SSI/SSP Benefit Levels Charts - Empire Justice Center

Effective Date Reference Link to Source on the WebJanuary 1, 2019 18 INF-15 http://otda.ny.gov/policy/directives/2018/INF/18-INF-15.pdf

January 1, 2018 17 INF-12 http://otda.ny.gov/policy/directives/2017/INF/17-INF-12.pdf













January 1, 2005 04 INF-22 http://otda.ny.gov/policy/directives/2004/INF/04_INF-22.pdf





January 1, 2000 GIS 99 TA/DC021 www.wnylc.net/pdf/Gis-messages/gis/99taDC021.pdf

January 1, 1999 GIS 98 TA/DC030 www.wnylc.net/pdf/Gis-messages/gis/98taDC030.pdf

January 1, 1998 GIS 97 TA/DC028 www.wnylc.net/pdf/gis-messages/gis/97ta028.PDF

January 1, 1997 97 ADM-01 www.otda.ny.gov/policy/directives/1997/ADM/97_ADM-01.pdf

January 1, 1996 95 ADM-23 www.otda.ny.gov/policy/directives/1995/ADM/95_ADM-23_cancelled.pdf






January 1, 1990 89 ADM-46 http://onlineresources.wnylc.net/pb/docs/89adm46.pdf







July 1, 1982 82 ADM-43 http://onlineresources.wnylc.net/pb/docs/82adm43.pdf




July 1, 1978 78 INF-21 http://onlineresources.wnylc.net/pb/docs/78inf21.pdf

July 1, 1977 77 INF-15 http://onlineresources.wnylc.net/pb/docs/77inf15.pdf

October 1, 1976 76 ADM-68 http://onlineresources.wnylc.net/pb/docs/76adm68.pdf

Compiled by:

(With the assistance of Gene Doyle, John Castellano, Joe Kelemen, and Dave Ralph!!)

CHARTS BY YEAR(Click on the Effective Date [left‐hand column] to view the chart for that year)

SSI/SSP Benefit Levels Charts(1976‐2019)

1 N. Main St., Ste 308, Cortland, NY 13045; Tel: (607) 753‐1134 E‐Mail: [email protected]

Legal Services of Central New York, Inc.

mailto:[email protected]

Jim

Typewritten Text

SSI and SSP Benefit Levels Chart effective January 1, 2019 (reflects the 2.8% federal COLA for January 2019)

Fed L/A

Code

State Supp Code

New York State Living Arrangement Individual Couple

Federal State Total1 Federal State Total

A A Living Alone $771 $87 $858 $1,157 $104 $1,261

A, C B Living With Others $771 $23 $794 $1,157 $46 $1,203

B F Living in the Household of Another 2 $514 $23 $537 $771.34 $46 $817.34

A C Congregate Care Level 1 – Family Care OCFS certified Family Type Homes for Adults; and, OMH or OPWDD certified Family Care Homes

NYC, Nassau, Rockland, Suffolk and Westchester Counties $771 $266.48 $1,037.48 $1,157 $917.96 $2,074.96 Rest of State $771 $228.48 $999.48 $1,157 $841.96 $1,998.96

A D Congregate Care Level 2 – Residential Care OMH or OPWDD certified Community Residences, Individualized Residential Alternatives and OASAS certified Chemical Dependence Residential Services

NYC, Nassau, Rockland, Suffolk and Westchester Counties $771 $435 $1,206 $1,157 $1,255 $2,412 Rest of State $771 $405 $1,176

$1,157 $1,195 $2,352

A E

Congregate Care Level 3 – Enhanced Residential Care DOH certified Adult Homes and Enriched Housing programs; and, OPWDD certified Schools for the Developmentally Disabled

$771

$694

$1,465

$1,157

$1,773

$2,930

D Z Title XIX (Medicaid certified) Institutions 3 $30 $04 $30 N/A N/A N/A

A Z see below 5 $771 $0 $771 $1,157 $0 $1,157

Minimum Personal Needs Allowances Limits on Countable Resources Congregate Care Level 1 - $ 148 Individuals $2,000 Statutory References: Chapter 59 of the Laws of 2018 Congregate Care Level 2 - $ 171 Couples $3,000 Congregate Care Level 3 - $ 204 Revised October 23, 2018

