+

391.00

+ +
+

1334.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

943.00

+ +
+

391.00

+ +
+

1334.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

628.671

+ +
+

24.27

+ +
+

652.94

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

628.67

+ +
+

213.96

+ +
+

842.63

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

628.67

+ +
+

0.00

+ +
+

628.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

943.00

+ +
+

109.30

+ +
+

1052.30

+ +

 

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1415.00

+ +
+

74.46

+ +
+

1489.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1415.00

+ +
+

374.60

+ +
+

1789.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1415.00

+ +
+

224.53

+ +
+

1639.53

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1415.00

+ +
+

37.23

+ +
+

1452.23

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1415.00

+ +
+

187.30

+ +
+

1602.30

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1415.00

+ +
+

881.00

+ +
+

2296.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1415.00

+ +
+

881.00

+ +
+

2296.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1415.00

+ +
+

881.00

+ +
+

2296.00

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1415.00

+ +
+

440.50

+ +
+

1855.50

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1415.00

+ +
+

440.50

+ +
+

1855.50

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

1415.00

+ +
+

0.00

+ +
+

1415.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

943.34

+ +
+

49.64

+ +
+

992.98

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

943.34

+ +
+

531.94

+ +
+

1475.28

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

943.34

+ +
+

290.79

+ +
+

1234.13

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

943.34

+ +
+

24.82

+ +
+

968.16

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

943.34

+ +
+

265.97

+ +
+

1209.31

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

943.34

+ +
+

0.00

+ +
+

943.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Living alone or with others

+ +

 

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +
+

Living alone with an ineligible spouse

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If + other persons, even minor children, are present in the household, you cannot apply + this OS + code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Licensed residential health care facilities (RHCF)

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to January 1, 2006. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey Congregate Care + Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Apply OS code “G” effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or + effective December 1, 1996, to children residing in public or private facilities where + private health insurance paid for their care. For determination of applicability of + $30 payment limit, see SI 00520.011. +

+ +
+
+

NOTE: All State Supplement payments, except for medicaid facilities, include a Lifeline + payment which is a utility assistance program for older people and people with disabilities + that offers an annual benefit amount for individuals who receive SSI. +

+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2024: +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

943.00

+ +
+

150.05

+ +
+

1093.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

943.00

+ +
+

31.25

+ +
+

974.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

943.00

+ +
+

152.99

+ +
+

1095.99

+ +
+

 

+ +
+

 

+ +
+

w/EP

+ +
+

1415.001

+ +
+

25.35

+ +
+

1440.35

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

943.00

+ +
+

210.05

+ +
+

1153.05

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

628.672

+ +
+

44.31

+ +
+

672.98

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

943.00

+ +
+

31.25

+ +
+

974.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.003

+ +
+

20.00

+ +
+

50.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1415.00

+ +
+

618.35

+ +
+

2033.351

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1415.00

+ +
+

25.35

+ +
+

1440.35

+ 1
+

 

+ +
+

I

+ +
+

All

+ +
+

1415.00

+ +
+

738.35

+ +
+

2153.351

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1415.00

+ +
+

0.00

+ +
+

1415.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

943.341

+ +
+

93.08

+ +
+

1036.421

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1This amount is the total of the federal payment, the state supplement amount, and + the lifeline payment. When added together and divided in half for each member of the + couple, the result includes a half penny. The total is rounded up to accommodate system + processing. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +
+

Living in the household of another with an EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a personal care boarding home (PCBH)

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2024: +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

C

+ +
+

All

+ +
+

1415.001

+ +
+

43.70

+ +
+

1458.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

943.00

+ +
+

634.30

+ +
+

1577.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

943.00

+ +
+

639.30

+ +
+

1582.30

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +

 

+ +
+

628.672

+ +
+

0.00

+ +
+

628.67

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

943.343

+ +
+

43.70

+ +
+

987.04

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

C

+ +
+

All

+ +
+

1887.001

+ +
+

68.05

+ +
+

1955.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1415.00

+ +
+

1347.40

+ +
+

2762.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1415.00

+ +
+

1357.40

+ +
+

2772.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1415.00

+ +
+

0.00

+ +
+

1415.00

+ +
+

B 

+ +
+

D

+ +
+

All

+ +
+

1258.002

+ +
+

68.05

+ +
+

1326.05

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

943.343

+ +
+

0.00

+ +
+

943.34

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients. +

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities as certified by the Rhode Island Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category “D” or “F”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2024: +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +

 

+ +

 

+ +
+

All

+ +

 

+ +

 

+ +
+

943.00

+ +

 

+ +

 

+ +
+

332.00

+ +

 

+ +

 

+ +
+

1275.00

+ +

 

+ +

 

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

943.00

+ +
+

0.00

+ +
+

943.00

+ +
+
+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living (except Chittenden County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +
+

Licensed residential care home or assisted living residence with + assistive community care services (Level III)

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of + Licensing and Protection for Vermont State. +

+ +
+

E

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +
+

Licensed residential care home or therapeutic community residence (Level + IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of + Licensing and Protection for Vermont State. +

+ +
+

H

+ +
+

Custodial care: family home +

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the above requirements. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +
+

Apply OS code “I” effective July 1, 1987, when the State elected Federal + administration of an optional State supplementary payment to residents in Title + XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2024: +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

943.00

+ +
+

55.68

+ +
+

998.68

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

943.00

+ +
+

55.68

+ +
+

998.68

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

943.00

+ +
+

51.77

+ +
+

994.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

943.00

+ +
+

239.62

+ +
+

1182.62

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

943.00

+ +
+

105.60

+ +
+

1048.60

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

628.67

+ +
+

42.05

+ +
+

670.72

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

943.00

+ +
+

55.68

+ +
+

998.68

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

943.00

+ +
+

55.68

+ +
+

998.68

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

30.001

+ +
+

49.93

+ +
+

79.93

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All(Except Chittenden County)

+ +
+

1415.00

+ +
+

105.80

+ +
+

1520.80

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

1415.00

+ +
+

105.80

+ +
+

1520.80

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1415.00

+ +
+

103.54

+ +
+

1518.54

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1415.00

+ +
+

601.40

+ +
+

2016.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1415.00

+ +
+

356.12

+ +
+

1771.12

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

943.341

+ +
+

51.69

+ +
+

995.03

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

99.85

+ +
+

159.85

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of their optional State supplement category. Contact other persons with + knowledge of the recipient’s living situation, if necessary (landlord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289. +

+

 

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415056
SI 01415.056 - Federally Administered Optional Supplementary Payment Programs for January 2024 - 08/26/2024
+Batch run: 02/19/2025
+Rev:08/26/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html new file mode 100644 index 00000000..b4d96bc5 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2025.html @@ -0,0 +1,11656 @@ + + +SSA - POMS: SI 01415.057 - Federally Administered Optional Supplementary Payment Programs for January 2025 - 12/23/2024 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 91 (12-24)

+

SI 01415.057 Federally Administered Optional Supplementary Payment Programs for January 2025 +

+ + +

 

+ +
+
+

A. List of States participating in the federally administered optional supplementary + payment program +

+
+
+

The following states participate in federally administered optional supplementary + payment programs: +

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
StateReference
CaliforniaSI + 01415.057B
DelawareSI + 01415.057C
District of ColumbiaSI + 01415.057D
HawaiiSI + 01415.057E
IowaSI + 01415.057F
MichiganSI + 01415.057G
MontanaSI + 01415.057H
NevadaSI + 01415.057I
New JerseySI + 01415.057J
PennsylvaniaSI + 01415.057K
Rhode IslandSI + 01415.057L
VermontSI + 01415.057M
+
+
+
+ +
+
+

B. Description of supplements for California +

+
+
+
+
+

1. Definitions of State living arrangement variations for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
A +

Use optional supplement (OS) code “A” for independent living with cooking facilities + for an eligible recipient or couple who meet one of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) “A” purposes, + and have cooking and food storage facilities or living arrangement provides meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX. +

    + +
    +
    +
  • +
+ +
B +

Apply OS code “B” for non-medical out-of-home care (NMOHC) when a recipient or couple + needs non-medical care or supervision in the following living arrangement situations: +

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. McMahon + decision); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a “certified family” home approved by a licensed home-finding + agency (“certified family home placement”). +

    + +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA “A” and resides in the home of a relative, legal + conservator, or guardian; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a State licensed NMOHC facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA “A” and resides in a family home certified by a family + home agency under State law. +

    + +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix “grand” or “great.”

    + +
    +
    +
  • +
+ +
C +

Independent living without cooking facilities

+ +

Apply OS code “C” to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living + arrangement. +

    + +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS “C.” +

+ +

A recipient or couple qualifies for OS “C” if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the + living arrangement (including cooking and food storage facilities, which are outside + the immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking + and food storage facilities that they can access for preparing meals; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, “over the garage”) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence + for preparing meals; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have + meals prepared and provided as part of the living arrangement (for example, the Supplemental + Security Income (SSI) recipient’s arrangement with the facility is to purchase only + shelter on a monthly basis). +

    + +
    +
    +
  • +
+ +

“Adequate” cooking and food storage facilities exist when a recipient or couple has + access to the following: +

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with + at least two working burners. (Do not consider the capacity of the refrigerator or + icebox when making this determination. Also, do not consider an ice chest to be adequate + storage.); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with + separate temperature controls, or two one-burner hotplates with temperature controls. + (Do not consider hotplates without temperature controls used for warming food as “adequate + cooking facilities.”); or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning + microwave oven in combination with at least one working burner on a stove, or a one-burner + hotplate with a temperature control. +

    + +
    +
    +
  • +
+ +

Eligibility for OS “C” begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month. +

+ +

NOTE: For purposes of OS “C,” “throughout a month” does not mean the recipient must + lack adequate cooking or food storage facilities from the very first moment of the + month. The recipient need only lack them from some time on the first day of the month. +

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases. +

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact. +

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available. +

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must + receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled + member of the couple. This living arrangement requires force due payment. +

+ +
D +

Living in the household of another

+ +

Apply OS code “D” when an eligible individual or couple is living in the household + of another and receives food and shelter from that person. Most recipient or couples + who are subject to a one-third reduction of their Federal SSI payments are eligible + for OS “D” because the criteria for this supplement level are the same as for charging + the one-third reduction. However, when the eligible recipient or couple lives in the + home of a relative (other than a spouse) and needs care and supervision, you must + obtain certification for non-medical out-of-home care (OS “F”) from the county welfare + office since this is the highest categorical supplement that a recipient or couple + can qualify. +

+ +
E +

Disabled child under age 18

+ +

Apply OS code “E” to a disabled (not blind) child under age 18 who resides with a + parent or relative by blood or marriage. +

+ +

NOTE: Only FLA “A” and “C” are compatible with OS “E.” If the value of the one-third + reduction (VTR) applies, see code “G.” +

+ +
F +

Non-medical out-of-home care living in the household of another

+ +

OS code “F” applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code “B” payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200. +

+ +
G +

Disabled child under 18 living in the home of another

+ +

OS code “G” applies to a disabled (not blind) child under age 18, who resides with + a parent or relative by blood or marriage, and is determined to receive the Federal + code “B” payment for living in the household of another person. For the one-third + reduction provision, see SI 00835.200. +

+ +
J +

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code “J” to an eligible recipient who is a + patient in a medical facility where Title XIX pays more than 50 percent of the costs. + Apply OS State code “J” to supplement Section 1619 cases. +

+ +
Y +

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement. +

+ +
Z +

No supplement cases

+ +

Apply OS code “Z” to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter. +

+ +

For periods prior to July 1, 1987, apply OS code “Z” to an eligible recipient who + is a patient in a medical facility where Title XIX pays more than 50 percent of the + costs. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for California +

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2025: +

+
+
+

a. Recipient payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFederal Benefit Rate (FBR)State Supplement LevelTotal Payment Levels
AAAged967.00239.941206.94
​​Blind967.00324.321291.32
​​Disabled967.00239.941206.94
​BAll967.00632.071599.07
​CAged967.00368.811335.81
​​Disabled967.00368.811335.81
​EDisabled967.0097.271064.27
​ZAll967.000.00967.00
BDAged644.671245.20889.87
​​Blind644.671329.58974.25
​​Disabled644.671245.20889.87
​FAll644.671624.401269.07
​GDisabled644.671102.53747.20
CABlind967.00324.321291.32
​EDisabled967.0097.271064.27
​ZAll967.000.00967.00
DJAll30.00232.0062.00
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: California is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. For more information + on multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState Supplement LevelTotal Payment Levels
AAAged/Aged1450.00607.832057.83
​​Blind/Blind1450.00833.352283.35
​​Disabled/Disabled1450.00607.832057.83
​​Aged/Blind1450.00747.442197.44
​​Aged/Disabled1450.00607.832057.83
​​Blind/Disabled1450.00747.442197.44
​BAll1450.001748.143198.14
​CAged/Aged1450.00865.572315.57
​​Disabled/Disabled1450.00865.572315.57
​​Aged/Disabled1450.00865.572315.57
​ZAll1450.000.001450.00
BDAged/Aged966.671615.701582.37
​​Blind/Blind966.671841.221807.89
​​Disabled/Disabled966.671615.701582.37
​​Aged/Blind966.671755.311721.98
​​Aged/Disabled966.671615.701582.37
​​Blind/Disabled966.671755.311721.98
​FAll966.6711604.202570.87
DJAll60.00264.00124.00
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR). +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware +

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult residential care facility, assisted living facility, or adult + foster care home

+ +

To be eligible for OS code “A,” the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for any recipient who is not included in OS categories “A” or “Y.”

+ +

Alternately, use OS code “Z” when the recipient is an “intervening” Federal code “A.”

+ +

For more information on optional State supplement codes see SM 01301.535.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware +

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2025: +

+
+
+

a. Recipient payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

967.00

+ +
+

140.00

+ +
+

1107.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

644.67

+ +
+

0.00

+ +
+

644.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.001

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Delaware +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1450.00

+ +
+

448.00

+ +
+

1898.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1450.00

+ +
+

0.00

+ +
+

1450.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

966.67

+ +
+

0.00

+ +
+

966.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.001

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia +

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Adult foster care home with 50 or fewer residents

+ +

Use OS code “A” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents. +

+ +
+

B

+ +
+

Adult foster care home with more than 50 residents

+ +

Use OS code “B” to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents. +

+ +
+

G

+ +
+

Apply OS code “G” to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” for all recipients not included in OS codes A, B, G, or Y.

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia +

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2025: +

+
+
+

a. Individual payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

967.00

+ +
+

678.00

+ +
+

1645.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

967.00

+ +
+

788.00

+ +
+

1755.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

644.671

+ +
+

0.00

+ +
+

644.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

76.00

+ +
+

106.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for the District of Columbia +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1450.00

+ +
+

1711.00

+ +
+

3161.00

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1450.00

+ +
+

1931.00

+ +
+

3381.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1450.00

+ +
+

0.00

+ +
+

1450.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

966.671

+ +
+

0.00

+ +
+

966.67

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.002

+ +
+

152.00

+ +
+

212.00

+ +
+
+

1Not the FBR; the amount represents the FBR less the VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii +

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

B

+ +
+

Living in a community care or foster care home

+ +

Apply OS code “B” to recipients who are both over age 18 and live in a state approved + care or foster care home. +

+ +
+

D

+ +
+

Living in a certified medical facility

+ +

Use OS code “D” for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care. +

+ +
+

H

+ +
+

Domiciliary care I (maximum of five residents)

+ +

Use OS code “H” for an eligible recipient (including a child) or couple living in + a domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities. +

+ +
+

I

+ +
+

Domiciliary care II

+ +

OS code “I” is the same as code “H” except the facility provides care for six or more + residents. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement + because of the following situations: +

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii +

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2025: +

+
+
+

a. Recipient payments levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A 

+ +
+

B

+ +
+

All

+ +
+

967.00

+ +
+

784.001

+ +
+

1751.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

967.00

+ +
+

784.001

+ +
+

1751.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

967.00

+ +
+

892.001

+ +
+

1859.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

644.67

+ +
+

0.00

+ +
+

644.67

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

30.002

+ +
+

45.00

+ +
+

75.00

+ +
+
+

1Rates went into effect October 1, 2024. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Hawaii +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

B

+ +
+

All

+ +
+

1450.00

+ +
+

1905.001

+ +
+

3355.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1450.00

+ +
+

1905.001

+ +
+

3355.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1450.00

+ +
+

2121.001

+ +
+

3571.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1450.00

+ +
+

0.00

+ +
+

1450.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

966.67

+ +
+

0.00

+ +
+

966.67

+ +
+

D

+ +
+

D

+ +
+

All

+ +
+

60.002

+ +
+

90.00

+ +
+

150.00

+ +
+
+

1Rates went into effect in October 2024. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa +

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Living in own household (blind only)

+ +

Only apply OS code “A” to an eligible blind recipient and the blind member of a couple + who: +

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code “A” is also compatible with Federal + codes “A” and “C.” +

    + +
    +
    +
  • +
+ +

OS code “A” is the proper code to use with an “intervening” Federal code “A.”

+ +

For optional State supplement codes, see SM 01301.535.

+ +
+

B

+ +
+

Living in the household of another (blind only)

+ +

OS code “B” is only for an eligible blind recipient and the blind member + of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation. +

+ +
+

C

+ +
+

Living with a dependent

+ +

Use OS code “C” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” or “C”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement. +

+ +
+

D

+ +
+

Living in a family life or boarding home

+ +

Use OS code “D” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “A” who resides in a family life home or boarding home + licensed by the State Department of Health or certified by the State Department of + Human Services. +

+ +
+

H

+ +
+

Living with a dependent person

+ +

Use OS code “H” for an eligible recipient or each member of an eligible couple in + Federal living arrangement “B”: +

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services. +

    + +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement. +

+ +
+

I

+ +
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA “B,” who resides + in a family life home or boarding home licensed by the State Department of Health, + or certified by the State Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Use OS code “Z” to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care. +

    + +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    + +
    +
    +
  6. +
+ +
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid. +

+
+
+
+
+

2. Coding and monthly payment levels for Iowa +

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2025: +

+
+
+

a. Recipient payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind

+ +
+

967.00

+ +
+

22.00

+ +
+

989.00

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

967.00

+ +
+

503.00

+ +
+

1470.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

967.00

+ +
+

525.00

+ +
+

1492.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

967.00

+ +
+

503.00

+ +
+

1470.00

+ +
+

 

+ +
+

D

+ +
+

Aged

+ +
+

967.00

+ +
+

142.00

+ +
+

1109.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

967.00

+ +
+

164.00

+ +
+

1131.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

967.00

+ +
+

142.00

+ +
+

1109.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

B

+ +
+

B

+ +
+

Blind

+ +
+

644.671

+ +
+

22.00

+ +
+

666.67

+ +
+

 

+ +
+

H

+ +
+

Aged

+ +
+

644.671

+ +
+

503.00

+ +
+

1147.67

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

644.671

+ +
+

525.00

+ +
+

1169.67

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

644.671

+ +
+

503.00

+ +
+

1147.67

+ +
+

 

+ +
+

I

+ +
+

Aged

+ +
+

644.671

+ +
+

142.00

+ +
+

786.67

+ +
+

 

+ +
+

I

+ +
+

Disabled

+ +
+

644.671

+ +
+

142.00

+ +
+

786.67

+ +
+

 

+ +
+

I

+ +
+

Blind

+ +
+

644.671

+ +
+

164.00

+ +
+

808.67

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

644.671

+ +
+

0.00

+ +
+

644.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

967.00

+ +
+

22.00

+ +
+

989.00

+ +
+

 

+ +
+

C

+ +
+

Blind

+ +
+

967.00

+ +
+

525.00

+ +
+

1492.00

+ +
+

 

+ +
+

 

+ +
+

Disabled

+ +
+

967.00

+ +
+

503.00

+ +
+

1470.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Blind/Blind

+ +
+

1450.00

+ +
+

44.00

+ +
+

1494.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

1450.00

+ +
+

22.00

+ +
+

1472.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1450.00

+ +
+

22.00

+ +
+

1472.00

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1450.00

+ +
+

503.00

+ +
+

1953.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1450.00

+ +
+

547.00

+ +
+

1997.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1450.00

+ +
+

503.00

+ +
+

1953.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1450.00

+ +
+

525.00

+ +
+

1975.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1450.00

+ +
+

503.00

+ +
+

1953.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1450.00

+ +
+

525.00

+ +
+

1975.00

+ +
+

 

+ +
+

D

+ +
+

Aged/Aged

+ +
+

1450.00

+ +
+

788.00

+ +
+

2238.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1450.00

+ +
+

832.00

+ +
+

2282.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1450.00

+ +
+

788.00

+ +
+

2238.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1450.00

+ +
+

810.00

+ +
+

2260.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1450.00

+ +
+

788.00

+ +
+

2238.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

1450.00

+ +
+

810.00

+ +
+

2260.00

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

1450.00

+ +
+

0.00

+ +
+

1450.00

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

1450.00

+ +
+

0.00

+ +
+

1450.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

1450.00

+ +
+

0.00

+ +
+

1450.00

+ +
+

B

+ +
+

B

+ +
+

Blind/Blind

+ +
+

966.671

+ +
+

44.00

+ +
+

1010.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Aged

+ +
+

966.671

+ +
+

22.00

+ +
+

988.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

966.671

+ +
+

22.00

+ +
+

988.67

+ +
+

 

+ +
+

H

+ +
+

Aged/Aged

+ +
+

966.671

+ +
+

503.00

+ +
+

1469.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

966.671

+ +
+

547.00

+ +
+

1513.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

966.671

+ +
+

503.00

+ +
+

1469.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

966.671

+ +
+

525.00

+ +
+

1491.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

966.671

+ +
+

503.00

+ +
+

1469.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

966.671

+ +
+

525.00

+ +
+

1491.67

+ +
+

 

+ +
+

I

+ +
+

Aged/Aged

+ +
+

966.671

+ +
+

788.00

+ +
+

1754.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

966.671

+ +
+

832.00

+ +
+

1798.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

966.671

+ +
+

788.00

+ +
+

1754.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

966.671

+ +
+

832.00

+ +
+

1798.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

966.671

+ +
+

788.00

+ +
+

1754.67

+ +
+

 

+ +
+

 

+ +
+

Blind/Disabled

+ +
+

966.671

+ +
+

832.00

+ +
+

1798.67

+ +
+

 

+ +
+

Z

+ +
+

Aged/Aged

+ +
+

966.671

+ +
+

0.00

+ +
+

966.67

+ +
+

 

+ +
+

 

+ +
+

Disabled/Disabled

+ +
+

966.671

+ +
+

0.00

+ +
+

966.67

+ +
+

 

+ +
+

 

+ +
+

Aged/Disabled

+ +
+

966.671

+ +
+

0.00

+ +
+

966.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+

NOTE: State-administered programs include recipients receiving: +

+
    +
  • +
    +
    •
    +
    +

    “Residential Care” and a payment based on a per diem rate plus a monthly personal + allowance; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “In-Home Health Care” and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    + +
    +
    +
  • +
+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan +

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Domiciliary care

+ +

Use OS code “D” for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care. +

+ +
+

E

+ +
+

Personal care

+ +

Apply OS code “E” to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged. +

+ +
+

F

+ +
+

Home for the aged

+ +

Apply OS code “F” for residents in homes for the aged. The State provides SSA with + a list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care. +

+ +
+

I

+ +
+

Effective January 1, 1988, OS code “I” applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan +

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2025: +

+
+
+

a. Recipient payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

967.00

+ +
+

87.00

+ +
+

1054.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

967.00

+ +
+

157.50

+ +
+

1124.50

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

967.00

+ +
+

179.30

+ +
+

1146.30

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.001

+ +
+

7.00

+ +
+

37.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Michigan +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +
+

All

+ +
+

1450.00

+ +
+

658.00

+ +
+

2108.00

+ +
+

 

+ +
+

E

+ +
+

All

+ +
+

1450.00

+ +
+

799.00

+ +
+

2249.00

+ +
+

 

+ +
+

F

+ +
+

All

+ +
+

1450.00

+ +
+

842.60

+ +
+

2292.60

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.001

+ +
+

14.00

+ +
+

74.00

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX +

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana +

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

G

+ +
+

State-certified personal care.

+ +
+

H

+ +
+

State-certified residence in-group home for mentally disabled.

+ +
+

I

+ +
+

State-certified residence in-group home for physically or developmentally disabled.

+ +
+

J

+ +
+

State-certified residence for child and adult foster care.

+ +
+

K

+ +
+

State-certified transitional living for developmentally disabled.

+ +
+

Y

+ +
+

Optional supplementation waived – Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases – Includes all recipients and couples not certified in State codes + G, H, I, J, or K. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana +

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2024: +

+
+
+

a. Recipient payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

967.00

+ +
+

94.00

+ +
+

1061.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

967.00

+ +
+

94.00

+ +
+

1061.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

967.00

+ +
+

94.00

+ +
+

1061.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

967.00

+ +
+

52.75

+ +
+

1019.75

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

967.00

+ +
+

26.00

+ +
+

993.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

644.671

+ +
+

0.00

+ +
+

644.67

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Montana +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

G

+ +
+

All

+ +
+

1450.00

+ +
+

193.00

+ +
+

1643.00

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1450.00

+ +
+

193.00

+ +
+

1643.00

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

1450.00

+ +
+

193.00

+ +
+

1643.00

+ +
+

 

+ +
+

J

+ +
+

All

+ +
+

1450.00

+ +
+

110.50

+ +
+

1560.50

+ +
+

 

+ +
+

K

+ +
+

All

+ +
+

1450.00

+ +
+

57.00

+ +
+

1507.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1450.00

+ +
+

0.00

+ +
+

1450.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

966.671

+ +
+

0.00

+ +
+

966.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada +

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living or living in parental household

+ +

Use OS code “A” for an aged or blind eligible recipient who meets one of the following + situations: +

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement “A” purposes;

    + +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or +

    + +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a “protected child”) + living in a parent's household. +

    + +
    +
    +
  6. +
+ +

Use with an “intervening” Federal code “A.” For optional State supplement codes, see + SM 01301.535. +

+ +
+

B

+ +
+

Living in the household of another

+ +

Use OS code “B” for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement “B” because the criteria for this supplement level are the same as for + Federal code “B.” +

+ +
+

C

+ +
+

Domiciliary care

+ +

Apply OS code “C” to aged or blind recipients who the State has certified to live + in a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor. +

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation. +

+ +
+

Z

+ +
+

Apply “No Supplement” code “Y” to the following recipients: +

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada +

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2025: +

+
+
+

a. Recipient payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged

+ +
+

967.00

+ +
+

36.40

+ +
+

1003.40

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

967.00

+ +
+

109.30

+ +
+

1076.30

+ +
+

 

+ +
+

C

+ +
+

Aged

+ +
+

967.00

+ +
+

391.00

+ +
+

1358.00

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

967.00

+ +
+

391.00

+ +
+

1358.00

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

B

+ +
+

B

+ +
+

Aged

+ +
+

644.671

+ +
+

24.27

+ +
+

668.94

+ +
+

 

+ +
+

 

+ +
+

Blind

+ +
+

644.671

+ +
+

213.96

+ +
+

858.63

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

644.671

+ +
+

0.00

+ +
+

644.67

+ +
+

C

+ +
+

A

+ +
+

Blind

+ +
+

967.00

+ +
+

109.30

+ +
+

1076.30

+ +

 

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.002

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Nevada +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

Aged/Aged

+ +
+

1450.00

+ +
+

74.46

+ +
+

1524.46

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1450.00

+ +
+

374.60

+ +
+

1824.60

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1450.00

+ +
+

224.53

+ +
+

1674.53

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1450.00

+ +
+

37.23

+ +
+

1487.23

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1450.00

+ +
+

187.30

+ +
+

1637.30

+ +
+

 

+ +
+

C

+ +
+

Aged/Aged

+ +
+

1450.00

+ +
+

881.00

+ +
+

2331.00

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

1450.00

+ +
+

881.00

+ +
+

2331.00

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

1450.00

+ +
+

881.00

+ +
+

2331.00

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

1450.00

+ +
+

440.50

+ +
+

1890.50

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

1450.00

+ +
+

440.50

+ +
+

1890.50

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

1450.00

+ +
+

0.00

+ +
+

1450.00

+ +
+

B

+ +
+

B

+ +
+

Aged/Aged

+ +
+

966.671

+ +
+

49.64

+ +
+

1016.31

+ +
+

 

+ +
+

 

+ +
+

Blind/Blind

+ +
+

966.671

+ +
+

531.94

+ +
+

1498.61

+ +
+

 

+ +
+

 

+ +
+

Aged/Blind

+ +
+

966.671

+ +
+

290.79

+ +
+

1257.46

+ +
+

 

+ +
+

 

+ +
+

Aged/

+ +

Disabled

+ +
+

966.671

+ +
+

24.82

+ +
+

991.49

+ +
+

 

+ +
+

 

+ +
+

Blind/

+ +

Disabled

+ +
+

966.671

+ +
+

265.97

+ +
+

1232.64

+ +
+

 

+ +
+

Z

+ +
+

Disabled

+ +
+

966.671

+ +
+

0.00

+ +
+

966.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.002

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey +

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Congregate care

+ +

Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement + includes: +

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services’ Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services. +

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Living alone or with others

+ +

 

+ +

Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and + who do not meet the requirements defined in other supplementation categories. +

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + “A” to be in optional supplement “B” unless they are residing in a residential health + care facility or living alone with an ineligible spouse. +

+ +

Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled + to optional supplement “B.” +

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations: +

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    + +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement “A;” or

    + +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services. +

    + +
    +
    +
  6. +
+ +

Optional supplement code “B” is the proper code to use with an “intervening” Federal + code “A.” For State supplement codes, see SM 01301.535. +

+ +

Use OS code “B” to address Section 1619 cases.

+ +
+

C

+ +
+

Living alone with an ineligible spouse

+ +

Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If other persons, even minor children, are present in + the household, you cannot apply this OS code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate “household” by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement “C” as long as no other person is considered part of the “household.” + There is no couple counterpart in this category. +

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code “C.” +

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code “B.” +

+ +
+

D

+ +
+

Living in the household of another

+ +

Apply OS code D to recipients who are “living in the household of another” for Federal + purposes. +

+ +
+

I

+ +

 

+ +

 

+ +

 

+ +

 

+ +
+

Licensed residential health care facilities (RHCF)

+ +

Apply OS code “I” to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    “free-standing” licensed residential health care facilities. We paid residents of + these facilities the OS “A” rate prior to January 1, 2006. +

    + +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey Congregate Care + Directory. +

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code “A” rate. Nursing home residents are in living arrangement + (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. +

+ +
+

G

+ +
+

Apply OS code “G” effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

Apply OS code “Z” to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    + +
    +
    +
  • +
+ +

You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or + effective December 1, 1996, to children residing in public or private facilities where + private health insurance paid for their care. For determination of applicability of + $30 payment limit, see SI 00520.011. +

+ +
+
+

NOTE: All State Supplement payments, except for medicaid facilities, include a Lifeline + payment which is a utility assistance program for older people and people with disabilities + that offers an annual benefit amount for individuals who receive SSI. +

+
+
+
+
+

2. Coding and monthly payment levels for New Jersey +

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2025: +

+
+
+

a. Recipient payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

967.00

+ +
+

150.05

+ +
+

1117.05

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

967.00

+ +
+

31.25

+ +
+

998.25

+ +
+

 

+ +
+

C

+ +
+

Individual

+ +
+

967.00

+ +
+

152.99

+ +
+

1119.99

+ +
+

 

+ +
+

I

+ +
+

All

+ +
+

967.00

+ +
+

210.05

+ +
+

1177.05

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

644.671

+ +
+

44.31

+ +
+

688.98

+ +
+

C

+ +
+

B

+ +
+

All

+ +
+

967.00

+ +
+

31.25

+ +
+

998.25

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

30.002

+ +
+

20.00

+ +
+

50.00

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

30.00

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for New Jersey +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All

+ +
+

1450.00

+ +
+

618.35

+ +
+

2068.351

+ +
+

 

+ +
+

B

+ +
+

All

+ +
+

1450.00

+ +
+

25.35

+ +
+

1475.35

+ 1
+

 

+ +
+

I

+ +
+

All

+ +
+

1450.00

+ +
+

738.35

+ +
+

2188.351

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1450.00

+ +
+

0.00

+ +
+

1450.00

+ +
+

B

+ +
+

D

+ +
+

All

+ +
+

966.672

+ +
+

93.08

+ +
+

1059.751

+ +
+

D

+ +
+

G

+ +
+

All

+ +
+

60.003

+ +
+

40.00

+ +
+

100.00

+ +
+
+

1This amount is the total of the federal payment, the state supplement amount, and + the lifeline payment. When added together and divided in half for each member of the + couple, the result includes a half penny. The total is rounded up to accommodate system + processing. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania +

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

C

+ +
+

Living with an essential person (EP)

+ +

Apply OS code “C” to recipients who are not living in the household of another or + in a foster care home for adults and who have one or more EP’s as defined under the + Federal rules. +

+ +
+

D

+ +
+

Living in the household of another with an EP

+ +

Apply OS code “D” to recipients who live in the household of another and have one + or more EP’s as defined under the Federal rules. +

+ +
+

G

+ +
+

Living in a domiciliary care facility

+ +

Apply OS code “G” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

H

+ +
+

Living in a personal care boarding home (PCBH)

+ +

Apply OS code “H” to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No supplement cases

+ +

OS code “Z” includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA “A” or FLA + “B” who receive a State-administered supplement. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania +

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2025: +

+
+
+

a. Recipient payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

C

+ +
+

All

+ +
+

1451.001

+ +
+

43.70

+ +
+

1494.70

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

967.00

+ +
+

634.30

+ +
+

1601.30

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

967.00

+ +
+

639.30

+ +
+

1606.30

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

B

+ +
+

Z

+ +
+

All

+ +

 

+ +
+

644.672

+ +
+

0.00

+ +
+

644.67

+ +
+

 

+ +
+

D

+ +
+

All

+ +
+

1128.673

+ +
+

43.70

+ +
+

1172.37

+ +
+

C

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

30.004

+ +
+

0.00

+ +
+

30.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR less VTR. +

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Pennsylvania +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

 A

+ +
+

C

+ +
+

All

+ +
+

1934.001

+ +
+

68.05

+ +
+

2002.05

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1450.00

+ +
+

1347.40

+ +
+

2797.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1450.00

+ +
+

1357.40

+ +
+

2807.40

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

1450.00

+ +
+

0.00

+ +
+

1450.00

+ +
+

B 

+ +
+

D

+ +
+

All

+ +
+

1450.672

+ +
+

68.05

+ +
+

1518.72

+ +
+

B

+ +
+

Z

+ +
+

All

+ +
+

966.673

+ +
+

0.00

+ +
+

966.67

+ +
+

D

+ +
+

Z

+ +
+

All

+ +
+

60.004

+ +
+

0.00

+ +
+

60.00

+ +
+
+

1Not the FBR; the amount represents the FBR plus EP increment. +

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR. +

+

3Not the FBR; the amount represents the FBR less VTR. +

+

4Not the FBR; the amount represents a payment cap to recipients. +

+

NOTE: Apply the payment level for couples in Pennsylvania’s PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvania’s + PCBHs, see SI PHI01415.010. +

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island +

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island +

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

D

+ +
+

Residential care or assisted living

+ +

Apply OS code “D” only to recipients living in residential care or assisted living + facilities as certified by the Rhode Island Department of Human Services. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+

