Supplemental Security Income (SSI), Optional State Supplementation (OSS) & Medicaid Long-Term Care

Overview of Supplemental Security Income, Optional State Supplementation, and Medicaid

Supplemental Security Income (SSI) is a federal program that provides cash assistance for seniors (aged 65+) or persons who are disabled or blind with very low income and assets. Via SSI, persons receive a small amount of monthly income to bring their income up to a minimum level. The maximum dollar amount that can be received is called the SSI Federal Benefit Rate (FBR). This amount increases annually in January, and in 2024, is $943 / month for individuals and $1,415 / month for couple. The Social Security Administration (SSA) administers SSI.

Some states “supplement” (increase) the amount of monthly income their residents receive via SSI. This is because SSI does not take into account state-specific differences in the cost of living. These state-funded payments are called Optional State Supplementation / Supplements (OSS) or State Supplementary Payments (SSP). OSS / SSP is intended to help SSI recipients pay for basic necessities, such as housing, utilities, food, and clothing. The topic of Optional State Supplementation is very complicated. While most states have OSS, six states do not: Arizona, Arkansas, Mississippi, North Dakota, Tennessee, and West Virginia. Furthermore, in the states that have OSS, the exact name of the program, the eligibility criteria, the benefit amount, the place of residence one can receive OSS, and how to apply, is all state-specific.

Relevant to a discussion of SSI and OSS is Medicaid. For persons who are aged, blind, or disabled, financial Medicaid eligibility is based on SSI rules. Persons who are SSI-eligible are generally also Medicaid-eligible. This is called the SSI-Related Pathway to Medicaid eligibility.

In most states, Medicaid may pay for care services and supports in assisted living residences, adult foster care homes, and other residential settings. However, in no state will Medicaid pay for room and board. SSI and OSS, therefore can complement Medicaid-funded benefits, by helping to cover the cost of room and board. Worth noting is that SSI and OSS can be provided in Medicaid-funded institutions, such as a nursing home, but the payments will be significantly smaller.

SSI & OSS for Assisted Living & Nursing Homes Residents

One’s place of residence can significantly impact the amount one receives via SSI and OSS. Persons who live in residential settings, such as assisted living residences and adult foster care homes, usually receive the highest combined benefit amount. This is to assist persons in paying the cost of room and board. For example, in California, one category of OSS is the Non-Medical Out-of-Home Care Rate (NMOHC) for persons residing in a residential care facility to the elderly (RCFE). This includes assisted living, memory care, and continuing care retirement communities. In 2024, the maximum State Supplementary Payment is $632.07 / month for an individual, bringing the total maximum payment (SSI + OSS) to $1,575.07. This benefit amount is much higher than those living independently in their homes. A senior living independently is limited to a SSP of up to $239.94 / month, with a combined maximum SSI / OSS payment of $1,182.94. The difference in the OSS amount is $392.13 / month.

Nursing home residents generally receive a much smaller SSI and OSS benefit amount than those in residential settings. In many cases, persons residing in Medicaid-funded nursing homes receive reduced SSI payments of $30 / month. This generally happens if Medicaid pays more than 50% of one’s nursing home costs and they will be in the nursing home greater than 90 days. In addition to receiving $30 / month in SSI, some states pay out a small OSS. For instance, in 2024, the following states have the following OSS benefit amounts for an individual in a nursing home: Michigan ($7), Pennsylvania ($15), Rhode Island ($20), and District of Columbia ($73.20). Note that Medicaid will cover the cost of room, board, and care services in nursing homes, and therefore, there are no costs that a Medicaid nursing home beneficiary must pay. However, if one does have a monthly income in excess of their state’s Personal Needs Allowance (PNA), any excess income must go towards one’s cost of care (with just a few exceptions). Based on the state, a PNA ranges from $30 – $200 / month. Therefore, SSI / OSS does not play a significant role in Medicaid-funded nursing home.

Eligibility Criteria for Supplemental Security Income & Optional State Supplementation

There are eligibility requirements that must be met in order for one to receive SSI and / or OSS. Since SSI is a federal program, the eligibility criteria is consistent from state-to-state. OSS, on the other hand, is state-funded and the eligibility criteria differs from state-to-state.

SSI

To be eligible for SSI, one must be aged (65 years or older), blind or disabled, and have limited income and assets. One’s income cannot exceed the maximum monthly SSI Federal Benefit Rate, which in 2024, is $943 for an individual and $1,415 for a couple. Assets can be no more than $2,000 for an individual and $3,000 for a couple.

OSS

To be eligible for OSS / SSP, an applicant must be a resident of the state in which they are applying. In many states, the eligibility requirements for OSS are the same as SSI. For instance, in Wisconsin, persons who are eligible and enrolled in SSI automatically receive the State Supplementary Payment. In other states, the eligibility criteria, such as the income limit, differs from that of SSI. As an example, in Iowa, one can still receive OSS if, with the exception of having too much income, they would receive SSI. As long as their income is less than the OSS amount, they are still eligible for OSS. Therefore, while one would think they have to be eligible for SSI to be eligible for OSS, this is not always the case. Furthermore, some states limit SSP to persons in specific living situations. For instance, in Washington DC, one must reside in a licensed adult foster care home, and in South Carolina, one must be in a licensed community residential care facility.