1 The combined federal and State SSI benefit provided to eligible individuals and eligible couples with no countable income. 2 The Living With Others category includes recipients whose federal benefit has been reduced by the "value of the 1/3 reduction" (VTR) due to the federal determination that they are both: a) Living in someone else's household; and, b) receiving some amount of free or subsidized food and shelter (room and board). 3 Applies when a SSI recipient is residing in a medical facility, is not expected to return home within 90 days, and Medicaid is paying for at least 50% of the cost of care. 4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $25 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA). Residents of other medical facilities receive a SSPNA of $5. 5 No State supplement is provided: a) when a SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a recipient resides in certain publicly operated residential facilities that serve more than 16 residents, or c) when a recipient resides in a public emergency shelter for 6 calendar months during a 9-month period.


Fed L/A

Code

State Supp Code



A A Living Alone $750 $87 $837 $1,125 $104 $1,229

A, C B Living With Others $750 $23 $773 $1,125 $46 $1,171

B F Living in the Household of Another 2 $500 $23 $523 $750 $46 $796

A C Congregate Care Level 1 - Family Care OCFS certified Family Type Homes for Adults; and OMH or OPWDD certified Family Care Homes

NYC, Nassau, Rockland, Suffolk and Westchester Counties $750 $266.48 $1,016.48 $1,125 $907.96 $2,032.96 Rest of State $750 $228.48 $978.48 $1,125 $831.96 $1,956.96

A D Congregate Care Level 2 - Residential Care OMH or OPWDD certified Community Residences, Individualized Residential Alternatives and OASAS certified Chemical Dependence Residential Services

NYC, Nassau, Rockland, Suffolk and Westchester Counties $750 $435 $1,185 $1,125 $1,245 $2,370 Rest of State $750 $405 $1,155

$1,125 $1,185 $2,310

A E

Congregate Care Level 3 – Enhanced Residential Care DOH certified Adult Homes and Enriched Housing programs; and OPWDD certified Schools for the Developmentally Disabled

$750

$694

$1,444

$1,125

$1,763

$2,888

D Z Title XIX (Medicaid certified) Institutions 3 $30 04 $30 N/A

A Z (see below) 5 $750 0 $750 $1,125 0 $1,125

Minimum Personal Needs Allowances Limits on Countable Resources Revised 6 Nov 2017 Congregate Care Level 1 - $ 144 Individuals $2,000 Statutory References: Chap. 56 of L. 2017 Congregate Care Level 2 - $ 166 Couples $3,000 Congregate Care Level 3 - $ 198

1 The combined federal and State SSI benefit provided to eligible individuals and eligible couples with no countable income. 2 The Living With Others category includes recipients whose federal benefit has been reduced by the "value of the 1/3 reduction" (VTR) due to the federal determination that they are both: a) Living in someone else's household, and b) receiving some amount of free or subsidized food and shelter (room and board). 3 Applies when an SSI recipient is residing in a medical facility, is not expected to return home within 90 days, and Medicaid is paying for at least 50% of the cost of care. 4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $25 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA). Residents of other medical facilities receive an SSPNA of $5. 5 No State supplement is provided: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a recipient resides in certain publicly operated residential facilities serving 16 or fewer residents, or c) while a recipient resides in a public emergency shelter for 6 calendar months during a 9 month period.


Fed L/A

Code

State Supp

Code New York State Living Arrangement

Individual Couple


A A Living Alone $735 $87 $822 $1,103 $104 $1,207

A, C B Living With Others $735 $23

$758 $1,103 $46

$1,149

(B) (F) (Living in the Household of Another) 2 ($490)

($513)

($735.33)

($781.33)

A

C

Congregate Care Level 1 - Family Care

OCFS certified Family Type Homes for Adults; and OMH or OPWDD certified Family Care Homes

NYC, Nassau, Rockland, Suffolk and Westchester Counties $735 $266.48 $1,001.48 $1,103 $899.96 $2,002.96