Z

+ +
+

No state supplement payable

+ +

Use OS code “Z” when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category “D” or “F”. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island +

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2025: +

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

D

+ +

 

+ +

 

+ +
+

All

+ +

 

+ +

 

+ +
+

967.00

+ +

 

+ +

 

+ +
+

332.00

+ +

 

+ +

 

+ +
+

1299.00

+ +

 

+ +

 

+ +
+

 

+ +
+

Z

+ +
+

All

+ +
+

967.00

+ +
+

0.00

+ +
+

967.00

+ +
+
+
+
+
+
+ +
+
+

M. Description of supplements for Vermont +

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont +

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+ +
+

Definition

+ +
+

A

+ +
+

Independent living (except Chittenden County)

+ +

Apply OS code “A” to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    + +
    +
    +
  • +
+ +
+

B

+ +
+

Independent living in Chittenden County

+ +

Apply OS code “B” to all recipients living in situations described in “A” above except + restricted to residents of Chittenden County. +

+ +
+

C

+ +
+

Licensed residential care home or assisted living residence with + assistive community care services (Level III)

+ +

Apply OS code “C” to recipients residing in Level III facilities identified by the + State. To determine if the facility meets the requirements for OS code “C,” refer + to the Division of + Licensing and Protection for Vermont State. +

+ +
+

E

+ +
+

Living in the household of another

+ +

Apply OS code “E” to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions). +

+ +
+

G

+ +
+

Licensed residential care home or therapeutic community residence (Level + IV)

+ +

Apply OS code “G” to recipients residing in Level IV facilities identified by the + State. Apply OS code “G” to recipients residing in Level IV facilities identified + by the State. To determine if a facility meets the requirements for OS code “G,” refer + to the Division of + Licensing and Protection for Vermont State. +

+ +
+

H

+ +
+

Custodial care: family home +

+ +

Apply OS code “H” to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    + +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less. +

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) “H.” To qualify these programs must meet the above requirements. +

+ +

Custodial care means providing basic room and board, plus personal services such as: +

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients. +

    + +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care. +

+ +
+

I

+ +
+

Apply OS code “I” effective July 1, 1987, when the State elected Federal + administration of an optional State supplementary payment to residents in Title + XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month. +

+ +
+

Y

+ +
+

Optional supplementation waived

+ +

Use this OS code “Y” to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation. +

+ +
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont +

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2025: +

+
+
+

a. Recipient payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

967.00

+ +
+

55.68

+ +
+

1022.68

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

967.00

+ +
+

55.68

+ +
+

1022.68

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

967.00

+ +
+

51.77

+ +
+

1018.77

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

967.00

+ +
+

239.62

+ +
+

1206.62

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

967.00

+ +
+

105.60

+ +
+

1072.60

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

644.67

+ +
+

42.05

+ +
+

686.72

+ +
+

C

+ +
+

A

+ +
+

All (Except Chittenden County)

+ +
+

967.00

+ +
+

55.68

+ +
+

1022.68

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

967.00

+ +
+

55.68

+ +
+

1022.68

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

30.001

+ +
+

49.93

+ +
+

79.93

+ +
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+

b. Couple payment levels for Vermont +

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+ +
+

State OS Code

+ +
+

Category

+ +
+

FBR

+ +
+

State Supplement Level

+ +
+

Total Payment Levels

+ +
+

A

+ +
+

A

+ +
+

All(Except Chittenden County)

+ +
+

1450.00

+ +
+

105.80

+ +
+

1555.80

+ +
+

 

+ +
+

B

+ +
+

All (Restricted to Chittenden County)

+ +
+

1450.00

+ +
+

105.80

+ +
+

1555.80

+ +
+

 

+ +
+

C

+ +
+

All

+ +
+

1450.00

+ +
+

103.54

+ +
+

1553.54

+ +
+

 

+ +
+

G

+ +
+

All

+ +
+

1450.00

+ +
+

601.40

+ +
+

2051.40

+ +
+

 

+ +
+

H

+ +
+

All

+ +
+

1450.00

+ +
+

356.12

+ +
+

1806.12

+ +
+

B

+ +
+

E

+ +
+

All

+ +
+

966.671

+ +
+

51.69

+ +
+

1018.36

+ +
+

D

+ +
+

I

+ +
+

All

+ +
+

60.002

+ +
+

99.85

+ +
+

159.85

+ +
+
+

1Not the FBR; the amount represents the FBR less VTR. +

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution. +

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination +

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations +

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events +

+
+
+

Unless you have reason to question the situation, document the recipient’s statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact). +

+
+
+
+
+

3. Questionable situations regarding optional State supplements +

+
+
+

In questionable situations, review any available evidence that supports the recipient’s + allegation of their optional State supplement category. Contact other persons with + knowledge of the recipient’s living situation, if necessary (landlord, homeowner, + facility manager). Document the file per the instructions on recording evidence in + GN 00301.285 through GN 00301.289. +

+
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415057
SI 01415.057 - Federally Administered Optional Supplementary Payment Programs for January 2025 - 12/23/2024
+Batch run: 02/19/2025
+Rev:12/23/2024
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html new file mode 100644 index 00000000..c2b194a5 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_2026.html @@ -0,0 +1,9447 @@ + + +SSA - POMS: SI 01415.058 - Federally Administered Optional Supplementary Payment Programs for January 2026 - 08/28/2026 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 95 (08-26)

+

SI 01415.058 Federally Administered Optional Supplementary Payment Programs for January 2026

+ + +

 

+ +
+
+

A. List of States participating in the federally administered optional supplementary + payment program

+
+
+

The following states participate in federally administered optional supplementary + payment programs:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
StateReference
CaliforniaSI 01415.058B
DelawareSI 01415.058C
District of ColumbiaSI 01415.058D
HawaiiSI 01415.058E
IowaSI 01415.058F
MichiganSI 01415.058G
MontanaSI 01415.058H
NevadaSI 01415.058I
New JerseySI 01415.058J
PennsylvaniaSI 01415.058K
Rhode IslandSI 01415.058L
VermontSI 01415.058M
+
+
+
+ +
+
+

B. Description of supplements for California

+
+
+
+
+

1. Definitions of State living arrangement variations for California

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
CodeDefinition
A +

Use optional supplement (OS) code A for independent living with cooking facilities + for an eligible recipient or couple who meet one of the following situations:

+ +
    +
  • +
    +
    •
    +
    +

    live in their own household, as defined for Federal living arrangement (FLA) A purposes, + and have cooking and food storage facilities or living arrangement provides meals;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a patient in a certified private medical facility where Title XIX does not pay more + than 50 percent of the cost of care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind child under age 18 living in the household of a parent or parents, or is a + disabled child age 18 or over who meets sharing criteria and is living in the household + of a parent or parents;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a blind recipient who lives in an independent living arrangement with or without cooking + and food storage facilities; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    lives in a private medical facility licensed by the State but not certified under + Title XIX.

    +
    +
    +
  • +
+
B +

Apply OS code B for non-medical out-of-home care (NMOHC) when a recipient or couple + needs non-medical care or supervision in the following living arrangement situations:

+ +

Children (under age 18)

+ +
    +
  • +
    +
    •
    +
    +

    blind child residing in a State licensed NMOHC facility;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind child residing in the home of a relative who is not a parent and not a legal + guardian;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in a State licensed NMOHC facility;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Disabled child residing in the home of a legal guardian who is not a relative;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    disabled child residing in the home of a relative who is not a parent (Major v. McMahon + decision); or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    blind or disabled child in a certified family home approved by a licensed home-finding + agency (certified family home placement).

    +
    +
    +
  • +
+ +

Adults (age 18 and over)

+ +

An aged, blind, or disabled recipient:

+ +
    +
  • +
    +
    •
    +
    +

    or couple is determined to be in FLA A and resides in the home of a relative, legal + conservator, or guardian;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA A and resides in a State licensed NMOHC facility; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is determined to be in FLA A and resides in a family home certified by a family home + agency under State law.

    +
    +
    +
  • +
+ +

For California optional supplement (OS) purposes, a relative is defined as a:

+ +
    +
  • +
    +
    •
    +
    +

    parent,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    child,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    half-

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    parent's sibling,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    sibling's child,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    first cousin, or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    any person of the preceding generation denoted by the prefix grand or great.

    +
    +
    +
  • +
+
C +

Independent living without cooking facilities

+ +

Apply OS code C to aged or disabled recipient or couples who are:

+ +
    +
  • +
    +
    •
    +
    +

    not given meals, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    do not have access to adequate cooking or food storage facilities as part of a living + arrangement.

    +
    +
    +
  • +
+ +

Transients, as defined in SI 00835.060, are also eligible for OS C.

+ +

A recipient or couple qualifies for OS C if any of the following situations exists:

+ +
    +
  • +
    +
    •
    +
    +

    Immediate living quarters do not have cooking and food storage facilities that the + recipient, couple, or another person (who is responsible for preparing their meals) + can prepare meals on a daily basis;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Does not have access to adequate cooking and food storage facilities as part of the + living arrangement (including cooking and food storage facilities, which are outside + the immediate living quarters) for the purpose of preparing meals or having them prepared + on their behalf;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a boarding house that does not have a communal kitchen with adequate cooking + and food storage facilities that they can access for preparing meals;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives with friends or relatives in private living quarters in the same house or in + separate living quarters (for example, over the garage) or in a similar situation + and does not have access to the cooking and food storage facilities in the main residence + for preparing meals; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Lives in a room and board facility and does not contract with the facility to have + meals prepared and provided as part of the living arrangement (for example, the Supplemental + Security Income (SSI) recipients arrangement with the facility is to purchase only + shelter on a monthly basis).

    +
    +
    +
  • +
+ +

Adequate cooking and food storage facilities exist when a recipient or couple has + access to the following:

+ +
    +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove without a working oven but with + at least two working burners. (Do not consider the capacity of the refrigerator or + icebox when making this determination. Also, do not consider an ice chest to be adequate + storage.);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a hotplate with at least two burners with + separate temperature controls, or two one-burner hotplates with temperature controls. + (Do not consider hotplates without temperature controls used for warming food as adequate + cooking facilities.); or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    both a working refrigerator or icebox and a stove with a working oven or functioning + microwave oven in combination with at least one working burner on a stove, or a one-burner + hotplate with a temperature control.

    +
    +
    +
  • +
+ +

Eligibility for OS C begins in the month the recipient applies for this supplement + rate, provided they have been without cooking and food storage facilities throughout + the month.

+ +

NOTE: For purposes of OS C, throughout a month does not mean the recipient must lack + adequate cooking or food storage facilities from the very first moment of the month. + The recipient need only lack them from some time on the first day of the month.

+ +

If you based eligibility on temporary loss or non-functioning of an appliance, advise + the recipient of their responsibility to report immediately when the temporary condition + ceases.

+ +

If the recipient provides an expected date when someone will replace or repair the + appliance, diary the case for re-contact.

+ +

Eligibility for this supplementary payment ceases the month following the month in + which the individual or couple receives meals or adequate cooking and food storage + facilities are available.

+ +

For a couple, comprised of an aged or disabled recipient and a blind recipient, whose + living arrangement lacks adequate cooking and storage facilities, the couple must + receive the Supplemental Security Income and State Supplement Payment level for a + blind, aged, or disabled couple plus the restaurant meals allowance for the disabled + member of the couple. This living arrangement requires force due payment.

+
D +

Living in the household of another

+ +

Apply OS code D when an eligible individual or couple is living in the household of + another and receives food and shelter from that person. Most recipient or couples + who are subject to a one-third reduction of their Federal SSI payments are eligible + for OS D because the criteria for this supplement level are the same as for charging + the one-third reduction. However, when the eligible recipient or couple lives in the + home of a relative (other than a spouse) and needs care and supervision, you must + obtain certification for non-medical out-of-home care (OS F) from the county welfare + office since this is the highest categorical supplement that a recipient or couple + can qualify.

+
E +

Disabled child under age 18

+ +

Apply OS code E to a disabled (not blind) child under age 18 who resides with a parent + or relative by blood or marriage.

+ +

NOTE: Only FLA A and C are compatible with OS E. If the value of the one-third reduction + (VTR) applies, see code G.

+
F +

Non-medical out-of-home care living in the household of another

+ +

OS code F applies whenever an eligible recipient or couple meets the criteria for + the non-medical out-of-home care payment rate, and is determined to receive the Federal + code B payment for living in the household of another. For the one-third reduction + provision, see SI 00835.200.

+
G +

Disabled child under 18 living in the home of another

+ +

OS code G applies to a disabled (not blind) child under age 18, who resides with a + parent or relative by blood or marriage, and is determined to receive the Federal + code B payment for living in the household of another person. For the one-third reduction + provision, see SI 00835.200.

+
J +

Residents of Title XIX facilities

+ +

Effective July 1, 1987, apply OS State code J to an eligible recipient who is a patient + in a medical facility where Title XIX pays more than 50 percent of the costs. Apply + OS State code J to supplement Section 1619 cases.

+
Y +

Optional supplementation waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement + but waived their right to receive the supplement.

+
Z +

No supplement cases

+ +

Apply OS code Z to an eligible recipient who is a patient in a private medical facility + not certified under Title XIX and not licensed by the State. Include in this category + those recipients who are residing throughout a month in a publicly operated emergency + shelter.

+ +

For periods prior to July 1, 1987, apply OS code Z to an eligible recipient who is + a patient in a medical facility where Title XIX pays more than 50 percent of the costs.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for California

+
+
+

The following charts display the coding and monthly payment levels for California + effective January 1, 2026:

+
+
+

a. Recipient payment levels for California

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFederal Benefit Rate (FBR)State Supplement LevelTotal Payment Levels
AAAged994.00239.941233.94
​​Blind994.00324.321318.32
​​Disabled994.00239.941233.94
​BAll994.00632.071626.07
​CAged994.00368.811362.81
​​Disabled994.00368.811362.81
​EDisabled994.0097.271091.27
​ZAll994.000.00994.00
BDAged662.671245.20907.87
​​Blind662.671329.58992.25
​​Disabled662.671245.20907.87
​FAll662.671624.401287.07
​GDisabled662.671102.53765.20
CABlind994.00324.321318.32
​EDisabled994.0097.271091.27
​ZAll994.000.00994.00
DJAll30.00232.0062.00
+
+

1Not a Federal benefit rate (FBR); the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: California is a concurrent category State and permits SSI recipients to receive + the highest categorical supplement for which they can qualify. For more information + on multi-category eligibility, see SI 00501.300B.3.

+
+
+
+
+

b. Couple payment levels for California

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Federal CodeState OS CodeCategoryFBRState Supplement LevelTotal Payment Levels
AAAged/Aged1491.00607.832098.83
​​Blind/Blind1491.00833.352324.35
​​Disabled/Disabled1491.00607.832098.83
​​Aged/Blind1491.00747.442238.44
​​Aged/Disabled1491.00607.832098.83
​​Blind/Disabled1491.00747.442238.44
​BAll1491.001761.143252.14
​CAged/Aged1491.00865.572356.57
​​Disabled/Disabled1491.00865.572356.57
​​Aged/Disabled1491.00865.572356.57
​ZAll1491.000.001491.00
BDAged/Aged994.001615.701609.70
​​Blind/Blind994.001841.221835.22
​​Disabled/Disabled994.001615.701609.70
​​Aged/Blind994.001755.311749.31
​​Aged/Disabled994.001615.701609.70
​​Blind/Disabled994.001755.311749.31
​FAll994.0011604.202598.20
DJAll60.00264.00124.00
+
+

1Not the federal benefit rate (FBR); the amount represents the FBR less the one-third + reduction (VTR).

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

 

+
+
+
+
+
+
+ +
+
+

C. Description of supplements for Delaware

+
+
+
+
+

1. Definitions of State living arrangement variations for Delaware

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult residential care facility, assisted living facility, or adult + foster care home

+ +

To be eligible for OS code A, the State must provide documentation that a recipient + is a resident of a certified adult residential care facility, assisted living facility, + or adult foster care home.

+
+

Y

+
+

Optional supplementation waived

+ +

Use code Y to indicate that a recipient is eligible for an optional supplement, but + has waived their right to receive supplementation.

+
+

Z

+
+

No supplement cases

+ +

Use OS code Z for any recipient who is not included in OS categories A or Y.

+ +

Alternately, use OS code Z when the recipient is an intervening Federal code A.

+ +

For more information on optional State supplement codes see SM 01301.535.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Delaware

+
+
+

The following charts display the coding and monthly payments levels for Delaware effective + January 1, 2026:

+
+
+

a. Recipient payment levels for Delaware

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

994.00

+
+

140.00

+
+

1134.00

+
+

 

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

B

+
+

Z

+
+

All

+
+

662.67

+
+

0.00

+
+

662.67

+
+

C

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

D

+
+

Z

+
+

All

+
+

30.001

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Delaware

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1491.00

+
+

448.00

+
+

1939.00

+
+

 

+
+

Z

+
+

All

+
+

1491.00

+
+

0.00

+
+

1491.00

+
+

B

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

D

+
+

Z

+
+

All

+
+

60.001

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

D. Description of supplements for District of Columbia

+
+
+
+
+

1. Definitions of State living arrangement variations for the District of Columbia

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Adult foster care home with 50 or fewer residents

+ +

Use OS code A to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with 50 or fewer residents.

+
+

B

+
+

Adult foster care home with more than 50 residents

+ +

Use OS code B to indicate that you received certification from the District of Columbia, + Department of Health that the recipient is a resident of an adult foster care home + with more than 50 residents.

+
+

G

+
+

Apply OS code G to residents of Title XIX facilities.

+
+

Y

+
+

Optional supplementation waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive such.

+
+

Z

+
+

No supplement cases

+ +

Use OS code Z for all recipients not included in OS codes A, B, G, or Y.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for the District of Columbia

+
+
+

The following charts display the coding and monthly payment levels for the District + of Columbia effective January 1, 2026:

+
+
+

a. Individual payment levels for the District of Columbia

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

994.00

+
+

681.00

+
+

1675.00

+
+

 

+
+

B

+
+

All

+
+

994.00

+
+

791.00

+
+

1785.00

+
+

 

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

B

+
+

Z

+
+

All

+
+

662.671

+
+

0.00

+
+

662.67

+
+

C

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

D

+
+

G

+
+

All

+
+

30.002

+
+

79.00

+
+

109.00

+
+
+

1Not the FBR; the amount represents the FBR less the VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for the District of Columbia

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1491.00

+
+

1717.00

+
+

3208.00

+
+

 

+
+

B

+
+

All

+
+

1491.00

+
+

1937.00

+
+

3428.00

+
+

 

+
+

Z

+
+

All

+
+

1491.00

+
+

0.00

+
+

1491.00

+
+

B

+
+

Z

+
+

All

+
+

994.001

+
+

0.00

+
+

994.00

+
+

D

+
+

G

+
+

All

+
+

60.002

+
+

158.00

+
+

218.00

+
+
+

1Not the FBR; the amount represents the FBR less the VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

 

+
+
+
+
+
+
+ +
+
+

E. Description of supplements for Hawaii

+
+
+
+
+

1. Definitions of State living arrangement variations for Hawaii

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

B

+
+

Living in a community care or foster care home

+ +

Apply OS code B to recipients who are both over age 18 and live in a state approved + care or foster care home.

+
+

D

+
+

Living in a certified medical facility

+ +

Use OS code D for an eligible recipient living in a medical treatment facility where + Title XIX pays a substantial part (more than 50 percent) of the cost of care.

+
+

H

+
+

Domiciliary care I (maximum of five residents)

+ +

Use OS code H for an eligible recipient (including a child) or couple living in a + domiciliary care facility that provides varying levels of care and services. A domiciliary + care facility is a private, non-medical facility established and maintained to provide + personal care and services to aged, infirm, or handicapped persons. The State provides + SSA with listings of these facilities.

+
+

I

+
+

Domiciliary care II

+ +

OS code I is the same as code H except the facility provides care for six or more + residents.

+
+

Y

+
+

Optional supplementation waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation.

+
+

Z

+
+

Use OS code Z when the recipient is not eligible to receive Hawaii state supplement + because of the following situations:

+ +
    +
  • +
    +
    •
    +
    +

    recipient is living in the household of another;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is a patient in a private medical facility that is not certified under Title + XIX; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipient is residing throughout a month in a publicly operated emergency shelter.

    +
    +
    +
  • +
+
+
+
+
+
+
+

2. Coding and monthly payment levels for Hawaii

+
+
+

The following charts display the coding and monthly payment levels for Hawaii effective + January 1, 2026:

+
+
+

a. Recipient payments levels for Hawaii

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

B

+
+

All

+
+

994.00

+
+

829.001

+
+

1823.00

+
+

 

+
+

H

+
+

All

+
+

994.00

+
+

829.001

+
+

1823.00

+
+

 

+
+

I

+
+

All

+
+

994.00

+
+

937.001

+
+

1931.00

+
+

 

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

B

+
+

Z

+
+

All

+
+

662.67

+
+

0.00

+
+

662.67

+
+

D

+
+

D

+
+

All

+
+

30.002

+
+

45.00

+
+

75.00

+
+
+

1Rates went into effect October 1, 2025.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Hawaii

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

B

+
+

All

+
+

1491.00

+
+

1995.001

+
+

3486.00

+
+

 

+
+

H

+
+

All

+
+

1491.00

+
+

1995.001

+
+

3486.00

+
+

 

+
+

I

+
+

All

+
+

1491.00

+
+

2211.001

+
+

3702.00

+
+

 

+
+

Z

+
+

All

+
+

1491.00

+
+

0.00

+
+

1491.00

+
+

B

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

D

+
+

D

+
+

All

+
+

60.002

+
+

90.00

+
+

150.00

+
+
+

1Rates went into effect in October 2025.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

F. Description of supplements for Iowa

+
+
+
+
+

1. Definitions of State living arrangement variations for Iowa

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Living in own household (blind only)

+ +

Only apply OS code A to an eligible blind recipient and the blind member of a couple + who:

+ +
    +
  • +
    +
    •
    +
    +

    does not live in any other State living arrangement variation, does not have an essential + person (EP); and is not otherwise excepted from supplementation; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    is a blind recipient living in a Title XIX facility where Medicaid pays 50 percent or less of + the cost of their care. Optional supplement code A is also compatible with Federal + codes A and C.

    +
    +
    +
  • +
+ +

OS code A is the proper code to use with an intervening Federal code A.

+ +

For optional State supplement codes, see SM 01301.535.

+
+

B

+
+

Living in the household of another (blind only)

+ +

OS code B is only for an eligible blind recipient and the blind member + of a couple who does not live in any other State living arrangement variation, lives in the household + of another for Federal purposes, does not have an EP, and is not otherwise excepted + from supplementation.

+
+

C

+
+

Living with a dependent

+ +

Use OS code C for an eligible recipient or each member of an eligible couple in Federal + living arrangement A or C:

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services.

    +
    +
    +
  • +
+ +

The payment level for this variation increases by $22 for each blind recipient or + blind member of a couple to reflect the categorical blind supplement.

+
+

D

+
+

Living in a family life or boarding home

+ +

Use OS code D for an eligible recipient or each member of an eligible couple in Federal + living arrangement A who resides in a family life home or boarding home licensed by + the State Department of Health or certified by the State Department of Human Services.

+
+

H

+
+

Living with a dependent person

+ +

Use OS code H for an eligible recipient or each member of an eligible couple in Federal + living arrangement B:

+ +
    +
  • +
    +
    •
    +
    +

    who has an ineligible spouse, parent, child, or adult child living in the home with + them, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    who is financially dependent upon the eligible recipient as defined by the State Department + of Human Services.

    +
    +
    +
  • +
+ +

Increase the payment level for this variation by $22 for each blind recipient or blind + member of a couple to reflect the categorical blind supplement.

+
+

I

+
+

Living in a family life or boarding home - eligible recipient or each member of an eligible couple in FLA B, who resides in + a family life home or boarding home licensed by the State Department of Health, or + certified by the State Department of Human Services.

+
+

Y

+
+

Optional supplementation waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation.

+
+

Z

+
+

No supplement cases

+ +

Use OS code Z to address:

+ +
    +
  • +
    +
    •
    +
    +

    SSI recipients residing throughout a month in publicly operated emergency shelters;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients living in their own households or living in the households + of others;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in medical facilities not certified under Title XIX;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients whose Federal payments are reduced to $30 or $60 due to living in a Title + XIX facility; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    aged or disabled recipients whose Federal payments are not reduced but who live in + a Title XIX facility where Medicaid pays 50 percent or less of the cost of care.

    +
    +
    +
  • +
+ +

NOTE: The State Department of Human Services administers three optional supplementation + programs:

+ +
    +
  1. +
    +
    1. 
    +
    +

    In-home health related care;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Residential care; and

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Supplement for Medicare and Medicaid Eligible.

    +
    +
    +
  6. +
+
+
+

NOTE: Iowa is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+

Blind recipients (either individuals or member of a couple) whose records include + an EP have a supplementary payment level that includes $22 for each recipient in addition + to the FBR and EP increment and must be force paid.

+
+
+
+
+

2. Coding and monthly payment levels for Iowa

+
+
+

The following charts display the coding and monthly payment levels for Iowa effective + January 1, 2026:

+
+
+

a. Recipient payment levels for Iowa

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind

+
+

994.00

+
+

22.00

+
+

1016.00

+
+

 

+
+

C

+
+

Aged

+
+

994.00

+
+

518.00

+
+

1512.00

+
+

 

+
+

 

+
+

Blind

+
+

994.00

+
+

540.00

+
+

1534.00

+
+

 

+
+

 

+
+

Disabled

+
+

994.00

+
+

518.00

+
+

1512.00

+
+

 

+
+

D

+
+

Aged

+
+

994.00

+
+

142.00

+
+

1136.00

+
+

 

+
+

 

+
+

Blind

+
+

994.00

+
+

164.00

+
+

1158.00

+
+

 

+
+

 

+
+

Disabled

+
+

994.00

+
+

142.00

+
+

1136.00

+
+

 

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

B

+
+

B

+
+

Blind

+
+

662.671

+
+

22.00

+
+

684.67

+
+

 

+
+

H

+
+

Aged

+
+

662.671

+
+

518.00

+
+

1180.67

+
+

 

+
+

 

+
+

Blind

+
+

662.671

+
+

540.00

+
+

1202.67

+
+

 

+
+

 

+
+

Disabled

+
+

662.671

+
+

518.00

+
+

1180.67

+
+

 

+
+

I

+
+

Aged

+
+

662.671

+
+

142.00

+
+

804.67

+
+

 

+
+

I

+
+

Disabled

+
+

662.671

+
+

142.00

+
+

804.67

+
+

 

+
+

I

+
+

Blind

+
+

662.671

+
+

164.00

+
+

826.67

+
+

 

+
+

Z

+
+

All

+
+

662.671

+
+

0.00

+
+

662.67

+
+

C

+
+

A

+
+

Blind

+
+

994.00

+
+

22.00

+
+

1016.00

+
+

 

+
+

C

+
+

Blind

+
+

994.00

+
+

540.00

+
+

1534.00

+
+

 

+
+

 

+
+

Disabled

+
+

994.00

+
+

518.00

+
+

1512.00

+
+

 

+
+

Z

+
+

Disabled

+
+

994.00

+
+

0.00

+
+

994.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: State-administered programs include recipients receiving:

+
    +
  • +
    +
    •
    +
    +

    Residential Care and a payment based on a per diem rate plus a monthly personal allowance;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    In-Home Health Care and a payment based on actual cost of in-home health care plus + basic Federal benefits; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    +
    +
    +
  • +
+
+
+
+
+

b. Couple payment levels for Iowa

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Blind/Blind

+
+

1491.00

+
+

44.00

+
+

1535.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

1491.00

+
+

22.00

+
+

1513.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1491.00

+
+

22.00

+
+

1513.00

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1491.00

+
+

518.00

+
+

2009.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1491.00

+
+

562.00

+
+

2053.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1491.00

+
+

518.00

+
+

2009.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1491.00

+
+

562.00

+
+

2053.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1491.00

+
+

518.00

+
+

2009.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1491.00

+
+

562.00

+
+

2053.00

+
+

 

+
+

D

+
+

Aged/Aged

+
+

1491.00

+
+

801.00

+
+

2292.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1491.00

+
+

845.00

+
+

2336.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1491.00

+
+

801.00

+
+

2292.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1491.00

+
+

823.00

+
+

2314.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1491.00

+
+

801.00

+
+

2292.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

1491.00

+
+

823.00

+
+

2314.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

1491.00

+
+

0.00

+
+

1491.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

1491.00

+
+

0.00

+
+

1491.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

1491.00

+
+

0.00

+
+

1491.00

+
+

B

+
+

B

+
+

Blind/Blind

+
+

994.001

+
+

44.00

+
+

1038.00

+
+

 

+
+

 

+
+

Blind/Aged

+
+

994.001

+
+

22.00

+
+

1016.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

994.001

+
+

22.00

+
+

1016.00

+
+

 

+
+

H

+
+

Aged/Aged

+
+

994.001

+
+

518.00

+
+

1512.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

994.001

+
+

562.00

+
+

1556.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

994.001

+
+

518.00

+
+

1512.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

994.001

+
+

540.00

+
+

1534.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

966.671

+
+

518.00

+
+

1512.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

994.001

+
+

540.00

+
+

1534.00

+
+

 

+
+

I

+
+

Aged/Aged

+
+

994.001

+
+

801.00

+
+

1795.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

994.001

+
+

845.00

+
+

1839.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

994.001

+
+

801.00

+
+

1795.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

994.001

+
+

823.00

+
+

1817.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

994.001

+
+

801.00

+
+

1795.00

+
+

 

+
+

 

+
+

Blind/Disabled

+
+

994.001

+
+

823.00

+
+

1817.00

+
+

 

+
+

Z

+
+

Aged/Aged

+
+

994.001

+
+

0.00

+
+

994.00

+
+

 

+
+

 

+
+

Disabled/Disabled

+
+

994.001

+
+

0.00

+
+

994.00

+
+

 

+
+

 

+
+

Aged/Disabled

+
+

994.00

+
+

0.00

+
+

994.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

NOTE: State-administered programs include recipients receiving:

+
    +
  • +
    +
    •
    +
    +

    Residential Care and a payment based on a per diem rate plus a monthly personal allowance;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    In-Home Health Care and a payment based on actual cost of in-home health care plus + basic Federal benefits. Treat members of a couple as individuals; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    a supplement for Medicare and Medicaid and a $1 monthly payment.

    +
    +
    +
  • +
+

 

+
+
+
+
+
+
+ +
+
+

G. Description of supplements for Michigan

+
+
+
+
+

1. Definitions of State living arrangement variations for Michigan

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Domiciliary care

+ +

Use OS code D for recipients residing in licensed non-medical facilities that provide + room, board, and supervision. The State provides a list of these facilities and certifies + recipients who are residents requiring this level of care.

+
+

E

+
+

Personal care

+ +

Apply OS code E to recipients residing in licensed non-medical facilities that provide + general supervision, physical care, and assistance to residents as they carry out + the basic activities of daily living. The State provides a list of these facilities + and certifies the recipients who are residents requiring this level of care. Such + care situations include, but are not limited to, licensed homes for the aged.

+
+

F

+
+

Home for the aged

+ +

Apply OS code F for residents in homes for the aged. The State provides SSA with a + list of these non-medical facilities for the aged and certifies the recipients who + are residents that require this level of care.

+
+

I

+
+

Effective January 1, 1988, OS code I applies to the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional supplementation waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but has waived their right to receive supplementation.

+
+

Z

+
+

No supplement cases

+ +

Recipients in Title XIX facilities where Medicaid pays more than 50 percent of the + cost of care and recipients in medical facilities not certified under Title XIX.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Michigan

+
+
+

The following charts display the coding and monthly payment levels for Michigan effective + January 1, 2026:

+
+
+

a. Recipient payment levels for Michigan

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

994.00

+
+

87.00

+
+

1081.00

+
+

 

+
+

E

+
+

All

+
+

994.00

+
+

157.50

+
+

1151.50

+
+

 

+
+

F

+
+

All

+
+

994.00

+
+

179.30

+
+

1173.30

+
+

D

+
+

I

+
+

All

+
+

30.001

+
+

7.00

+
+

37.00

+
+

 

+
+

Z

+
+

All

+
+

30.00

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Michigan

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+
+

All

+
+

1491.00

+
+

671.00

+
+

2162.00

+
+

 

+
+

E

+
+

All

+
+

1491.00

+
+

812.00

+
+

2303.00

+
+

 

+
+

F

+
+

All

+
+

1491.00

+
+

855.60

+
+

2346.60

+
+

D

+
+

I

+
+

All

+
+

60.001

+
+

14.00

+
+

74.00

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX

+
+
+
+
+
+
+ +
+
+

H. Description of supplements for Montana

+
+
+
+
+

1. Definitions of State living arrangement variations for Montana

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

G

+
+

State-certified personal care.

+
+

H

+
+

State-certified residence in-group home for mentally disabled.

+
+

I

+
+

State-certified residence in-group home for physically or developmentally disabled.

+
+

J

+
+

State-certified residence for child and adult foster care.

+
+

K

+
+

State-certified transitional living for developmentally disabled.

+
+

Y

+
+

Optional supplementation waived Use this code to indicate that a recipient is eligible + for an optional supplement but waived their right to receive supplementation.

+
+

Z

+
+

No supplement cases Includes all recipients and couples not certified in State codes + G, H, I, J, or K.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Montana

+
+
+

The following charts display the coding and monthly payment levels for Montana effective + January 1, 2026:

+
+
+

a. Recipient payment levels for Montana

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

994.00

+
+

94.00

+
+

1088.00

+
+

 

+
+

H

+
+

All

+
+

994.00

+
+

94.00

+
+

1088.00

+
+

 

+
+

I

+
+

All

+
+

994.00

+
+

94.00

+
+

1088.00

+
+

 

+
+

J

+
+

All

+
+

994.00

+
+

52.75

+
+

1046.75

+
+

 

+
+

K

+
+

All

+
+

994.00

+
+

26.00

+
+

1020.00

+
+

 

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

B

+
+

Z

+
+

All

+
+

662.671

+
+

0.00

+
+

662.67

+
+

C

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Montana

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

G

+
+

All

+
+

1491.00

+
+

193.00

+
+

1684.00

+
+

 

+
+

H

+
+

All

+
+

1491.00

+
+

193.00

+
+

1684.00

+
+

 

+
+

I

+
+

All

+
+

1491.00

+
+

193.00

+
+

1684.00

+
+

 

+
+

J

+
+

All

+
+

1491.00

+
+

110.50

+
+

1601.50

+
+

 

+
+

K

+
+

All

+
+

1491.00

+
+

57.00

+
+

1548.00

+
+

 

+
+

Z

+
+

All

+
+

1491.00

+
+

0.00

+
+

1491.00

+
+

B

+
+

Z

+
+

All

+
+

994.001

+
+

0.00

+
+

994.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

 

+
+
+
+
+
+
+ +
+
+

I. Description of supplements for Nevada

+
+
+
+
+

1. Definitions of State living arrangement variations for Nevada

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent living or living in parental household

+ +

Use OS code A for an aged or blind eligible recipient who meets one of the following + situations:

+ +
    +
  1. +
    +
    a. 
    +
    +

    Lives in their own household as defined for Federal living arrangement A purposes;

    +
    +
    +
  2. +
  3. +
    +
    b. 
    +
    +

    Is a patient in a certified private medical facility where Title XIX does not pay more than 50 percent of the cost of care; or +

    +
    +
    +
  4. +
  5. +
    +
    c. 
    +
    +

    Is a blind child under age 18 (age 21 for recipients who qualify as a protected child) + living in a parent's household.

