2637 Effect of Institutionalization

When an SSI recipient enters an institution the following provisions apply.

An SSI recipient who enters an institution for a temporary (short term) stay (see 8113 ) will continue to receive SSI benefits. SSI recipient status continues. An SSI recipient who enters a medical institution for a long term stay in which Medicaid will pay for all or a portion of their care will be limited to a maximum $30/month SSI benefit for each full month in the institution. As a result, some individuals may lose their SSI benefit while institutionalized if their countable income exceeds $30/month. SSI recipient status would cease for those who lose their SSI benefit. Continued eligibility for those losing SSI recipient status shall be determined as described in 2636 .

NOTE : An individual age 21 to 64 residing in a mental health nursing home will continue to receive unreduced SSI benefits because Medicaid will not pay for their care in the facility. The full amount of the SSI benefit, and any other countable income, shall be budgeted in determining the monthly patient liability. See 8112.4 (2) .

There is no SSI eligibility for individuals who reside in most public institutions such as prisons or other correctional facilities (see 8111 ), unless it is a medical facility for which Medicaid payments can be provided, such as the state psychiatric (except for residents age 21 to 64) and intellectual disability hospitals. SSI payments may be reinstated to these individuals once they return to the community. This provision does not apply to SSI recipients who are in the institution less than a full calendar month.

SSI recipients in a Medicaid approved institution for a long term stay may have a patient liability if income exceeds the $62/month protected income level beginning with the month following the month of entrance (see 8172 ). SSA may continue SSI benefits for up to 3 months following the month of entrance (2 months for 1619 eligibles). Those SSI payments shall be disregarded in determining the patient liability if long term stay budgeting is being applied. Any other countable income shall be included in the determination.

NOTE : The transfer of property provisions apply to an individual who retains SSI recipient status while institutionalized. See 5720.1 .