210-RICR-50-00-3. SSI-Related Coverage Groups (version Technical Revision, 11/13/2017 to 05/16/2019)

3.1 Institutionalized SSI Beneficiaries This coverage group consists of individuals in a medical or nursing facility who would be eligible for SSI if living in the community. This includes individuals with sufficient income to meet personal needs while in the facility, but not enough income to meet their needs outside the community according to SSI and State Supplement Standards. 3.2 Non-Institutionalized SSI Beneficiaries This coverage group consists of individuals in a medical or nursing facility who would not be eligible for SSI if s/he were living in the community. While in the facility these individuals are Medicaid eligible under a special income level for institutionalized individuals (the Federal Cap). The resources of institutionalized persons in this coverage group must be within SSI limits. 3.3 Residents of Long-Term Care Facilities A. This coverage group consists of individuals who were eligible for Medicaid as residents or inpatients of Title XIX facilities or were, on the basis of need for institutional care, considered to be eligible for Medicaid in the month of December 1973. The Title XIX facilities are the Eleanor Slater Hospital and Zambarano Hospital. B. Eligibility for Medicaid continues for these individuals as long as they: 1. Remain residents of the Title XIX facilities; and 2. Meet the eligibility conditions of Medicaid as of December 1973; and 3. Are in need of institutionalized care. 3.4 Short Inpatient Stays A. This coverage group consists of SSI recipients who enter medical facilities, including acute care hospitals and Nursing facilities, and who intend to return to their community residences within ninety (90) days. The Omnibus Budget Reconciliation Act (OBRA) of 1987 provides for the continuation of full SSI benefits for up to three months. The intent of the OBRA provision is to allow individuals to retain their community residences while temporarily confined to a hospital or Long Term Care facility. B. The eligibility requirements for continued SSI benefits are: 1. A physician must certify in writing that the individual's medical confinement is not expected to exceed ninety (90) days; and 2. The individual must certify in writing that s/he needs the benefit to maintain the home; and 3. Documents attesting to the above conditions must be received by the SSA not later than ten (10) days after the end of the month in which the individual entered the hospital. 3.5 Working Disabled A. This coverage group consists of disabled persons who are working and who receive special SSI payments under Section 1619b of the Social Security Act. Individuals who received SSI payments in the month prior to institutionalization receive two (2) months of continued benefits when admitted to: 1. Eleanor Slater Hospital; 2. Zambarano Hospital. 3.6 Cash Assistance Beneficiaries A. This coverage group consists of individuals who, whether or not they actually received cash assistance in December 1973 satisfy the following criteria: 1. Eligibility for cash assistance in December 1973 because they were blind or disabled under the State's approved Medicaid plan; and 2. For each consecutive month after December 1973, continued eligibility based on the December 1973 conditions of blindness or disability, and the other conditions of the plan in effect in December 1973; and 3. Income and resources within current SSI standards.