Transcript State Supplementation Overview

State Supplementation
Overview
What You Need to Know to
Authorize State Supplementation
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What is State Supplementation?
Payments from state funds are available to
eligible individuals to pay for Personal Care
Homes (PCH), Family Care Homes (FCH) or
Caretaker Services (CS).
The Grant (payment) is paid monthly to
either the PCH, FCH or to the individual for
Caretaker Services.
Medicaid also pays the SMI premium for all
SSP recipients with Medicare Part B.
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Who is Eligible for SSP?
Aged, blind or disabled individuals who have
insufficient income to meet special needs for
care in a licensed PCH or FCH, or to purchase
Caretaker Services to prevent
institutionalization.
SSI Individuals already meet resource
eligibility requirements for SSP.
Non-SSI individuals must meet SSI/AMA
technical and resource eligibility requirements.
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What are PCH and FCH?
Personal Care Home
 Provides general supervision and residential care
for individuals unable to manage normal activities
of daily living, and need monitoring to ensure
health related services are carried out.
 A rest home is an example of a PCH.
Family Care Home
 Provides 24-hour protective and personal care in a
residential home for 2 or 3 individuals who do not
have an illness or injury requiring nursing care, but
need help with self-care.
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PCH and FCH
 Personal Care Homes (PCH) and Family Care
Homes (FCH) must be licensed by the Certificate
of Need and Licensure Board.
 KAMES Inquiry for State Supplementation is
selection “H”.
 A PCH directory can be found on KAMES Inquiry.
 An FCH directory can be found online at:
http://chfs.ky.gov/NR/rdonlyres/0129B7AC-A7A7-4BF2913F-29EAA96B60EA/0/FCHDirectory.doc
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Caretaker Services
CS may be as simple as someone hired to come and
clean house, or prepare meals for the individual.
Services provided by a caretaker must:
 Enable the individual to remain safely and
adequately at home, in some other family setting or
a room and board situation.
 Prevent institutionalization
 Be provided at regular intervals
Services may be provided by a live-in attendant, or
one or more persons hired to come to the home.
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More on Caretaker Services
Caretaker payments are not made if:
 The individual is taken daily or periodically to the
caretaker’s home (sitter arrangement)
 The caretaker is the recipient’s spouse, parent or
adult child, living with recipient
Contact the caretaker to verify:
 Service prevents institutionalization
 How often service is provided
 Payment made for services
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SSP Providers and Allowances
Utilize KAMES Inquiry to obtain current allowances
 Personal Care Home - $_____
 Family Care Home - $_____
 Caretaker Services for a single individual in their own
home or receiving room, board and care - $_____
 Personal Needs Allowance
(included in allowances above)
Personal Care Home - $____
Family Care Home - $____
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SSP Payment Determination
The SSP payment is the difference between
the standard and the countable income.
Using the current income scale, what would
be the grant payment amount if the
income was $880.00 per month?
(Allowance minus Income = Payment)
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SSP Procedures
Process all SSP applications within 30 days
on KAMES using category codes FP, GP, or
HP for non SSI SSP cases and AP, BP, or
DP for SSI SSP cases.
Review living situation and income every 12
months, and adjust payment, if appropriate.
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Conclusion
SSP is a money payment, referred to as a
“Grant” payment
Services covered by SSP are PCH, FCH, or
Caretaker Services
SSI Individuals already meet SSP technical
and financial eligibility requirements
The SSP payment amount is the standard
cost of care, minus countable income.
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