Rest of State $735 $228.48 $963.48 $1,103 $823.96 $1,926.96

A

D

Congregate Care Level 2 - Residential Care

OMH or OPWDD certified Community Residences, Individualized Residential Alternatives and OASAS certified Chemical Dependence Residential Services

NYC, Nassau, Rockland, Suffolk and Westchester Counties $735 $435 $1,170 $1,103 $1,237 $2,340

Rest of State $735 $405 $1,140

$1,103 $1,177 $2,280

A

E

Congregate Care Level 3 – Enhanced Residential Care

DOH certified Adult Homes and Enriched Housing programs; and OPWDD certified Schools for the Developmentally Disabled

$735

$694

$1,429

$1,103

$1,755

$2,858

D Z Title XIX (Medicaid certified) Institutions 3 $30 04 $30 N/A

A Z (see below) 5 $735 0 $735 $1,103 0 $1,103

Minimum Personal Needs Allowances Limits on Countable Resources Revised 24 Oct 2016 Congregate Care Level 1 - $ 141 Individuals $2,000 Statutory References: Chap. 54 of L. 2016 Congregate Care Level 2 - $ 163 Couples $3,000 Congregate Care Level 3 - $ 194

1 The combined federal and State SSI benefit provided to eligible individuals and eligible couples with no countable income. 2 The Living With Others category includes recipients whose federal benefit has been reduced by the "value of the 1/3 reduction" (VTR) due to the federal determination that they are both: a) Living in someone else's household, and b) receiving some amount of free or subsidized food and shelter (room and board). 3 Applies when an SSI recipient is residing in a medical facility, is not expected to return home within 90 days, and Medicaid is paying for at least 50% of the cost of care. 4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $25 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA). Residents of other medical facilities receive an SSPNA of $5. 5 No State supplement is provided: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a recipient resides in certain publicly operated residential facilities serving 16 or fewer residents, or c) while a recipient resides in a public emergency shelter for 6 calendar months during a 9 month period.

SSI and SSP Benefit Levels Chart effective January 1, 2016 (reflects the 0% federal COLA for January 2016)

Fed L/A Code

State Supp Code New York State Living Arrangement

Individual Couple Federal State Total1 Federal State Total

A A Living Alone $733 $87 $820 $1,100 $104 $1,204

A, C B Living With Others $733

$23

$756 $1,100

$46

$1,146

(B) (F) (Living in the Household of Another) 2

($488.67)

($511.67)

($733.34)

($779.34)

A

C



NYC, Nassau, Rockland, Suffolk and Westchester Counties $733 $266.48 $999.48 $1,100 $898.96 $1,998.96

Rest of State $733 $228.48 $961.48 $1,100 $822.96 $1,922.96

A

D




Rest of State $733 $405 $1,138

$1,100 $1,176 $2,276

A

E



$733

$694

$1,427

$1,100

$1,754

$2,854

D Z Title XIX (Medicaid certified) Institutions 3 $30 04 $30 $60 0 $60

A Z (see below) 5 $733 0 $733 $1,100 0 $1, 100

Minimum Personal Needs Allowances Limits on Countable Resources Revised 20 Oct 2015

Congregate Care Level 1 - $ 141 Individuals $2,000 Statutory References: Chap. 57 of L. 2015

Congregate Care Level 2 - $ 163 Couples $3,000

Congregate Care Level 3 - $ 193

1 The combined federal and State SSI benefit provided to eligible individuals and eligible couples with no countable income.

2 The Living With Others category includes recipients whose federal benefit has been reduced by the "value of the 1/3 reduction" (VTR) due to the federal determination that they are both:

a) Living in someone else's household, and b) receiving some amount of free or subsidized food and shelter (room and board). 3 Applies when an SSI recipient is residing in a medical facility, is not expected to return home within 90 days, and Medicaid is paying for at least 50% of the cost of care.

4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $25 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA). Residents of other medical

facilities receive an SSPNA of $5. 5 No State supplement is provided: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a recipient resides in certain

publicly operated residential facilities serving 16 or fewer residents, or c) while a recipient resides in a public emergency shelter for 6 calendar months during a 9 month period.