    +
    +
    +
  6. +
+ +

Use with an intervening Federal code A. For optional State supplement codes, see SM + 01301.535.

+
+

B

+
+

Living in the household of another

+ +

Use OS code B for aged or blind recipient who is living in the household of another + and receiving food and shelter from that person. Aged or blind recipients who are subject + to a one-third reduction (VTR) of their Federal SSI payment are eligible for optional + supplement B because the criteria for this supplement level are the same as for Federal + code B.

+
+

C

+
+

Domiciliary care

+ +

Apply OS code C to aged or blind recipients who the State has certified to live in + a private non-medical facility or, a residential facility serving 16 or fewer persons + that provides personal care and services to aged, infirm, or handicapped adult persons + who are unrelated to the proprietor.

+ +

The State licenses these facilities for direct payment. The State provides SSA with + listings of these facilities.

+
+

Y

+
+

Optional supplementation waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement + but has waived their right to receive supplementation.

+
+

Z

+
+

Apply No Supplement code Y to the following recipients:

+ +
    +
  • +
    +
    •
    +
    +

    disabled eligible recipient or disabled member of eligible couple;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple in a medical facility where Title + XIX pays more than 50 percent of the cost;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    eligible recipient or member of eligible couple who is a patient in a private medical + facility, which is not certified under Title XIX; or +

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients who are residing throughout a month in publicly operated emergency shelters.

    +
    +
    +
  • +
+
+
+

NOTE: Nevada is a concurrent category State and permits SSI recipients to receive the highest + categorical supplement for which they can qualify. For more information on multi-category + eligibility, see SI 00501.300B.3.

+
+
+
+
+

2. Coding and monthly payment levels for Nevada

+
+
+

The following charts display the coding and monthly payment levels for Nevada effective + January 1, 2026:

+
+
+

a. Recipient payment levels for Nevada

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged

+
+

994.00

+
+

36.40

+
+

1030.40

+
+

 

+
+

 

+
+

Blind

+
+

994.00

+
+

109.30

+
+

1103.30

+
+

 

+
+

C

+
+

Aged

+
+

994.00

+
+

391.00

+
+

1385.00

+
+

 

+
+

 

+
+

Blind

+
+

994.00

+
+

391.00

+
+

1385.00

+
+

 

+
+

Z

+
+

Disabled

+
+

994.00

+
+

0.00

+
+

994.00

+
+

B

+
+

B

+
+

Aged

+
+

662.671

+
+

24.27

+
+

686.94

+
+

 

+
+

 

+
+

Blind

+
+

662.671

+
+

213.96

+
+

876.63

+
+

 

+
+

Z

+
+

Disabled

+
+

662.671

+
+

0.00

+
+

662.67

+
+

D

+
+

Z

+
+

All

+
+

30.002

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Nevada

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

Aged/Aged

+
+

1491.00

+
+

74.46

+
+

1565.46

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1491.00

+
+

374.60

+
+

1865.60

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1491.00

+
+

224.53

+
+

1715.53

+
+

 

+
+

 

+
+

Aged/

+ +

Disabled

+
+

1491.00

+
+

37.23

+
+

1528.23

+
+

 

+
+

 

+
+

Blind/

+ +

Disabled

+
+

1491.00

+
+

187.30

+
+

1678.30

+
+

 

+
+

C

+
+

Aged/Aged

+
+

1491.00

+
+

881.00

+
+

2372.00

+
+

 

+
+

 

+
+

Blind/Blind

+
+

1491.00

+
+

881.00

+
+

2372.00

+
+

 

+
+

 

+
+

Aged/Blind

+
+

1491.00

+
+

881.00

+
+

2372.00

+
+

 

+
+

 

+
+

Aged/

+ +

Disabled

+
+

1491.00

+
+

440.50

+
+

1931.50

+
+

 

+
+

 

+
+

Blind/

+ +

Disabled

+
+

1491.00

+
+

440.50

+
+

1931.50

+
+

 

+
+

Z

+
+

Disabled

+
+

1491.00

+
+

0.00

+
+

1491.00

+
+

B

+
+

B

+
+

Aged/Aged

+
+

994.001

+
+

49.64

+
+

1043.64

+
+

 

+
+

 

+
+

Blind/Blind

+
+

994.001

+
+

531.94

+
+

1525.94

+
+

 

+
+

 

+
+

Aged/Blind

+
+

994.001

+
+

290.79

+
+

1284.79

+
+

 

+
+

 

+
+

Aged/

+ +

Disabled

+
+

994.001

+
+

24.82

+
+

1018.82

+
+

 

+
+

 

+
+

Blind/

+ +

Disabled

+
+

994.001

+
+

265.97

+
+

1259.97

+
+

 

+
+

Z

+
+

Disabled

+
+

994.001

+
+

0.00

+
+

994.00

+
+

D

+
+

Z

+
+

All

+
+

60.002

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

J. Description of supplements for New Jersey

+
+
+
+
+

1. Definitions of State living arrangement variations for New Jersey

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Congregate care

+ +

Apply OS code A to recipients in Federal living arrangement A. The living arrangement + includes:

+ +
    +
  • +
    +
    •
    +
    +

    recipients in residential facilities who are under the supervision of the Department + of Human Services;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    children and adults in residential facilities (both inside and outside of NJ) who + are under the supervision of, or placed by the NJ Department of Human Services Division + of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); + and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    recipients living in assisted living residences or comprehensive personal care homes + (CPCH) licensed by the Department of Health and Senior Services.

    +
    +
    +
  • +
+
+

B

+
+

Living alone or with others

+ +

 

+ +

Use OS code B for recipients whose Federal living arrangements are A or C and who + do not meet the requirements defined in other supplementation categories.

+ +

You must consider any eligible recipient who meets the requirement for a Federal code + A to be in optional supplement B unless they are residing in a residential health + care facility or living alone with an ineligible spouse.

+ +

Likewise, any child meeting the criteria for a Federal code C is automatically entitled + to optional supplement B.

+ +

This category includes, but is not limited to, recipients who are in one of the following + situations:

+ +
    +
  1. +
    +
    1. 
    +
    +

    Living physically alone;

    +
    +
    +
  2. +
  3. +
    +
    2. 
    +
    +

    Living with others in a private dwelling, but meet some criteria for Federal living + arrangement A; or

    +
    +
    +
  4. +
  5. +
    +
    3. 
    +
    +

    Placed in a transitional residency program by the Division of Mental Health and Hospitals, + Department of Human Services.

    +
    +
    +
  6. +
+ +

Optional supplement code B is the proper code to use with an intervening Federal code + A. For State supplement codes, see SM 01301.535.

+ +

Use OS code B to address Section 1619 cases.

+
+

C

+
+

Living alone with an ineligible spouse

+ +

Use OS code C when a recipient lives with ONLY their ineligible spouse and NO other + persons are part of the household. Use Federal criteria to determine an ineligible + spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding + out as spouses) who is either not eligible for SSI or who chooses not to apply. If other persons, even minor children, are present in + the household, you cannot apply this OS code.

+ +

It is possible that a claimant and the ineligible spouse live with others and allege + that they are a separate household by virtue of the fact that they eat their meals + out or have separate purchase and preparation of food. In this instance, you may consider + an optional supplement C as long as no other person is considered part of the household. + There is no couple counterpart in this category.

+ +

A transient recipient who co-exists only with an ineligible spouse also qualifies + as OS code C.

+ +

Always consider parent(s) with minor children to be in the same household and code + the case OS code B.

+
+

D

+
+

Living in the household of another

+ +

Apply OS code D to recipients who are living in the household of another for Federal + purposes.

+
+

I

+ +

 

+ +

 

+ +

 

+ +

 

+
+

Licensed residential health care facilities (RHCF)

+ +

Apply OS code I to recipients living in:

+ +
    +
  • +
    +
    •
    +
    +

    attached nursing homes;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    assisted living residence;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    CPCH; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    free-standing licensed residential health care facilities. We paid residents of these + facilities the OS A rate prior to January 1, 2006.

    +
    +
    +
  • +
+ +

We must base our authorization for this payment on the recipient's verified residence at + a facility listed in the New Jersey Congregate Care + Directory.

+ +

Only the RHCF section of a multipurpose facility is eligible for the OS code I rate. + Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose + facility) at the OS code A rate. Nursing home residents are in living arrangement + (D or G) if Medicaid pays more than 50 percent of the cost of care.

+
+

G

+
+

Apply OS code G effective September 1, 1988, when the State elected Federal administration + of an optional State supplementary payment to residents of Title XIX facilities.

+
+

Y

+
+

Optional supplementation waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement + but waived their right to receive supplementation.

+
+

Z

+
+

No supplement cases

+ +

Apply OS code Z to recipients:

+ +
    +
  • +
    +
    •
    +
    +

    in licensed medical facilities where Medicaid is paying less than 50 percent of the + cost of care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    in publicly operated community residences having 16 or less residents; and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    residing throughout a month in publicly operated emergency shelters.

    +
    +
    +
  • +
+ +

You can also apply OS code Z to cases that were FLA D prior to January 1988, or effective + December 1, 1996, to children residing in public or private facilities where private + health insurance paid for their care. For determination of applicability of $30 payment + limit, see SI 00520.011.

+
+
+

NOTE: All State Supplement payments, except for medicaid facilities, include a Lifeline + payment which is a utility assistance program for older people and people with disabilities + that offers an annual benefit amount for individuals who receive SSI.

+
+
+
+
+

2. Coding and monthly payment levels for New Jersey

+
+
+

The following charts display the coding and monthly payments levels for New Jersey + effective January 1, 2026:

+
+
+

a. Recipient payment levels for New Jersey

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

994.00

+
+

150.05

+
+

1144.05

+
+

 

+
+

B

+
+

All

+
+

994.00

+
+

31.25

+
+

1025.25

+
+

 

+
+

C

+
+

Individual

+
+

994.00

+
+

152.99

+
+

1146.99

+
+

 

+
+

I

+
+

All

+
+

994.00

+
+

210.05

+
+

1204.05

+
+

 

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

B

+
+

D

+
+

All

+
+

662.671

+
+

44.31

+
+

706.98

+
+

C

+
+

B

+
+

All

+
+

994.00

+
+

31.25

+
+

1025.25

+
+

D

+
+

G

+
+

All

+
+

30.002

+
+

20.00

+
+

50.00

+
+

 

+
+

Z

+
+

All

+
+

30.00

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for New Jersey

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All

+
+

1491.00

+
+

618.35

+
+

2109.351

+
+

 

+
+

B

+
+

All

+
+

1491.00

+
+

25.35

+
+

1516.35

+ 1
+

 

+
+

I

+
+

All

+
+

1491.00

+
+

738.35

+
+

2229.351

+
+

 

+
+

Z

+
+

All

+
+

1491.00

+
+

0.00

+
+

1491.00

+
+

B

+
+

D

+
+

All

+
+

994.002

+
+

93.08

+
+

1087.081

+
+

D

+
+

G

+
+

All

+
+

60.003

+
+

40.00

+
+

100.00

+
+
+

1This amount is the total of the federal payment, the state supplement amount, and + the lifeline payment. When added together and divided in half for each member of the + couple, the result includes a half penny. The total is rounded up to accommodate system + processing.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+

 

+
+
+
+
+
+
+ +
+
+

K. Description of supplements for Pennsylvania

+
+
+
+
+

1. Definitions of State living arrangement variations for Pennsylvania

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

C

+
+

Living with an essential person (EP)

+ +

Apply OS code C to recipients who are not living in the household of another or in + a foster care home for adults and who have one or more EPs as defined under the Federal + rules.

+
+

D

+
+

Living in the household of another with an EP

+ +

Apply OS code D to recipients who live in the household of another and have one or + more EPs as defined under the Federal rules.

+
+

G

+
+

Living in a domiciliary care facility

+ +

Apply OS code G to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities.

+
+

H

+
+

Living in a personal care boarding home (PCBH)

+ +

Apply OS code H to adult persons (age 18 and over) certified by the State to reside + in non-medical residential care facilities.

+
+

Y

+
+

Optional supplementation waived

+ +

Use code Y to indicate that a recipient is eligible for an optional supplement, but + waived their right to receive supplementation.

+
+

Z

+
+

No supplement cases

+ +

OS code Z includes all recipients who are residing in a medical facility that Title + XIX pays more than 50 percent of the cost of care and recipients in FLA A or FLA B + who receive a State-administered supplement.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Pennsylvania

+
+
+

The following charts display the coding and monthly payment levels for Pennsylvania + effective January 1, 2026:

+
+
+

a. Recipient payment levels for Pennsylvania

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

C

+
+

All

+
+

1492.001

+
+

43.70

+
+

1535.70

+
+

 

+
+

G

+
+

All

+
+

994.00

+
+

634.30

+
+

1628.30

+
+

 

+
+

H

+
+

All

+
+

994.00

+
+

639.30

+
+

1633.30

+
+

 

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

B

+
+

Z

+
+

All

+ +

 

+
+

662.672

+
+

0.00

+
+

662.67

+
+

 

+
+

D

+
+

All

+
+

1160.673

+
+

43.70

+
+

1204.37

+
+

C

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+

D

+
+

Z

+
+

All

+
+

30.004

+
+

0.00

+
+

30.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR less VTR.

+

3Not the FBR; the amount represents the FBR plus EP increment less VTR.

+

4Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Pennsylvania

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

C

+
+

All

+
+

1989.001

+
+

68.05

+
+

2057.05

+
+

 

+
+

G

+
+

All

+
+

1491.00

+
+

1347.40

+
+

2838.40

+
+

 

+
+

H

+
+

All

+
+

1491.00

+
+

1357.40

+
+

2848.40

+
+

 

+
+

Z

+
+

All

+
+

1491.00

+
+

0.00

+
+

1491.00

+
+

B

+
+

D

+
+

All

+
+

1492.002

+
+

68.05

+
+

1560.05

+
+

B

+
+

Z

+
+

All

+
+

994.003

+
+

0.00

+
+

994.00

+
+

D

+
+

Z

+
+

All

+
+

60.004

+
+

0.00

+
+

60.00

+
+
+

1Not the FBR; the amount represents the FBR plus EP increment.

+

2Not the FBR; the amount represents the FBR plus EP increment less VTR.

+

3Not the FBR; the amount represents the FBR less VTR.

+

4Not the FBR; the amount represents a payment cap to recipients.

+

NOTE: Apply the payment level for couples in Pennsylvanias PCBHs only in the month they + move into the PCBH. You must regard them as individual recipients in the month following + the month of move. For more information on the payment levels for couples in Pennsylvanias + PCBHs, see SI PHI01415.010.

+
+
+
+
+
+
+ +
+
+

L. Description of supplements for Rhode Island

+
+
+
+
+

1. Definitions of State living arrangement variations for Rhode Island

+
+
+

Definitions of State Living Arrangement Variations are as follows:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

D

+
+

Residential care or assisted living

+ +

Apply OS code D only to recipients living in residential care or assisted living facilities + as certified by the Rhode Island Department of Human Services.

+
+

Y

+
+

Optional supplementation waived

+ +

Use OS code Y to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation.

+
+

Z

+
+

No state supplement payable

+ +

Use OS code Z when the State of Rhode Island does not pay a supplement unless the + recipient resides in a licensed adult care facility described in category D or F.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Rhode Island

+
+
+

The following charts display the coding and monthly payment levels for Rhode Island + effective January 1, 2026:

+

Recipient payment levels for Rhode Island

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

D

+ +

 

+ +

 

+
+

All

+ +

 

+ +

 

+
+

994.00

+ +

 

+ +

 

+
+

332.00

+ +

 

+ +

 

+
+

1326.00

+ +

 

+ +

 

+
+

 

+
+

Z

+
+

All

+
+

994.00

+
+

0.00

+
+

994.00

+
+
+
+
+
+
+ +
+
+

M. Description of supplements for Vermont

+
+
+
+
+

1. Definitions of State living arrangement variations for Vermont

+
+
+

Use this table to view the code and definitions of State living arrangement variations:

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Code

+
+

Definition

+
+

A

+
+

Independent living (except Chittenden County)

+ +

Apply OS code A to several situations including recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    are not living in the household of another;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are not in a residential or custodial care situation;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    are under age 18 and live with a parent;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside in a private Title XIX facility where Medicaid is not paying more than 50 percent + of the cost of care;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    reside throughout a month in a publicly operated emergency shelter.

    +
    +
    +
  • +
+
+

B

+
+

Independent living in Chittenden County

+ +

Apply OS code B to all recipients living in situations described in A above except + restricted to residents of Chittenden County.

+
+

C

+
+

Licensed residential care home or assisted living residence with + assistive community care services (Level III)

+ +

Apply OS code C to recipients residing in Level III facilities identified by the State. + To determine if the facility meets the requirements for OS code C, refer to the Division of + Licensing and Protection for Vermont State.

+
+

E

+
+

Living in the household of another

+ +

Apply OS code E to recipients who live in the household of another and receive support + and maintenance from them (subject to the Federal one-third reduction provisions).

+
+

G

+
+

Licensed residential care home or therapeutic community residence (Level + IV)

+ +

Apply OS code G to recipients residing in Level IV facilities identified by the State. + Apply OS code G to recipients residing in Level IV facilities identified by the State. + To determine if a facility meets the requirements for OS code G, refer to the Division of + Licensing and Protection for Vermont State.

+
+

H

+
+

Custodial care: family home

+ +

Apply OS code H to recipients who:

+ +
    +
  • +
    +
    •
    +
    +

    live in another's home,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    pay room and board to that home owner, and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    receive one or more of the services outlined under the custodial care definition.

    +
    +
    +
  • +
+ +

To qualify as a home under this arrangement, a resident of the home must provide the + services to two persons or less.

+ +

In some cases, the Vermont Department of Disabilities, Aging, and Independent Living + (DAIL) has established outplacement programs meeting the definition of living arrangement + (L/A) H. To qualify these programs must meet the above requirements.

+ +

Custodial care means providing basic room and board, plus personal services such as:

+ +
    +
  • +
    +
    •
    +
    +

    help with feeding,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    dressing,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    bathing,

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    moving about under normal circumstances, or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    occasional tray service (tray service two-three times a week), which may include supervision + for the recipient's protection. Supervision for the recipient's protection deals primarily + with protection services for retarded and emotionally disturbed recipients.

    +
    +
    +
  • +
+ +

A person who receives one or more of these personal services is receiving custodial + care.

+
+

I

+
+

Apply OS code I effective July 1, 1987, when the State elected Federal + administration of an optional State supplementary payment to residents in Title + XIX facilities. This includes children under the age of 18 for whom Medicaid alone pays, or is expected + to pay, over 50 percent of the cost of care for that month.

+
+

Y

+
+

Optional supplementation waived

+ +

Use this OS code Y to indicate that a recipient is eligible for an optional supplement, + but waived their right to receive supplementation.

+
+
+
+
+
+
+

2. Coding and monthly payment levels for Vermont

+
+
+

The following charts display the coding and monthly payment levels for Vermont effective + January 1, 2026:

+
+
+

a. Recipient payment levels for Vermont

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All (Except Chittenden County)

+
+

994.00

+
+

55.68

+
+

1049.68

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

994.00

+
+

55.68

+
+

1049.68

+
+

 

+
+

C

+
+

All

+
+

994.00

+
+

51.77

+
+

1045.77

+
+

 

+
+

G

+
+

All

+
+

994.00

+
+

239.62

+
+

1233.62

+
+

 

+
+

H

+
+

All

+
+

994.00

+
+

105.60

+
+

1099.60

+
+

B

+
+

E

+
+

All

+
+

662.67

+
+

42.05

+
+

704.72

+
+

C

+
+

A

+
+

All (Except Chittenden County)

+
+

994.00

+
+

55.68

+
+

1049.68

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

994.00

+
+

55.68

+
+

1049.68

+
+

D

+
+

I

+
+

All

+
+

30.001

+
+

49.93

+
+

79.93

+
+
+

1Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+

b. Couple payment levels for Vermont

+
+
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+

Federal Code

+
+

State OS Code

+
+

Category

+
+

FBR

+
+

State Supplement Level

+
+

Total Payment Levels

+
+

A

+
+

A

+
+

All(Except Chittenden County)

+
+

1491.00

+
+

105.80

+
+

1596.80

+
+

 

+
+

B

+
+

All (Restricted to Chittenden County)

+
+

1491.00

+
+

105.80

+
+

1596.80

+
+

 

+
+

C

+
+

All

+
+

1491.00

+
+

103.54

+
+

1594.54

+
+

 

+
+

G

+
+

All

+
+

1491.00

+
+

601.40

+
+

2092.40

+
+

 

+
+

H

+
+

All

+
+

1491.00

+
+

356.12

+
+

1847.12

+
+

B

+
+

E

+
+

All

+
+

944.001

+
+

51.69

+
+

1045.69

+
+

D

+
+

I

+
+

All

+
+

60.002

+
+

99.85

+
+

159.85

+
+
+

1Not the FBR; the amount represents the FBR less VTR.

+

2Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

+
+
+
+
+
+
+ +
+
+

N. Procedure for documenting optional state category determination

+
+
+
+
+

1. Documentation requirements for initial claims, pre-effectuation reviews, and redeterminations

+
+
+

You do not need additional documentation unless you have reason to question the situation.

+
+
+
+
+

2. Documentation requirements for all other claims events

+
+
+

Unless you have reason to question the situation, document the recipients statement + that supports the optional state category determination on an SSA-795 (Statement of + Claimant or Other Person), or on an SSA-5002 (Report of Contact).

+
+
+
+
+

3. Questionable situations regarding optional State supplements

+
+
+

In questionable situations, review any available evidence that supports the recipients + allegation of their optional State supplement category. Contact other persons with + knowledge of the recipients living situation, if necessary (landlord, homeowner, facility + manager). Document the file per the instructions on recording evidence in GN 00301.285 through GN 00301.289.

+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415058
SI 01415.058 - Federally Administered Optional Supplementary Payment Programs for January 2026 - 08/28/2026
+Batch run: 08/28/2026
+Rev:08/28/2026
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_si_01415_index.html b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_index.html new file mode 100644 index 00000000..11f45253 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_si_01415_index.html @@ -0,0 +1,666 @@ + + +SSA - POMS: SI 01415.000 - Elements of State Supplementary Payments - Table of Contents - 10/21/2026 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

SI 01415.000 Elements of State Supplementary Payments

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Subchapter Table of Contents
Section Latest
Transmittal
SI 01415.001State Supplementary ProgramsTN 27 01-08
SI CHI01415.001(MI) Michigan State Supplementation
SI DAL01415.001State Supplementary Programs
SI PHI01415.008Administration of State Supplementary Programs — Delaware (RTN 61 — 12/2015)
SI PHI01415.009Administration of State Supplementary Programs — District of Columbia (RTN 66 - 12/2014)
SI 01415.010Administration of State Supplementary ProgramsTN 26 12-06
SI BOS01415.010Maine Optional State Supplementary Payments
SI DEN01415.010Supplementary Payments In Montana
SI PHI01415.010Administration of State Supplementary Programs — Pennsylvania (RTN 63 — 12/2014)
SI DEN01415.011State Supplementation Payments In South Dakota
SI BOS01415.012Rhode Island Optional State Supplementary Payments
SI BOS01415.013Vermont SSI State Supplement
SI DEN01415.013Supplementary Payments In Wyoming
SI 01415.024States Electing to Maintain Mandatory Minimum Supplementary Payment LevelsTN 96 10-26
SI BOS01415.024Massachusetts Mandatory Supplementary Payments
SI NY01415.025New Jersey Payments (RTS 398 - 06/2006)
SI NY01415.026New York Payments (RTS 399 - 06/2006)
SI 01415.031Federally Administered Optional Supplementary Payment Programs — January 1999 Payment + LevelsTN 64 03-24
SI 01415.032Federally Administered Optional Supplementary Payment Programs — 1/00 Payment LevelsTN 65 03-24
SI 01415.033Federally Administered Optional Supplementary Payment Programs – 1/01 Payment LevelsTN 67 07-24
SI 01415.034Federally Administered Optional Supplementary Payment Programs – January 2002 Payment + LevelsTN 69 08-24
SI SEA01415.034Seattle Region State Supplementation Payments
SI 01415.035Federally Administered Optional Supplementary Payment Programs - 1/03 Payment LevelsTN 72 08-24
SI 01415.036Federally Administered Optional Supplementary Payment Programs – 1/04 Payment LevelsTN 88 08-24
SI 01415.037Federally Administered Optional Supplementary Payment Programs – 1/05 Payment LevelsTN 68 08-24
SI 01415.038Federally Administered Optional Supplementary Payment Programs – 1/06 Payment LevelsTN 71 08-24
SI 01415.039Federally Administered Optional Supplementary Payment Programs – 1/07 Payment LevelsTN 74 08-24
SI 01415.040Federally Administered Optional Supplementary Payment Programs – 1/08 Payment LevelsTN 70 08-24
SI 01415.041Federally Administered Optional Supplementary Payment Programs for 01/09 Payment LevelsTN 82 08-24
SI 01415.042Federally Administered Optional Supplementary Payment Programs for 01/10 Payment LevelsTN 81 08-24
SI 01415.043Federally Administered Optional Supplementary Payment Programs for 01-11 Payment LevelsTN 78 08-24
SI 01415.044Federally Administered Optional Supplementary Payment Programs for 01/12 Payment LevelsTN 77 08-24
SI 01415.045Federally Administered Optional Supplementary Payment Programs for 01/13 Payment LevelsTN 79 08-24
SI 01415.046Federally Administered Optional Supplementary Payment Programs for 01/14 Payment LevelsTN 90 08-24
SI 01415.047Federally Administered Optional Supplementary Payment Programs for 01/15 Payment LevelsTN 73 08-24
SI 01415.048Federally Administered Optional Supplementary Payment Programs for January 2016 Payment + LevelsTN 76 08-24
SI 01415.049Federally Administered Optional Supplementary Payment Programs for January 2017 Payment + LevelsTN 75 08-24
SI 01415.050Federally Administered Optional Supplementary Payment Programs for January 2018 Payment + LevelsTN 83 08-24
SI 01415.051Federally Administered Optional Supplementary Payment Programs for January 2019TN 84 08-24
SI 01415.052Federally Administered Optional Supplementary Payment Programs for January 2020TN 85 08-24
SI 01415.053Federally Administered Optional Supplementary Payment Programs for January 2021TN 87 08-24
SI 01415.054Federally Administered Optional Supplementary Payment Programs for January 2022TN 80 08-24
SI 01415.055Federally Administered Optional Supplemental Payment Programs for January 2023TN 86 08-24
SI 01415.056Federally Administered Optional Supplementary Payment Programs for January 2024TN 89 08-24
SI 01415.057Federally Administered Optional Supplementary Payment Programs for January 2025TN 91 12-24
SI 01415.058Federally Administered Optional Supplementary Payment Programs for January 2026TN 95 08-26
SI SF01415.100State Supplementation - California (RTN 01, 05/2015)
SI SF01415.110California Optional State Supplement (OSS) A - Independent Living with Cooking Facilities + (RTN 01, 05/2015)
SI SF01415.120California Optional State Supplement (OSS) B - Nonmedical Out-of-Home Care (NMOHC) + (RTN 01, 05/2015)
SI SF01415.130California Optional State Supplement (OSS) F – Nonmedical Out-of Home Care Living + in the Household of Another - effective February 1, 1982 (RTN 01, 05/2015)
SI SF01415.140California Optional State Supplement (OSS) C - Independent Living Without Cooking + Facilities (RTN 01, 05/2015)
SI SF01415.150California Optional State Supplement (OSS) D - Living in the Household of Another + (RTN 01, 05/2015)
SI SF01415.160California Optional State Supplement (OSS) E – Disabled Child under Age 18 and G – + Disabled Child under Age 18 Living in the Household of Another (effective February + 1, 1982) (RTN 01, 05/2015)
SI SF01415.170California Optional State Supplement (OSS) J – Resident of a Public or Private Institution + with Title XIX (Medicaid/Medi-Cal) paying more than 50% of the cost of care (RTN 01, + 05/2015)
SI SF01415.180California Optional State Supplement (OSS) Y – OSS Waived and Z – No State Supplementation + (RTN 01, 05/2015)
SI SF01415.190California — Exhibits (RTN 01, 05/2015)
SI SF01415.200Hawaii Optional State Supplementation (BASIC 07/2014)
SI SF01415.210Hawaii Optional State Supplementation – Current Living Arrangements (BASIC 07/2014)
SI SF01415.220Hawaii Optional State Supplementation – Prior Living Arrangements (BASIC 07/2014)
SI SF01415.300Nevada Optional State Supplementation (BASIC 06/2014)
SI BOS01415.910BOS — Maine Optional State Supplementary Payments
SI BOS01415.930Massachusetts Optional State Supplementary Payments
SI BOS01415.950Rhode Island Optional Supplementary Payments
SI BOS01415.970Vermont Optional State Supplementary Payments
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501415000
SI 01415.000 - Elements of State Supplementary Payments - Table of Contents - 10/21/2026
+Batch run: 10/21/2026
+Rev:10/21/2026
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_sl_1920001201.html b/data/external/snapshots/income_resources_d4_v1/poms_sl_1920001201.html new file mode 100644 index 00000000..1795ebcf --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_sl_1920001201.html @@ -0,0 +1,444 @@ + + +SSA - POMS: SL 20001.201 - Introduction to Section 218 and State and Local Coverage - 05/05/2025 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 2 (05-25)

+

SL 20001.201 Introduction to Section 218 and State and Local Coverage +

+ + +
+
+

A. Overview +

+
+
+

State and local government employees may be covered for Social Security and Medicare + through a Section 218 Agreement between the State and the Social Security Administration + (SSA) or mandatorily under Section 210(a)(7)(F) of the Social Security Act (Act). +

+

The original Act of 1935 did not extend Social Security coverage to State and local + government employees, because there was a legal question regarding the Federal government’s + authority to tax State and local governments. However, because many government employers + did not have their own retirement system, Congress amended the Act in 1950 and created + Section 218 of the Act (codified at 42 U.S.C. § 418). Since it became effective on + January 1, 1951, Section 218 of the Act has permitted States to cover State and local + employees' positions voluntarily through an Agreement with SSA. Over time, Congress + has expanded the scope of these Agreements to give States more flexibility to cover + their employees. +

+

To date, all 50 States, Puerto Rico, the Virgin Islands, and a number of interstate + instrumentalities have entered into Section 218 Agreements with SSA to cover at least + some of their State and local employees. This is equivalent to providing Social Security + and Medicare or Medicare-only coverage to approximately 22 million employees. +

+
+
+ +
+
+

B. Timeline +

+
+
+

The following is a chronology of relevant dates and facts throughout the history of + State and local coverage: +

+
    +
  • +
    +
    •
    +
    +

    1950: On August 28, 1950, Section 218 of the Act was enacted, allowing states, voluntarily, + to extend Social Security coverage to governmental employees not covered under a retirement + system by entering into a Section 218 Agreement (P.L. 81-734, Section 106). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    1954: The Social Security Amendments of 1954 expanded the Act to allow states to extend + Social Security coverage to state and local government employees who were members + of a public retirement system (except police officers and firefighters), provided + coverage was authorized by the state and approved through a voluntary referendum of + all retirement system members (P.L. 83-761, Section 101). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    1956: The Social Security Amendments of 1956 authorized certain states to divide a retirement + system and cover only those members who voted for coverage, and all new members. Additional + States have been authorized to use this procedure through subsequent amendments to + Section 218 (P.L. 84-880, Section 104). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    1965: Medicare was legislated and employees covered by Social Security were automatically + covered for Medicare Hospital Insurance (HI). This included employees covered under + a Section 218 Agreement (P.L. 89-97, Section 101). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    1983: Before 1983, States could terminate Social Security coverage for employees covered + under the States' Section 218 Agreements. The 1983 Social Security Amendments rescinded + this provision of the Act and prohibited States from terminating coverage beginning + April 20, 1983 (P.L. 98-21, Section 103). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    1986: Medicare coverage became mandatory for State and local government employees hired + or rehired after March 31, 1986 (P.L. 99-272, Section 13205). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    1987: Prior to 1987, SSA and the States were responsible for collecting Social Security + and Medicare payments from governmental employers. Effective January 1, 1987, that + responsibility shifted to the Internal Revenue Service (IRS). Governmental employers + now pay Social Security and Medicare taxes directly to the IRS under the Federal Insurance + Contributions Act (FICA) (P.L. 99-509, Section 9002). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    1991: On July 2, 1991, Social Security and Medicare coverage became mandatory for State + and local government employees who were not members of a public retirement system + under IRS rules and who were not covered under a Section 218 Agreement (P.L. 101-508, + Section 11332). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    1994: On August 16, 1994, all States were authorized to extend Social Security and Medicare-only + coverage to police officers and firefighters covered by a retirement system. Prior + to this date, only certain States could cover the services of these positions (P.L. + 103-296, Section 305). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    2004: The Social Security Protection Act of 2004 was enacted, requiring state and local + government employers to disclose the effect of the Windfall Elimination Provision + (WEP) and the Government Pension Offset (GPO) to employees hired on or after January + 1, 2005, in jobs not covered by Social Security. Employers must provide this disclosure + using Form SSA-1945, Statement Concerning Your Employment in a Job Not Covered by + Social Security (P.L. 108-203, Section 419). +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    2025: On January 5, 2025, the President signed the Social Security Fairness Act of 2023 + (SSFA), which repealed WEP and GPO, beginning with benefits payable for January 2024 + (generally paid in February 2024). Despite the repeal of WEP and GPO, the law did + not remove the requirement for employers to provide Form SSA-1945. +

    + +
    +
    +
  • +
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1920001201
SL 20001.201 - Introduction to Section 218 and State and Local Coverage - 05/05/2025
+Batch run: 05/05/2025
+Rev:05/05/2025
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_sl_1930001331.html b/data/external/snapshots/income_resources_d4_v1/poms_sl_1930001331.html new file mode 100644 index 00000000..668eeeb5 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_sl_1930001331.html @@ -0,0 +1,781 @@ + + +SSA - POMS: SL 30001.331 - Divided-Vote Referendums - 11/16/2023 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 17 (11-23)

+

SL 30001.331 Divided-Vote Referendums +

+ + +
+
+

A. Divided-vote referendum authority (Section 218(d)(6)) +

+
+
+

Section 218(d)(6)(C) of the Social Security Act (Act) authorizes 23 States and all + interstate instrumentalities to divide a retirement system established by a State, + a political subdivision of such State, or an interstate instrumentality after a referendum + based on whether the employees in positions under that system desire Social Security + coverage. The State holds a referendum among all members of the retirement system + designated by the State for purposes of that referendum (see SL 30001.321). +

+

The States authorized to use the divided-vote process (including the enactment date + of amendments that permitted this coverage) are: +

+
    +
  • +
    +
    •
    +
    +

    Alaska (7-20-65);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    California (8-30-57);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Connecticut (8-30-57);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Florida (8-1-56);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Georgia (8-1-56);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Hawaii (8-1-56);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Illinois (1-2-68);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Kentucky (3-2-04);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Louisiana (3-2-04);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Massachusetts (8-27-58);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Minnesota (8-30-57);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Nevada (7-23-64);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    New Jersey (12-20-77);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    New Mexico (6-30-61);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    New York (8-1-56);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    North Dakota (8-1-56);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Pennsylvania (8-1-56);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Rhode Island (8-30-57);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Tennessee (8-1-56);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Texas (9-13-60);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Vermont (8-27-58);

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Washington (8-1-56); and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Wisconsin (8-1-56).

