2121. Institutionalization

2121.1 Are you eligible for SSI if you are institutionalized?

Institutionalization affects your eligibility and your benefit rate. If you are a resident of a public institution for a full calendar month, you are not eligible for SSI unless one of the following exceptions applies:

1. The public institution is a medical treatment facility and Medicaid pays more than 50 percent of the cost of care. In the case of a child under age 18, Medicaid and/or private health insurance pays more than 50 percent of the cost of care. If these conditions are met, you are eligible for a monthly payment of $30. However, you may be eligible to receive full SSI benefits for up to the first three full months of institutionalization if a physician certifies that:

   • Your stay in a medical facility is not likely to last more than three months; and

   • You can demonstrate that you need to continue to maintain and provide for the expenses of your home to which you may return.

2. You are living in a publicly operated community residence that serves no more than 16 residents. Such a facility must provide an alternative living arrangement to a large institution and be residential (i.e., not a correctional, educational, or medical facility);

3. The public institution is a public emergency shelter for the homeless. Such a facility provides food, a place to sleep, and some services to homeless individuals on a temporary basis. Payments to a resident of a public emergency shelter for the homeless are limited to no more than six months in any nine-month period;

4. You are in a public institution primarily to receive educational or vocational training. To qualify, the training must be an approved program and must be designed to prepare you for gainful employment;

5. You were eligible for SSI under one of the special work incentive provisions described in §§2178 and 2179 in the month before the first full month you live in a medical or psychiatric institution and the institution agrees to permit you to retain benefit payments. Payments under the special work incentive provisions may be made for the first two full months of institutionalization. If your stay in the institution is expected to be temporary you may be eligible for one additional month if you meet the conditions for a full benefit per (A) in this section.

6. A physician certifies that:

   1. Your stay in a medical facility is not likely to last more than three months; and

   2. You need to continue to maintain and provide for the expenses of your home to which you may return.

Payments may be made for up to the first three full months of institutionalization.

2121.2 When is your payment limited to the $30 Federal Benefit Rate?

In general, payment is limited to a maximum of $30 per month (minus any countable income) when:

1. You are a resident throughout a month in a public or private medical treatment institution; and

2. Medicaid pays over 50 percent of the cost of care for that month. In the case of a child under age 18, Medicaid and/or private health insurance pays more than 50 percent of the cost of care.

As with other benefits, States can supplement the $30 payment.

2121.3 Are there exceptions to the maximum payment limit?

There are two exceptions to the maximum payment limit:

1. If you meet the requirements of 2121.1 (A) above, you may receive full payment for the first two full months of institutionalization; or

2. If you meet the requirements of 2121.1 (E) above, you may receive full payment for the first three full months of institutionalization or for three months if 2121.1 (A) above also applies.

2121.4 What is the prerelease program?

The prerelease program helps aged or disabled institutionalized individuals return to community living. You may have nearly completed your sentence in a correctional facility or are ready to be released from a medical institution, but cannot financially support yourself. The prerelease program allows you to apply for SSI payments and food stamps several months before your anticipated release so your benefits can begin quickly after you leave the institution.

2121.5 How can you participate in the prerelease program?

A formal prerelease agreement can be developed between an institution and the local Social Security office. However, you can file an application for SSI under the prerelease procedures even if your institution does not have a formal agreement.

Last Revised: Feb. 1, 2008