Fed L/A Code


Individual Couple Federal State Total1 Federal State Total

A A Living Alone $733 $87 $820 $1,100 $104 $1,204

A, C B Living With Others $733

$23

$756 $1,100

$46

$1,146

(B) (F) (Living in the Household of Another) 2

($488.67)

($511.67)

($733.34)

($779.34)

A

C



NYC, Nassau, Rockland, Suffolk and Westchester Counties $733 $266.48 $999.48 $1,100 $898.96 $1,998.96

Rest of State $733 $228.48 $961.48 $1,100 $822.96 $1,922.96

A

D




Rest of State $733 $405 $1,138

$1,100 $1,176 $2,276

A

E



$733

$694

$1,427

$1,100

$1,754

$2,854

D Z Title XIX (Medicaid certified) Institutions 3 $30 04 $30 $60 0 $60

A Z (see below) 5 $733 0 $733 $1,100 0 $1, 100


Congregate Care Level 1 - $ 141 Individuals $2,000 Statutory References: Chap. 58 of L. 2014

Congregate Care Level 2 - $ 163 Couples $3,000

Congregate Care Level 3 - $ 193



a) Living in someone else's household, and b) receiving some amount of free or subsidized food and shelter (room and board). 3 Applies when an SSI recipient is residing in a medical facility, is not expected to return home within 90 days, and Medicaid is paying for at least 50% of the cost of care.

4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $25 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA). Residents of other medical

facilities receive an SSPNA of $5. 5 No State supplement is provided: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a recipient resides in certain

publicly operated residential facilities serving 16 or fewer residents, or c) while a recipient resides in a public emergency shelter for 6 calendar months during a 9 month period.

SSI Benefit Levels Chart effective January 1, 2014 (reflects the 1.5% federal COLA for January 2014)

Fed L/A Code

State Supp Code


Federal State TOTAL 1 Federal State TOTAL 1

A A Living Alone $721 $87 $808 $1, 082 $104 $1,186

A, C B Living With Others 721 23

744 1,082 46

1,128

(B) (F) (Living in the Household of Another) 2 (480.67) (503.67) (721.34) (767.34)

A

C


OCFS certified Family Type Homes for Adults OMH or OPWDD certified Family Care Homes

NYC, Nassau, Rockland, Suffolk and Westchester Counties 721 266.48 987.48 1,082 892.96 1,974.96

Rest of State 721 228.48 949.48 1,082 816.96 1,898.96

A

D



NYC, Nassau, Rockland, Suffolk and Westchester Counties 721 435 1,156 1,082 1,230 2,312

Rest of State 721 405 1,126 1,082 1,170 2,252

A

E


DOH certified Adult Homes and Enriched Housing programs OPWDD certified Schools for the Mentally Retarded

721

694

1,415

1,082

1,748

2,830

D Z Title XIX (Medicaid certified) Institutions 3 30 0 4 30

4 60 0

4 60

4

A Z (see below) 5 721 0 721 1,082 0 1,082

Minimum Personal Needs Allowances Limits on Countable Resources Revised 6 Nov 2013

Congregate Care Level 1 - $139 Individuals $2,000 Statutory References: Chap. 57 of L. 2013

Congregate Care Level 2 - $160 Couples $3,000

Congregate Care Level 3 - $190



a) living in someone else's household, and b) receiving some amount of free or subsidized food and shelter (room and board). 3 Applies when an SSI recipient is residing in a medical facility, is not expected to return home within 90 days, and Medicaid is paying for at least 50% of the cost of care. 4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $25 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA). Residents of other

medical facilities receive an SSPNA of $5.

5 This zero federally-administered State supplement applies: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a

Recipient resides in certain publicly operated residential facilities serving 16 or fewer residents, or c) while a recipient resides in a public emergency shelter for 6 calendar months during a 9 month

period.