    + +
    +
    +
  • +
+
+
+

NOTE: 

+
+
+ +

These States and interstate instrumentalities may cover employees in retirement system + positions on a majority-vote basis, if they prefer. +

+ +
+
+
+
+ +
+
+

B. Referendum conditions +

+
+
+

While the referendum itself is a State matter, Federal law requires certain minimum + conditions be met. The Governor or an official designated by the Governor must certify + that the referendum met certain conditions listed below. The Governor's delegation + of their certification responsibility may be general or specific, continuing or limited. + The certification must specify that: +

+
    +
  • +
    +
    •
    +
    +

    The vote was held by written or an electronic ballot (Federal law does not prescribe + the ballot format or the voting mechanics); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The opportunity to vote was given and limited to the eligible employees;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The employees were given notice of the vote at least 90 days before the vote is to + be held (Federal law does not prescribe the form of notice); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The vote was supervised by the Governor or by a named designee of the Governor; and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The retirement system was divided into two deemed retirement systems, one composed + of positions of members of the system who voted for coverage and the other composed + of the remaining positions under the retirement system (see SL 30001.331F). +

    + +
    +
    +
  • +
+
+
+ +
+
+

C. Certification form requirements +

+
+
+

One certification is required for each referendum held in a retirement system (e.g., + if one referendum was held by a retirement system covering a number of political subdivisions, + only one certification should be submitted). If a State held separate referendums + for the employees of any one or more political subdivisions, institutions of higher + learning or hospitals as separate retirement systems, a certification is required + for each referendum held (a combined certification for each referendum may be shown + on one form). The certification should identify the precise retirement system covered + by the certification. +

+
+
+ +
+
+

D. Employees eligible to vote +

+
+
+

To be eligible to vote in a referendum an employee must be:

+
    +
  • +
    +
    •
    +
    +

    A member of the retirement system at the time the referendum is held and

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    In a position under the retirement system, i.e., be in an employment relationship + (as distinguished from actually performing services) both at the time the notice of + the referendum is given and at the time the referendum is held. +

    + +
    +
    +
  • +
+

After December 31, 1959, employees who are in positions that make them eligible to + join the retirement system but have not yet exercised their option to do so are considered + members of the retirement system and participate in the referendum. +

+

An employee does not lose eligibility to vote when absent from work because of illness, + summer vacation, or leave of absence (e.g., teachers on summer vacation, members of + the National Guard, or reservists of the U.S. military and naval services who are + called up for active duty) if the employment relationship continues. +

+
+
+ +
+
+

E. Employees not eligible to vote +

+
+
+

Employees who are not eligible to vote are those:

+
    +
  • +
    +
    •
    +
    +

    Who are already covered under the Agreement (e.g., a member of an absolute coverage + group whose position is now being brought under a retirement system); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Who are not members of the retirement system;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Who are excluded from coverage by the required or optional exclusions;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Who are members of the retirement system but are not State or local government employees + (e.g., cooperative extension agents of the Department of Agriculture, are not eligible + for coverage under an Agreement); and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Who are hired after the date the 90-day notice is given and before the date the referendum + is held. +

    + +
    +
    +
  • +
+
+
+ +
+
+

F. Dividing the retirement system into separate "deemed" retirement systems following + the referendum +

+
+
+

Following the referendum, the State must divide the retirement system designated for + purposes of the referendum into the following two separate “deemed” retirement systems: +

+
    +
  • +
    +
    •
    +
    +

    A deemed retirement system consisting of the members of the system who voted to be + covered in the referendum and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    A deemed retirement system consisting of the members who did not vote to be covered + in the referendum. +

    + +
    +
    +
  • +
+

The State is authorized to extend coverage under its Section 218 Agreement to only + the deemed retirement system comprised of those who elected coverage. +

+
+
+ +
+
+

G. Referendum time limitations +

+
+
+

Two time limitations apply to a referendum:

+
    +
  • +
    +
    •
    +
    +

    The Agreement or Modification to extend coverage must be executed within two years + of the date of the referendum and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Another referendum cannot be held among the employees of the same retirement system + group for at least one year after a previous referendum. This prohibition does not + apply where a failure to satisfy one of the referendum conditions (see SL 30001.323A) precluded the first referendum from being legally sufficient to support a valid + Modification. +

    + +
    +
    +
  • +
+

The one-year time limitation between referendums in Section 218(d)(3) of the Act applies + only when there is a subsequent referendum within that period for the same type of + coverage for the same retirement system group. It was designed to prevent immediate + or repetitive referendums for the same type of voluntary coverage for the same retirement + system group. +

+
+

Example: A retirement system group held an unsuccessful referendum for Social Security coverage + on September 1, 2003. That same retirement system can hold a referendum for Medicare + Hospital Insurance (HI)-only coverage on January 3, 2004. +

+ +
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1930001331
SL 30001.331 - Divided-Vote Referendums - 11/16/2023
+Batch run: 11/16/2023
+Rev:11/16/2023
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_sl_1930001347.html b/data/external/snapshots/income_resources_d4_v1/poms_sl_1930001347.html new file mode 100644 index 00000000..c1b1e541 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_sl_1930001347.html @@ -0,0 +1,634 @@ + + +SSA - POMS: SL 30001.347 - Providing Coverage for Police Officers and Firefighters - 01/29/2020 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 8 (01-20)

+

SL 30001.347 Providing Coverage for Police Officers and Firefighters

+ + +

A State may cover police officer and firefighter positions as a part of an absolute + coverage group or as a retirement system coverage group.

+ +
+
+

A. Covering police officer and firefighter positions as part of an absolute coverage + group

+
+
+
+
+

1. General rule

+
+
+

If police officer and/or firefighter positions were not covered by a retirement system + at the time an entity obtained Social Security coverage under the State's Section + 218 Agreement for all positions not covered by a retirement system, the police officer + and firefighter positions are covered. Coverage obtained under a Section 218 Agreement + continues even if these positions later come under a retirement system.

+

Employees in police officer or firefighter positions who are retirement system ineligibles + cannot be covered as a part of, or as an addition to, the absolute coverage group.

+
+
+

NOTE: 

+
+
+ +

See SL 30001.370 for special Federal legislation authorizing Oklahoma to cover certain ineligibles + in police positions.

+
+
+

Notwithstanding the above rule, Social Security regulations provide that if State + law requires a State or political subdivision to have a retirement system, a retirement + system is considered to be established even where no action has actually been taken + to establish the system as required by law (see 20 C.F.R. § 404.1206). Therefore, + where such laws have been enacted, the police officer and firefighter positions are + considered covered by a retirement system, and those positions would not become covered + as part of an absolute coverage group regardless of whether an entity actually established + a retirement system in accordance with State law.

+
+
+
+
+

2. Historical option to remove police officer or firefighter positions from a retirement + system for purposes of obtaining absolute coverage

+
+
+
+
+

a. Police officers

+
+
+

Before August 16, 1994, a State lacking specific authority to cover police officer + positions under a retirement system could remove those positions from the retirement + system at any time before expanding coverage to an absolute coverage group in order + to cover those positions as part of the absolute coverage group.

+

For States authorized to cover police officer positions by statute before August 16, + 1994 (SL 30001.347.B.3), police officer positions under a retirement system could be covered under the + State's Section 218 Agreement only through the referendum procedures, including coverage + for Medicare. The option to dissolve a retirement system or remove police officer + positions from a retirement system in order provide coverage as part of the absolute + coverage group was not available to these States.

+
+
+
+
+

b. Firefighters

+
+
+

Before January 2, 1968, a State lacking specific statutory authority to cover firefighter + positions under a retirement system could remove those positions from the retirement + system at any time before expanding coverage to an absolute coverage group in order + to cover those positions as part of the absolute coverage group.

+

Beginning January 2, 1968, all States were authorized to cover firefighter positions + that are under a retirement system through referendum procedures. The option to dissolve + a retirement system or remove firefighter positions from a retirement system in order + to provide coverage for firefighters as part of the absolute coverage group was no + longer available.

+
+
+
+
+
+
+ +
+
+

B. Covering police officer and firefighter positions as a retirement system coverage + group

+
+
+
+
+

1. Current law—coverage options for police officer and firefighter positions after August + 15, 1994

+
+
+

After August 15, 1994, all States were authorized to provide coverage for police officer + and firefighter positions under a retirement system. A coverage group for police officer + and firefighter positions established through a majority-vote referendum consists + of all current and future employees in positions under the retirement system in which + the referendum was held, including ineligibles. Those States and all interstate instrumentalities + authorized to use divided-vote referendum procedures may do so for police officer + and firefighter positions. If the divided-vote procedure is used, the retirement system + coverage group consists of all members who chose coverage and future members except + that “ineligibles” may not be covered as a part of such a group.

+

Notwithstanding Federal authorization to cover police officer and firefighter positions + under a retirement system, State law must also authorize the State to cover those + positions under the State’s Section 218 Agreement. The State must first review State + statutes and its enabling act to see if existing language prohibits extending Social + Security coverage under the Section 218 Agreement to police officer and firefighter + positions under a retirement system. If this language exists, the State must remove + it, which usually requires action by the State legislature. Once the legislature passes + corrective legislation, or if there is no prohibitive language to correct, then the + State must modify the language of the State’s Section 218 Agreement to permit coverage + of police officer and firefighter positions already covered by a retirement system + (see template in SL 40001.490, Exhibit 30). After all of these actions have been taken, the State may begin holding + referendums and extending coverage to those positions.

+

Before holding the referendum, the State must decide what the retirement system will + be for referendum and coverage purposes. In addition to the State’s option to designate + a retirement system for purposes of a referendum (SL 30001.321A), the State has additional choices for covering police officers and firefighters. + The state may designate the following groups as the designated retirement system:

+
    +
  • +
    +
    •
    +
    +

    The police positions only;

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The firefighter positions only; or

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The positions of police officers and firefighters.

    +
    +
    +
  • +
+
+
+
+
+

2. Historical coverage options for firefighter positions under a retirement system only—all + states January 2, 1968 through August 15, 1994

+
+
+

Beginning January 2, 1968, all States were authorized to extend coverage to employees + in firefighter positions under a retirement system provided the Governor (or a State + official designated by the Governor) certified to the Social Security Administration + (SSA) that extending Social Security coverage would improve the overall benefit protection + of these employees. The firefighter positions had to be treated as a separate retirement + system for purposes of the referendum and coverage, and the State was required to + use majority-vote procedures regardless of whether it was authorized to use divided-vote + procedures generally.

+

Following the referendum, the State was required to submit the Governor’s certification + (specified above) alongside the Modification for coverage.

+
+
+
+
+

3. Historical coverage options for police officer and firefighter positions under a retirement + system—specific states prior to 1994

+
+
+

In addition to the general authority to cover firefighters noted above, 23 States + were specifically authorized to cover both police officer and firefighter positions + under a retirement system by statute. States that specifically were authorized to + expand coverage to these positions, as listed below, were also permitted to use divided-vote + procedures if authorized to do so by law (see SL 30001.331). The following States were authorized to expand coverage as of the date shown:

+
    +
  • +
    +
    •
    +
    +

    Alabama (8/30/57);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    California (9/16/59);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Florida (8/1/56);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Georgia (8/30/57);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Hawaii (8/30/57);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Idaho (10/30/72);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Kansas (9/16/59);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Maine (10/24/62);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Maryland (8/30/57);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Mississippi (12/20/77);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Montana (12/31/74);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    New York (8/30/57);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    North Carolina (8/1/56);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    North Dakota (9/16/59);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Oregon (8/1/56);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Puerto Rico (1/2/68);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    South Carolina (8/1/56);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    South Dakota (8/1/56);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Tennessee (8/30/57);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Texas (7/2/64);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Vermont (9/16/59);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Virginia (9/13/60);

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Washington (8/28/58); and

    +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Interstate Instrumentalities (8/28/58).

    +
    +
    +
  • +
+
+
+
+
+
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1930001347
SL 30001.347 - Providing Coverage for Police Officers and Firefighters - 01/29/2020
+Batch run: 09/04/2026
+Rev:01/29/2020
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_sl_1950001501.html b/data/external/snapshots/income_resources_d4_v1/poms_sl_1950001501.html new file mode 100644 index 00000000..d7e44a98 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_sl_1950001501.html @@ -0,0 +1,491 @@ + + +SSA - POMS: SL 50001.501 - Mandatory Social Security Coverage - 01/29/2020 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 1 (01-20)

+

SL 50001.501 Mandatory Social Security Coverage +

+ + +
+
+

CITATIONS:

+
+
+ +
Social Security Act, Sections 210(a)(7)(F) and 210(p)
+ +
+
+
+
+

A. Mandatory Social Security coverage +

+
+
+

Beginning July 2, 1991, Section 11332 of Public Law 101-508 mandates Social Security + coverage for State and local government employees who are neither members of a qualified + retirement system nor covered by a Section 218 Agreement, unless coverage is specifically + excluded by law. The mandatory Social Security provisions apply to those State and + local employees who have the option to become members of the retirement system but + have chosen not to do so (optionals) as well as those employees who are personally + ineligible for membership in the retirement system (ineligibles). +

+

Because voluntary coverage under a State’s Section 218 Agreement precludes application + of the mandatory provisions, always verify whether a position is covered under the + State’s Section 218 Agreement first before considering whether the individual employee + in that position is subject to mandatory Social Security coverage. If the employee’s + position is covered by the State’s Section 218 Agreement, then the employee is covered + regardless of possible participation in a qualified retirement system. +

+
+
+

NOTE: 

+
+
+ +

Section 226 of the Social Security Act (Act) provides Medicare Hospital Insurance + (HI) coverage automatically to individuals who have Social Security coverage. +

+ +
+
+
+
+ +
+
+

B. Qualified Retirement System for purposes of mandatory coverage +

+
+
+

A “qualified retirement system” is a pension plan maintained by a public employer + that meets certain criteria established by the Internal Revenue Service (IRS) (see + IRS Revenue Procedure 91-40; 26 C.F.R. § 31.3121(b)(7)-2). The mandatory Social Security + provisions do not apply to any individual employee who participates in a qualified + retirement system +

+

IRS is responsible for determining whether an employee is a member of a qualified + retirement system under its rules. +

+
+
+

NOTE: 

+
+
+ +

Be extremely cautious not to confuse “retirement system” as the Social Security Administration + (SSA) defines it for purposes of voluntary Section 218 coverage (SL 30001.302) and “retirement system” as IRS defines it for purposes of mandatory Social Security + coverage. For purposes of Section 218 coverage, SSA defines “retirement system” broadly + to establish a basic standard governing when a State must provide referendum procedures + to employees before expanding voluntary coverage to certain positions. For purposes + of mandatory Social Security coverage, IRS defines “retirement system” with highly + specific qualitative standards that govern the applicability of mandatory coverage. + In order to distinguish the two concepts, SSA uses the term “qualified retirement + system” when referencing a retirement system that satisfies IRS’s qualitative standards + for purposes of mandatory Social Security. An employee can be a member of a retirement + system that does not constitute a qualified retirement system. +

+ +
+
+
+
+ +
+
+

C. Cessation of mandatory coverage for State and local government employees +

+
+
+

Mandatory Social Security coverage ceases either (1) when a state or local government + employee becomes a member of a qualified retirement system or (2) where a State expands + coverage under its Section 218 Agreement to the employee’s position. +

+
+
+

NOTE: 

+
+
+ +

Cessation of mandatory Social Security coverage may affect an employee’s Medicare + coverage under SSA’s continuous employment exception rules (see 50001.510.B). +

+ +
+
+
+
+ +
+
+

D. Services not subject to mandatory Social Security coverage +

+
+
+

The following services are excluded from mandatory Social Security coverage. Some + services, while excluded from mandatory coverage are optional exclusions under Section + 218 and, therefore, may be covered under a Section 218 Agreement. The exclusions that + may be covered under a Section 218 Agreement are noted below. +

+
    +
  • +
    +
    •
    +
    +

    Services performed by individuals hired to be relieved from unemployment. (This does + not include many programs financed from Federal funds where the primary purpose is + to give the employee work experience or training.) +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services performed in a hospital, home, or other institution by a patient or inmate + of such institution as an employee of a state or local government employer. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services performed by an employee on a temporary basis in case of fire, storm, snow, + earthquake, volcano, flood, or other similar emergency. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services performed by non-resident aliens with F-1, J-1, M-1, and Q-1 visas.

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services in positions compensated solely by fees that are subject to the Self-Employment + Contributions Act (SECA), unless a Section 218 Agreement covers these services. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services performed by a student enrolled and regularly attending classes at the school, + college, or university where they are working, unless a Section 218 Agreement covers + student services. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services performed by an election worker or official whose pay in a calendar year + is less than the amount mandated by law, unless a Section 218 Agreement covers election + workers. To find the coverage status of election workers for each State, see the Election + Worker Coverage Chart. +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services that would be excluded if performed for a private employer because it is + not work defined as employment under Section 210(a) of the Act, unless a Section 218 + Agreement covers certain agricultural services. +

    + +
    +
    +
  • +
+
+
+

NOTE: 

+
+
+ +

If the services are covered under a Section 218 Agreement, they are subject to Social + Security and Medicare under the terms of the Agreement because coverage under a Section + 218 Agreement supersedes all other considerations. First determine whether a worker's + services are covered under an Agreement; if not, coverage is determined under the + mandatory coverage and exclusion rules. +

+ +
+
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1950001501
SL 50001.501 - Mandatory Social Security Coverage - 01/29/2020
+Batch run: 02/11/2020
+Rev:01/29/2020
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/poms_sl_1950001510.html b/data/external/snapshots/income_resources_d4_v1/poms_sl_1950001510.html new file mode 100644 index 00000000..77e12d72 --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/poms_sl_1950001510.html @@ -0,0 +1,513 @@ + + +SSA - POMS: SL 50001.510 - Mandatory Medicare Coverage - 12/09/2003 + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + + + + + + +
+ + + + + +

Program Operations Manual System (POMS)

+ + +
+ + + +
+ +
+ +
+
+ + +
+

TN 1 (01-20)

+

SL 50001.510 Mandatory Medicare Coverage +

+ + +
+
+

CITATIONS:

+
+ +
+

The Social Security Administration (SSA) uses the term "mandatory Medicare coverage" + to refer to Medicare Hospital Insurance (HI) coverage for employees who are not covered + under Social Security. Section 13205 of Public Law 99-272 mandates Medicare HI coverage + for State and local government employees hired (or rehired) on or after April 1, 1986, + who do not have Social Security coverage. These employees are required to pay the + Medicare HI portion of the Federal Insurance Contributions Act (FICA) tax even though + they do not have Social Security coverage and do not pay the Social Security portion + of the FICA tax. +

+ +

The following rules only apply to State and local government employees who are not + covered by Social Security. +

+ +

By contrast, the following rules do not apply to employees in positions already covered + under a Section 218 Agreement or to employees who are currently subject to the mandatory + Social Security provisions. Section 226 of the Social Security Act (Act) provides + Medicare HI coverage automatically to individuals who are entitled to Social Security + benefits. +

+ +
+
+

A. Continuing employment exception +

+
+
+

Employees who have been continuously employed with the employer since before April + 1, 1986, remain exempt from mandatory Medicare taxes and corresponding coverage unless + either: (1) the State has voluntarily covered their positions using an HI-only Agreement + (SL 30001.395), or (2) the employee is currently subject to the mandatory Social Security provisions + under Section 210 (SL 50001.501). In the absence of Social Security coverage, these employees may not make Medicare + contributions. +

+

For purposes of this exception, SSA considers the employee to be continuously employed if + all of the following requirements are met: +

+
    +
  • +
    +
    •
    +
    +

    The employee was performing regular and substantial services for remuneration for + the State or political subdivision employer before April 1, 1986; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The employee was a bona fide employee of that employer before April 1, 1986;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The employment relationship with that employer was not entered into for purposes of + avoiding the Medicare tax; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    The employment relationship with that employer has been continuous since before April + 1, 1986; and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    For services performed after July 1, 1991, the employee was not subject to mandatory + Social Security coverage for the time period corresponding to those services (see + SL 50001.501). +

    + +
    +
    +
  • +
+
+
+

NOTE: 

+
+
+ +

If mandatory Social Security coverage, applicable to services performed after July + 1, 1991, ceases because the employee becomes a member of a qualified retirement system, + then the employee will lose corresponding Medicare coverage if they are exempt from + mandatory Medicare under the continuous employment exception. If the employee was + hired on or after April 1, 1986, mandatory Medicare provisions would apply (see SL 50001.510). +

+ +
+
+

An employee hired before April 1, 1986, by a State employer and who transfers on or + after April 1, 1986, to another State employer of the same State qualifies for the + continuing employment exception, provided the transfer was made without a termination + of the employee’s overall employment relationship with that State. The same rule applies + to an employee hired before April 1, 1986, by a political subdivision employer, who + transfers on or after April 1, 1986, to another employer of the same political subdivision. +

+

However, an employee hired before April 1, 1986, does not qualify for the continuing + employment exception if on or after April 1, 1986, the employee transfers from a State + employer to a political subdivision employer, or from a political subdivision employer + to a State employer. Likewise, an employee does not qualify for the exception if the + employee transfers from a political subdivision employer in one political subdivision + to a political subdivision employer in a different political subdivision. +

+
+
+

NOTE: 

+
+
+ +

Section 218(n) authorizes a State to modify its Agreement to request HI-only coverage + for those employees who meet the continuing employment exception and who are not otherwise + covered under a Section 218 Agreement (see SL 30001.395). +

+ +
+
+
+
+ +
+
+

B. Services not subject to mandatory Medicare coverage +

+
+
+

The following services are not subject to mandatory Medicare coverage even though + the services are performed by an employee hired after March 31, 1986: +

+
    +
  • +
    +
    •
    +
    +

    Services performed by individuals hired to be relieved from unemployment (this does + not include many programs financed from Federal funds where the primary purpose is + to give the employee work experience or training); +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services performed in a hospital, home, or other institution by a patient or inmate + of such institutions as an employee of a State or local government employer; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services performed by an employee on a temporary basis in case of fire, storm, snow, + earthquake, volcano, flood, or other similar emergency; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services performed by non-resident aliens with F-1, J-1, M-1, and Q-1 visas;

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services in positions compensated solely by fees that are subject to the Self-Employment + Contribution Act (SECA), unless a Section 218 Agreement covers these services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services performed by a student enrolled and regularly attending classes at the school, + college, or university where they are working, unless a Section 218 Agreement covers + student services; +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services performed by an election worker or official whose pay in a calendar year + is less than the amount mandated by law, unless a Section 218 Agreement covers election + workers (to find the coverage status of election workers for each State, see the Election + Worker Coverage Chart); and +

    + +
    +
    +
  • +
  • +
    +
    •
    +
    +

    Services that would be excluded if performed for a private employer because it is + not work defined as employment under Section 210(a) of the Act, unless a Section 218 + Agreement covers certain agricultural services. +

