How Does SSI Disability Work When You Live in a Nursing Home?
Your SSI benefit may be terminated or lowered if you move to a nursing home where Medicaid pays for part of your stay.
Many people who receive SSI disability benefits will need to receive care in a nursing home at some point in their lives. Nationwide, nine million seniors received some type of long-term care in 2012. However, if you think that nursing home care is just for the elderly, you’re wrong. An SSI recipient who uses nursing home care could be a disabled child recuperating from surgery in a nursing home or an injured adult who needs life-long, round-the-clock care.
Whatever their age, when individual SSI recipients live in nursing homes, the amount of SSI that they receive each month will be affected. The type of facility they live in and the length of the stay will determine how much SSI individuals can keep. In a nutshell, your SSI benefit may be terminated or lowered if you move to a nursing home where Medicaid pays for part of your stay. On the other hand, if you pay for a private facility, your state may supplement your SSI payment.
Medicaid and Non-Medicaid Facilities
Not all nursing facilities accept Medicaid payments. Nursing facilities must be inspected and licensed before they can accept Medicaid. Each state has an agency that contracts with the federal government to license and inspect nursing homes to make sure they meet federal standards. If you are looking for a nursing home that will accept Medicaid, talk to the nursing home staff or your state Medicaid agency about whether that nursing home is licensed to accept Medicaid patients.The amount of SSI that a person may receive while living in a nursing home depends on whether Medicaid is paying more than half of the cost of care.
Medicaid paying for care. If you are in a nursing home and Medicaid is paying more than half the cost of your care, you are eligible for only a small, reduced SSI benefit. You will only receive the reduced payment if the nursing facility is one that can provide inpatient medical services (Medicaid will not pay for non-medical facilities like an assisted living facility). Your SSI benefit will be reduced to $30/month for individuals or $60/month for a married couple who both receive SSI. Some states supplement this amount and allow you to keep more. (See more about state supplements below.)
Public nursing home without Medicaid. If you live in a public medical facility where Medicaid does not pay for more than half of your care, then you are not eligible for any SSI benefit.
Private nursing home. If you are living in a private care facility that does not accept Medicaid, then you can keep your SSI, although you may not be eligible for it if you have enough income to afford private care.
Children receiving SSI. The rules for children who receive SSI are more generous: children are eligible for the $30 reduced payment if they lives in a nursing home where either Medicaid or private insurance pays for more than half the cost of care.
Spouse needing nursing home care. If both you and your spouse receive SSI, you will continue to receive SSI if your spouse enters a nursing home. Instead of receiving the couple rate of $1,103/month, you will start to receive the individual rate of $735/month.
State Supplements to SSI
Most states give additional money to SSI recipients in the form of a supplement to the federal monthly SSI payment. For example, California pays a $20 supplement to SSI recipients who live in a nursing home and are eligible for the reduced federal $30/month SSI payment. Alaska adds a $45 supplement to the $30 reduced SSI amount.
As mentioned above, Medicaid will not pay for room and board costs at a non-medical facility like an assisted living facility. But since the monthly SSI amount is not enough to afford the typical cost of an assisted living facility, many states have separate programs through which they supplement the SSI payments of people in non-medical long-term care facilities. For instance, California adds a extra $412/month to individuals living in non-medical out-of-home care to supplement the federal SSI payment, for a monthly total of $1122. Alaska adds $100/month, for a monthly total of $840.
In some states, the SSI state supplement is paid directly to the facility.
An Exception for Short Stays
If you are only going to be in the nursing home for a short time, you can keep your full SSI payment if your doctor tells Social Security in writing that you will be there 90 days or less and you tell Social Security that you need your SSI to preserve your permanent housing. Social Security calls this benefit “temporary institutionalization” benefits. Temporary institutionalization benefits are available to adults in Medicaid-certified nursing homes or public hospitals or institutions, and to children in any type of facility, including a private medical facility.
Dealing With the Social Security Administration
SSI recipients must notify Social Security when they enter a nursing home. Usually, nursing home staff will help the SSI recipient notify Social Security, particularly if the nursing home will be billing Medicaid for its services. Nursing home staff are usually good sources of information about Medicaid and Social Security benefits for residents.
If you are leaving a nursing home, ask the nursing home staff about SSI's prerelease procedures so can get your full SSI benefit back as soon as you get home.
SSI recipients who have questions about their benefits can also contact their state’s Medicaid agency. You can locate your state’s Medicaid agency at Medicaid.gov.
If your SSI has been terminated and you disagree with the decision, consult a disability lawyer.