SSI Benefit Levels Chart Effective January 1, 2013 (reflects the 1.7% federal COLA for January 2013)

Fed L/A Code


Individual Couple Federal State TOTAL 1 Federal State TOTAL 1

A A Living Alone $710 $87 $797 $1,066 $104 $1,170


733 1,066 46

1,112


A C Congregate Care Level 1 - Family Care q OCFS certified Family Type Homes q OMH or OPWDD certified Family Care Homes

NYC, Nassau, Rockland, Suffolk and Westchester Counties 710 266.48 976.48 1,066 886.96 1,952.96 Rest of State 710 228.48 938.48 1,066 810.96 1,876.96

A D Congregate Care Level 2 - Residential Care DOH certified Residences for Adults OMH or OPWDD certified Community Residences, Individualized Residential Alternatives and OASAS certified Chemical Dependence Residential Services

NYC, Nassau, Rockland, Suffolk and Westchester Counties 710 435 1,145 1,066 1,224 2,290 Rest of State 710 405 1,115 1,066 1,164 2,230

A E Congregate Care Level 3 – Enhanced Residential Care q DOH certified Adult Homes and Enriched Housing programs q OPWDD certified Schools for the Mentally Retarded 710 694 1,404 1,066 1,742 2,808

D Z Title XIX (Medicaid certified) Institutions 3 30 0 4 30 4 60 0 4 60 4

A Z (see below) 5 710 0 710 1,066 0 1,066


q Congregate Care Level 1 - $137 q Individuals $2,000 Statutory References: Chap. 57 of L. 2012 q Congregate Care Level 2 - $158 q Couples $3,000 q Congregate Care Level 3 - $187

1 The combined federal and State SSI benefit provided to eligible individuals and eligible couples with no countable income. 2 The Living With Others category includes recipients whose federal benefit has been reduced by the "value of the 1/3 reduction" (VTR) due to the federal determination that they are both:

a) living in someone else's household, and b) receiving some amount of free or subsidized food and shelter (room and board). 3 Applies when an SSI recipient is residing in a medical facility, is not expected to return home within 90 days, and Medicaid is paying for at least 50% of the cost of care. 4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $25 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA). Residents of other

medical facilities receive an SSPNA of $5. 5 This zero federally-administered State supplement applies: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a

recipient resides in certain publicly operated residential facilities serving 16 or fewer residents, or c) while a recipient resides in a public emergency shelter for 6 calendar months during a 9 month period.


Fed L/A Code

State Supp Code



A A Living Alone $698 $87 $785 $1,048 $104 $1,152


721 1,048 46

1,094


A

C


OCFS certified Family Type Homes OMH or OPWDD certified Family Care Homes


Rest of State 698 228.48 926.48 1,048 804.96 1,852.96

A

D


DOH certified Residences for Adults OMH or OPWDD certified Community Residences, Individualized Residential

Alternatives and OASAS certified Chemical Dependence Residential Services


Rest of State 698 405 1,103 1.048 1,158 2,206

A

E


DOH certified Adult Homes and Enriched Housing programs OPWDD certified Schools for the Mentally Retarded

698

694

1,392

1,048

1,736

2,784


4 60 0

4 60

4

A Z (see below) 5 698 0 698 1,048 0 1,048







a) living in someone else's household, and b) receiving some amount of free or subsidized food and shelter (room and board). 3 Applies when an SSI recipient is residing in a medical facility, is not expected to return home within 90 days, and Medicaid is paying for at least 50% of the cost of care. 4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $25 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA). Residents of

other medical facilities receive an SSPNA of $5. 5 This zero federally-administered State supplement applies: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b)

when a recipient resides in certain publicly operated residential facilities serving 16 or fewer residents, or c) while a recipient resides in a public emergency shelter for 6 calendar months during a 9 month period.

SSI Benefit Levels Chart effective January 1, 2011 (reflects the 0% federal COLA for January 2011)

Fed L/A Code

State Supp Code



A A Living Alone $674 $87 $761 $1,011 $104 $1,115


697 1,011 46

1,057


A

C


OCFS certified Family Type Homes OMH or OMRDD certified Family Care Homes


Rest of State 674 228.48 902.48 1,011 793.96 1,804.96

A

D


DOH certified Residences for Adults OMH or OMRDD certified Community Residences, Individualized Residential



Rest of State 674 405 1,079 1.011 1,147 2,158

A

E


DOH certified Adult Homes and Enriched Housing programs OMRDD certified Schools for the Mentally Retarded