    + +
    +
    +
  • +
+
+
+ + +
+
+
+ + +
To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/1950001510
SL 50001.510 - Mandatory Medicare Coverage - 12/09/2003
+Batch run: 01/29/2020
+Rev:12/09/2003
+
+ + +
+ + +
+ + +
+ + + + + + + +
+ + + + + +
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ + diff --git a/data/external/snapshots/income_resources_d4_v1/ssa_manifest.txt b/data/external/snapshots/income_resources_d4_v1/ssa_manifest.txt new file mode 100644 index 00000000..c2a8befc --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/ssa_manifest.txt @@ -0,0 +1,2 @@ +# Reused, not fetched: https://www.ssa.gov/policy/docs/statcomps/supplement/2025/4b.html +2026-07-27T13:02:54Z c228920ea9d53b1e323e5933b6d9f926e3c9b609d868b549fabc40118554b449 488165 ../ssa_level_anchors_vintage1/supplement2025_4b.html diff --git a/data/external/snapshots/income_resources_d4_v1/ssa_registry.json b/data/external/snapshots/income_resources_d4_v1/ssa_registry.json new file mode 100644 index 00000000..9874ddde --- /dev/null +++ b/data/external/snapshots/income_resources_d4_v1/ssa_registry.json @@ -0,0 +1,433 @@ +[ + { + "identifier": "ssa_2025_4b1", + "publisher": "Social Security Administration", + "edition": "Annual Statistical Supplement 2025", + "url": "https://www.ssa.gov/policy/docs/statcomps/supplement/2025/4b.html#table4.b1", + "capture_file": "data/external/snapshots/ssa_level_anchors_vintage1/supplement2025_4b.html", + "sha256": "c228920ea9d53b1e323e5933b6d9f926e3c9b609d868b549fabc40118554b449", + "byte_size": 488165, + "retrieved_at": "2026-07-27T13:02:54Z", + "units": [ + "thousand_workers", + "million_usd", + "percent", + "usd_per_worker" + ], + "years": [ + 1937, + 1940, + 1945, + 1950, + 1951, + 1952, + 1953, + 1954, + 1955, + 1956, + 1957, + 1958, + 1959, + 1960, + 1961, + 1962, + 1963, + 1964, + 1965, + 1966, + 1967, + 1968, + 1969, + 1970, + 1971, + 1972, + 1973, + 1974, + 1975, + 1976, + 1977, + 1978, + 1979, + 1980, + 1981, + 1982, + 1983, + 1984, + 1985, + 1986, + 1987, + 1988, + 1989, + 1990, + 1991, + 1992, + 1993, + 1994, + 1995, + 1996, + 1997, + 1998, + 1999, + 2000, + 2001, + 2002, + 2003, + 2004, + 2005, + 2006, + 2007, + 2008, + 2009, + 2010, + 2011, + 2012, + 2013, + 2014, + 2015, + 2016, + 2017, + 2018, + 2019, + 2020, + 2021, + 2022, + 2023, + 2024 + ], + "geography": [ + "United States" + ], + "parser": "ssa_4b", + "role": "classifier_input_ce3_report_only_context", + "selector": { + "id": "table4.b1", + "column_units": [ + "thousand_workers", + "thousand_workers", + "thousand_workers", + "million_usd", + "million_usd", + "percent", + "usd_per_worker", + "usd_per_worker" + ] + } + }, + { + "identifier": "ssa_2025_4b2", + "publisher": "Social Security Administration", + "edition": "Annual Statistical Supplement 2025", + "url": "https://www.ssa.gov/policy/docs/statcomps/supplement/2025/4b.html#table4.b2", + "capture_file": "data/external/snapshots/ssa_level_anchors_vintage1/supplement2025_4b.html", + "sha256": "c228920ea9d53b1e323e5933b6d9f926e3c9b609d868b549fabc40118554b449", + "byte_size": 488165, + "retrieved_at": "2026-07-27T13:02:54Z", + "units": [ + "thousand_workers", + "million_usd", + "percent", + "usd_per_worker" + ], + "years": [ + 1951, + 1952, + 1953, + 1954, + 1955, + 1956, + 1957, + 1958, + 1959, + 1960, + 1961, + 1962, + 1963, + 1964, + 1965, + 1966, + 1967, + 1968, + 1969, + 1970, + 1971, + 1972, + 1973, + 1974, + 1975, + 1976, + 1977, + 1978, + 1979, + 1980, + 1981, + 1982, + 1983, + 1984, + 1985, + 1986, + 1987, + 1988, + 1989, + 1990, + 1991, + 1992, + 1993, + 1994, + 1995, + 1996, + 1997, + 1998, + 1999, + 2000, + 2001, + 2002, + 2003, + 2004, + 2005, + 2006, + 2007, + 2008, + 2009, + 2010, + 2011, + 2012, + 2013, + 2014, + 2015, + 2016, + 2017, + 2018, + 2019, + 2020, + 2021, + 2022, + 2023, + 2024 + ], + "geography": [ + "United States" + ], + "parser": "ssa_4b", + "role": "classifier_input_ce3_report_only_context", + "selector": { + "id": "table4.b2", + "column_units": [ + "thousand_workers", + "thousand_workers", + "million_usd", + "million_usd", + "percent", + "usd_per_worker", + "usd_per_worker", + "million_usd", + "million_usd", + "percent", + "usd_per_worker", + "usd_per_worker" + ] + } + }, + { + "identifier": "ssa_2025_4b10", + "publisher": "Social Security Administration", + "edition": "Annual Statistical Supplement 2025", + "url": "https://www.ssa.gov/policy/docs/statcomps/supplement/2025/4b.html#table4.b10", + "capture_file": "data/external/snapshots/ssa_level_anchors_vintage1/supplement2025_4b.html", + "sha256": "c228920ea9d53b1e323e5933b6d9f926e3c9b609d868b549fabc40118554b449", + "byte_size": 488165, + "retrieved_at": "2026-07-27T13:02:54Z", + "units": [ + "thousand_workers", + "million_usd" + ], + "years": [ + 2023 + ], + "geography": [ + "All areas", + "Alabama", + "Alaska", + "Arizona", + "Arkansas", + "California", + "Colorado", + "Connecticut", + "Delaware", + "District of Columbia", + "Florida", + "Georgia", + "Hawaii", + "Idaho", + "Illinois", + "Indiana", + "Iowa", + "Kansas", + "Kentucky", + "Louisiana", + "Maine", + "Maryland", + "Massachusetts", + "Michigan", + "Minnesota", + "Mississippi", + "Missouri", + "Montana", + "Nebraska", + "Nevada", + "New Hampshire", + "New Jersey", + "New Mexico", + "New York", + "North Carolina", + "North Dakota", + "Ohio", + "Oklahoma", + "Oregon", + "Pennsylvania", + "Rhode Island", + "South Carolina", + "South Dakota", + "Tennessee", + "Texas", + "Utah", + "Vermont", + "Virginia", + "Washington", + "West Virginia", + "Wisconsin", + "Wyoming", + "Outlying area", + "Puerto Rico", + "Other and unknown" + ], + "parser": "ssa_4b", + "role": "gate_truth_ce_g_state_cells_if_ir0_powered", + "selector": { + "id": "table4.b10", + "column_units": [ + "thousand_workers", + "thousand_workers", + "thousand_workers", + "million_usd", + "million_usd", + "million_usd", + "million_usd", + "million_usd", + "million_usd" + ] + } + }, + { + "identifier": "ssa_2025_4b11", + "publisher": "Social Security Administration", + "edition": "Annual Statistical Supplement 2025", + "url": "https://www.ssa.gov/policy/docs/statcomps/supplement/2025/4b.html#table4.b11", + "capture_file": "data/external/snapshots/ssa_level_anchors_vintage1/supplement2025_4b.html", + "sha256": "c228920ea9d53b1e323e5933b6d9f926e3c9b609d868b549fabc40118554b449", + "byte_size": 488165, + "retrieved_at": "2026-07-27T13:02:54Z", + "units": [ + "thousand_workers", + "million_usd" + ], + "years": [ + 1937, + 1940, + 1945, + 1950, + 1951, + 1952, + 1953, + 1954, + 1955, + 1956, + 1957, + 1958, + 1959, + 1960, + 1961, + 1962, + 1963, + 1964, + 1965, + 1966, + 1967, + 1968, + 1969, + 1970, + 1971, + 1972, + 1973, + 1974, + 1975, + 1976, + 1977, + 1978, + 1979, + 1980, + 1981, + 1982, + 1983, + 1984, + 1985, + 1986, + 1987, + 1988, + 1989, + 1990, + 1991, + 1992, + 1993, + 1994, + 1995, + 1996, + 1997, + 1998, + 1999, + 2000, + 2001, + 2002, + 2003, + 2004, + 2005, + 2006, + 2007, + 2008, + 2009, + 2010, + 2011, + 2012, + 2013, + 2014, + 2015, + 2016, + 2017, + 2018, + 2019, + 2020, + 2021, + 2022, + 2023, + 2024 + ], + "geography": [ + "United States" + ], + "parser": "ssa_4b", + "role": "classifier_input_ce3_report_only_context", + "selector": { + "id": "table4.b11", + "column_units": [ + "thousand_workers", + "thousand_workers", + "thousand_workers", + "million_usd", + "million_usd", + "million_usd", + "million_usd", + "million_usd", + "million_usd" + ] + } + } +] diff --git a/scripts/first_estimates_birth_evidence.py b/scripts/first_estimates_birth_evidence.py index 4558261d..8285e356 100644 --- a/scripts/first_estimates_birth_evidence.py +++ b/scripts/first_estimates_birth_evidence.py @@ -436,9 +436,15 @@ # nothing in the historical projection imports them. Path("src/populace_dynamics/data/psid_income_wealth.py"), Path("src/populace_dynamics/data/psid_income_wealth_registry.py"), + # The income-and-resources aggregate-table readers (D4) are opt-in + # source readers; nothing in the historical projection imports them. + Path("src/populace_dynamics/income_resources/__init__.py"), + Path("src/populace_dynamics/income_resources/aggregate_coverage.py"), + Path("src/populace_dynamics/income_resources/aggregate_pensions.py"), + Path("src/populace_dynamics/income_resources/aggregate_poms.py"), + Path("src/populace_dynamics/income_resources/aggregate_tables.py"), # The SSI interface (SSI0) is opt-in; nothing in the historical # projection imports it. - Path("src/populace_dynamics/income_resources/__init__.py"), Path("src/populace_dynamics/income_resources/ssi/__init__.py"), Path("src/populace_dynamics/income_resources/ssi/_child.py"), Path("src/populace_dynamics/income_resources/ssi/contract.py"), diff --git a/src/populace_dynamics/income_resources/aggregate_coverage.py b/src/populace_dynamics/income_resources/aggregate_coverage.py new file mode 100644 index 00000000..01cc100d --- /dev/null +++ b/src/populace_dynamics/income_resources/aggregate_coverage.py @@ -0,0 +1,286 @@ +"""Pinned public-pension tables and Section 218 cited references. + +Invariants: + +* Every entry point verifies the registered byte size and SHA-256 before + examining its payload. +* Reference prose remains cited text. State authority lists are never + interpreted as observed coverage, membership or a coverage probability. +* Table columns require explicit units and published row labels. Missing + or suppressed cells remain missing, with their source flags. +* Expanded HTML headers retain their full hierarchy, and duplicate cell + identities are refused. Parser errors and representations disclose + structure only. + +The captured RS 01505 sections concern administrative procedures. The +state authority lists and mandatory-coverage rules are in the State and +Local Coverage Handbook's SL sections. These references support CE1 and +provide CE3 context; they do not supply state noncoverage observations. +The Census parser accepts explicitly mapped CSV, API JSON or HTML; a +blocked Census source does not create a registry table or invented data. +""" + +from __future__ import annotations + +import csv +import io +import json +import re +from dataclasses import dataclass, field +from pathlib import Path + +from .aggregate_tables import ( + AggregateCell, + TableSpec, + TableStructureError, + expand_html_table, + load_registry, + normalized_text, + parse_html, + parse_number, + read_verified, + verify_payload, +) + + +@dataclass(frozen=True) +class ReferenceText: + """One cited subsection; its prose is excluded from representations.""" + + table: str + section: str + citation: str + text: str = field(repr=False) + + +def parse_reference( + spec: TableSpec, payload: bytes +) -> tuple[ReferenceText, ...]: + """Extract POMS subsection text without treating prose as table cells.""" + verify_payload(spec, payload) + if spec.record_kind != "reference": + raise TableStructureError("Reference parser requires reference entry") + document = parse_html(payload) + bodies = [el for el in document.iter("div") if el.get("class") == "poms"] + if len(bodies) != 1: + raise TableStructureError("Expected one POMS reference body") + body = bodies[0] + titles = [normalized_text(el) for el in body.iter("h1")] + if titles != [spec.selector["title"]]: + raise TableStructureError("POMS reference title differs") + sections = [el for el in body if el.get("class") == "poms-subsection1"] + result = [] + for section in sections: + headings = [normalized_text(el) for el in section.iter("h2")] + texts = [ + el for el in section if el.get("class") == "poms-subsection1-body" + ] + if len(headings) != 1 or len(texts) != 1: + raise TableStructureError("POMS subsection structure differs") + result.append( + ReferenceText( + spec.identifier, + headings[0], + f"{spec.url} ({headings[0]})", + normalized_text(texts[0]), + ) + ) + if not sections: + result.append( + ReferenceText( + spec.identifier, titles[0], spec.url, normalized_text(body) + ) + ) + expected = spec.selector.get("sections") + if expected is not None and [row.section for row in result] != expected: + raise TableStructureError("POMS reference section labels differ") + if not all(row.text for row in result): + raise TableStructureError("Empty POMS cited text") + return tuple(result) + + +def read_reference( + table: str | TableSpec, root: Path | None = None +) -> tuple[ReferenceText, ...]: + """Read and verify a registered reference, then return cited text.""" + spec = load_registry(root)[table] if isinstance(table, str) else table + return parse_reference(spec, read_verified(spec, root)) + + +def _html_cells(spec: TableSpec, payload: bytes) -> tuple[AggregateCell, ...]: + document = parse_html(payload) + tables = [ + el + for el in document.iter("table") + if el.get("id") == spec.selector["table_id"] + ] + if len(tables) != 1: + raise TableStructureError("Expected one identified coverage table") + grid = expand_html_table(tables[0]) + header_rows = spec.selector["header_rows"] + row_columns = spec.selector.get("row_columns", 1) + if ( + not grid + or not 1 <= header_rows < len(grid) + or not 1 <= row_columns < len(grid[0]) + ): + raise TableStructureError("Invalid coverage table dimensions") + labels = [] + header_flags = [] + for column in range(row_columns, len(grid[0])): + parts = [] + for row in grid[:header_rows]: + label = row[column].text + if label and (not parts or parts[-1] != label): + parts.append(label) + labels.append(" | ".join(parts)) + header_flags.append( + tuple( + dict.fromkeys( + flag + for row in grid[:header_rows] + for flag in row[column].flags + ) + ) + ) + if not all(labels) or len(set(labels)) != len(labels): + raise TableStructureError("Missing or duplicate coverage headers") + units = spec.selector.get("column_units", [spec.units[0]] * len(labels)) + if len(units) != len(labels) or any(u not in spec.units for u in units): + raise TableStructureError("Coverage units differ from registry") + year = spec.selector.get("year") + if year is not None and year not in spec.years: + raise TableStructureError("Coverage year differs from registry") + cells = [] + seen = set() + for row in grid[header_rows:]: + if not any(cell.text for cell in row): + continue + key = " | ".join(cell.text for cell in row[:row_columns] if cell.text) + if not key: + raise TableStructureError("Missing coverage row label") + row_flags = tuple( + flag for token in row[:row_columns] for flag in token.flags + ) + for offset, (label, unit) in enumerate( + zip(labels, units, strict=True) + ): + identity = key, label, year + if identity in seen: + raise TableStructureError("Duplicate coverage cell identity") + seen.add(identity) + token = row[row_columns + offset] + number = parse_number(token.text) + cells.append( + AggregateCell( + spec.identifier, + key, + label, + year, + unit, + number.value, + tuple( + dict.fromkeys( + header_flags[offset] + + row_flags + + token.flags + + number.footnote_flags + ) + ), + ) + ) + if not cells: + raise TableStructureError("No coverage table cells") + return tuple(cells) + + +def parse_coverage( + spec: TableSpec, payload: bytes +) -> tuple[AggregateCell, ...]: + """Parse an explicitly identified numeric coverage table, if supplied.""" + verify_payload(spec, payload) + if spec.record_kind != "table": + raise TableStructureError( + "Cited coverage prose is not a numeric table" + ) + return _html_cells(spec, payload) + + +def parse_census(spec: TableSpec, payload: bytes) -> tuple[AggregateCell, ...]: + """Parse explicitly mapped public-pension CSV, API JSON or HTML cells.""" + verify_payload(spec, payload) + if spec.record_kind != "table": + raise TableStructureError("Census parser requires table entry") + format_name = spec.selector["format"] + if format_name == "html": + return _html_cells(spec, payload) + try: + if format_name == "csv": + rows = list(csv.reader(io.StringIO(payload.decode("utf-8-sig")))) + elif format_name == "json": + rows = json.loads(payload) + else: + raise TableStructureError("Unsupported Census capture format") + except (UnicodeError, json.JSONDecodeError, csv.Error): + raise TableStructureError("Unreadable Census table payload") from None + if not isinstance(rows, list) or len(rows) < 2: + raise TableStructureError("Census table lacks headers or rows") + header = rows[0] + if ( + not isinstance(header, list) + or not all(isinstance(label, str) for label in header) + or len(set(header)) != len(header) + ): + raise TableStructureError("Invalid Census header schema") + mapping = spec.selector["data_columns"] + fields = spec.selector["row_fields"] + if not mapping or not fields: + raise TableStructureError("Census mapping lacks rows or columns") + year_field = spec.selector.get("year_field") + required = fields + [column["field"] for column in mapping] + if year_field: + required.append(year_field) + if any(field not in header for field in required): + raise TableStructureError("Census mapped field absent") + if any(column["unit"] not in spec.units for column in mapping): + raise TableStructureError("Census units differ from registry") + cells = [] + seen = set() + for row in rows[1:]: + if not isinstance(row, list) or len(row) != len(header): + raise TableStructureError("Census row width differs from header") + record = dict(zip(header, row, strict=True)) + labels = [ + "" if record[field] is None else str(record[field]).strip() + for field in fields + ] + if not all(labels): + raise TableStructureError("Missing Census geography label") + key = " | ".join(labels) + raw_year = record[year_field] if year_field else spec.selector["year"] + if not isinstance(raw_year, (str, int)) or not re.fullmatch( + r"\d{4}", str(raw_year).strip() + ): + raise TableStructureError("Invalid Census reference year") + year = int(raw_year) + if year not in spec.years: + raise TableStructureError("Census year differs from registry") + for column in mapping: + identity = key, column["label"], year + if identity in seen: + raise TableStructureError("Duplicate Census cell identity") + seen.add(identity) + raw = record[column["field"]] + number = parse_number("" if raw is None else str(raw)) + cells.append( + AggregateCell( + spec.identifier, + key, + column["label"], + year, + column["unit"], + number.value, + number.footnote_flags, + ) + ) + return tuple(cells) diff --git a/src/populace_dynamics/income_resources/aggregate_pensions.py b/src/populace_dynamics/income_resources/aggregate_pensions.py new file mode 100644 index 00000000..856dd66f --- /dev/null +++ b/src/populace_dynamics/income_resources/aggregate_pensions.py @@ -0,0 +1,243 @@ +"""Pinned pension and household aggregates for D4's report-only WP8 inputs. + +Invariants +---------- +* Every exposed reader verifies its capture before inspecting table contents. +* Federal Reserve series retain positional dictionary line identities, so a + repeated series code cannot overwrite another published table line. +* Workbook headers expand only published merged ranges; physical coordinates + distinguish repeated row labels and worksheet continuations. +* Published missing/suppressed cells remain missing, never zero. Excel percent + formats convert fractions to percent; monetary scales follow source headers. +* Readers return cells without printing/logging values; errors name structure. + +The registry stores explicit workbook data regions and source column units. +These are aggregate publications, not Form 5500 or taxpayer record files. +""" + +from __future__ import annotations + +import csv +import io +import re +import zipfile +from decimal import Decimal +from functools import lru_cache +from typing import TYPE_CHECKING + +import openpyxl + +from .aggregate_tables import ( + AggregateCell, + ParsedNumber, + TableSpec, + TableStructureError, + parse_number, + verify_payload, +) + +if TYPE_CHECKING: + from openpyxl.worksheet.worksheet import Worksheet + + +def _text(value: object) -> str: + return " ".join(str(value).split()) if value is not None else "" + + +def parse_fed(spec: TableSpec, payload: bytes) -> tuple[AggregateCell, ...]: + """Read one June-2026-code Z.1 table and its positional dictionary.""" + verify_payload(spec, payload) + try: + with zipfile.ZipFile(io.BytesIO(payload)) as archive: + csv_text = archive.read(spec.selector["csv_member"]).decode( + "utf-8-sig" + ) + dictionary = archive.read( + spec.selector["dictionary_member"] + ).decode("utf-8-sig") + except (KeyError, ValueError, zipfile.BadZipFile, UnicodeDecodeError): + raise TableStructureError("Z.1 archive structure mismatch") from None + entries = list(csv.reader(io.StringIO(dictionary), delimiter="\t")) + rows = csv.reader(io.StringIO(csv_text)) + header = next(rows, []) + if not header or header[0] != "date" or len(header) != len(entries) + 1: + raise TableStructureError("Z.1 dictionary/header width mismatch") + for code, entry in zip(header[1:], entries, strict=True): + if len(entry) != 5 or entry[0] != code: + raise TableStructureError("Z.1 positional dictionary mismatch") + result = [] + for row in rows: + if len(row) != len(header): + raise TableStructureError("Z.1 observation width mismatch") + period = row[0] + if not re.fullmatch(r"\d{4}(?:[: -]?Q[1-4])?", period): + raise TableStructureError("Z.1 period label mismatch") + year = int(period[:4]) + for entry, token in zip(entries, row[1:], strict=True): + number = parse_number(token) + result.append( + AggregateCell( + spec.identifier, + " | ".join((entry[2], entry[1], entry[0])), + period, + year, + entry[4], + number.value, + number.footnote_flags, + ) + ) + return _validate_cells(spec, result) + + +def _validate_cells( + spec: TableSpec, cells: list[AggregateCell] +) -> tuple[AggregateCell, ...]: + if not cells: + raise TableStructureError("Registered table has no cells") + if any( + c.year not in spec.years or c.unit not in spec.units for c in cells + ): + raise TableStructureError("Cell coverage differs from registry") + keys = [(c.row_key, c.column_key, c.year) for c in cells] + if len(keys) != len(set(keys)): + raise TableStructureError("Published cell keys are not distinct") + return tuple(cells) + + +@lru_cache(maxsize=2) +def _workbook(payload: bytes): + """Reuse a verified workbook across its many registered tables.""" + try: + return openpyxl.load_workbook(io.BytesIO(payload), data_only=True) + except (ValueError, KeyError, zipfile.BadZipFile): + raise TableStructureError("Workbook structure mismatch") from None + + +def _expanded_headers(sheet: Worksheet) -> dict[tuple[int, int], str]: + headers = { + (cell.row, cell.column): _text(cell.value) + for row in sheet + for cell in row + if cell.value is not None + } + for merged in sheet.merged_cells.ranges: + value = headers.get((merged.min_row, merged.min_col), "") + for row in range(merged.min_row, merged.max_row + 1): + for column in range(merged.min_col, merged.max_col + 1): + headers[row, column] = value + return headers + + +def workbook_header(sheet: Worksheet, rows: list[int], column: int) -> str: + """Join the distinct levels of one published merged column header.""" + expanded = _expanded_headers(sheet) + labels = [] + for row in rows: + label = expanded.get((row, column), "") + if ( + label + and label not in labels + and not re.fullmatch(r"\(\d+\)", label) + ): + labels.append(label) + return " / ".join(labels) + + +def _label_flags(label: str) -> tuple[str, ...]: + flags = re.findall(r"\[([^\]]+)\]", label) + # DOL puts ordinary trailing footnote digits in its Excel labels. + flags.extend(re.findall(r"\s([1-9])(?=$|\s*/)", label)) + return tuple(flags) + + +def _parse_workbook( + spec: TableSpec, payload: bytes +) -> tuple[AggregateCell, ...]: + book = _workbook(payload) + result = [] + for region in spec.selector["regions"]: + name = region["sheet"] + if name not in book.sheetnames: + raise TableStructureError("Registered worksheet absent") + sheet = book[name] + expanded = _expanded_headers(sheet) + columns = region["columns"] + headers = { + col: workbook_header(sheet, region["header_rows"], col) + for col in columns + } + if any(not header for header in headers.values()): + raise TableStructureError("Registered column header absent") + for row in region["data_rows"]: + labels = [] + for col in range(1, min(columns)): + label = expanded.get((row, col), "") + if label and label not in labels: + labels.append(label) + if not labels: + raise TableStructureError("Registered row label absent") + row_key = f"{name}/r{row}: " + " / ".join(labels) + for col in columns: + cell = sheet.cell(row, col) + token = _text(cell.value) + # Bulletin notes define these as quantities below its + # reporting threshold, not observed zeros. + number = ( + ParsedNumber(None, ("below_reporting_threshold", token)) + if token in {"*/", "**/"} + else parse_number(token) + ) + value = number.value + unit = region["column_units"][str(col)] + format_flags = tuple( + re.findall(r'"(\*+)\s*"', cell.number_format) + ) + # IRS marks a hidden zero section as ** where the source + # combines data to prevent disclosure. A numeric ** estimate + # remains published and retains the combined-data flag. + if value == 0 and re.search(r';;"\*\*"', cell.number_format): + value = None + format_flags += ("suppressed",) + if value is not None and "%" in cell.number_format: + value *= Decimal(100) + if unit != "percent": + raise TableStructureError( + "Percent format/unit mismatch" + ) + year = region.get("column_years", {}).get( + str(col), region.get("year", 2023) + ) + flags = tuple( + dict.fromkeys( + number.footnote_flags + + format_flags + + tuple( + f for label in labels for f in _label_flags(label) + ) + + _label_flags(headers[col]) + ) + ) + result.append( + AggregateCell( + spec.identifier, + row_key, + headers[col], + year, + unit, + value, + flags, + ) + ) + return _validate_cells(spec, result) + + +def parse_dol(spec: TableSpec, payload: bytes) -> tuple[AggregateCell, ...]: + """Read one published bulletin table, including continuation sheets.""" + verify_payload(spec, payload) + return _parse_workbook(spec, payload) + + +def parse_irs(spec: TableSpec, payload: bytes) -> tuple[AggregateCell, ...]: + """Read one IRS IRA point-estimate table with count/amount units.""" + verify_payload(spec, payload) + return _parse_workbook(spec, payload) diff --git a/src/populace_dynamics/income_resources/aggregate_poms.py b/src/populace_dynamics/income_resources/aggregate_poms.py new file mode 100644 index 00000000..7f5a7b8e --- /dev/null +++ b/src/populace_dynamics/income_resources/aggregate_poms.py @@ -0,0 +1,1719 @@ +"""POMS SI 01415 federally administered supplement payment tables. + +Invariants +---------- +* Both the public dispatcher and this parser verify the pinned bytes. +* A payment table retains its state, claimant type, Federal living-arrangement + code, State supplement code, category and original numeric column labels. + Blank code cells continue the preceding code; categories never continue. +* Payment effective dates and the section's revision dates remain distinct. + Conflicting payment dates remain named alternatives, with no chosen date. +* Missing and malformed amounts remain explicit missing cells. Source + footnotes survive. Stacked subrows retain each separately published amount. +* Published component/total discrepancies are flagged, never corrected. +* No parser prints or logs source amounts, and no amount is reconstructed. + +Only federally administered optional supplement tables are represented. +State-administered programs described in prose are cited by the capture but +are not silently represented as a complete state parameter series. The +State OS code identifies the living arrangement defined in the State's +code-definition tables (``definitions_table_indexes`` in selectors). A State's +definitions may span more than one physical table; the reader merges them and +refuses a code whose tables define it differently. Definitions come only from +the chart's own State section, and a State named only in a date line, with no +section heading, refuses. Paragraphs and headings end where HTML ends them, +end tag or not, and every block that ends a paragraph, apart from a table or +rule, is read from its own text. So a State heading in a block left open +still names its State, and a list item, section or blockquote reads the same +after a closed heading as inside one left open. A block is read whole and +also line by line, a line being its text between ``br`` tags and the blocks +HTML keeps inside it, so a block or ``br`` after a heading's words does not +hide its State, claimant or date. Each whole text and line is read three +ways: joined, as HTML renders inline elements; bare, the joined reading +without footnote markers (a ``sup``, or a link to an anchor on the page, +whose text is one to three word characters or footnote signs, as +``1``); and spaced, with a space at every element's edge. A +longer ``sup`` and a link elsewhere are text in these readings. The date +checks also read a fourth, unmarked, the joined reading without any element +either marker rule counts: the bare reading's markers, and any ``sup`` or +link whose href holds "fn", as table cells count them; and a fifth, +unlinked, the unmarked reading without any link whose text has a marker's +size, wherever its href points. Every reading drops Unicode format +characters (category Cf), such as zero-width spaces, joiners and soft +hyphens, and the text of ``script`` and ``style`` elements, which HTML does +not render, a marker's text included. The joined and bare readings name a +block's State heading and claimant, so ``Utah`` and +``Utah1`` head Utah. The date sentence is chosen from the joined +reading; a sentence whose bare, unmarked or unlinked reading states other +dates, or a range where the joined one does not, refuses, so a link of a +marker's size inside a date, as ``January 15, +2031``, refuses whatever its href holds. So does a line that is a dated +sentence only in its bare, unmarked or unlinked reading, unless what those +readings drop all leads it, as a footnote body's markers do. A block's whole +text is its date sentence when it is one; otherwise each line that is one +dates the block, and lines that date differently remain named alternatives. +A range is "effective from", a date, "to" or "through", and a date, as +"effective from March 1, 2031 to June 30, 2031"; it dates a chart from and +to when its two dates are the only ones the sentence states, and any other +dates remain named alternatives. A "to" that no date follows ends no range, +so "effective from March 1, 2031 to residents of homes licensed before June +30, 2031" names its two dates as alternatives. A range that does not end +after it starts, as "effective from June 30, 2031 to March 1, 2031" or one +from a date to the same date, refuses. Every State net runs over the joined, +bare and spaced readings of the whole text and of every line, and refuses if +any of them names a State other than the section's: + +- a line that dates another State, or an effective-date sentence that names + one, refuses, since that State's section heading was not read; +- a line that mentions a claimant word, prose included, that names another + State refuses, and so does a claimant line that only the spaced reading + shows; +- a line shaped as another State's heading that heads no section refuses: + one in a block whose whole text is a State date line, one only the spaced + reading shows, and one whose postal code is not its State's, as "New York + (NJ)" in Nevada's section; +- any line of an h1-h6 heading that names another State refuses, so a + heading names no State but the one it heads or its section's; +- a line under 80 characters, in a block of any kind, that opens as another + State's caption refuses: after optional leading dashes, bullets, + asterisks, quotation marks or parentheses, a list label ("1.", "2)", + "(b)"), a heading prefix, "The" and "State of", that State's name, + spelling or alias, abbreviation or upper-case postal code, as "Utah + (continued)", "(b) Utah", "The State of Utah", "N.J. notes" or "UT + (continued)". The District's alias is read first, so "Washington, D.C." + opens with the District; +- any other line under 80 characters that names another State, as + "Supplements for Utah", refuses, since it may open that State's section + in a form no heading takes. These two nets run last, so the others keep + their messages; +- a block whose lines head two States refuses. + +Only a claimant line names a chart's claimant: a heading form ("a. +Individual payment levels for Nevada", "Couple") or a caption that ends +with its claimant word after a State date line or effective-date sentence +that ends with a date or a State ("Utah Effective 1/1/03 Individual"). A +block with a claimant line names every claimant word, or its plural, that +any reading of its whole text or lines holds, prose lines included, so +"Individual
or couple" names two types and refuses. A heading, or a line +under 80 characters, that holds a claimant word or its plural but is no +claimant line, such as "Couple payment levels:", "Eligible couple" or +"Couples", names a claimant the reader does not read: it names none, and +the next chart refuses unless a later claimant line names one; if it holds +two types, as "Individual or couple for Nevada", it refuses. Prose of 80 +characters or more, outside a heading, that mentions a claimant word, such +as a long "A recipient or couple qualifies if ..." paragraph, names none and +leaves the claimant line before it standing. Before any State heading, the +chart refuses instead. A postal code after a State's name must be that +State's, and "Washington, D.C.", "Washington,DC" and "Washington DC" name the +District. The spellings "Hawaiʻi", "Hawai‘i", "Hawai’i" and "Hawai'i" name +Hawaii and may head its section. To the nets, a postal code in parentheses, +as in "(UT)" or "(ut)", an upper-case postal code standing as a word, as in +"for UT", and a State's abbreviation, as in "N.J." or "Nev.", also name their +States; they never head a section. Each chart needs its own claimant line +after the chart before it. + +A section's date stands for its later charts until another effective-date +sentence or State heading. A heading, or a line under 80 characters, that +names a date no effective-date sentence of its block or the section states, +as "Payment levels as of January 1, 2031", "Effective: January 1, 2031" or +"January 1, 2031", leaves the date unread, and the next chart refuses unless +a later sentence dates it. So does one that holds a date in any of these +forms, which no sentence reads, the section's own date included, apart from +an ISO date that equals a date in force: an abbreviated month +("Jan. 1, 2031"), a month and year ("January 2031"), a day before its +month ("1 January 2031"), an ISO or dashed date ("2031-01-01", +"1-1-2031"), an ordinal day ("July 1st, 2030", "1st of July"), a comma with +no space after it or a space before it ("July 1,2030", "July 1 , 2030"), a +dotted date ("07.01.2030"), a date that opens with its year ("2030/07/01"), +a month and year in numbers ("7/2030"), or a month glued to the word before +it ("as ofJuly 1, 2030"). So does a heading that holds a year from 1900 to +2099, in four digits with no digit beside them, outside the years of the +dates in force, and a line under 80 characters that holds such a year after +them, or before them with a dating word ("payment", "level", "effective", +"as of" or "rate", inside another word too, in any case), as in a section +dated 2030 "Payment levels for 2031", "FY2031", "Calendar year 2031 payment +levels", "Payment levels for 2029" or "Rates for 2029"; with no date in +force, every such year counts. Each line names its own dates, and a heading's +whole text, or that of a block under 80 characters, adds those it names more +often, in one reading, than its lines together do, as a date split across a +``br``, so a footnote line that names the same date does not cover a split +one, though a revision range on a line still counts among the lines. Outside +a heading, a footnote body dates no chart: a line, or a block's whole text, +that opens with footnote markers by either marker rule, every word they drop +one to three digits or footnote signs or a single letter, and holds none +after them, as +"1Revised March 1, 2031" or "aRevised March 1, 2031". +A leading ``sup`` or ``#`` link that holds another word, as +``As of`` or ``New``, makes no footnote body. +A block other than a heading whose whole text is one dates no chart in any +line, and a heading is never one. Nor does the section's revision range +("Effective Dates: 02/03/2040 - Present") date a chart: the net drops it +from a line before naming the line's dates and years, so the rest of the +line still names its own. The net and the date sentence's exclusion of +that range read the label in title case only, the form every pinned page +holds, so "effective dates:" counts as a sentence's words. + +Every definition table of a section precedes its first chart; a definition +table after a chart refuses, because the source does not say which earlier +chart it serves. A jointly published code +("C/H" in a definition table, "A or B" in a chart) names each single code it +lists. A chart code that no definition table defines stays undefined and is +recorded in ``poms_open_questions.json``; no definition is inferred for it. + +Not modelled: an abbreviation without its period, such as "Calif", or not +in ``_ABBREVIATIONS``, such as "Ia." or "Ut.", and a lower-case postal code +outside parentheses, which name no State to the nets; a caption in a table +cell, or in a chart's own ``caption`` element, which no block holds; text +outside any block, as in a ``span`` or ``strong`` or bare text between +blocks, which is never read, so "Utah (continued)" or "Couple" there neither +names nor resets a State, claimant or date; and text that HTML or CSS +hides, other than script and style, such as the ``hidden`` attribute, which +is read as text, so ``Utah Effective January 1, 2031`` +is read as prose, as "Utahx Effective January 1, 2031" would be. +``aggregate_tables`` lists the tree's own gaps, HTML's script data escape +states and foreign content among them, with the pages it refuses for them. + +Limits: the nets over-refuse in several places, and no pinned page meets +any of them. + +- An acronym that spells a postal code names that State. In Pennsylvania's + section, "(MA recipients)" or "for IA cases" names Massachusetts or Iowa, + so the page refuses, and so does "DE MINIMIS rule" in Nevada's. +- A line under 80 characters that names another State refuses wherever the + name stands: one that opens with it, as "California residents who move + here" in Nevada's section, "New Jersey border counties" in New York's or + "Washington metropolitan area" in the District's, and one that names it + later, as "Residents who move from California". +- A heading or line under 80 characters that names two claimant types + refuses, even where a later claimant line would name the chart's own. +- A heading or line under 80 characters that names a date no sentence + states makes the next chart refuse, even where the date concerns + something else, as "Revised March 1, 2031", and a date in a form no + sentence reads does so even when it is the section's own date, as "Jan. + 1, 2030" or "July 1st, 2030", or stands in a sentence, as "Payment levels + effective January 2031". So does a number shaped as a dotted date, as + "Section 2.1.10". +- A heading that holds a year outside the years of the dates in force, or a + line under 80 characters that holds a later year, or an earlier one and a + dating word, makes the next chart refuse even where the year concerns + something else, as "Revised 2031", "Section 2031 rules" or "Separate + programs for 2029", whose "Separate" holds "rate"; with no date in force, + so does any year. A sentence whose date takes a form no sentence reads, + as "Payment levels effective January 1st, 2031", states no date, so the + date it holds refuses the next chart rather than leave its date + unstated. +- A footnote marker that is neither one to three digits or footnote signs + nor a single letter, as ``ii`` or ``1a``, makes no + footnote body, and a heading is never one, so a date in such a line, as + ``
1Revised March 1, 2031
``, leaves the section's date + unread. +- A footnote marker after a date's year, as "January 1, 20311", + or an ordinal marker, as "January 1st, 2031", makes the + sentence date differently without it, so the page refuses, and so does a + link of a marker's size inside a date that is no footnote marker, as + ``January 1, 2031``. +- A range from a date to the same date refuses, though it may mean a single + day. +- Footnote markers that lead a line with no space between them, as + ``1234Revised March 1, 2031``, join into a word of + more than three digits, so the line is no footnote body, and a date in it + leaves the section's date unread. + +A line of 80 characters or more, outside a heading, names a claimant only +as a claimant line and a date only as an effective-date sentence, and of the +State nets only those before the caption net read it. So one that mentions +a claimant word in prose, states a date in another form, or names another +State in other words leaves the claimant, date or State before it standing. +These forms also leave the claimant or date before them standing: + +- a claimant named in other words than "Individual", "Recipient" or + "Couple", as a heading "Both members eligible", "Eligible spouses" or + "Married pair" after an "Individual" heading, names none, so the earlier + claimant line still names the chart's claimant; +- a date whose year has two digits in a form no sentence reads, as "January + 1, 31", names no date and holds no year; a year split across a ``br``, as + "20
31", holds none; and a date split across two blocks, as + ``

