1. Definitions of State living arrangement variations for New Jersey

Code Definition A Congregate care Apply OS code “A” to recipients in Federal living arrangement “A.” The living arrangement includes: • recipients in residential facilities who are under the supervision of the Department of Human Services; • children and adults in residential facilities (both inside and outside of NJ) who are under the supervision of, or placed by the NJ Department of Human Services’ Division of Developmental Disabilities (DDD) or Division of Youth and Family Services (DYFS); and • recipients living in assisted living residences or comprehensive personal care homes (CPCH) licensed by the Department of Health and Senior Services. B Living alone or with others Use OS code “B” for recipients whose Federal living arrangements are “A” or “C” and who do not meet the requirements defined in other supplementation categories. You must consider any eligible recipient who meets the requirement for a Federal code “A” to be in optional supplement “B” unless they are residing in a residential health care facility or living alone with an ineligible spouse. Likewise, any child meeting the criteria for a Federal code “C” is automatically entitled to optional supplement “B.” This category includes, but is not limited to, recipients who are in one of the following situations: 1. Living physically alone; 2. Living with others in a private dwelling, but meet some criteria for Federal living arrangement “A;” or 3. Placed in a transitional residency program by the Division of Mental Health and Hospitals, Department of Human Services. Optional supplement code “B” is the proper code to use with an “intervening” Federal code “A.” For State supplement codes, see SM 01301.535. Use OS code “B” to address Section 1619 cases. C Living alone with an ineligible spouse Use OS code “C” when a recipient lives with ONLY their ineligible spouse and NO other persons are part of the household. Use Federal criteria to determine an ineligible spouse for State supplementation purposes (i.e., a spouse, either by marriage or holding out as spouses) who is either not eligible for SSI or who chooses not to apply. If other persons, even minor children, are present in the household, you cannot apply this OS code. It is possible that a claimant and the ineligible spouse live with others and allege that they are a separate “household” by virtue of the fact that they eat their meals out or have separate purchase and preparation of food. In this instance, you may consider an optional supplement “C” as long as no other person is considered part of the “household.” There is no couple counterpart in this category. A transient recipient who co-exists only with an ineligible spouse also qualifies as OS code “C.” Always consider parent(s) with minor children to be in the same household and code the case OS code “B.” D Living in the household of another Apply OS code D to recipients who are “living in the household of another” for Federal purposes. I Licensed residential health care facilities (RHCF) Apply OS code “I” to recipients living in: • attached nursing homes; • assisted living residence; • CPCH; or • “free-standing” licensed residential health care facilities. We paid residents of these facilities the OS “A” rate prior to January 1, 2006. We must base our authorization for this payment on the recipient's verified residence at a facility listed in the New Jersey Congregate Care Directory. Only the RHCF section of a multipurpose facility is eligible for the OS code “I” rate. Pay residents of the assisted living resident (ALR or CPCH section of a multipurpose facility) at the OS code “A” rate. Nursing home residents are in living arrangement (“D” or “G”) if Medicaid pays more than 50 percent of the cost of care. G Apply OS code “G” effective September 1, 1988, when the State elected Federal administration of an optional State supplementary payment to residents of Title XIX facilities. Y Optional supplementation waived Use OS code “Y” to indicate that a recipient is eligible for an optional supplement but waived their right to receive supplementation. Z No supplement cases Apply OS code “Z” to recipients: • in licensed medical facilities where Medicaid is paying less than 50 percent of the cost of care; • in publicly operated community residences having 16 or less residents; and • residing throughout a month in publicly operated emergency shelters. You can also apply OS code “Z” to cases that were FLA “D” prior to January 1988, or effective December 1, 1996, to children residing in public or private facilities where private health insurance paid for their care. For determination of applicability of $30 payment limit, see SI 00520.011 .

NOTE: All State Supplement payments, except for medicaid facilities, include a Lifeline payment which is a utility assistance program for older people and people with disabilities that offers an annual benefit amount for individuals who receive SSI.