674

694

1,368

1,011

1,725

2,736


4 60 0

4 60

4

A Z (see below) 5 674 0 674 1,011 0 1,011










SSI Benefit Levels Chart effective January 1, 2010 (reflects the 0% federal COLA for January 2010) Fed L/A Code


Individual Couple Federal State TOTAL 1 Federal State TOTAL 1

A A Living Alone $674 $87 $761 $1,011 $104 $1,115


697 1,011 46

1,057


A

C

Congregate Care Level 1 - Family Care OCFS certified Family Type Homes OMH or OMRDD certified Family Care Homes


Rest of State 674 228.48 902.48 1,011 793.96 1,804.96

A

D

Congregate Care Level 2 - Residential Care DOH certified Residences for Adults OMH or OMRDD certified Community Residences, Individualized Residential



Rest of State 674 405 1,079 1.011 1,147 2,158

A

E

Congregate Care Level 3 – Enhanced Residential Care DOH certified Adult Homes and Enriched Housing programs OMRDD certified Schools for the Mentally Retarded

674

694

1,368

1,011

1,725

2,736

D Z Title XIX (Medicaid certified) Institutions 3 30 0 4 30 4 60 0

4 60 4

A Z (see below) 5 674 0 674 1,011 0 1,011


Congregate Care Level 1 - $130 Individuals $2,000 Statutory References: Chap. 57 of L. 2009 Congregate Care Level 2 - $150 Couples $3,000 Congregate Care Level 3 - $178






Fed L/A Code

State Supp Code



A A Living Alone $674 $87 $761 $1,011 $104 $1,115


697 1,011 46

1,057


A

C



Rest of State 674 228.48 902.48 1,011 793.96 1,804.96

A

D Congregate Care Level 2 - Residential Care

DOH certified Residences for Adults OMH or OMRDD certified Community Residences, Individualized Residential



Rest of State 674 405 1,079 1.011 1,147 2,158

A

E Congregate Care Level 3 – Enhanced Residential Care


674

694

1,368

1,011

1,725

2,736


4 60 4

A Z (see below) 5 674 0 674 1,011 0 1,011

Minimum Personal Needs Allowances Limits on Countable Resources Revised 16 Oct 2008 Congregate Care Level 1 - $130 Individuals $2,000 Statutory References: Chap. 57 of L. 2006 and Chap. 57 Congregate Care Level 2 - $150 Couples $3,000 of L. 2008 Congregate Care Level 3 - $178






Individual Couple Fed L/A Code

State Supp Code

New York State Living Arrangement Federal State TOTAL 1 Federal State TOTAL 1

A A Living Alone $637 $87 $724 $956 $104 $1,060

A, C B Living With Others 637 660 956 1002

(B) (F) (Living in the Household of Another) 2 (424.67) 23

(447.67) (637.34) 46

(683.34)


NYC, Nassau, Rockland, Suffolk and Westchester Counties 637 266.48 903.48 956 850.96 1,806.96

A

C

Rest of State 637 228.48 865.48 956 774.96 1,730.96



NYC, Nassau, Rockland, Suffolk and Westchester Counties 637 435 1,072 956 1,188 2,144

A

D

Rest of State 637 405 1,042 956 1,128 2,084

A



637

656

1,293

956

1,630

2,586


4 60 4

A Z (see below) 5 637 0 637 956 0 956

Minimum Personal Needs Allowances Limits on Countable Resources Revised 18 Oct 2007 Congregate Care Level 1 - $123 Individuals $2,000 Statutory References: Chap. 57 of L. 2006 and Chap. 132 Congregate Care Level 2 - $142 Couples $3,000 of L. 2007 Congregate Care Level 3 - $168







State Supp Code


A A Living Alone $623 $87 $710 $934 $104 $1,038


(B) (F) (Living in the Household of Another) 2 (415.34) 23

(438.34) (622.67) 46

(668.67)



A

C

Rest of State 623 228.48 851.48 934 768.96 1,702.96




A

D

Rest of State 623 405 1,028 934 1,122 2,056

A



623

641

1,264

934

1,594

2,528


4 60 4

A Z (see below) 5 623 0 623 934 0 934

Minimum Personal Needs Allowances Limits on Countable Resources Revised 18 Oct 2006 Congregate Care Level 1 - $120 Individuals $2,000 Statutory References: Part C of Chap. 58 of the L. 2005, Congregate Care Level 2 - $139 Couples $3,000 Part C of Chap. 57 of L. 2006, and Chap. 515 of L. 2006 Congregate Care Level 3 - $164







