1. Definitions of State living arrangement variations for Hawaii

Code Definition B Living in a community care or foster care home Apply OS code “B” to recipients who are both over age 18 and live in a state approved care or foster care home. D Living in a certified medical facility Use OS code “D” for an eligible recipient living in a medical treatment facility where Title XIX pays a substantial part (more than 50 percent) of the cost of care. H Domiciliary care I (maximum of five residents) Use OS code “H” for an eligible recipient (including a child) or couple living in a domiciliary care facility that provides varying levels of care and services. A domiciliary care facility is a private, non-medical facility established and maintained to provide personal care and services to aged, infirm, or handicapped persons. The State provides SSA with listings of these facilities. I Domiciliary care II OS code “I” is the same as code “H” except the facility provides care for six or more residents. Y Optional supplementation waived Use OS code “Y” to indicate that a recipient is eligible for an optional supplement, but has waived their right to receive supplementation. Z Use OS code “Z” when the recipient is not eligible to receive Hawaii state supplement because of the following situations: • recipient is living in the household of another; • recipient is a patient in a private medical facility that is not certified under Title XIX; or • recipient is residing throughout a month in a publicly operated emergency shelter.