Payment levels as of March 1,

2031

`` in a section dated + 2031, names none in either; +- an effective-date sentence of 80 characters or more, outside a heading, + names only the dates in a sentence's date form, so "Monthly payment + levels effective January 1, 2030 and July 1st, 2030", run on past 80 + characters, drops its second date; +- a line under 80 characters, outside a heading, that holds only years + before the dates in force and no dating word, as "State-administered + programs: For Calendar Year 2029 -" in a section dated 2030, leaves the + date standing, as one pinned page's line on a State-administered program + for the year before does ahead of a chart; +- a line after a footnote body's first line in the same block, outside a + heading, as the second line of ``1Revised March 1, 2031
+ Payment levels as of March 1, 2031``, is part of that footnote body and + dates no chart; +- a date in a form that no sentence reads and the list above leaves out + names none, as "July 1", "7/1", "July of 2030", "01-Jul-2030" and + "1.VII.2030"; +- a date split across a ``br`` in a block of 80 characters or more, outside + a heading, names none, since only a shorter block's whole text adds it; +- a line that holds "Effective Dates:" in title case is no sentence, so + "Monthly payment levels effective January 1, 2031 (Effective Dates: + 01/01/2031 - Present)", at 80 characters or more, names no date; +- a leading link or ``sup`` of one letter or digit makes a footnote body + even where it opens a word or a year, as ``A new + payment level applies from March 1, 2031`` or ``2031 + payment levels``, whose date or year dates no chart. +""" + +from __future__ import annotations + +import re +from collections import Counter +from dataclasses import replace +from datetime import date, datetime +from decimal import Decimal +from functools import cache, lru_cache +from typing import Any +from xml.etree import ElementTree as ET + +from .aggregate_tables import ( + PARAGRAPH_CLOSERS, + AggregateCell, + CellToken, + TableSpec, + TableStructureError, + _cell_token, + _is_footnote_marker, + expand_html_table, + normalized_text, + parse_html, + parse_number, + verify_payload, +) + +_STATES = ( + "California", + "Delaware", + "District of Columbia", + "Hawaii", + "Iowa", + "Massachusetts", + "Michigan", + "Montana", + "Nevada", + "New Jersey", + "New York", + "Pennsylvania", + "Rhode Island", + "Utah", + "Vermont", + "Washington", + "Wisconsin", +) +_POSTAL_CODES = dict( + zip( + _STATES, + "CA DE DC HI IA MA MI MT NV NJ NY PA RI UT VT WA WI".split(), + strict=True, + ) +) +# "Washington, D.C.", "Washington,DC" and "Washington DC" name the District, +# not the State. +_DISTRICT_ALIAS = r"Washington,?\s*D\.?\s?C\b\.?" +# Other spellings of a State's name, which may head its section. +_SPELLINGS = {"Hawaii": "Hawai[ʻ‘’']?i"} +# Abbreviations that name a State in prose; they never head its section. +# Hawaii, Iowa and Utah have none here. +_ABBREVIATIONS = { + "California": r"(?:Calif|Cal)\.", + "Delaware": r"Del\.", + "District of Columbia": r"D\.\s?C\.", + "Massachusetts": r"Mass\.", + "Michigan": r"Mich\.", + "Montana": r"Mont\.", + "Nevada": r"Nev\.", + "New Jersey": r"N\.\s?J\.", + "New York": r"N\.\s?Y\.", + "Pennsylvania": r"(?:Penna|Penn|Pa)\.", + "Rhode Island": r"R\.\s?I\.", + "Vermont": r"Vt\.", + "Washington": r"Wash\.", + "Wisconsin": r"Wisc?\.", +} +_MONTHS = ( + "January February March April May June July August September October " + "November December" +).split() +_DATE = re.compile( + r"\b(?:" + + "|".join(_MONTHS) + + r")\s+\d{1,2},?\s+\d{4}\b|\b\d{1,2}\s*/\s*\d{1,2}\s*/\s*\d{2,4}\b", + re.IGNORECASE, +) +# Other ways to write a date, which no effective-date sentence reads: an +# abbreviated month, a month and year with no day, a day before its month, +# an ISO or dashed date, an ordinal day ("July 1st, 2030", "1st of July"), +# a comma with no space after it or a space before it ("July 1,2030", +# "July 1 , 2030"), a dotted date ("07.01.2030"), a date that opens with +# its year ("2030/07/01"), a month and year in numbers ("7/2030"), and a +# month glued to the word before it ("as ofJuly 1, 2030"). To the +# unread-date net they name a date. +_SHORT_MONTHS = r"(?:Jan|Feb|Mar|Apr|Jun|Jul|Aug|Sept?|Oct|Nov|Dec)" +_ANY_MONTH = rf"(?:{'|'.join(_MONTHS)}|{_SHORT_MONTHS})" +_OTHER_DATE = re.compile( + rf"\b{_SHORT_MONTHS}\.?\s+\d{{1,2}},?\s+\d{{4}}\b" + rf"|\b{_ANY_MONTH}\.?,?\s+\d{{4}}\b" + rf"|\b\d{{1,2}}\s+{_ANY_MONTH}\.?,?\s+\d{{4}}\b" + r"|\b\d{4}-\d{1,2}-\d{1,2}\b|\b\d{1,2}-\d{1,2}-\d{2,4}\b" + rf"|\b{_ANY_MONTH}\.?\s+\d{{1,2}}\s*(?:st|nd|rd|th)\b,?\s*\d{{4}}\b" + rf"|\b\d{{1,2}}\s*(?:st|nd|rd|th)\s+(?:of\s+)?{_ANY_MONTH}\b" + rf"|\b{_ANY_MONTH}\.?\s+\d{{1,2}}(?:,|\s+,\s*)\d{{4}}\b" + r"|\b\d{1,2}\.\d{1,2}\.\d{2,4}\b" + r"|\b\d{4}\s*[/.]\s*\d{1,2}\s*[/.]\s*\d{1,2}\b" + r"|(? None: + """Record in ``short``, by id, the text of ``element`` and of each + element under it when it is no longer than a marker's, else None. + + The text is ``normalized_text``'s, its text nodes joined by spaces and + whitespace collapsed, without format characters or the text of a + ``script`` or ``style`` element, as every reading drops them. An + element's text holds each child's, so a child too long makes its parent + too long. The walk keeps its own stack and reads each element once, so + nested candidates cost no more than one. + """ + pending = [(element, False)] + while pending: + node, read = pending.pop() + if not read: + pending.append((node, True)) + pending.extend( + (child, False) + for child in node + if child.tag not in _UNRENDERED + ) + continue + parts = [node.text or ""] + for child in node: + text = "" if child.tag in _UNRENDERED else short[id(child)] + parts += [text, child.tail or ""] + text = None if None in parts else _collapse(" ".join(parts)) + short[id(node)] = ( + text if text is not None and len(text) <= _MARKER_LENGTH else None + ) + + +def _marker_sized(element: ET.Element, short: dict[int, str | None]) -> bool: + """Whether an element's text (``_short_texts``) is one to three word + characters or footnote signs, as a footnote marker's is.""" + if id(element) not in short: + _short_texts(element, short) + text = short[id(element)] + return text is not None and _MARKER_TEXT.fullmatch(text) is not None + + +def _line_marker(element: ET.Element, short: dict[int, str | None]) -> bool: + """Whether an element of a block's line is a footnote marker: a ``sup``, + or a link to an anchor on the page (an href starting "#"), whose text + is one to three word characters or footnote signs, as ``1`` + and ``2``. A ``sup`` with longer text, and a link + elsewhere, are text, so the bare reading drops no word of prose. Table + cells keep their own, wider rule (``aggregate_tables``'s + ``_is_footnote_marker``).""" + if element.tag != "sup" and not ( + element.tag == "a" and element.get("href", "").startswith("#") + ): + return False + return _marker_sized(element, short) + + +def _line_readings( + element: ET.Element, +) -> list[tuple[str, str, str, str, str]]: + """A block's own lines, each read five ways: joined, bare, spaced, + unmarked and unlinked. + + A line is the block's text between ``br`` tags and where a block nested + in it starts or ends. In the joined reading the text of inline elements + joins without a separator, as HTML renders it, so ``Utah`` + reads "Utah". The bare reading is the joined one without footnote + markers (``_line_marker``: a ``sup``, or a link to an anchor on the + page, holding one to three word characters or footnote signs), so + ``Utah1`` reads "Utah". The spaced reading puts a space at + every element's edges, so a name that touches the text of the element + next to it, as in ``Utah1``, still stands as a word. The + unmarked reading, which only the date checks read, is the joined one + without any element that either marker rule counts: the bare reading's + markers, and any ``sup`` or link whose href holds "fn", the rule table + cells keep (``aggregate_tables``'s ``_is_footnote_marker``). The + unlinked reading, which the date checks also read, is the unmarked one + without any link whose text has a marker's size, wherever its href + points, so ``January 15, 2031`` reads + "January 1, 2031" there. Every reading collapses whitespace and drops + Unicode format characters, such as zero-width spaces and soft hyphens, + and no reading holds the text of a ``script`` or ``style`` element, + which HTML does not render. A line is kept when its joined reading + holds any text. + + The text stops at the first block that ends the element + (``_TEXT_STOPS``). Before that only a heading can hold a nested block, + so a block other than a heading splits only at a ``br``. The walk does + not recurse, so deep nesting cannot exhaust the interpreter stack. + """ + stops = _TEXT_STOPS[element.tag] + short: dict[int, str | None] = {} + # Each part is a text, whether a footnote marker holds it, whether an + # element either marker rule counts holds it, and whether such an + # element or a link of a marker's size holds it. + lines: list[list[tuple[str, bool, bool, bool]]] = [ + [(element.text or "", False, False, False)] + ] + walk = [(element, iter(element), False, False, False)] + while walk: + node, children, *_ = walk[-1] + child = next(children, None) + if child is None: + walk.pop() + if walk: + if node.tag in _LINE_BREAKS: + lines.append([]) + lines[-1].append((node.tail or "", *walk[-1][2:])) + continue + if child.tag in stops: + break + if child.tag in _UNRENDERED: + lines[-1].append((child.tail or "", *walk[-1][2:])) + continue + if child.tag in _LINE_BREAKS: + lines.append([]) + marked = walk[-1][2] or _line_marker(child, short) + noted = walk[-1][3] or marked or _is_footnote_marker(child) + linked = ( + walk[-1][4] + or noted + or child.tag == "a" + and _marker_sized(child, short) + ) + lines[-1].append((child.text or "", marked, noted, linked)) + walk.append((child, iter(child), marked, noted, linked)) + readings = [] + for parts in lines: + joined = _collapse("".join(part[0] for part in parts)) + if joined: + bare = "".join(text for text, marked, *_ in parts if not marked) + spaced = " ".join(part[0] for part in parts) + unmarked = "".join( + text for text, _, noted, _ in parts if not noted + ) + unlinked = "".join( + text for text, *_, linked in parts if not linked + ) + readings.append( + ( + joined, + _collapse(bare), + _collapse(spaced), + _collapse(unmarked), + _collapse(unlinked), + ) + ) + return readings + + +def _line_renderings(element: ET.Element) -> list[tuple[str, str, str]]: + """A block's own lines in the joined, bare and spaced readings of + ``_line_readings``.""" + return [reading[:3] for reading in _line_readings(element)] + + +def _collapse(text: str) -> str: + return " ".join(_blank(text).split()) + + +def _lines(element: ET.Element) -> list[str]: + """A block's own lines in their joined reading (``_line_renderings``).""" + return [joined for joined, _, _ in _line_renderings(element)] + + +def _own_text(element: ET.Element) -> str: + """Normalize a block's own text, up to the first block that ends it. + + When no block or ``br`` nests inside the element, this is its text + content with whitespace collapsed and format characters removed. + Unlike ``normalized_text``, which separates every text node, inline + elements join without a separator. A heading left open is read without + the next heading or the table the tree nests under it. + """ + return " ".join(_lines(element)) + + +def _renderings(element: ET.Element) -> list[tuple[str, str, str, str, str]]: + """A block's whole text, then each of its lines, in the joined, bare, + spaced, unmarked and unlinked readings of ``_line_readings``.""" + lines = _line_readings(element) + whole = tuple( + " ".join(line[k] for line in lines if line[k]) for k in range(5) + ) + return [whole, *lines] + + +# What may come before a State's name in its section heading. A dash may be +# a hyphen, an en or em dash, or a minus sign. +_DASH = r"\s*[-‐-―−]\s*" +_HEADING_PREFIX = ( + r"(?:[A-Z]\.\s*)?" + rf"(?:Description of supplements(?:\s+for\s+(?:the\s+)?|{_DASH})" + rf"|Procedure{_DASH})?" +) + + +@cache +def _state_name(name: str) -> str: + """A pattern for a State's name or another spelling of it, or for the + District, an alias.""" + if name == "District of Columbia": + return rf"(?:{re.escape(name)}|{_DISTRICT_ALIAS})" + return _SPELLINGS.get(name, re.escape(name)) + + +@cache +def _state_reference(name: str) -> str: + """A pattern for a State's name with its optional postal suffix. The + 2009 and 2010 sections append the code, as in "New Jersey (NJ)".""" + return _state_name(name) + rf"(?:\s*\({_POSTAL_CODES[name]}\))?" + + +def _state_heading(name: str, text: str) -> bool: + return bool( + re.fullmatch( + _HEADING_PREFIX + _state_reference(name), text, re.IGNORECASE + ) + ) + + +def _misnamed_heading(text: str) -> bool: + """Whether a line has a State heading's shape with a postal code that + is not that State's, as in "New York (NJ)".""" + return any( + re.fullmatch( + _HEADING_PREFIX + _state_name(name) + r"\s*\([A-Z]{2}\)", + text, + re.IGNORECASE, + ) + and not _state_heading(name, text) + for name in _STATES + ) + + +def _state_date_line(text: str) -> str | None: + """The State a line such as "Nevada Effective 1/1/30" opens with, by + the names, aliases and postal suffixes its section heading may take.""" + for name in _STATES: + if re.match(_state_reference(name) + r"\s+Effective\b", text, re.I): + return name + return None + + +def _effective_line(text: str) -> bool: + return ( + "effective" in text.lower() + and "Effective Dates:" not in text + and len(text) < 400 + and bool( + re.search(r"payments? levels?", text, re.I) + or text.lower().startswith("effective ") + or _state_date_line(text) + ) + ) + + +def _claimant_mention(text: str) -> re.Match[str] | None: + """Whether a line mentions a claimant: a claimant word that ends it, + after an optional "payment(s)" and "levels", or that "for" or "or" and + any text follow, anywhere in the line. Prose such as "A recipient or + couple qualifies" mentions one. The claimant State guard reads every + line that mentions a claimant; only a claimant line names one.""" + if len(text) >= 250: + return None + return re.search( + r"(?:^|\s)(Individual|Recipient|Couple)" + r"(?:\s+payments?)?(?:\s+levels)?" + r"(?:\s+(?:for|or)\s+.+)?$", + text, + re.IGNORECASE, + ) + + +_CLAIMANT_WORD = r"(?PIndividual|Recipient|Couple)" +_CLAIMANT_WORDS = re.compile(r"\b(?:Individual|Recipient|Couple)\b", re.I) +# A claimant word or its plural; the group is the word, so "Couples" names +# a couple. +_CLAIMANT_FORMS = re.compile(r"\b(Individual|Recipient|Couple)s?\b", re.I) +# Any State's name, spelling or District alias, with its optional postal +# suffix. +_ANY_STATE = "(?:" + "|".join(map(_state_reference, _STATES)) + ")" +_CLAIMANT_HEADING = re.compile( + r"(?:(?:[A-Za-z]|\d{1,2})[.)]\s*)?" + + _CLAIMANT_WORD + + r"(?:\s+payments?)?(?:\s+levels?)?" + + rf"(?:\s+(?:for|or)\s+(?:the\s+)?{_ANY_STATE})?", + re.IGNORECASE, +) +_CLAIMANT_CAPTION = re.compile( + r"(?P.*\S)\s+" + _CLAIMANT_WORD, re.IGNORECASE +) +_CAPTION_PREFIX_END = re.compile( + rf"(?:{_DATE.pattern}|{_ANY_STATE})$", re.IGNORECASE +) + + +def _claimant_line(text: str) -> re.Match[str] | None: + """A claimant line, the only kind of line that names a chart's claimant. + + It is a heading form, matched as the whole line: an optional list label + ("a." or "2)"), the claimant word, an optional "payment(s)" and + "level(s)", and then optionally "for" (or the source's "or"), an + optional "the" and a State, as in "a. Individual payment levels for + the District of Columbia". Or it is a caption whose last word is the + claimant word, after a State date line or an effective-date line that + ends with a date or a State, as in "Utah Effective 1/1/03 Individual". + Any other line that holds a claimant word is prose and names none. + ``match["word"]`` is the claimant word. + """ + if len(text) >= 250 or not _CLAIMANT_WORDS.search(text): + return None + heading = _CLAIMANT_HEADING.fullmatch(text) + if heading: + return heading + caption = _CLAIMANT_CAPTION.fullmatch(text) + if ( + caption + and ( + _state_date_line(caption["prefix"]) + or _effective_line(caption["prefix"]) + ) + and _CAPTION_PREFIX_END.search(caption["prefix"]) + ): + return caption + return None + + +def _claimant_type(word: str) -> str: + """The claimant type a claimant word names, as ``match["word"]`` of a + claimant line; "Recipient" names an individual.""" + return "couple" if word.lower() == "couple" else "individual" + + +_STATE_OF_CODE = {code: name for name, code in _POSTAL_CODES.items()} + + +def _named_states(text: str) -> set[str]: + """The States a text names: by name, spelling or alias, by an + abbreviation such as "N.J.", by a postal code in parentheses, in either + case, as in "(UT)", or by an upper-case postal code standing as a word, + as in "for UT".""" + text = re.sub( + r"\b" + _DISTRICT_ALIAS, "District of Columbia", text, flags=re.I + ) + named = { + name + for name in _STATES + if re.search(rf"\b{_state_name(name)}\b", text, re.I) + or name in _ABBREVIATIONS + and re.search(rf"\b{_ABBREVIATIONS[name]}", text) + } + for match in re.finditer(r"\(\s*([A-Za-z]{2})\s*\)", text): + if match[1].upper() in _STATE_OF_CODE: + named.add(_STATE_OF_CODE[match[1].upper()]) + for match in re.finditer(r"\b([A-Z]{2})\b", text): + if match[1] in _STATE_OF_CODE: + named.add(_STATE_OF_CODE[match[1]]) + return named + + +def _view_states(view: tuple[str, ...]) -> set[str]: + """The States any reading of a whole text or line names.""" + return set().union(*map(_named_states, view)) + + +# What may open a State's caption before its name: leading dashes, bullets, +# asterisks, quotation marks, parentheses and spaces; a list label, as a +# claimant line takes ("1.", "2)", "b)"), or one in parentheses ("(b)"); a +# heading's prefix; "The"; and "State of". +_CAPTION_OPENING = ( + r"[-‐-―−•·*\"“‘'(\s]*" + r"(?:(?:\(?(?:[A-Za-z]|\d{1,2})[.)]|\((?:[A-Za-z]|\d{1,2})\))\s*)?" + + _HEADING_PREFIX + + r"(?:The\s+)?(?:State\s+of\s+)?" +) +# For each State, a caption opening with its name, spelling or alias in any +# case, and one opening with its upper-case postal code or abbreviation. +_CAPTIONS = { + name: ( + re.compile(_CAPTION_OPENING + _state_name(name) + r"\b", re.I), + re.compile( + _CAPTION_OPENING + + rf"(?:{_POSTAL_CODES[name]}\b" + + (rf"|{_ABBREVIATIONS[name]}" if name in _ABBREVIATIONS else "") + + ")" + ), + ) + for name in _STATES +} + + +def _opening_states(text: str) -> set[str]: + """The States a short line, under 80 characters, opens with as a + caption: after an optional heading prefix and "State of", a State's + name, spelling or alias in any case, or its abbreviation or upper-case + postal code, as in "Utah (continued)", "State of Utah", "N.J. notes" or + "UT (continued)". The District's alias is read first, so "Washington, + D.C." opens with the District, not with Washington State.""" + if len(text) >= 80: + return set() + text = re.sub( + r"\b" + _DISTRICT_ALIAS, "District of Columbia", text, flags=re.I + ) + return { + name + for name, (spelled, coded) in _CAPTIONS.items() + if spelled.match(text) or coded.match(text) + } + + +# Unicode's format characters (category Cf, Unicode 16.0), such as the +# zero-width space, joiners, the byte order mark and the soft hyphen. They +# are invisible, so they neither separate nor join words. +_FORMAT_CHARACTERS = re.compile( + "[\u00ad\u0600-\u0605\u061c\u06dd\u070f\u0890\u0891\u08e2\u180e" + "\u200b-\u200f\u202a-\u202e\u2060-\u2064\u2066-\u206f\ufeff" + "\ufff9-\ufffb\U000110bd\U000110cd\U00013430-\U0001343f" + "\U0001bca0-\U0001bca3\U0001d173-\U0001d17a\U000e0001" + "\U000e0020-\U000e007f]" +) + + +def _blank(text: str) -> str: + return _FORMAT_CHARACTERS.sub("", text).strip() + + +def _date_string(text: str) -> str: + text = re.sub(r"\s*/\s*", "/", text).replace(",", "") + for fmt in ("%B %d %Y", "%m/%d/%Y", "%m/%d/%y"): + try: + return datetime.strptime(text, fmt).date().isoformat() + except ValueError: + continue + raise TableStructureError("Unrecognized POMS effective date") + + +# An effective-date sentence that states a range of dates: "effective +# from", a date, "to" or "through", and a date, as in "effective from March +# 1, 2031 to June 30, 2031". A "to" that no date follows, as in "effective +# from March 1, 2031 to residents of ...", ends no range. +_DATE_RANGE = re.compile( + rf"effective from\s+(?P(?:{_DATE.pattern}))" + rf",?\s+(?:to|through)\s+(?P(?:{_DATE.pattern}))", + re.IGNORECASE, +) +# The section's revision range, as "Effective Dates: 02/03/2040 - Present". +_REVISION = re.compile( + r"Effective Dates:\s*(\d{2}/\d{2}/\d{4})\s*-\s*" + r"(Present|\d{2}/\d{2}/\d{4})" +) + + +def _date_reading(text: str) -> tuple[tuple[str, ...], bool]: + """The distinct dates an effective-date sentence states, in order, and + whether it states them as a range (``_DATE_RANGE``). A range that does + not end after it starts, as "effective from June 30, 2031 to March 1, + 2031" or "effective from March 1, 2031 to March 1, 2031", refuses. A + range whose two dates are all the sentence states gives them in the + range's order, from and to, wherever else the sentence names them.""" + dates = tuple( + dict.fromkeys(_date_string(m[0]) for m in _DATE.finditer(text)) + ) + ranges = list(_DATE_RANGE.finditer(text)) + for match in ranges: + if _date_string(match["end"]) <= _date_string(match["start"]): + raise TableStructureError( + "POMS effective-date range does not end after it starts" + ) + if ranges and len(dates) == 2: + # Every range here runs from the earlier date to the later one. + dates = tuple(sorted(dates)) + return dates, bool(ranges) + + +# The readings the date checks read: joined, bare, unmarked and unlinked. +_DATE_READINGS = (0, 1, 3, 4) + + +def _date_counts(text: str) -> Counter[str]: + """How many times a text names each date. A date the reader cannot + parse, and one written in a form no effective-date sentence reads + (``_OTHER_DATE``), names itself by its text, so no sentence states + it.""" + counts: Counter[str] = Counter() + for match in _DATE.finditer(text): + try: + counts[_date_string(match[0])] += 1 + except TableStructureError: + counts[match[0]] += 1 + counts.update(match[0] for match in _OTHER_DATE.finditer(text)) + return counts + + +def _named_dates(view: tuple[str, ...]) -> set[str]: + """The dates a whole text or line names (``_date_counts``) in its + joined, bare, unmarked or unlinked reading.""" + return set().union(*(_date_counts(view[k]) for k in _DATE_READINGS)) + + +def _split_dates(full: list[tuple[str, ...]]) -> set[str]: + """The dates a block's whole text, without the revision range, names + more often in one of those readings than its lines together do there, + as a date split across a ``br``. So a line that names the same date, + a footnote body's included, does not cover a split one, though a + revision range on a line still counts among the lines.""" + whole = _unrevised(full[0]) + split = set() + for k in _DATE_READINGS: + by_lines: Counter[str] = Counter() + for line in full[1:]: + by_lines.update(_date_counts(line[k])) + split |= { + day + for day, count in _date_counts(whole[k]).items() + if count > by_lines[day] + } + return split + + +def _named_years(view: tuple[str, ...]) -> set[str]: + """The years (``_YEAR``) a whole text or line holds in its joined, bare, + unmarked or unlinked reading, as "2031" in "January 1st, 2031", "for + 2031", "1/2031", "01.01.2031" or "2031/01/01".""" + return { + match[0] + for text in (view[0], view[1], view[3], view[4]) + for match in _YEAR.finditer(text) + } + + +def _footnote_body(view: tuple[str, ...]) -> bool: + """Whether a whole text or line opens with footnote markers, by either + marker rule, and holds none after them, as a footnote body does. Each + word the markers drop must be one to three digits or footnote signs, or + a single letter (``_FOOTNOTE_WORD``), so a longer ``sup`` or link to a + footnote that opens a line, or wraps it whole, makes no footnote body, + and nor does a word such as "New" or "As" in a leading ``sup`` or + ``#`` link.""" + return any( + view[0] != text + and view[0].endswith(text) + and all( + _FOOTNOTE_WORD.fullmatch(word) + for word in view[0][: len(view[0]) - len(text)].split() + ) + for text in (view[1], view[3]) + ) + + +def _unrevised(view: tuple[str, ...]) -> tuple[str, ...]: + """A whole text or line without the section's revision range + (``_REVISION``), which dates no chart.""" + return tuple(_REVISION.sub(" ", text) for text in view) + + +@lru_cache(maxsize=32) +def _document(payload: bytes) -> tuple[ET.Element, tuple[ET.Element, ...]]: + document = parse_html(payload) + return document, tuple(document.iter("table")) + + +def describe_poms_tables(payload: bytes) -> tuple[dict[str, Any], ...]: + """Return structural selectors for payment tables, without amounts. + + The selectors retain the original chart effective-date text and the + section revision range. More than one chart date is an explicit open + alternative; it does not silently select either date. + """ + document, tables = _document(payload) + section_text = normalized_text(document) + revision = _REVISION.search(section_text) + revision_start = _date_string(revision[1]) if revision else None + revision_end = ( + _date_string(revision[2]) + if revision and revision[2] != "Present" + else None + ) + state = None + claimant = None + effective_text = "" + dates: tuple[str, ...] = () + # Whether the dates state a range, and whether a later line names a date + # no sentence states. + ranged = False + unread_date = False + definitions: list[int] = [] + charted = False + table_indexes = {id(table): i for i, table in enumerate(tables)} + contexts: list[dict[str, Any]] = [] + + def visit(element: ET.Element) -> bool: + """Read one element; return whether to read its children.""" + nonlocal state, claimant, effective_text, dates, ranged, unread_date + nonlocal definitions, charted + if element.tag == "table": + index = table_indexes[id(element)] + grid = expand_html_table(element) + if not grid: + return False + first = tuple(_blank(c.text) for c in grid[0]) + if any( + tuple(_blank(c.text) for c in row) == ("Code", "Definition") + for row in grid[:3] + ): + if charted: + # Which of the section's earlier charts a later table + # defines codes for is not stated, so refuse rather than + # apply it to some charts and not others. + raise TableStructureError( + f"POMS definition table {index} follows a payment " + "chart in its State section" + ) + definitions.append(index) + if len(first) >= 5 and first[0] == "Federal Code": + if state is None or claimant is None: + raise TableStructureError( + f"POMS payment table {index} lacks state or claimant context" + ) + if unread_date: + raise TableStructureError( + f"POMS payment table {index} follows a date that no " + "effective-date sentence states" + ) + # A range dates a chart from and to only with two dates; + # any other dates remain named alternatives. + span = ranged and len(dates) == 2 + contexts.append( + { + "table_index": index, + "state": state, + "claimant_type": claimant, + "header_labels": list(first), + "definitions_table_indexes": list(definitions), + "effective_from": ( + dates[0] if len(dates) == 1 or span else None + ), + "effective_to": dates[1] if span else None, + "parameter_effective_date_text": effective_text, + "date_options": ( + { + f"source_date_{i + 1}": value + for i, value in enumerate(dates) + } + if len(dates) > 1 and not span + else {"not_stated": None} if not dates else {} + ), + "section_effective_from": revision_start, + "section_effective_to": revision_end, + } + ) + charted = True + # Every chart needs its own claimant line. + claimant = None + return False + if element.tag in _BLOCKS: + # Only the block's own text: a table or heading nested under a + # heading left open is read in turn, not as part of it. HTML + # keeps other blocks inside a heading left open, after its words + # or around them, and a br breaks a line, so a block is read + # whole and line by line, each in five readings. The joined and + # bare readings name the block's State heading and claimant, the + # joined reading its date; the joined, bare and spaced readings + # pass the State guards, and the date checks read the unmarked + # and unlinked ones too. + full = _renderings(element) + views = [view[:3] for view in full] + readings = [view[:2] for view in views] + # A whole-text State date line stays a date line: its lines do + # not head a section. + date_block = any(map(_state_date_line, readings[0])) + headed = [ + name + for name in _STATES + if not date_block + and any( + _state_heading(name, text) + for reading in readings + for text in reading + ) + ] + if len(headed) > 1: + raise TableStructureError("POMS heading names two States") + if headed and state != headed[0]: + state = headed[0] + claimant = None + effective_text = "" + dates = () + ranged = False + unread_date = False + definitions = [] + charted = False + if any( + _state_heading(name, text) + for name in _STATES + if name != state + for view in views + for text in view + ): + # A line shaped as another State's heading that heads no + # section here, as a line of a whole-text date line or a + # heading only the spaced reading shows, means that State's + # section was not read. + raise TableStructureError( + "POMS State changes without a section heading" + if date_block + else "POMS heading names a State it does not head" + ) + if any(_misnamed_heading(text) for view in views for text in view): + # A line shaped as a State heading whose postal code is not + # its State's heads no section, so its section was not read. + raise TableStructureError( + "POMS heading names a State it does not head" + ) + # Every line is checked in every reading, so a date line nested + # in a heading cannot carry another State's date into this + # section, and an effective-date sentence may name no State but + # this section's. + if any( + any( + _state_date_line(text) not in {None, state} + for text in view + ) + or state is not None + and any(map(_effective_line, view)) + and _view_states(view) - {state} + for view in views + ): + # Definitions are collected per section heading; a State + # named only in a date line has none of its own, so the + # reader refuses rather than reuse another State's. + raise TableStructureError( + "POMS State changes without a section heading" + ) + # The date sentence is chosen as it renders, footnote markers and + # all, so a footnote body that opens with its marker, as + # "1Effective ...", is no date sentence. A marker inside + # a sentence, as in "January 12, 2031", would change + # or hide its date, so a sentence that dates differently without + # its markers, by either marker rule, or without its links of a + # marker's size, refuses, and so does a line that is a dated + # sentence only without them, unless they all lead it. A whole + # text that is no sentence, as one of 400 characters or more, + # gives each line that is one; lines that date differently remain + # named alternatives. + if _effective_line(views[0][0]): + sentences = [0] + else: + sentences = [ + i + for i, view in enumerate(views) + if _effective_line(view[0]) + ] + found = [] + for i in sentences: + reading = _date_reading(full[i][0]) + if any( + _date_reading(full[i][k]) != reading for k in (1, 3, 4) + ): + raise TableStructureError( + "POMS effective date reads differently without its " + "footnote markers" + ) + found.append(reading) + if found: + if all(reading == found[0] for reading in found): + effective_text = views[sentences[0]][0] + dates, ranged = found[0] + else: + effective_text = " ".join(views[i][0] for i in sentences) + dates = tuple( + dict.fromkeys( + day for reading in found for day in reading[0] + ) + ) + ranged = False + unread_date = False + if any( + _effective_line(text) + and _DATE.search(text) + and not _effective_line(view[0]) + and not view[0].endswith(text) + for view in full + for text in (view[1], view[3], view[4]) + ): + raise TableStructureError( + "POMS effective-date sentence reads only without its " + "footnote markers" + ) + if state is not None: + # A heading, or a line under 80 characters, that names a date + # no effective-date sentence states, as "Payment levels as of + # January 1, 2031", leaves the section's date unread, so the + # next chart refuses unless a sentence dates it. So does a + # heading that holds a year outside the years of the dates in + # force, or a line under 80 characters that holds a year after + # them, as "Payment levels for 2031" in a section dated 2030, + # or an earlier year and a dating word (_DATING_WORDS), as + # "Payment levels for 2029"; one pinned page's short note on a + # State-administered program for the year before holds none, + # and dates no chart. Outside a heading, a footnote body that + # opens with its marker dates no chart, and nor does any line + # of a block whose whole text is one; nor does the section's + # revision range. Each line names its own dates, and the whole + # text adds those it names more often than its lines do, as a + # date split across a br. + stated: set[str] = set() + years: set[str] = set() + in_force = {day[:4] for day in dates} + heading = element.tag in _HEADINGS + if heading or not _footnote_body(full[0]): + for view in full[1:]: + if not heading and ( + _footnote_body(view) or len(view[0]) >= 80 + ): + continue + unrevised = _unrevised(view) + stated |= _named_dates(unrevised) + years |= { + year + for year in _named_years(unrevised) + if heading + or year > max(in_force, default="") + or any( + _DATING_WORDS.search(unrevised[k]) + for k in _DATE_READINGS + ) + } + if heading or len(full[0][0]) < 80: + stated |= _split_dates(full) + if stated - set(dates) or years - in_force: + unread_date = True + # Before any State heading a claimant line names nothing: the + # heading resets the claimant, and a chart before it refuses. + named = False + for view in views if state is not None else (): + matches = [_claimant_line(text) for text in view] + if not any(matches) and not any(map(_claimant_mention, view)): + continue + # Every line that mentions a claimant is guarded, prose + # included, not only the first, so a block's whole text + # cannot cover a line nested in it, and a line may name no + # State but this section's. + if _view_states(view) - {state}: + # The section heading that should have named this State + # was not read, so refuse rather than chart it under the + # State before it. + raise TableStructureError( + "POMS claimant line names another State" + ) + if not any(matches): + # Prose that mentions a claimant names none. + continue + if not any(matches[:2]): + raise TableStructureError( + "POMS claimant line reads only with its inline " + "elements spaced" + ) + named = True + # A block with a claimant line names every claimant word, or its + # plural, that any view holds, the whole text and prose lines + # included, so "Individual
or couple" names two. A heading, or + # a line under 80 characters, that holds one but is no claimant + # line, as "Couple payment levels:" or "Couples", names a + # claimant the reader does not read: it names none, and the next + # chart refuses unless a later claimant line names one. Either + # way two types refuse. + counted = [ + view + for view in (views if state is not None else ()) + if named or element.tag in _HEADINGS or len(view[0]) < 80 + ] + types = { + _claimant_type(word) + for view in counted + for text in view + for word in _CLAIMANT_FORMS.findall(text) + } + if len(types) > 1: + raise TableStructureError("POMS block names two claimants") + if named: + (claimant,) = types + elif types: + claimant = None + if ( + element.tag in _HEADINGS + and state is not None + and any(_view_states(view) - {state} for view in views) + ): + # Any line of a heading that names another State, in any + # reading, means that State's section was not read. + raise TableStructureError( + "POMS heading names a State it does not head" + ) + if state is not None and any( + _opening_states(text) - {state} + for view in views + for text in view + ): + # A short line that opens as another State's caption, as + # "Utah (continued)" or "State of Utah", in a block of any + # kind, means that State's section was not read. This net + # and the next run last, so the nets above keep their + # messages; a line of an h1-h6 heading, one HTML keeps + # inside a heading left open included, has passed the + # heading net, which refuses any heading line that names + # another State. + raise TableStructureError( + "POMS short line opens as another State's caption" + ) + if state is not None and any( + len(view[0]) < 80 and _view_states(view) - {state} + for view in views + ): + # A line under 80 characters that names another State + # anywhere, as "Supplements for Utah", may introduce that + # State's section in a form no heading takes, so refuse + # rather than chart the section before it on. + raise TableStructureError( + "POMS short line names another State" + ) + return True + + # Document order without recursion, so deep nesting cannot exhaust the + # interpreter stack. + pending = [document] + while pending: + element = pending.pop() + if visit(element): + pending.extend(list(element)[::-1]) + return tuple(contexts) + + +def _payment_rows(table: ET.Element) -> tuple[tuple[CellToken, ...], ...]: + """Split publisher-stacked subrows while reusing the shared span logic.""" + # The span logic reads a skeleton of the table whose cells hold only a + # key to the original cell. It is built without recursion, as deepcopy + # is not, so a deeply nested cell cannot crash the interpreter. + lookup = {} + skeleton = ET.Element(table.tag, table.attrib) + pending = [(table, skeleton)] + while pending: + original, copy = pending.pop() + for child in original: + node = ET.SubElement(copy, child.tag, child.attrib) + if child.tag in {"td", "th"}: + node.text = f"poms-cell-{len(lookup)}" + lookup[node.text] = child + else: + pending.append((child, node)) + rows = [] + for row in expand_html_table(skeleton): + elements = [lookup.get(token.text) for token in row] + tokens = [ + _cell_token(element) if element is not None else CellToken("") + for element in elements + ] + segments = [ + ( + [ + _cell_token(p) + for p in element.findall("p") + if _blank(normalized_text(p)) + ] + if element is not None + else [] + ) + for element in elements + ] + grouped = [] + for element in elements: + groups: list[list[CellToken]] = [] + group: list[CellToken] = [] + for paragraph in ( + element.findall("p") if element is not None else [] + ): + if _blank(normalized_text(paragraph)): + group.append(_cell_token(paragraph)) + elif group: + groups.append(group) + group = [] + if group: + groups.append(group) + grouped.append(groups) + # Numeric columns determine the subrow count. A single paragraph in + # the source remains a single cell even when its punctuation is bad. + count = max([len(parts) for parts in segments[3:]] or [1]) + if count <= 1: + rows.append(tuple(tokens)) + continue + for subrow in range(count): + result = [] + for column, (token, parts, groups) in enumerate( + zip(tokens, segments, grouped, strict=True) + ): + if len(parts) in {0, 1}: + result.append(token) + elif len(parts) == count: + result.append(parts[subrow]) + elif ( + column == 2 + and count == 2 + and len(parts) == 3 + and parts[0].text.startswith(parts[1].text + " ") + ): + # Washington prints the repeated category prefix and its + # second county label in adjacent continuation paragraphs. + group = parts[:1] if subrow == 0 else parts[1:] + result.append( + CellToken( + " ".join(p.text for p in group), + tuple( + dict.fromkeys( + f for p in group for f in p.flags + ) + ), + token.is_header, + ) + ) + elif len(groups) == count: + group = groups[subrow] + result.append( + CellToken( + " ".join(p.text for p in group), + tuple( + dict.fromkeys( + f for p in group for f in p.flags + ) + ), + token.is_header, + ) + ) + elif len(parts) % count == 0: + width = len(parts) // count + group = parts[subrow * width : (subrow + 1) * width] + result.append( + CellToken( + " ".join(p.text for p in group), + tuple( + dict.fromkeys( + f for p in group for f in p.flags + ) + ), + token.is_header, + ) + ) + else: + raise TableStructureError( + "POMS stacked rows do not align: " + f"subrows={count}, paragraphs={len(parts)}, groups={len(groups)}" + ) + rows.append(tuple(result)) + return tuple(rows) + + +def poms_living_arrangements( + spec: TableSpec, payload: bytes +) -> dict[str, str]: + """Return cited State OS code definitions from the same verified section. + + A State's definitions may span several physical tables. Each table is + read in full and the tables are merged; a code two tables define + differently raises rather than choosing either definition. A row that + defines codes jointly, such as "C/H", defines each code it names, and a + full-width note row defines no code. + """ + verify_payload(spec, payload) + _, tables = _document(payload) + indexes = spec.selector.get("definitions_table_indexes") + if not indexes: + raise TableStructureError("POMS definition table is not identified") + merged: dict[str, str] = {} + for index in indexes: + for published, definition in _definitions_table(tables[index]).items(): + for code in poms_code_alternatives(published): + if merged.get(code, definition) != definition: + raise TableStructureError( + "POMS living-arrangement code has conflicting " + "definitions" + ) + merged[code] = definition + return merged + + +def poms_code_alternatives(code: str) -> tuple[str, ...]: + """Return the single State OS codes that a published code names. + + POMS writes some codes jointly: a definition row "C/H" defines both C + and H, and a chart row "A or B" pays either code the same amount. Any + other code, joint or not, is returned unchanged. + """ + parts = tuple(re.split(r"\s*/\s*|\s+or\s+", code.strip())) + if len(parts) > 1 and all(re.fullmatch(r"[A-Z]", part) for part in parts): + return parts + return (code,) + + +def _definitions_table(table: ET.Element) -> dict[str, str]: + grid = expand_html_table(table) + header_index = next( + ( + index + for index, row in enumerate(grid[:3]) + if tuple(_blank(c.text) for c in row) == ("Code", "Definition") + ), + None, + ) + if header_index is None: + raise TableStructureError("POMS code definition headers differ") + definitions = {} + previous = None + physical_rows = list(table.iter("tr")) + for row_index, row in enumerate( + grid[header_index + 1 :], header_index + 1 + ): + code = _blank(row[0].text) + definition = _blank(row[1].text) + cells = [ + cell + for cell in physical_rows[row_index] + if cell.tag in {"td", "th"} + ] + if len(cells) == 1 and int(cells[0].get("colspan", "1")) >= 2: + # A full-width row is a note on the table, not a code. + continue + if not code and previous: + definitions[previous] += " " + definition + continue + if code == previous and len(cells) == 1: + definitions[previous] += " " + definition + continue + if not code and not definition: + continue + if not code or code in definitions: + raise TableStructureError( + "POMS living-arrangement code is blank or repeats" + ) + definitions[code] = definition + previous = code + return definitions + + +def _is_header_row(row: tuple[CellToken, ...]) -> bool: + return all(token.is_header for token in row[3:]) or _blank( + row[3].text + ) in { + "FBR", + "Federal Benefit Rate (FBR)", + } + + +def parse_poms(spec: TableSpec, payload: bytes) -> tuple[AggregateCell, ...]: + """Verify and parse one State/claimant payment chart into typed cells.""" + verify_payload(spec, payload) + _, tables = _document(payload) + selector = spec.selector + try: + table = tables[selector["table_index"]] + except (IndexError, KeyError): + raise TableStructureError("Missing registered POMS table") from None + grid = expand_html_table(table) + header = tuple(_blank(c.text) for c in grid[0]) if grid else () + if ( + header != tuple(selector["header_labels"]) + or header[0] != "Federal Code" + ): + raise TableStructureError("POMS payment headers differ from registry") + if len(header) < 5 or len(header) > 8: + raise TableStructureError("Unexpected POMS payment column count") + effective = selector.get("effective_from") + alternate_years = { + date.fromisoformat(value).year + for value in selector.get("date_options", {}).values() + if value + } + year = ( + date.fromisoformat(effective).year + if effective + else ( + next(iter(alternate_years)) + if len(alternate_years) == 1 + else selector.get("nominal_year") if not alternate_years else None + ) + ) + if year is not None and year not in spec.years: + raise TableStructureError("POMS chart year is outside registry") + federal_code = "" + state_code = "" + federal_flags = () + state_flags = () + logical_rows = _payment_rows(table) + header_rows = [logical_rows[0]] + [ + row for row in logical_rows[1:] if _is_header_row(row) + ] + column_labels = [ + " | ".join( + dict.fromkeys( + _blank(row[ci].text) + for row in header_rows + if _blank(row[ci].text) + ) + ) + for ci in range(len(header)) + ] + repeated_labels = { + label + for label in column_labels[3:] + if label and column_labels[3:].count(label) > 1 + } + for ci in range(3, len(header)): + if not column_labels[ci]: + column_labels[ci] = f"Unlabelled amount column {ci + 1}" + elif column_labels[ci] in repeated_labels: + column_labels[ci] += f" | source column={ci + 1}" + column_flags = [ + tuple( + dict.fromkeys( + flag for row in header_rows for flag in row[ci].flags + ) + ) + for ci in range(len(header)) + ] + output = [] + for ordinal, row in enumerate(logical_rows[1:], start=1): + if len(row) != len(header): + raise TableStructureError("POMS payment row width differs") + if _is_header_row(row): + continue + if _blank(row[0].text): + federal_code = _blank(row[0].text) + federal_flags = row[0].flags + else: + federal_flags = tuple(dict.fromkeys(federal_flags + row[0].flags)) + if _blank(row[1].text): + state_code = _blank(row[1].text) + state_flags = row[1].flags + else: + state_flags = tuple(dict.fromkeys(state_flags + row[1].flags)) + category = _blank(row[2].text) + missing_category = not category + category = category or "" + # The ordinal preserves separately published rows with identical labels. + key = " | ".join( + ( + selector["state"], + selector["claimant_type"], + f"Federal code={federal_code}", + f"State OS code={state_code}", + f"Category={category}", + f"source row={ordinal}", + ) + ) + row_cells = [] + for ci, token in enumerate(row[3:], start=3): + raw = _blank(token.text) + malformed = bool(re.fullmatch(r"\d{1,3}\.\d{3}\.\d{2}", raw)) + # The source prints two decimal points in these cells. Choosing + # which punctuation to change would invent an amount. + try: + parsed = parse_number("") if malformed else parse_number(raw) + except TableStructureError: + raise TableStructureError( + f"Unrecognized POMS numeric cell at row {ordinal}, " + f"column {ci + 1}" + ) from None + label = column_labels[ci] + flags = ( + federal_flags + + state_flags + + row[2].flags + + token.flags + + tuple(f for flags in column_flags[:3] for f in flags) + + column_flags[ci] + ) + flags += parsed.footnote_flags + if missing_category: + flags += ("missing_category",) + if malformed: + flags += ("source_numeric_punctuation", "unresolved_amount") + if not header[ci]: + flags += ("unlabelled_column",) + if not effective: + flags += ("ambiguous_effective_date",) + row_cells.append( + AggregateCell( + table=spec.identifier, + row_key=key, + column_key=label, + year=year, + unit="USD per month", + value=parsed.value, + footnote_flags=tuple(dict.fromkeys(flags)), + effective_from=effective, + effective_to=selector.get("effective_to"), + ) + ) + if ( + len(row_cells) == 3 + and "Total Payment Level" in column_labels[-1] + and all(cell.value is not None for cell in row_cells) + and abs( + row_cells[0].value + row_cells[1].value - row_cells[2].value + ) + > Decimal("0.02") + ): + row_cells = [ + replace( + cell, + footnote_flags=cell.footnote_flags + + ("published_identity_discrepancy",), + ) + for cell in row_cells + ] + output.extend(row_cells) + return tuple(output) diff --git a/src/populace_dynamics/income_resources/aggregate_tables.py b/src/populace_dynamics/income_resources/aggregate_tables.py new file mode 100644 index 00000000..d1140179 --- /dev/null +++ b/src/populace_dynamics/income_resources/aggregate_tables.py @@ -0,0 +1,838 @@ +"""Pinned aggregate sources for income and resources, D4. + +Invariants +---------- +* Every public reader verifies SHA-256 and byte size before parsing. +* One cell retains its table, row, column, year, unit and footnote flags; + missing and suppressed cells are explicit ``None``, never zero. +* Numeric decoration (separators and footnote markers) changes neither + magnitude nor sign. Unrecognized numeric text is refused without echoing it. +* HTML merged headers expand to a rectangular grid without losing flags. +* Parsing never prints or logs values. Cell representations omit values. +* Registry roles describe intended use, never admission by an empirical gate. + +Registry fragments live with the captures so part 2 can add sources and +parser dispatch entries without changing existing source identities. Annual +Supplement 4.B uses the existing vintage-1 capture without fetching it again. +""" + +from __future__ import annotations + +import hashlib +import json +import re +from dataclasses import dataclass, field +from decimal import Decimal, InvalidOperation +from html.parser import HTMLParser +from pathlib import Path +from typing import Any +from xml.etree import ElementTree as ET + +ROOT = Path(__file__).resolve().parents[3] +CAPTURE_DIRECTORY = Path("data/external/snapshots/income_resources_d4_v1") + + +@dataclass(frozen=True) +class ParsedNumber: + """A decimal or an explicit missing marker, with source flags.""" + + value: Decimal | None = field(repr=False) + footnote_flags: tuple[str, ...] = () + + +@dataclass(frozen=True) +class AggregateCell: + """One published cell; representations disclose structure only.""" + + table: str + row_key: str + column_key: str + year: int | None + unit: str + value: Decimal | None = field(repr=False) + footnote_flags: tuple[str, ...] = () + effective_from: str | None = None + effective_to: str | None = None + + +@dataclass(frozen=True) +class CellToken: + """An HTML cell after superscript extraction and span expansion.""" + + text: str = field(repr=False) + flags: tuple[str, ...] = () + is_header: bool = False + + +@dataclass(frozen=True) +class TableSpec: + """Identity, coverage and intended role of one captured table.""" + + identifier: str + publisher: str + edition: str + url: str + capture_file: str + sha256: str + byte_size: int + retrieved_at: str + units: tuple[str, ...] + years: tuple[int, ...] + geography: tuple[str, ...] + parser: str + role: str + selector: dict[str, Any] = field(default_factory=dict) + record_kind: str = "table" + + +class CaptureMismatchError(ValueError): + """Capture bytes differ from the registered identity.""" + + +class TableStructureError(ValueError): + """A source no longer has the adjudicated structure.""" + + +_MISSING = { + "": "missing", + "...": "not_available", + "..": "not_available", + "…": "not_available", + "—": "not_available", + "–": "not_available", + "-": "not_available", + "--": "not_available", + "n/a": "not_available", + "na": "not_available", + "none": "not_available", + "nd": "not_available", + "n.a.": "not_available", + "(na)": "not_available", + "(x)": "not_applicable", + "(d)": "suppressed", + "d": "suppressed", + "s": "suppressed", + "(s)": "suppressed", + "*": "suppressed", + "**": "suppressed", + "(z)": "rounded_nonzero", +} + + +def parse_number(raw: str) -> ParsedNumber: + """Parse publisher numeric tokens without treating missing as zero. + + Letter/symbol suffixes and bracketed footnote numbers are retained as + flags. Numeric superscripts must be extracted from HTML before this call; + a trailing ordinary digit always remains part of the numeric value. + """ + token = raw.strip().replace("−", "-") + compact = re.sub(r"\s+", "", token).lower() + if compact in _MISSING: + return ParsedNumber(None, (_MISSING[compact],)) + flags = [] + while match := re.search( + r"\[([^\]]+)\]$|([a-zA-Z*†‡¹²³⁴⁵⁶⁷⁸⁹⁰]+)$" + r"|(?<=\d)\s*\(([a-zA-Z0-9]+)\)$", + token, + ): + if re.sub(r"\s+", "", token).lower() in _MISSING: + break + if match.start() == 0: + raise TableStructureError("Unrecognized numeric cell") + flags.append(next(group for group in match.groups() if group)) + token = token[: match.start()].strip() + compact = re.sub(r"\s+", "", token).lower() + if compact in _MISSING: + return ParsedNumber(None, (_MISSING[compact], *reversed(flags))) + if token.endswith("%"): + token = token[:-1].strip() + negative = token.startswith("(") and token.endswith(")") + if negative: + token = token[1:-1].strip() + token = re.sub(r"^([+-]?)\s*\$\s*", r"\1", token).strip() + if negative and token.startswith(("-", "+")): + raise TableStructureError("Unrecognized numeric cell") + # Commas and spaces may separate groups, but malformed commas are refused. + token = re.sub(r"[\s\u00a0\u202f]", "", token) + if not re.fullmatch( + r"[+-]?(?:(?:\d{1,3}(?:,\d{3})+|\d+)(?:\.\d*)?|\.\d+)", token + ): + raise TableStructureError("Unrecognized numeric cell") + try: + value = Decimal(token.replace(",", "")) + except InvalidOperation: + raise TableStructureError("Unrecognized numeric cell") from None + if negative: + value = -value + return ParsedNumber(value, tuple(reversed(flags))) + + +# Start tags that close an open paragraph in the WHATWG HTML parsing rules +# ("in body" insertion mode), with table as in standards mode. +PARAGRAPH_CLOSERS = frozenset( + """address article aside blockquote center dd details dialog dir div dl + dt fieldset figcaption figure footer form h1 h2 h3 h4 h5 h6 header + hgroup hr li listing main menu nav ol p plaintext pre search section + summary table ul xmp""".split() +) + + +class _HTMLTree(HTMLParser): + """Build a tolerant stdlib tree; publishers' void tags never nest. + + The tree is the same under every supported Python. Python 3.13 reads + only script and style as raw text and 3.14 also xmp, iframe, noembed + and noframes, so the tree pins the set to HTML's raw text elements + (noscript is markup, as in HTML with scripting off). Python 3.14 reads + everything after a ``plaintext`` start tag as text, as HTML does, and + 3.13 reads it as markup, so the tree refuses a page with one. It + refuses a page holding "" or "", an empty comment that HTML + closes at that ``>``: 3.14 closes it there, and 3.13 runs on to a later + "-->". It refuses a page whose script text holds "" comes between, ``\\s`` also matches + a vertical tab and Unicode spaces such as U+00A0, which do not end the + tag name there in HTML, and ``re.IGNORECASE`` matches a long s (ſ) as s + and "İ" or "ı" as i, so "<ſcript>" counts too. It refuses a page with a + script, style, xmp, iframe, noembed, noframes, textarea or title start + tag that closes itself, as ````: here the script ends there, so + the tree refuses a page whose script text holds both (no pinned script + does); + and foreign content, the elements inside ``svg`` or ``math``, which + HTML parses by other rules. HTML ends an open svg or math at the start + tag of one of its breakout elements, among them h1 to h6, p, div, li, + table, b and span, and at a font start tag with a color, face or size + attribute; it builds any other start tag there, such as section, td or + form, as a foreign element, which it does not render as a block or + cell. Inside svg's foreignObject, desc or title, MathML's mi, mo, mn, + ms or mtext, or an annotation-xml whose encoding is text/html or + application/xhtml+xml, it + builds HTML elements again, and an end tag there, as ```` in + ``
``, does not end the heading outside them. The + tree models none of this, so it refuses a page on which a start tag + other than an svg or MathML element of ``_FOREIGN_VOCABULARY`` comes + inside svg or math, or on which svg or math ends other than at its own + end tag, the end of the page included. It does not model an HTML + element built inside one of those integration points, so in + ```` HTML ignores the end tag and keeps + the svg open while the tree ends it, and the blocks and cells after it + read here and stay foreign in HTML. It refuses + ``