State Supp Code


A A Living Alone $603 $87 $690 $904 $104 $1,008


(B) (F) (Living in the Household of Another) 2 (402) 23

(425) (602.67) 46

(648.67)



A

C

Rest of State 603 228.48 831.48 904 758.96 1,662.96




A

D

Rest of State 603 405 1,008 904 1,112 2,016

Congregate Care Level 3 – Enhanced Residential Care DOH certified Adult Homes and Enriched Housing programs OMRDD certified Schools for the Mentally Retarded


A

E

Rest of State 603 510 1,113 904 1,309 2,213


4 60 4

A Z (see below) 5 603 0 603 904 0 904

Minimum Personal Needs Allowances Limits on Countable Resources Revised 17 Oct 2005 Congregate Care Level 1 - $116 Individuals $2,000 Congregate Care Level 2 - $135 Couples $3,000 Statutory References: Chapters 58 and 713 of the Laws of 2005 Congregate Care Level 3 - $150



other medical facilities receive an SSPNA of $5. 5 This zero State supplement applies: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a recipient resides

in certain publicly operated residential facilities serving 16 or fewer residents, or c) while a recipient resides in a public emergency shelter for 6 calendar months during a 9 month period.



State Supp Code


A A Living Alone $579 $87 $666 $869 $104 $973


602 869 46

915

(B) (F) (Living in the Household of Another) 2 (386) (409) (579.34) (625.34)



A

C

Rest of State 579 228.48 807.48 869 745.96 1,614.96

Congregate Care Level 2 - Residential Care DOH certified Adult Care Facilities OMH, OMRDD, or OASAS certified Community Residences, Individualized

Residential Alternatives, Residential Substance Abuse Treatment Programs


A

D

Rest of State 579 405 984 869 1,099 1,968

Congregate Care Level 3 - School for the Mentally Retarded

New York City 579 482.96 1,061.96 869 1,254.92 2,123.92

A

E

Rest of State 579 458.96 1,037.96 869 1,206.92 2,075.92


4 60 4

A Z (see below) 5 579 0 579 869 0 869


Congregate Care Level 1 - $111 Individuals $2,000

Congregate Care Level 2 - $130 Couples $3,000 Statutory Reference: Chapter 310 of the Laws of 2004 Congregate Care Level 3 - $89





03 INF 40



State Supp Code


A A Living Alone $564 $87 $651 $846 $104 $950


587 846 46

892

(B) (F) (Living in the Household of Another) 2 (376) (399) (564) (610)



A

C

Rest of State 564 228.48 792.48 846 738.96 1,584.96

Congregate Care Level 2 - Residential Care DOH certified Adult Care Facilities OMH, OMRDD, or OASAS certified Community Residences, Individualized


NYC, Nassau, Rockland, Suffolk and Westchester Counties 564 435 999 846 1,152 1,998

A

D

Rest of State 564 405 969 846 1,092 1,938

Congregate Care Level 3 - School for the Mentally Retarded

New York City 564 482.96 1,046.96 846 1,247.92 2,093.92

A

E

Rest of State 564 458.96 1,022.96 846 1,199.92 2,045.92


4 60 4

A Z (see below) 5 564 0 564 846 0 846


Congregate Care Level 1 - $108 Individuals $2,000

Congregate Care Level 2 - $127 Couples $3,000 Statutory Reference: Chapter 62 of the Laws of 2003 Congregate Care Level 3 - $87





02 INF 35



State Supp Code

New York State Living Arrangement Federal State TOTAL 1

Federal State TOTAL 1 A A Living Alone $552 $87 $639 $829 $104 $933


575 829 46

875


Congregate Care Level I - Family Care q OCFS certified Family Type Homes q OMH or OMRDD certified Family Care Homes


A

C

Rest of State 552 228.48 780.48 829 731.96 1,560.96

Congregate Care Level II - Residential Care q DOH certified Adult Care Facilities q OMH, OMRDD, or OASAS certified Community Residences, Individualized


