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Exceptions for SSI benefits eligibility when institutionalized

On Behalf of | Sep 13, 2018 | Supplemental Security Income

New Jersey residents who are seeking or receiving Supplemental Security Income (SSI) should be aware of the rules that regulate who can receive the benefits. Since SSI-related benefits are for people who are blind, disabled or 65 and older, there are times that some who fit into these categories will need to be institutionalized. With SSI, it is imperative to know that the benefits will generally stop if the recipient is institutionalized. Being a resident in an institution that is considered “public” meaning that it is a state or federal facility with the person being there for a full calendar month will render them ineligible for SSI. However, there are exceptions that can allow the benefits to continue.

It can be a public institution if it is for medical treatment and Medicaid is paying more than half the cost for the person to receive care. For children under 18, Medicaid and/or private insurance must pay more than half for the care. The person will then be eligible for $30 per month. The SSI benefits can be paid in full for three months while institutionalized if: a physician gives certification that the stay is unlikely to go beyond three months and the person demonstrates that he or she must pay for home expenses for when they return.

The benefits can continue if the person lives in a community residence that is publicly operated and has no more than 16 residents there. If the public institution is for the homeless and is a public emergency shelter providing food, a place to sleep and other services, the person will be eligible. The payments can be made for six months in a nine-month time-frame. If it is a public institution for vocational or educational purposes, the person remains eligible. The program is subject to approval and is to provide the person with training for gainful employment. Finally, if the person was eligible for SSI under a work incentive provision in the month before living in an institution for medical or psychiatric care and the facility agrees to let the person keep the benefits, the benefits can continue.

Institutionalization is sometimes necessary for people who are getting SSI. But, they might be under the mistaken impression that their SSI-related benefits will stop when this happens. It is not always the case as the above-listed exceptions show. For help with retaining benefits even when institutionalized, a law firm that has an understanding of the rules for Supplemental Security Income can help.

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