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SSI Ineligible due to Residence in Medical Institution - Iowa

When a person enters a medical institution in which Medicaid will be paying at least 50% of the cost of care, the SSI program reduces the person’s maximum benefit rate to $30 per month. This means that people who were eligible for SSI while living in their home will lose SSI eligibility when they enter a medical institution if their income is greater than $30.

Medicaid is available to a person who would be eligible for SSI or State Supplemental Assistance if the person was not living in a medical institution. Eligibility begins on the first day of the month the person entered the institution. Payments begin for the nursing facility on day of entry, provided level of care has been met. Retroactive benefits may also be available for up to three months before the month of application if all requirements are met.

1. Mr. A, a 67-year-old person living in a nursing facility, has been using his resources to pay privately. In July 1996, Mr. A applies for Medicaid because his resources have been depleted and are now less than $2,000. Mr. A’s only income is social security of $400.

Because Mr. A’s income does not exceed the SSI payment standard for an individual living at home, his correct coverage group beginning July 1996 is "persons ineligible for SSI due to residence in a medical institution."

2. Ms. J enters a nursing facility and applies for Medicaid on July 20. In the month of July her resources were $2,200. Ms. J’s only income is social security of $400. As of August 1, Ms. J’s resources are reduced to $1,900.

See Also:

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees’ Manual

Title 8 Medicaid

·                        Chapter F, Coverage Groups

Legal reference: 42 CFR 435.211, 441 IAC 75.1(6)

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