NYC, Nassau, Rockland, Suffolk and Westchester Counties 552 435 987 829 1,145 1,974

A

D

Rest of State 552 405 957 829 1,085 1,914

Congregate Care Level III - School for the Mentally Retarded

New York City 552 482.96 1,034.96 829 1,240.92 2,069.92

A

E

Rest of State 552 458.96 1,010.96 829 1,192.92 2,021.92

D G Title XIX (Medicaid certified) Institutions 3 30 5 4 35 4 60 10

4 70 4

A Z (see below) 5 552 0 552 829 0 829


q Congregate Care Level I - $106 q Individuals $2,000 q Congregate Care Level II - $124 q Couples $3,000 Statutory Reference: Chapter 109 of the Laws of 2002 q Congregate Care Level III - $85


a) living in someone else's household, and b) receiving some amount of free or subsidized food and shelter (room and board). 3 Applies when an SSI recipient is residing in a medical facility, is not expected to return home within 90 days, and Medicaid is paying for at least 50% of the cost of care. 4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $20 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA). 5 This zero State supplement applies: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a recipient resides


01 INF 27 Attachment I


Individual CoupleFedL/ACode

StateSuppCode

New York State Living ArrangementFederal State TOTAL 1 Federal State TOTAL 1

A A Living Alone $545 $87 $632 $817 $104 $921

A, C B Living With Others 545 23 568 817 46 863


Congregate Care Level I - Family Careq OCFS certified Family Type Homesq OMH or OMRDD certified Family Care Homes


A C

Rest of State 545 228.48 773.48 817 729.96 1,546.96

Congregate Care Level II - Residential Careq DOH certified Adult Care Facilitiesq OMH, OMRDD, or OASAS certified Community Residences, Residential

Substance Abuse Treatment Programs, Residential Care Centers for AdultsNYC, Nassau, Rockland, Suffolk and Westchester Counties 545 435 980 817 1,143 1,960

A D

Rest of State 545 405 950 817 1,083 1,900

Congregate Care Level III - School for the Mentally RetardedNew York City 545 482.96 1,027.96 817 1,238.92 2,055.92

A E

Rest of State 545 458.96 1,003.96 817 1,190.92 2,007.92


4 70 4

A Z (see below) 5 545 0 545 817 0 817

Minimum Personal Needs Allowances Limits on Countable Resources Revised 19 Oct 2001q Congregate Care Level I - $105 q Individuals $2,000

q Congregate Care Level II - $122 q Couples $3,000 Statutory Reference: Chapter 89 of the Laws of 2001q Congregate Care Level III - $84

1 The combined federal and State SSI benefit provided to eligible individuals and eligible couples with no countable income.2 The Living With Others category includes recipients whose federal benefit has been reduced by the "value of the 1/3 reduction" (VTR) due to the federal determination that they are both:

a) living in someone else's household, and b) receiving some amount of free or subsidized food and shelter (room and board).3 Applies when an SSI recipient is residing in a medical facility, is not expected to return home within 3 months, and Medicaid is paying for at least 50% of the cost of care.4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $20 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA).5 This zero State supplement applies: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a recipient resides


Corrected SSI Benefits Level Chart effective August 1, 2001 (reflects the January 2001 3.5% federal COLA and August COLA correction)

Individual CoupleFedL/ACode

StateSuppCode

New York State Living ArrangementFederal State TOTAL 1 Federal State TOTAL 1

A A Living Alone $531 $87 $618 $796 $104 $900

A, C B Living With Others 531 23 554 796 46 842

(B) (F) (Living in the Household of Another) 2 (354) (377) (530.67) (576.67)

Congregate Care Level I - Family Careq OCFS certified Family Type Homesq OMH or OMRDD certified Family Care Homes


A C

Rest of State 531 228.48 759.48 796 722.96 1,518.96

Congregate Care Level II - Residential Careq DOH certified Adult Care Facilitiesq OMH, OMRDD, or OASAS certified Community Residences, Residential

Substance Abuse Treatment Programs, Residential Care Centers for AdultsNYC, Nassau, Rockland, