Supplemental Security Income (SSI) in Residential Care Facilities
RCFE / Assisted Living Fact Sheet
What is SSI/SSP?
Supplemental Security Income/State Supplementary Payment (SSI/SSP) is
a program funded by the federal and state governments to guarantee a minimum
monthly income to single persons and couples who are aged (65 +), blind
or disabled, and have limited income and resources. Certain resources
are exempt, such as a car, and a house of
any value, if it is the recipient's primary residence. The resource
limits are $2000 for an individual and $3000 for a couple. Countable
resources over these limits will make a person or couple ineligible.
Eligibility for Supplemental Security Income/State Supplementary Payment
(SSI/SSP) also makes one eligible for Medi-Cal.
Medi-Cal eligibility is a valuable resource because coverage includes
hospital and nursing home care, as well as doctor's care, home health,
medications, Medicare deductibles and co-payments, and Part B premiums.
(Refer to CANHR's Fact Sheets on Medi-Cal.) Please remember: Medi-Cal
still does not pay for residential care in California except on a limited basis through the Assisted Living Waiver Pilot Project (ALWPP). (Refer to ALWPP Fact Sheet.)
Does SSI/SSP Pay for Residential Care?
Yes. There is a special non-medical Board and Care rate that is higher than the regular SSI rate for persons living independently in homes or apartments.
What is the SSI/SSP Benefit Amount?
As of January 2008, the maximum SSI/SSP Non-Medical Board and Care
benefit is $1,049 for an individual and twice that amount for a couple living
in the same Residential Care Facility for the Elderly ($2,098).
How Much Can the Facility Charge Someone on SSI/SSP?
The law does not allow facilities to charge more than the amount set by the
state. The SSI/SSP recipient is allowed to keep a portion of the SSI/SSP
benefit for personal expenses, which is called the Personal and Incidental
Needs Allowance (P & I). As of January 2007, this amount is $121 for an
individual and $242 for a couple.
Of the $1,049 benefit, a single person must pay $928 to the facility as rent, and may
keep $121 as his/her P & I Allowance. If you and your spouse are both on SSI/SSP
and living in the same facility, you will be paid $2,098 in SSI/SSP, and you must pay
$1,856 to the facility. You and your spouse may then keep $242 each month.
Note: If the SSI/SSP recipient has other income besides SSI/SSP, the facility
may charge an extra $20 if it is stated in the resident's Admission Agreement, e.g. $948 for an individual.
The resident is required to use all of his/her retirement and SSI/SSP funds,
except for the P & I Allowance, to pay the facility each month.
Example: John is age 67, not married, and lives in an RCFE. His
Social Security Retirement benefit is $600. The Social Security
Administration (SSA) excludes $20 of his income in determining
his SSI/SSP benefit, which brings his countable income down to
$580. Because he is older than 65, and his income is less than the
SSI/SSP benefit rate of $1,015, he will be eligible for SSI/SSP in the
amount of $469 ($1,049 - $580 = $469). Each month John must pay the facility a minimum of $916. If his signed agreement allows for an extra charge, he might pay as high as $948. He would be able to keep at least $121 for personal use.
What Happens If Only One Spouse Needs Residential Care?
Each spouse is treated as an individual for purposes of SSI/SSP
eligibility. Therefore, it is possible for both the spouse at home and
the spouse in the residential care facility to receive SSI/SSP benefits.
Each would have a $2,000 resource limit.
Do Residential Care/Assisted Living Facilities Accept or Keep Persons on SSI/SSP?
Yes but fewer and fewer facilities are willing to take the low payment rate. If a person has low personal care needs and requires primarily room and board and distribution of medication, some facilities will take a person on SSI/SSP. Sometimes a facility will keep a resident who has exhausted their personal savings by paying private pay rates over a number of years, and then applies for SSI/SSP. This occurs when either the resident’s personal care needs are limited or when the resident has become like "part of the family."
However, be on the alert because when care level needs increase the SSI/SSP resident is more vulnerable than the private pay resident for eviction actions.
Can the Facility Require Families to Supplement SSI/SSP?
No. However, families or other parties can make voluntary
contributions to the facility on behalf of the resident. These voluntary
contributions cannot be part of the formal admission agreement, and
if not paid cannot be grounds to evict a resident.
In order to protect the resident's SSI/SSP eligibility, contributions
must be made directly to the facility and must be used only for personal care services
(not for shelter or food) in order to prevent a loss of eligibility
or a reduction in the SSI/SSP benefit amount.
Where Do You Apply for SSI Non-Medical Board & Care?
Apply at the nearest Social Security Administration Office. Besides documentation regarding income and resources, you must bring proof that a person has signed a contract (admission agreement) or is already a resident in a Residential Care Facility for the Elderly.
The most pertinent laws are found in California Health & Safety
Code, Sections 1501, 1531, 1568.02, 1568.072, 1569.1, 1569.2, 1569.30,
1569.31, 1569.312, 1569.313 and Welfare & Institutions Code, Section
12350. The most relevant regulations are in the California Code of Regulations,
Title 22, Division 6, Sections 81060(a), 85060(a), 87590(e), 87860(b).
Updated 01/09/2008
