S.C. Code Regs. 126-920 - Eligibility
A. An individual
must meet the following requirements in order to be eligible for OSS benefits:
(1) Be a resident of the State of South
Carolina;
(2) Has been determined
by the Social Security Administration (SSA) or by the State in accordance with
applicable SSA criteria to be aged, blind, or disabled;
(3) Has countable resources that do not
exceed the eligibility limitations for resources set by the federal
Supplemental Security Income (SSI) Program;
(4) Meets one of the following four
conditions with respect to countable income:
(a) Receives an SSI payment, which when
combined with other countable income gives the individual total countable
income that is less than the applicable net income limitation of the OSS
Program; or
(b) Receives countable
income that exceeds the SSI payment standard, but is less than the applicable
net income limitation of the OSS Program; or
(c) Receives countable income that is less
than the SSI payment standard and has applied for SSI benefits; or
(d) Receives countable income that is less
than the SSI payment standard, but has not applied for SSI benefits or has been
denied SSI benefits for the sole reason that the community residential care
facility in which the applicant resides is considered by the SSI Program to be
a public institution;
(5) Meets all other eligibility criteria to
receive benefits under the SSI Program, with the allowable exception of meeting
a condition described in (4)(b) or (4)(d) above;
(6) Resides in a community residential care
facility that has executed a "Facility Participation Agreement for the South
Carolina Optional State Supplementation (OSS) Program" with the Department of
Health and Human Services; AND
(7)
Has applied for all benefits, public or private, to which he or she may be
legally entitled.
B.
When both members of a couple reside or wish to reside in a community
residential care facility and apply for benefits from the OSS Program, the
eligibility determination process shall treat both members as individuals
beginning in the month of admission to the community residential care facility,
even if both members occupy the same room.
C. Under the terms of a contract between the
Department of Health and Human Services and the Department of Social Services
(DSS), determinations of OSS Program eligibility are conducted by the county
DSS offices. An individual seeking OSS benefits must file an application with
his or her county DSS office. Changes that might affect the eligibility of an
individual or a couple must also be reported to the county Department of Social
Services.
D. OSS Program
eligibility shall be re-established every twelve (12) months, or more
frequently as may be necessary.
E.
Changes that might affect the eligibility of an individual or a couple must be
reported to the Department of Social Services within ten (10) days of the
change. When such a change is reported, a redetermination of eligibility and
benefit payments shall be made promptly.
F. The OSS Program is not part of the South
Carolina Medicaid Program, but all OSS recipients are eligible for Medicaid
because of their participation in the OSS Program.
G. A community residential care facility
participating in the OSS Program may not charge an OSS recipient or the
recipient's family any additional amount for services included in the OSS
facility rate. Failure to adhere to this requirement may subject the OSS
recipient to a loss or reduction of OSS benefits and/or a loss of Medicaid
eligibility because such additional payment is considered to be additional
countable income. The imposition of additional charges for services included in
the OSS facility rate also constitutes grounds for termination of the
facility's OSS participation.
H.
OSS recipients who lose their OSS eligibility as the result of cost-of-living
increases in Social Security Title II benefits [Retirement, Survivors, or
Disability Insurance (RSDI)] may continue to be eligible for Medicaid through a
pass along category of eligibility (Category 16).
Notes
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