Benefit Amounts for Supplemental Security Income & Optional State Supplementation

For SSI, the maximum benefit amount is $943 / month for an individual and $1,415 / month for a couple. However, the exact benefit amount is dependent on one’s monthly income. To calculate one’s benefit amount, their monthly income is subtracted from the maximum Federal Benefit Rate. As an example, the current FBR for an individual is $943 / month. If one has a monthly income of $525, their SSI benefit is $418 / month ($943 – $525 = $418). Note that this is an oversimplified example, as certain income may not be counted towards the calculation.

For OSS, the benefit amount varies based on the state. In 2024, these state-funded supplements range from approximately $7 – $784.16 / month. Even within a given state, the benefit amount is not the same across the board. Several factors can impact the amount one receives. This includes one’s monthly income, marital status, and living situation (i.e., private home vs. residential home). In some states, such as New York, the benefit amount may even vary in some living settings by geographic region within the state. For instance, in 2024 in New York, a senior can have the following living arrangements and receive the following SSPs: living alone ($87 / month), living with others ($23 / month), in congregate care level 1 – family care in NYC, Nassau, Rockland, Suffolk, and Westchester Counties ($266.48 / month), in congregate care level 1 – family care in the remaining parts of the state ($228.48 / month), in congregate care level 2 – residential care in NYC, Nassau, Rockland, Suffolk, and Westchester Counties ($435 / month), in congregate care level 2 – residential care in the remaining parts of the state ($405 / month), in congregate care level 3 – enhanced residential care, which includes assisted living, ($694 / month). New York does not provide a SSP for persons residing in nursing homes.

State Specific Differences Supplemental Security Income & Optional State Supplementation

Recall that all states, but six (Arizona, Arkansas, Mississippi, North Dakota, Tennessee, and West Virginia) have Optional State Supplementation. Among the states that have OSS, the rules that govern a state’s program varies.

Program Name
Optional State Supplementation goes by many different names and varies based on the state. For instance, the following states use the following names: California (Optional State Supplement), District of Columbia (Optional State Supplemental Payment Program – OSSP), Iowa (State Supplementary Assistance – SSA), Rhode Island (SSI State Supplemental Payment – SSP), and Wisconsin (SSI State Payment / SSI-E – Exceptional Expense Supplement).

Eligibility
States that have OSS set their own eligibility criteria. In some states, if one is eligible for SSI, they are also eligible for OSS. In other states, the eligibility criteria differs from that of SSI. For instance, one may be ineligible for SSI due to having too high a monthly income, but if their income is below the OSS benefit amount, they may still be eligible for OSS. Furthermore, in some states, OSS may only be available to persons who reside in residential settings, such as assisted living, or they may limit OSS to only adults.

Benefit Amount
The maximum benefit amount is state-specific. Furthermore, the amount one can receive may be based on the setting in which one lives. OSS payments do not usually increase annually. Furthermore, all categories of OSS in a state may not increase at the same time. For instance, in Washington DC, the OSS rate for Medicaid facilities increased in February 2023, but the rate for adult foster care did not.

Administration / Payment
Who administers OSS is state-specific. In most states, the state administers their own OSS program. In these states, the state makes the recipient payment separately from their federal SSI payment. In approximately 7 states, including California, OSS is administered by the Social Security Administration (SSA). In these states, the state-funded supplement is added to one’s federal SSI payment and persons receive a single payment. In other states, OSS is dually administered. This means SSA administers some categories of SSP and the state administers the others.

SSI and OSS payments are received by direct deposit or check. SSI payments are generally made on the first of the month. While OSS payments generally follow the same schedule, a state may choose a different schedule. For instance, Michigan pays out quarterly (March, June, September and December). Based on the state, OSS may be able to be paid directly to an assisted living facility or nursing home. For example, in Florida, OSS payments are made directly to an assisted living residence or the operator of an adult family care home. In contrast, in the District of Columbia, a beneficiary can name a facility as a “representative payee” and the facility will receive the payment and then pay the beneficiary their Personal Needs Allowance. Otherwise, a beneficiary receives their own payment.

How to Apply for Supplemental Security Income & Optional State Supplements

Persons can apply for SSI through their local Social Security Administration Office. Find one’s local SSA office here or contact Social Security at 800-772-1213. Persons can also start the application process online.

For OSS / SSP, where to apply depends on the administering agency. In states where OSS is administered by SSA, there is no need to apply separately for OSS. An application for SSI is also an application for OSS. In the remaining states, how and where to apply for OSS is state-specific. In some states with state-administered OSS, there is no need to submit a separate application for SSP. New York is one such state. An application for SSI also serves as one’s OSS application, as SSA shares this information with the state, who then determines one’s OSS eligibility. In other states, one must apply with the state for SSP. Persons can inquire about where to apply via their local Social Security office, by calling SSA at 1-800-772-1213, or by contacting their state’s Medicaid agency.

State-by-State OSS Details Chart

The chart below was last updated in February of 2024 and is a work-in-progress. More state-specific information will be added.