Utah

``, whose h3 HTML builds after the svg, as it + refuses ``
Couple
`` and ````, + which HTML builds as foreign elements. Outside those integration + points, HTML reads the content of a script, style, title or textarea + there as markup and honours a self-closing slash, so in + ``

Utah

`` HTML reads a Utah heading + that this tree holds as script text. The tree refuses a page whose svg + or math holds a raw text or RCDATA element whose text holds "<", even + where HTML reads the same text, as in + ```` or a script in a foreignObject, and + its refusal of a self-closed raw text tag covers those HTML closes + there, as ````. No pinned svg, all icons of path, + title and desc elements, meets any of these refusals, and no pinned + page holds math. + """ + + # HTML's raw text elements; Python versions differ (see above). + CDATA_CONTENT_ELEMENTS = ( + "script", + "style", + "xmp", + "iframe", + "noembed", + "noframes", + ) + # Elements whose content the tree holds as text: the raw text elements + # and HTML's RCDATA elements, which both Pythons read as RCDATA. + _TEXT_CONTENT = frozenset(CDATA_CONTENT_ELEMENTS) | {"textarea", "title"} + _VOID = frozenset( + "area base br col embed hr img input link meta param source track wbr".split() + ) + _HEADINGS = frozenset("h1 h2 h3 h4 h5 h6".split()) + # An element is in scope unless one of these encloses it, and in button + # scope unless a button does too. + _SCOPE = frozenset( + "applet caption html marquee object select table td template th".split() + ) + _BUTTON_SCOPE = _SCOPE | {"button"} + _TABLE_SECTIONS = frozenset("table thead tbody tfoot".split()) + # Start tags that clear the stack back to a table context. + _TABLE_CONTEXT = frozenset("caption colgroup thead tbody tfoot".split()) + # End tags that close only within their own table. + _TABLE_PARTS = frozenset( + "caption colgroup tbody td tfoot th thead tr".split() + ) + # WHATWG's "special" HTML elements. + _SPECIAL = frozenset( + """address applet area article aside base basefont bgsound blockquote + body br button caption center col colgroup dd details dir div dl dt + embed fieldset figcaption figure footer form frame frameset h1 h2 h3 + h4 h5 h6 head header hgroup hr html iframe img input keygen li link + listing main marquee menu meta nav noembed noframes noscript object + ol p param plaintext pre script search section select source style + summary table tbody td template textarea tfoot th thead title tr + track ul wbr xmp""".split() + ) + + # Start tags after which HTML drops a newline that comes next. + _NEWLINE_DROPPING = frozenset({"pre", "listing", "textarea"}) + # The svg and MathML elements that may start inside svg or math, in + # HTMLParser's lower case; any other start tag there refuses the page. + _FOREIGN_VOCABULARY = frozenset( + """svg math path g title desc circle rect line polyline polygon + ellipse use defs symbol clippath lineargradient radialgradient stop + mask pattern text tspan image metadata style script foreignobject mi + mo mn ms mtext mrow msup msub msubsup mfrac msqrt mroot mstyle mspace + mtable mtr mtd semantics annotation annotation-xml""".split() + ) + + def __init__(self) -> None: + super().__init__(convert_charrefs=True) + self.root = ET.Element("document") + self.stack = [self.root] + # Whether the last token built one of _NEWLINE_DROPPING. + self._drop_newline = False + # The open svg and math elements, each with its place on the stack. + self._foreign: list[tuple[int, ET.Element]] = [] + + def _open_foreign(self) -> int: + """How many svg and math elements are open. + + The stack only grows or loses its top, so when an entry's place no + longer holds its element, the tree has popped that element and + every later entry's with it. + """ + while self._foreign: + place, element = self._foreign[-1] + if place < len(self.stack) and self.stack[place] is element: + break + self._foreign.pop() + return len(self._foreign) + + def _close_paragraph(self) -> None: + for i in range(len(self.stack) - 1, 0, -1): + if self.stack[i].tag == "p": + del self.stack[i:] + return + if self.stack[i].tag in self._BUTTON_SCOPE: + return + + def _close_open(self, closes: set[str], bounds: frozenset[str]) -> None: + """Pop the innermost open ``closes`` element below ``bounds``.""" + for i in range(len(self.stack) - 1, 0, -1): + if self.stack[i].tag in closes: + del self.stack[i:] + return + if self.stack[i].tag in bounds: + return + + def handle_starttag(self, tag, attrs): + self._drop_newline = False + if tag == "plaintext": + raise TableStructureError("HTML plaintext element is not read") + if self._open_foreign() and tag not in self._FOREIGN_VOCABULARY: + # HTML ends the svg or math at some HTML start tags and keeps + # the others there as foreign elements; the tree models neither. + raise TableStructureError( + "HTML element other than svg or MathML starts inside svg or " + "math" + ) + if tag == "html" and ( + len(self.root) or (self.root.text or "").strip("\t\n\f\r ") + ): + # Only the document's first content builds the html element. A + # page that opens with other content implies it, and the root + # stands for it. + first = self.root.find("html") + if first is None: + first = self.root + for key, value in attrs: + first.attrib.setdefault(key, value or "") + return + if tag in self._TABLE_PARTS | {"col"} and all( + node.tag != "table" for node in self.stack + ): + # HTML ignores a table part's start tag outside any table. + return + if tag in PARAGRAPH_CLOSERS: + self._close_paragraph() + if tag in self._HEADINGS and self.stack[-1].tag in self._HEADINGS: + self.stack.pop() + if tag == "button": + self._close_open({"button"}, self._SCOPE) + if tag in {"li", "dd", "dt"}: + # A list item ends the open one, unless a special element other + # than address, div or p is open inside it. + closes = {"li"} if tag == "li" else {"dd", "dt"} + for i in range(len(self.stack) - 1, 0, -1): + if self.stack[i].tag in closes: + del self.stack[i:] + break + if self.stack[i].tag in self._SPECIAL - { + "address", + "div", + "p", + }: + break + if tag == "table": + for node in reversed(self.stack): + if node.tag in {"td", "th", "caption"}: + break + if node.tag in self._TABLE_SECTIONS | {"tr", "colgroup"}: + # A table directly in a table ends it, as in HTML. + self._close_open({"table"}, frozenset()) + break + if tag in self._TABLE_CONTEXT or ( + tag == "col" and self.stack[-1].tag != "colgroup" + ): + # Anything open in the innermost table ends with it. + for i in range(len(self.stack) - 1, 0, -1): + if self.stack[i].tag == "table": + del self.stack[i + 1 :] + break + if tag in {"tr", "td", "th"}: + self._close_open({"caption", "colgroup"}, frozenset({"table"})) + if tag in {"td", "th"}: + # A new cell closes the open one, with anything left open in it. + self._close_open({"td", "th"}, self._TABLE_SECTIONS | {"tr"}) + if tag == "tr": + self._close_open({"td", "th", "tr"}, self._TABLE_SECTIONS) + self._close_open({"tr"}, self._TABLE_SECTIONS) + if tag in {"tr", "td", "th"} and self.stack[-1].tag == "table": + # HTML puts a row that starts directly in a table in a tbody. + self.stack.append(ET.SubElement(self.stack[-1], "tbody")) + if tag in {"td", "th"} and self.stack[-1].tag in self._TABLE_SECTIONS: + # HTML implies the row of a cell that starts outside one. + self.stack.append(ET.SubElement(self.stack[-1], "tr")) + el = ET.SubElement(self.stack[-1], tag, {k: v or "" for k, v in attrs}) + if tag not in self._VOID: + self.stack.append(el) + if tag in {"svg", "math"}: + # The check above dropped every entry popped before this + # tag, and an svg or math start tag pops nothing. + self._foreign.append((len(self.stack) - 1, el)) + self._drop_newline = tag in self._NEWLINE_DROPPING + + def handle_startendtag(self, tag, attrs): + if tag in self._TEXT_CONTENT: + # HTML ignores the slash and reads what follows as the + # element's text; both Pythons read it as markup. + raise TableStructureError( + "HTML self-closed raw text element is not read" + ) + self.handle_starttag(tag, attrs) + if tag not in self._VOID: + self.handle_endtag(tag) + + def handle_endtag(self, tag): + self._drop_newline = False + open_foreign = self._open_foreign() + innermost = self._foreign[-1][1].tag if open_foreign else None + self._end_tag(tag) + # An end tag that names the innermost svg or math ends only that + # one, since it closes the innermost element of its name. + ended = open_foreign - self._open_foreign() + if ended and tag != innermost: + # Only its own end tag ends an svg or math as HTML ends it. + raise TableStructureError( + "HTML svg or math ends without its own end tag" + ) + + def close(self): + super().close() + if self._open_foreign(): + raise TableStructureError( + "HTML svg or math ends without its own end tag" + ) + + def _end_tag(self, tag): + """Close what an end tag closes, by the rules above.""" + if tag in self._HEADINGS: + # Any h1-h6 end tag ends the open heading in scope. + self._close_open(self._HEADINGS, self._SCOPE) + elif tag == "br": + self.handle_starttag("br", []) + elif tag in {"body", "html"}: + return + elif tag == "table": + self._close_open({"table"}, frozenset()) + elif tag in self._TABLE_PARTS: + self._close_open({tag}, frozenset({"table"})) + elif tag == "p": + depth = len(self.stack) + self._close_open({"p"}, self._BUTTON_SCOPE) + if len(self.stack) == depth: + # With no paragraph to close, HTML inserts an empty one. + ET.SubElement(self.stack[-1], "p") + elif tag == "li": + self._close_open({"li"}, self._SCOPE | {"ol", "ul"}) + elif tag in self._SPECIAL - {"noscript"}: + self._close_open({tag}, self._SCOPE) + else: + # Any other end tag, noscript's included (HTML with scripting + # off gives it no rule of its own). + for i in range(len(self.stack) - 1, 0, -1): + if self.stack[i].tag == tag: + del self.stack[i:] + return + if self.stack[i].tag in self._SPECIAL: + return + + def handle_data(self, data): + if self._drop_newline: + self._drop_newline = False + data = data.removeprefix("\n") + if not data: + return + parent = self.stack[-1] + if len(parent): + parent[-1].tail = (parent[-1].tail or "") + data + else: + parent.text = (parent.text or "") + data + + def handle_comment(self, data): + # A comment, declaration or processing instruction is a token, so + # a newline after it is text. + self._drop_newline = False + + handle_decl = handle_pi = unknown_decl = handle_comment + + +def parse_html(payload: bytes | str) -> ET.Element: + """Build a tolerant HTML tree without fetching external resources. + + The end of the page ends any element left open, as in HTML, so the text + of a raw text element without its end tag is kept. As in HTML, CR LF + and a lone CR read as one newline. + """ + text = ( + payload.decode("utf-8", errors="replace") + if isinstance(payload, bytes) + else payload + ) + if re.search("", ""]) +def test_invented_abruptly_closed_comment_refuses_the_page(comment): + """HTML ends "" and "" as empty comments. Python 3.14 does + too, while 3.13 runs either on to a later "-->", hiding the text + between, so the page refuses on both.""" + with pytest.raises(TableStructureError, match="comment"): + parse_html(f"

Nevada

w0{comment}w1-->w2

") + + +@pytest.mark.parametrize( + "comment", ["", "", "", ""] +) +def test_invented_other_comments_hide_only_themselves(comment): + """Every other comment ends at its first "-->", on both versions, and + the text around it joins as HTML renders it.""" + root = parse_html(f"

w0{comment}w1

") + assert normalized_text(root.find(".//p")) == "w0w1" + + +def test_invented_effective_date_inside_a_heading_block_is_read(): + payload = invented_payload( + "

Description of supplements for California

" + + invented_definitions([("A", "Invented first")]) + + "
Monthly payment levels effective " + "
January 1, 2031
" + + f"

Individual

{INVENTED_HEADER}
" + ) + spec, _ = invented_spec_for(payload) + assert spec.selector["effective_from"] == "2031-01-01" + + +def test_invented_state_date_line_inside_a_heading_is_still_refused(): + payload = invented_nevada_after_california( + "

Nevada
Effective 1/1/30

" + ) + with pytest.raises(TableStructureError, match="section heading"): + describe_poms_tables(payload) + + +@pytest.mark.parametrize("close", ["", ""]) +def test_invented_heading_left_open_before_its_table_names_its_state(close): + """Regression: an open heading once read its tables as heading text.""" + payload = invented_payload( + invented_section("California", [[("A", "Invented first")]]), + f"

Description of supplements for Nevada{close}" + + invented_definitions([("B", "Invented second")]) + + INVENTED_CHART.format(state="Nevada"), + ) + spec, payload = invented_spec_for(payload, 1) + assert spec.selector["state"] == "Nevada" + assert poms_living_arrangements(spec, payload) == {"B": "Invented second"} + + +@settings(deadline=None, max_examples=100) +@given(invented_paragraph_sections(), st.data()) +def test_invented_selectors_do_not_depend_on_blocks_inside_headings( + sections, data +): + """HTML keeps blocks inside a heading; its text, and selectors, stay.""" + pieces, _ = sections + wraps = [ + ( + data.draw( + st.sampled_from( + ["", "div", "section", "p", "blockquote"] + + ["state:div", "state:section", "state:span"] + + ["follow:div", "follow:p", "follow:section"] + + ["end:h4"] + ) + ) + if kind == "h3" + else "" + ) + for kind, _ in pieces + ] + closed = [True] * len(pieces) + assert poms_outcome( + invented_rendering(pieces, closed, wraps) + ) == poms_outcome(invented_rendering(pieces, closed)) + + +@pytest.mark.parametrize( + ("before", "message"), + [ + # Before any State heading, the chart itself refuses. + ("", "lacks state or claimant context"), + ("California", "names another State"), + ], +) +def test_invented_claimant_line_naming_another_state_is_refused( + before, message +): + """A State whose heading went unread refuses at its claimant line.""" + section = ( + invented_section("California", [[("A", "Invented first")]]) + if before + else "" + ) + payload = invented_payload( + section, + "

Invented heading the reader does not know

" + + INVENTED_CHART.format(state="Nevada"), + ) + with pytest.raises(TableStructureError, match=message): + describe_poms_tables(payload) + + +@pytest.mark.parametrize( + ("filler", "after"), + [("

Invented filler" * 2400, ""), ("

" * 3000, "
" * 3000)], + ids=["unclosed_paragraphs", "nested_divs"], +) +def test_invented_deep_pages_read_without_recursion(filler, after): + """Regression: thousands of unclosed paragraphs exhausted the stack.""" + payload = invented_payload( + invented_section("California", [[("A", "Invented first")]]), + filler, + invented_section("Nevada", [[("B", "Invented second")]]), + after, + ) + states = [c["state"] for c in describe_poms_tables(payload)] + assert states == ["California", "Nevada"] + + +@settings(deadline=None, max_examples=100) +@given( + st.lists( + st.lists( + st.tuples( + st.text("Invented 0123456789 ", min_size=1, max_size=8), + st.booleans(), + st.booleans(), + ), + min_size=1, + max_size=4, + ), + min_size=1, + max_size=4, + ) +) +def test_invented_optional_cell_and_paragraph_ends_keep_the_grid(rows): + """HTML lets td, tr and p end without end tags; the grid is the same.""" + + def render(explicit: bool) -> str: + return ( + "" + + "".join( + "" + + "".join( + "" if explicit or end else "") + for text, in_paragraph, end in row + ) + + ("" if explicit else "") + for row in rows + ) + + "
" + + (f"

{text}" if in_paragraph else text) + + ("

" if in_paragraph and explicit else "") + + ("
" + ) + + def grid(html: str): + table = parse_html(html).find("table") + return [ + [_blank(c.text) for c in row] for row in expand_html_table(table) + ] + + assert grid(render(False)) == grid(render(True)) + + +@pytest.mark.parametrize( + "heading", + [ + "

Nevada

Invented note

", + "

Nevada

Monthly payment levels effective January 1, 2030

", + "

Nevada
Invented subtitle

", + "

Nevada

Invented subtitle

", + "

Nevada

Invented note

", + "

Description of supplements for Nevada
Invented" + "

", + # The State follows the nested block, in the heading's own text. + "

Invented subtitle
Nevada

", + "

Invented subtitle

Description of supplements for Nevada", + # A div's own text ends at a block nested in it. + "
Description of supplements for Nevada
Invented
", + ], +) +def test_invented_block_after_a_state_heading_does_not_hide_it(heading): + """Regression: a block after a heading's words kept California.""" + spec, payload = invented_spec_for( + invented_nevada_after_california(heading), 1 + ) + assert spec.selector["state"] == "Nevada" + assert spec.selector["definitions_table_indexes"] == [] + + +@pytest.mark.parametrize( + "line", + [ + "

Individual

Invented note

", + "

Individual
Invented note

", + "

Individual

", + ], +) +def test_invented_block_after_a_claimant_heading_does_not_hide_it(line): + """Regression: a block after "Individual" kept the couple claimant.""" + chart = f"{INVENTED_HEADER}
" + payload = invented_payload( + "

Description of supplements for California

" + + invented_definitions([("A", "Invented first")]) + + "

Couple

" + + chart + + line + + chart + ) + assert [c["claimant_type"] for c in describe_poms_tables(payload)] == [ + "couple", + "individual", + ] + + +def test_invented_effective_line_after_heading_words_is_read(): + payload = invented_payload( + "

Description of supplements for California

" + + invented_definitions([("A", "Invented first")]) + # The date line is the heading's own text after a nested block. + + "
Invented note
Effective January 1, 2031
" + + f"

Individual

{INVENTED_HEADER}
" + ) + spec, _ = invented_spec_for(payload) + assert spec.selector["effective_from"] == "2031-01-01" + + +def test_invented_table_inside_an_open_heading_is_not_heading_text(): + """HTML nests a table in a heading left open; it is read as a table.""" + spec, _ = invented_spec_for( + invented_nevada_after_california( + "

Description of supplements for Nevada" + "
Utah
" + ), + 1, + ) + assert spec.selector["state"] == "Nevada" + + +def test_invented_heading_whose_lines_name_two_states_is_refused(): + payload = invented_nevada_after_california( + "

Nevada
Utah

" + ) + with pytest.raises(TableStructureError, match="names two States"): + describe_poms_tables(payload) + + +@pytest.mark.parametrize( + "page", + [ + "

" + + "
" * 1500 + + "Description of supplements for Nevada" + + "
" * 1500 + + "

", + "

" + "" * 1500 + "Nevada" + "" * 1500 + "

", + "

" + "" * 1500 + "Nevada", + ], + ids=["divs_in_heading", "spans_in_paragraph", "open_spans_in_heading"], +) +def test_invented_deeply_nested_heading_text_reads_without_recursion(page): + """Regression: a heading's own text was collected recursively.""" + spec, _ = invented_spec_for(invented_nevada_after_california(page), 1) + assert spec.selector["state"] == "Nevada" + + +def test_invented_claimant_line_before_any_state_heading_is_not_refused(): + """With no State yet, a chart would refuse, and a heading resets it.""" + payload = invented_payload( + "

Individual payment levels for Nevada

", + invented_section("California", [[("A", "Invented first")]]), + ) + assert [c["state"] for c in describe_poms_tables(payload)] == [ + "California" + ] + + +@pytest.mark.parametrize( + ("line", "claimant"), + [ + ("Individual payment levels for Washington, D.C.", "individual"), + ("Couple for Washington, D.C.", "couple"), + # Round 9 pinned this line as individual, its first word, and round + # 10 as prose that names no claimant, so the chart refused "lacks + # state or claimant context". A heading that holds two claimant + # types refuses as naming two, claimant line or not. + ("Individual or couple for Washington, D.C.", None), + ], +) +def test_invented_washington_dc_names_the_district(line, claimant): + payload = invented_payload( + invented_section( + "District of Columbia", [[("A", "Invented first")]] + ).replace( + "a. Individual payment levels for District of Columbia", line + ) + ) + if claimant is None: + with pytest.raises(TableStructureError, match="two claimants"): + describe_poms_tables(payload) + return + (context,) = describe_poms_tables(payload) + assert context["state"] == "District of Columbia" + assert context["claimant_type"] == claimant + + +def invented_grid(html: str) -> list[list[str]]: + table = parse_html(html).find(".//table") + return [[_blank(c.text) for c in row] for row in expand_html_table(table)] + + +@pytest.mark.parametrize("section", ["thead", "tbody", "tfoot"]) +def test_invented_table_section_start_ends_the_open_cell(section): + """Regression: a section start tag left the open header cell open.""" + html = ( + "
RowCol ACol B" + f"<{section}>
Label12
" + ) + assert invented_grid(html) == [ + ["Row", "Col A", "Col B"], + ["Label", "1", "2"], + ] + + +@pytest.mark.parametrize("tag", ["caption", "colgroup"]) +def test_invented_caption_or_colgroup_start_ends_the_open_row(tag): + html = f"
ab<{tag}>
cd
" + assert invented_grid(html) == [["a", "b"], ["c", "d"]] + + +@pytest.mark.parametrize("start", ["", "", ""]) +def test_invented_row_or_cell_start_ends_an_open_caption(start): + table = parse_html( + f"
Invented caption{start}a
" + ).find(".//table") + caption = table.find("caption") + assert normalized_text(caption) == "Invented caption" + assert caption.find(".//tr") is None + assert caption.find(".//td") is None and caption.find(".//th") is None + + +def test_invented_row_start_ends_the_open_row(): + """HTML never nests a row in a row.""" + table = parse_html("
a
b
").find(".//table") + rows = list(table.iter("tr")) + assert len(rows) == 2 + assert all(row.find(".//tr") is None for row in rows) + + +@pytest.mark.parametrize("end", ["

", "", ""]) +def test_invented_any_heading_end_tag_ends_the_open_heading(end): + root = parse_html(f"

Invented heading{end}

Invented note

") + assert root.find(".//h3//p") is None + assert normalized_text(root.find(".//h3")) == "Invented heading" + + +def test_invented_heading_end_tag_stops_at_its_scope(): + """A heading end tag inside a cell does not end a heading outside it.""" + root = parse_html( + "

Invented
ab
c

" + ) + # The ignored end tag leaves "a" and "b" as one run of cell text. + assert normalized_text(root.find(".//td")) == "ab" + assert root.find(".//h3//table") is not None + + +def test_invented_heading_start_ends_only_a_heading_that_is_current(): + """HTML pops an open heading only when it is the current node.""" + root = parse_html("

Invented

Other

") + assert root.find(".//h3//h4") is not None + root = parse_html("

Invented

Other

") + assert root.find(".//h3//h4") is None + + +def test_invented_definition_table_after_a_chart_is_refused(): + """Regression: a later table once defined codes for later charts only.""" + payload = invented_payload( + "

Description of supplements for California

" + + invented_definitions([("A", "Invented first")]) + + INVENTED_CHART.format(state="California") + + invented_definitions([("B", "Invented second")]) + + INVENTED_CHART.format(state="California") + ) + with pytest.raises(TableStructureError, match="follows a payment chart"): + describe_poms_tables(payload) + + +@settings(deadline=None, max_examples=60) +@given( + st.lists( + st.sampled_from(["definitions", "chart"]), min_size=1, max_size=8 + ).filter(lambda kinds: "chart" in kinds), + st.data(), +) +def test_invented_interleaved_definitions_are_read_in_full_or_refused( + kinds, data +): + """Each chart reads every table of its section, or the section refuses. + + The tables of one State section arrive in any order. A definition table + after a chart refuses; otherwise every chart reads every definition + table of its section, and a section with none refuses at the reader. + """ + codes = iter(string.ascii_uppercase) + groups = { + index: [ + (next(codes), f"Invented arrangement {index}.{row}") + for row in range(data.draw(st.integers(1, 2))) + ] + for index, kind in enumerate(kinds) + if kind == "definitions" + } + payload = invented_payload( + "

Description of supplements for California

" + + "".join( + ( + invented_definitions(groups[index]) + if kind == "definitions" + else INVENTED_CHART.format(state="California") + ) + for index, kind in enumerate(kinds) + ) + ) + if "definitions" in kinds[kinds.index("chart") :]: + with pytest.raises(TableStructureError, match="follows a payment"): + describe_poms_tables(payload) + return + mapping = {code: text for group in groups.values() for code, text in group} + for chart in range(kinds.count("chart")): + spec, payload = invented_spec_for(payload, chart) + assert spec.selector["definitions_table_indexes"] == sorted(groups) + if not groups: + with pytest.raises(TableStructureError, match="not identified"): + poms_living_arrangements(spec, payload) + continue + assert poms_living_arrangements(spec, payload) == mapping + + +INVENTED_TAGS = ("p", "div", "h3", "h4", "span", "b", "table", "td", "ul") + + +@settings(deadline=None, max_examples=200) +@given( + st.lists( + st.tuples(st.sampled_from(INVENTED_TAGS), st.sampled_from(["", "/"])), + max_size=30, + ) +) +def test_invented_tree_ends_paragraphs_and_headings_as_html_does(tokens): + """No paragraph holds a block that HTML says ends it, end tag or not. + + A paragraph closer nests under a paragraph only across a cell, table or + other button-scope boundary, and a heading never holds a heading as its + direct child. + """ + document = parse_html( + "".join(f"<{end}{tag}>Invented" for tag, end in tokens) + ) + boundaries = {"td", "th", "table", "caption", "button"} + + def check(node, open_paragraph: bool) -> None: + for child in node: + assert not (open_paragraph and child.tag in PARAGRAPH_CLOSERS) + if node.tag in {"h3", "h4"}: + assert child.tag not in {"h3", "h4"} + check( + child, + (open_paragraph or child.tag == "p") + and child.tag not in boundaries, + ) + + check(document, False) + + +@pytest.mark.parametrize("close", ["", ""]) +@pytest.mark.parametrize("block", ["section", "blockquote", "li"]) +@pytest.mark.parametrize( + ("line", "message"), + [ + ("Utah Effective January 1, 2031", "section heading"), + ("Couple for Utah", "names another State"), + ], + ids=["date_line", "claimant_line"], +) +def test_invented_line_nested_in_a_heading_passes_the_state_guards( + close, block, line, message +): + """Regression: a date or claimant line HTML kept inside a heading left + open skipped both State guards; it now refuses, as after a closed one.""" + nested = ( + f"
  • {line}
" + if block == "li" + else f"<{block}>{line}" + ) + payload = invented_nevada_after_california(f"

Nevada{close}{nested}") + with pytest.raises(TableStructureError, match=message): + describe_poms_tables(payload) + + +def test_invented_claimant_guard_reads_every_claimant_line(): + """Regression: only a heading's first claimant line was guarded, and its + whole text, which also names its section's State, covered the rest.""" + payload = invented_nevada_after_california( + "

Nevada

Individual for Nevada
Couple for Utah

" + ) + with pytest.raises(TableStructureError, match="names another State"): + describe_poms_tables(payload) + + +INVENTED_BLOCK_KINDS = ("p", "div", "section", "blockquote", "li", "article") + + +def invented_block(kind: str, body: str, block: str, open_: bool) -> str: + """Render a piece with its line in ``block``, or a heading left open.""" + if kind == "h3": + return f"

{body}" + ("" if open_ else "

") + if kind == "p": + if block == "li": + return f"
  • {body}
" + return f"<{block}>{body}" + return body + + +@settings(deadline=None, max_examples=100) +@given(invented_paragraph_sections(), st.data()) +def test_invented_selectors_do_not_depend_on_heading_ends_or_block_kinds( + sections, data +): + """A heading left open holds the blocks HTML nests in it, and a State + heading, date or claimant line may sit in any of these blocks; the + selectors are those of closed headings and paragraphs.""" + pieces, states = sections + blocks = [data.draw(st.sampled_from(INVENTED_BLOCK_KINDS)) for _ in pieces] + left_open = [data.draw(st.booleans()) for _ in pieces] + explicit = poms_outcome(invented_rendering(pieces, [True] * len(pieces))) + varied = invented_payload( + *( + invented_block(kind, body, block, open_) + for (kind, body), block, open_ in zip( + pieces, blocks, left_open, strict=True + ) + ) + ) + assert poms_outcome(varied) == explicit + if not isinstance(explicit, str): + assert [context["state"] for context in explicit] == states + + +@pytest.mark.parametrize( + "heading", + [ + "

Nevada
Invented note

", + "

Invented note
Nevada

", + "

Nevada

Invented note

", + "

Nevada

Invented note

", + "

Nevada​

", + "

Invented note
Nevada‌

", + "

Nev­ada

", + "

Description of supplements for Nevada

", + "
Nevada
Invented note
", + "

Description of supplements for Nevada
Invented note

", + "
  • Description of supplements for Nevada
", + ], +) +def test_invented_line_break_or_zero_width_character_keeps_a_state_heading( + heading, +): + """Regression: a br or zero-width character kept California's selector.""" + spec, _ = invented_spec_for(invented_nevada_after_california(heading), 1) + assert spec.selector["state"] == "Nevada" + assert spec.selector["definitions_table_indexes"] == [] + + +@pytest.mark.parametrize( + "heading", + [ + "

Nevada (Invented)

", + "

New York (NJ)

", + "

Washington (DC)

", + "

Invented note on Nevada

", + "

Invented note on Nevada
Invented note

", + ], +) +def test_invented_heading_naming_a_state_it_does_not_head_is_refused( + heading, +): + """Regression: these headings kept California's definitions silently.""" + with pytest.raises(TableStructureError, match="does not head"): + describe_poms_tables(invented_nevada_after_california(heading)) + + +def test_invented_heading_naming_its_own_state_is_admitted(): + payload = invented_payload( + invented_section("California", [[("A", "Invented first")]]).replace( + "

Monthly", "

Invented note on California

Monthly" + ) + ) + (context,) = describe_poms_tables(payload) + assert context["state"] == "California" + + +@pytest.mark.parametrize( + "block", + [ + "

Invented note
Invented note on Nevada

", + "

Invented note
Nevada (Invented)

", + "

Invented note
Nevada (continued)

", + "

Invented note
State of Nevada

", + "
Invented note
Invented
Notes on Nevada
", + "

Invented note
Invented note (NV)

", + ], +) +def test_invented_later_heading_line_naming_another_state_is_refused(block): + """Round 8 admitted a heading whose later line named another State, + since only a heading's first line was netted. A heading is short, and + a State it names but does not head is one this reader cannot tell + from a section break, so every line of h1-h6 is netted now.""" + payload = invented_payload( + invented_section("California", [[("A", "Invented first")]]).replace( + "

Monthly", block + "

Monthly" + ) + ) + with pytest.raises(TableStructureError, match="does not head"): + describe_poms_tables(payload) + + +@pytest.mark.parametrize( + "block", + [ + # A later heading line may name the section's own State. + "

Invented note
Invented note on California

", + "

Invented note
Invented note (CA)

", + # A long paragraph that names another State is prose, not a + # heading; a short one refuses (the short-line State net). + f"

Invented note on Nevada{INVENTED_LONG_TAIL}

", + ], +) +def test_invented_later_heading_line_own_state_or_paragraph_is_admitted( + block, +): + payload = invented_payload( + invented_section("California", [[("A", "Invented first")]]).replace( + "

Monthly", block + "

Monthly" + ) + ) + (context,) = describe_poms_tables(payload) + assert context["state"] == "California" + + +def test_invented_line_after_a_br_dating_another_state_is_refused(): + """A br-separated line that dates another State refuses, as a block + whose whole text does.""" + payload = invented_payload( + invented_section("California", [[("A", "Invented first")]]).replace( + "

Monthly", + "

Invented note
Nevada Effective 1/1/30

Monthly", + ) + ) + with pytest.raises(TableStructureError, match="section heading"): + describe_poms_tables(payload) + + +@pytest.mark.parametrize( + "heading", + [ + "Washington, D.C.", + "Description of supplements for Washington, D.C.", + "Washington DC", + "Washington, DC (DC)", + ], +) +def test_invented_washington_dc_heading_names_the_district(heading): + """Regression: a "Washington, D.C." heading kept the prior State.""" + spec, _ = invented_spec_for( + invented_nevada_after_california(f"

{heading}

"), 1 + ) + assert spec.selector["state"] == "District of Columbia" + assert spec.selector["definitions_table_indexes"] == [] + + +def invented_nevada_with(fragment: str, before: str = "") -> bytes: + """A Nevada section whose chart follows ``fragment``, after its own + definitions, date and claimant heading, with ``before`` ahead of it.""" + return invented_payload( + before + + "

Nevada

" + + invented_definitions([("A", "Invented Nevada definition")]) + + "

Monthly payment levels effective January 1, 2030

" + "

Individual

" + fragment + f"{INVENTED_HEADER}
" + ) + + +def invented_selector(payload: bytes): + (context,) = describe_poms_tables(payload) + return ( + context["state"], + context["claimant_type"], + context["effective_from"], + context["definitions_table_indexes"], + ) + + +def test_invented_nevada_control_reads_its_own_section(): + assert invented_selector(invented_nevada_with("")) == ( + "Nevada", + "individual", + "2030-01-01", + [0], + ) + + +# Long enough that the whole text is no effective-date or claimant line. +INVENTED_FILLER = "
" + "Invented filler " * 30 + "
" + + +@pytest.mark.parametrize( + ("fragment", "message"), + [ + ( + "

Nevada Effective January 1, 2031
" + "Utah Effective January 1, 2032

", + "section heading", + ), + ( + "

Nevada Effective January 1, 2031
Couple for Utah

", + "section heading", + ), + ( + "

Nevada Effective January 1, 2031" + + INVENTED_FILLER + + "Utah Effective January 1, 2032

", + "section heading", + ), + ( + "

Nevada Effective January 1, 2031" + + INVENTED_FILLER + + "Couple for Utah

", + "names another State", + ), + ( + "

Nevada Effective January 1, 2031
Utah

", + "section heading", + ), + # The round-8 review's E1, E2 and E3. + ( + "

Nevada Effective January 1, 2031" + + INVENTED_FILLER + + "Utah

", + "section heading", + ), + ( + "

Nevada Effective January 1, 2031" + + INVENTED_FILLER + + "Description of supplements for Utah

", + "section heading", + ), + ( + "

Nevada Effective January 1, 2031" + + INVENTED_FILLER + + "Utah (UT)

", + "section heading", + ), + ], + ids=[ + "date_line", + "claimant_line", + "long_date_line", + "long_claimant_line", + "heading_line", + "long_heading_line", + "long_heading_line_supplements", + "long_heading_line_code", + ], +) +def test_invented_lines_after_a_whole_text_state_date_are_guarded( + fragment, message +): + """Regression: a block whose whole text is a State date line skipped + its lines, so a later line could date, head or name another State. A + short whole text refused only as an effective-date sentence naming + another State, and a long one, which is no such sentence, read the + section on. Each line now passes the State guards, and a line shaped + as another State's heading refuses, whatever the whole text's length: + a date line's lines do not head a section, so that State's section + was not read.""" + with pytest.raises(TableStructureError, match=message): + describe_poms_tables(invented_nevada_with(fragment)) + + +def test_invented_whole_text_state_date_lines_do_not_head_a_section(): + """A whole-text date line's own lines still date the section and name + its claimant, but do not head it.""" + payload = invented_nevada_with( + "

Nevada Effective January 1, 2031
Couple

" + ) + assert invented_selector(payload) == ( + "Nevada", + "couple", + "2031-01-01", + [0], + ) + + +@pytest.mark.parametrize( + ("line", "refused"), + [ + ("Couple for Utah (see Nevada)", True), + ("Couple for Nevada and Utah", True), + ("Couple for Nevada", False), + # A claimant line with no space before its claimant word. + ("1)Couple for Utah", True), + ], +) +def test_invented_claimant_line_may_name_only_its_own_state(line, refused): + """Regression: a claimant line that named another State beside its own + passed the guard.""" + payload = invented_nevada_with(f"

{line}

") + if refused: + with pytest.raises(TableStructureError, match="names another State"): + describe_poms_tables(payload) + else: + assert invented_selector(payload)[:2] == ("Nevada", "couple") + + +@pytest.mark.parametrize( + ("later", "refused"), + [("Couple for Utah", True), ("Individual for Nevada", False)], +) +def test_invented_claimant_lines_after_the_first_are_guarded(later, refused): + """Every claimant line of a block is guarded, not only the first. With + the whole text too long to read as a claimant line, a later line naming + another State still refuses; lines naming one claimant name it.""" + payload = invented_nevada_with( + f"

Individual
{later}{INVENTED_FILLER}

" + ) + if refused: + with pytest.raises(TableStructureError, match="names another State"): + describe_poms_tables(payload) + else: + assert invented_selector(payload)[:2] == ("Nevada", "individual") + + +@pytest.mark.parametrize( + "fragment", + [ + # The round-8 review's four forms, each read silently before. + "

Individual
Couple

", + "

Individual for Nevada
Couple for Nevada

", + "

Couple
Individual

", + "

Couple for Nevada
Individual for Nevada

", + # The whole text too long to be a claimant line. + f"

Individual
Couple{INVENTED_FILLER}

", + # A block HTML keeps inside a heading left open. + "

Couple
Individual

", + # Two lines name one claimant, a third the other. + "

Couple for Nevada
Individual
Couple

", + ], +) +def test_invented_block_naming_two_claimants_is_refused(fragment): + """Regression: a block whose lines named two claimant types charted + whichever line was read last or first, without refusing.""" + with pytest.raises(TableStructureError, match="two claimants"): + describe_poms_tables(invented_nevada_with(fragment)) + + +@pytest.mark.parametrize( + ("fragment", "claimant"), + [ + ("

Couple
Couple payment levels

", "couple"), + ("

Individual
Recipient for Nevada

", "individual"), + ], +) +def test_invented_block_naming_one_claimant_names_it(fragment, claimant): + """Lines that name one claimant type, in any of its words, name it.""" + assert invented_selector(invented_nevada_with(fragment))[:2] == ( + "Nevada", + claimant, + ) + + +@pytest.mark.parametrize("line", ["

Couples

", "

Invented note

"]) +def test_invented_second_chart_needs_its_own_claimant_line(line): + """Regression: a second chart after a block that names no claimant took + the first chart's claimant. Each chart now needs a claimant line after + the chart before it.""" + payload = invented_nevada_with("") + ( + f"{line}{INVENTED_HEADER}
".encode() + ) + with pytest.raises(TableStructureError, match="lacks state or claimant"): + describe_poms_tables(payload) + + +@pytest.mark.parametrize( + "line", ["

Couple

", "

Couple1

"] +) +def test_invented_charts_each_after_a_claimant_line_read_their_own(line): + """The round-8 review's ``Couple1`` reads as a couple line now + that footnote markers are dropped for recognition.""" + payload = invented_nevada_with("") + ( + f"{line}{INVENTED_HEADER}
".encode() + ) + contexts = describe_poms_tables(payload) + assert [c["claimant_type"] for c in contexts] == ["individual", "couple"] + + +@pytest.mark.parametrize( + "line", + [ + "Utah payment levels effective January 1, 2031", + "Payment levels effective January 1, 2031 for Utah", + "Effective January 1, 2031 for Washington DC", + "Washington, D.C. Effective January 1, 2031", + "Utah (UT) Effective January 1, 2031", + ], +) +def test_invented_effective_line_naming_another_state_is_refused(line): + """Regression: an effective-date sentence that dated another State in a + form other than "State Effective" carried that date into this section.""" + with pytest.raises(TableStructureError, match="section heading"): + describe_poms_tables(invented_nevada_with(f"

{line}

")) + + +def test_invented_effective_line_before_any_state_heading_is_not_refused(): + """Before the first State heading no section is open, and the heading + that opens one sets its own date.""" + payload = invented_nevada_with( + "", before="

Payment levels effective January 1, 2031 for Utah

" + ) + assert invented_selector(payload) == ( + "Nevada", + "individual", + "2030-01-01", + [0], + ) + + +@pytest.mark.parametrize( + "line", + [ + "Nevada payment levels effective January 1, 2031", + "Nevada (NV) Effective January 1, 2031", + ], +) +def test_invented_effective_line_naming_its_own_state_is_read(line): + payload = invented_nevada_with(f"

{line}

") + assert invented_selector(payload) == ( + "Nevada", + "individual", + "2031-01-01", + [0], + ) + + +@pytest.mark.parametrize( + ("fragment", "expected"), + [ + ( + "

Utah

Individual

", + ("Utah", "individual", None, []), + ), + ( + "

Couple

", + ("Nevada", "couple", "2030-01-01", [0]), + ), + ], + ids=["state_heading", "claimant_heading"], +) +def test_invented_inline_markup_inside_a_word_keeps_the_word( + fragment, expected +): + """Regression: a space at each inline element's edge split "Utah" and + "Couple", keeping Nevada's definitions and claimant.""" + assert invented_selector(invented_nevada_with(fragment)) == expected + + +@pytest.mark.parametrize( + "block", + [ + "

Invented note
New York (NJ)

", + "

Invented note
Description of supplements for Utah (NV)

", + "

New York (NJ)

", + "

New York1 (NJ)

", + ], +) +def test_invented_state_heading_line_with_another_code_is_refused(block): + """Regression: a later line shaped as a State heading, with a postal + code that is not that State's, kept Nevada's selector.""" + with pytest.raises(TableStructureError, match="does not head"): + describe_poms_tables(invented_nevada_with(block)) + + +def test_invented_later_state_heading_line_with_its_own_code_heads(): + payload = invented_nevada_with( + "

Invented note
New Jersey (NJ)

Individual

" + ) + assert invented_selector(payload) == ( + "New Jersey", + "individual", + None, + [], + ) + + +@pytest.mark.parametrize( + "heading", + [ + # The round-8 review's A1, its supplement-heading form and its + # footnote-link form. + "

Utah1

", + "

Description of supplements for Utah1

", + "

Utah1

", + "

Description of supplements for Utah2

", + "

1Utah

", + "

Utah1

", + ], +) +def test_invented_footnote_marker_after_a_state_name_heads_it(heading): + """Regression: a footnote marker glued to a State's name hid it, so + Nevada's definitions charted Utah. Footnote markers are dropped when a + heading is recognized, as they are from table cells.""" + payload = invented_nevada_with(heading + "

Individual

") + assert invented_selector(payload) == ("Utah", "individual", None, []) + + +@pytest.mark.parametrize( + ("fragment", "message"), + [ + # A4: rendered, the words run together, so the heading names Utah + # but heads nothing. + ( + "

Description of supplements forUtah

" + "

Individual

", + "does not head", + ), + # The same heading in a paragraph, which no heading net reads. + ( + "

Description of supplements forUtah

" + "

Individual

", + "does not head", + ), + # B1. + ("

Couple for Utah1

", "names another State"), + ("

Couple for Utah1

", "names another State"), + # C1 and its trailing form. + ( + "

Utah1 payment levels effective January 1, 2031

", + "section heading", + ), + ( + "

Payment levels effective January 1, 2031 for Utah2" + "

", + "section heading", + ), + # D1: hidden text glued to the name. + ("

Utah

", "does not head"), + ("

Invented note
Utahx

", "does not head"), + # A claimant line only the spaced reading shows. + ("

Couplefor Nevada

", "inline elements spaced"), + ], +) +def test_invented_state_name_glued_across_an_inline_edge_is_refused( + fragment, message +): + """Regression: a State name glued to the text of the element beside it + became another word, so no State net saw it and Nevada's selector + charted the block. Every net now also reads each line with a space at + every element's edge.""" + with pytest.raises(TableStructureError, match=message): + describe_poms_tables(invented_nevada_with(fragment)) + + +GLUED_NAMES = [(name, name) for name in _STATES if name != "Nevada"] + [ + ("Washington, D.C.", "District of Columbia"), + ("Hawaiʻi", "Hawaii"), +] +GLUED_CONTEXTS = [ + "

{name}

Individual

", + "

Description of supplements for {name}

Individual

", + "

Invented note
{name}

", + "

Couple for {name}

", + "

{name} payment levels effective January 1, 2031

", + "

Payment levels effective January 1, 2031 for {name}

", + "

{name} Effective January 1, 2031

", +] + + +def invented_nevada_outcome(fragment: str): + """The last chart's State, or None when the page refuses.""" + try: + selectors = describe_poms_tables(invented_nevada_with(fragment)) + except TableStructureError: + return None + return selectors[-1]["state"] + + +@settings(deadline=None, max_examples=150) +@given( + st.sampled_from(GLUED_NAMES), + st.sampled_from(["{w}", "{w}"]), + st.booleans(), + st.text("0123456789x", min_size=1, max_size=3), + st.sampled_from(GLUED_CONTEXTS), +) +def test_invented_footnote_marker_on_a_state_name_never_charts_nevada( + named, marker, before, word, context +): + """Property: a footnote marker touching a State's name, on either side, + in a heading, claimant line or date sentence of Nevada's section, + leaves that block read as without the marker: it reads that State's + section or refuses, and never charts under Nevada's selector.""" + text, name = named + piece = marker.format(w=word) + glued = piece + text if before else text + piece + assert invented_nevada_outcome(context.format(name=glued)) in {name, None} + + +@settings(deadline=None, max_examples=150) +@given( + st.sampled_from(GLUED_NAMES), + st.sampled_from( + [ + "{w}", + "{w}", + "", + "{w}", + "{w}", + ] + ), + st.booleans(), + st.text("0123456789x", min_size=1, max_size=3), + st.sampled_from(GLUED_CONTEXTS), +) +def test_invented_inline_edge_hides_no_state_from_a_net( + named, glue, before, word, context +): + """Property: an inline element glued to a State's name hides that + State from no net. Whenever the page with a space at the glued edge + refuses or reads that State, the glued page refuses or reads it too. + (The space-separated page may read as prose: "x Utah Effective" is no + date sentence.)""" + text, name = named + piece = glue.format(w=word) + glued = piece + text if before else text + piece + spaced = piece + " " + text if before else text + " " + piece + if invented_nevada_outcome(context.format(name=spaced)) in {name, None}: + assert invented_nevada_outcome(context.format(name=glued)) in { + name, + None, + } + + +@pytest.mark.parametrize( + ("fragment", "message"), + [ + # R1: only a line of the block, not its whole text, is an + # effective-date sentence. + ( + "

Utah payment levels effective January 1, 2031" + + INVENTED_FILLER + + "

", + "section heading", + ), + # R3: no space before the code, in a block that is no heading. + ("

New York(NJ)

", "does not head"), + ("

Invented note
New York(NJ)

", "does not head"), + # R5: only the whole text is a claimant line. + ("

Couple for
Utah residents

", "names another State"), + ], + ids=["R1", "R3", "R3_line", "R5"], +) +def test_invented_round_8_mutant_witnesses_are_refused(fragment, message): + """The round-8 review's R1, R3 and R5 mutants each read one of these + pages silently; each now fails this test.""" + with pytest.raises(TableStructureError, match=message): + describe_poms_tables(invented_nevada_with(fragment)) + + +def test_invented_long_state_date_line_with_a_footnote_is_refused(): + """A line too long to be an effective-date sentence that still opens + as another State's date line, once its footnote marker is dropped, + refuses: that State's section heading was not read.""" + payload = invented_nevada_with( + "

Utah1 Effective January 1, 2031 " + + "Invented filler " * 30 + + "

" + ) + with pytest.raises(TableStructureError, match="section heading"): + describe_poms_tables(payload) + + +def test_invented_footnote_marker_glued_to_effective_starts_no_date(): + """The date sentence is read from the joined text, footnote markers + and all, so "Effective" with a marker glued to it starts no date + sentence and the section's date stands. One pinned page holds such a + paragraph; reading its bare text would move that page's chart date.""" + payload = invented_nevada_with("

Effective1 invented

") + assert invented_selector(payload) == ( + "Nevada", + "individual", + "2030-01-01", + [0], + ) + + +@pytest.mark.parametrize( + "line", + [ + "Couple for Washington, D.C.", + "Couple for Washington,DC", + "Couple for washington dc", + ], +) +def test_invented_district_claimant_line_names_its_own_section(line): + """A claimant line naming the District, by any alias, names no other + State in the District's section, Washington State included.""" + payload = invented_payload( + "

Washington, D.C.

" + + invented_definitions([("A", "Invented District definition")]) + + "

Monthly payment levels effective January 1, 2030

" + + f"

{line}

{INVENTED_HEADER}
" + ) + assert invented_selector(payload) == ( + "District of Columbia", + "couple", + "2030-01-01", + [0], + ) + + +def invented_washington_with(fragment: str) -> bytes: + """Washington State's section, then ``fragment`` and a chart.""" + return invented_payload( + "

Washington

" + + invented_definitions([("A", "Invented Washington definition")]) + + "

Monthly payment levels effective January 1, 2030

" + "

Individual

" + fragment + f"{INVENTED_HEADER}
" + ) + + +@pytest.mark.parametrize( + "heading", ["Washington,DC", "Washington,D.C.", "Washington D.C."] +) +def test_invented_district_heading_without_a_space_heads_the_district( + heading, +): + """Regression: in Washington State's section, "Washington,DC" heads + nothing, so the chart kept Washington's definitions.""" + payload = invented_washington_with( + f"

{heading}

Individual

" + ) + assert invented_selector(payload) == ( + "District of Columbia", + "individual", + None, + [], + ) + + +@pytest.mark.parametrize( + ("fragment", "message"), + [ + ("

Couple for Washington,D.C.

", "names another State"), + ( + "

Washington,D.C. Effective January 1, 2031

", + "section heading", + ), + ], +) +def test_invented_district_line_in_washington_section_is_refused( + fragment, message +): + """Regression: these lines passed in Washington State's section, the + date carrying the District's date into Washington's chart.""" + with pytest.raises(TableStructureError, match=message): + describe_poms_tables(invented_washington_with(fragment)) + + +@pytest.mark.parametrize( + "heading", + [ + "U­tah", + "Ut​ah", + "Utah", + "Hawaiʻi", + "Hawai'i", + "Hawai‘i", + "Hawai’i", + "Description of supplements – Utah", + "Description of supplements—Utah", + "Procedure − Utah", + ], +) +def test_invented_heading_name_forms_head_their_state(heading): + """Regression: a soft hyphen or other format character in a State's + name, the okina in "Hawaiʻi" and a dash other than a hyphen after a + heading's prefix each kept Nevada's selector.""" + name = "Hawaii" if "Hawai" in heading else "Utah" + payload = invented_nevada_with(f"

{heading}

Individual

") + assert invented_selector(payload) == (name, "individual", None, []) + + +@pytest.mark.parametrize( + ("fragment", "message"), + [ + ("

Couple for U­tah

", "names another State"), + ("

⁠
Utah residents

", "does not head"), + # A postal code in parentheses names its State. + ( + "

Payment levels effective January 1, 2031 (UT)

", + "section heading", + ), + ("

Couple for residents (ut)

", "names another State"), + # So do an upper-case code standing as a word and an abbreviation. + ( + "

Payment levels effective January 1, 2031 for UT

", + "section heading", + ), + ("

Couple for N.J.

", "names another State"), + ("

Couple for Calif.

", "names another State"), + ("

Invented note
Pa. notes

", "does not head"), + ("

Couple for D.C.

", "names another State"), + ( + "

Payment levels effective January 1, 2031 for N. Y.

", + "section heading", + ), + ("

Invented note
R.I. notes

", "does not head"), + ], +) +def test_invented_other_name_forms_are_netted(fragment, message): + """Regression: each of these named another State in Nevada's section + and passed every net.""" + with pytest.raises(TableStructureError, match=message): + describe_poms_tables(invented_nevada_with(fragment)) + + +@pytest.mark.parametrize( + "fragment", + [ + "

N.J.

Individual

", + "

Mich.

Individual

", + "

(UT)

Individual

", + "

UT

Individual

", + ], +) +def test_invented_abbreviation_or_code_alone_heads_nothing(fragment): + """An abbreviation or a postal code alone names a State to the nets but + heads no section, so the block refuses rather than heads one.""" + with pytest.raises(TableStructureError, match="does not head"): + describe_poms_tables(invented_nevada_with(fragment)) + + +def test_invented_format_characters_are_unicode_category_cf(): + """The pinned format characters are exactly Unicode's Cf category as + this interpreter's unicodedata has it (Unicode 15.1 on 3.13, 16.0 on + 3.14, which agree on Cf).""" + pinned = { + point + for point in range(sys.maxunicode + 1) + if _blank("a" + chr(point) + "a") == "aa" + } + category = { + point + for point in range(sys.maxunicode + 1) + if unicodedata.category(chr(point)) == "Cf" + } + assert pinned == category + + +def test_invented_deeply_nested_chart_cell_reads_without_recursion(): + """Regression: copying a chart whose cell nests 50,000 spans crashed the + interpreter (exit 139), so the read runs in its own process.""" + program = ( + "from populace_dynamics.income_resources.aggregate_poms import " + "_payment_rows\n" + "from populace_dynamics.income_resources.aggregate_tables import " + "parse_html\n" + "depth = 50_000\n" + "page = ('
A' + '' * depth + '100' " + "+ '' * depth + '
')\n" + "rows = _payment_rows(parse_html(page).find('.//table'))\n" + "print(len(rows), [token.text for token in rows[0]])\n" + ) + result = subprocess.run( + [sys.executable, "-c", program], + capture_output=True, + text=True, + timeout=600, + ) + assert result.returncode == 0 + assert result.stdout.strip() == "1 ['A', '100']" + + +def test_invented_table_nested_in_a_chart_cell_adds_no_rows(): + """A table inside a chart cell is that cell's text, as the copy before + the skeleton read it; its rows are not the chart's.""" + page = ( + "
A

100

" + "
w1w2
w3
" + "
B200
" + ) + rows = _payment_rows(parse_html(page).find(".//table")) + assert [[token.text for token in row] for row in rows] == [ + ["A", "100 w1 w2 w3"], + ["B", "200"], + ] + + +def invented_tables(html: str): + """Each table's caption text and its rows' cell texts, in order.""" + root = parse_html(html) + pending, out = [root], [] + while pending: + node = pending.pop() + pending.extend(list(node)[::-1]) + if node.tag == "table": + caption = node.find("caption") + out.append( + ( + normalized_text(caption) if caption is not None else None, + [ + [ + normalized_text(c) + for c in row + if c.tag in {"td", "th"} + ] + for row in node.iter("tr") + ], + ) + ) + return out + + +# Each page's expected tables are what html5lib 1.1 builds for it. +@pytest.mark.parametrize( + ("html", "expected"), + [ + pytest.param( + "
w1
w2
w3
w4" + "
w5
", + [ + (None, [["w1 w2 w3 w4", "w5"], ["w2"], ["w3"]]), + (None, [["w2"], ["w3"]]), + ], + id="section_start_in_a_nested_table_cell", + ), + pytest.param( + "" + "
w1
w2
w3
", + [("w1 w2", [["w1"], ["w3"]]), (None, [["w1"]])], + id="caption_holding_a_table", + ), + pytest.param( + "
w0
w1
w2
w3
", + [("w0 w1 w2", [["w1"], ["w3"]]), (None, [["w1"]])], + id="row_start_ends_a_caption_after_its_nested_table", + ), + pytest.param( + "
w1
w2
", + [(None, [["w1"], ["w2"]])], + id="colgroup_start_in_a_cell", + ), + pytest.param( + "
w9w10
w11
", + [(None, [["w9", "w10"], ["w11"]])], + id="col_start_in_a_cell", + ), + pytest.param( + "
w1
", + [(None, [["w1"]])], + id="cell_start_ends_an_open_colgroup", + ), + pytest.param( + "
w1
w2
", + [(None, [["w1"], ["w2"]])], + id="cell_after_a_section_start_implies_a_row", + ), + pytest.param( + "
w1w2
", + [(None, [["w1", "w2"]])], + id="cell_directly_in_a_table_implies_a_row", + ), + pytest.param( + "
w1
w2
", + [(None, [["w1"]]), (None, [["w2"]])], + id="table_start_in_a_table_ends_it", + ), + pytest.param( + "w0
w1
", + [(None, [[""], ["w1"]])], + id="section_end_tag_closes_the_implied_tbody", + ), + pytest.param( + "
w1w2w3
", + [(None, [["w1w2", "w3"]])], + id="block_end_tag_stops_at_the_cell", + ), + pytest.param( + "
w2
w1
w3
w4" + "
", + [(None, [["w1 w2 w3", "w4"], ["w1"]]), (None, [["w1"]])], + id="row_end_tag_stops_at_its_table", + ), + ], +) +def test_invented_tree_builds_tables_as_html_does(html, expected): + """Regression: each page built different tables before these rules.""" + assert invented_tables(html) == expected + + +def invented_blocks( + html: str, tags=("p", "h3", "button", "li", "dt", "dd", "div", "object") +): + root = parse_html(html) + pending, out = [root], [] + while pending: + node = pending.pop() + pending.extend(list(node)[::-1]) + if node.tag in tags and normalized_text(node): + out.append((node.tag, normalized_text(node))) + return out + + +# Each page's expected blocks are what html5lib 1.1 builds for it. +@pytest.mark.parametrize( + ("html", "expected"), + [ + pytest.param( + "

w2

w3

", + [("h3", "w1"), ("button", "w1"), ("p", "w3")], + id="heading_end_tag_ends_a_button_inside_it", + ), + pytest.param( + "

w3

", + [("p", "w1 w2 w3"), ("button", "w1"), ("button", "w2")], + id="button_start_ends_an_open_button", + ), + pytest.param( + "

w0

w1

", + [("h3", "w0 w1")], + id="paragraph_end_tag_without_a_paragraph", + ), + pytest.param( + "
  • w0
  • w1
    w2
  • w3
", + [("li", "w0"), ("li", "w1 w2"), ("div", "w2"), ("li", "w3")], + id="list_item_start_ends_the_open_item", + ), + pytest.param( + "
w0w1
", + [("div", "w0w1")], + id="body_end_tag_closes_nothing", + ), + pytest.param( + "

w0w1

w2w3

", + [("p", "w0 w1w2 w3")], + id="block_end_tag_without_its_block_is_ignored", + ), + pytest.param( + "
w0

w1w2

w3
", + [("div", "w0 w1w2 w3"), ("p", "w1w2")], + id="inline_end_tag_stops_at_an_open_block", + ), + pytest.param( + "
  • w0
    • w1
    w2
", + [("li", "w0 w1 w2"), ("li", "w1")], + id="nested_list_item_start_keeps_the_outer_item", + ), + pytest.param( + "
w0w1
", + [("div", "w0w1")], + id="body_end_tag_after_a_body_start_closes_nothing", + ), + pytest.param( + "

w0w3", + [("p", "w0 w1 w2 w3"), ("button", "w1 w2")], + id="paragraph_end_tag_inside_a_button", + ), + pytest.param( + "

  • w0
      w1w2
", + [("li", "w0 w1w2")], + id="list_item_end_tag_stops_at_a_nested_list", + ), + pytest.param( + "
w0

w1

w2", + [("div", "w0 w1"), ("p", "w1")], + id="block_end_tag_closes_its_open_paragraph", + ), + pytest.param( + "
w0w1
", + [("div", "w0 w1"), ("object", "w0")], + id="scope_element_end_tag_closes_itself", + ), + pytest.param( + "
  • w0
    w1
  • w2
", + [("li", "w0 w1"), ("li", "w2")], + id="list_item_start_ends_the_item_around_an_address", + ), + pytest.param( + "
w0
w1
", + [("dt", "w0"), ("dd", "w1")], + id="dd_start_ends_an_open_dt", + ), + pytest.param( + "
w0
w1
", + [("dd", "w0"), ("dt", "w1")], + id="dt_start_ends_an_open_dd", + ), + pytest.param( + "
w0w1
", + [("div", "w0w1")], + id="html_end_tag_after_an_html_start_closes_nothing", + ), + pytest.param( + "
w0w1
", + [("div", "w0w1")], + id="html_end_tag_closes_nothing", + ), + pytest.param( + "

w0w1

w2

w3

", + [("p", "w0w1"), ("h3", "w3")], + id="html_start_tag_in_a_paragraph_builds_nothing", + ), + pytest.param( + "

w0w1

w2

w3

", + [("h3", "w0w1")], + id="html_start_tag_in_a_heading_builds_nothing", + ), + pytest.param( + "
w0w1
w2", + [("div", "w0w1")], + id="second_html_start_tag_builds_nothing", + ), + pytest.param( + "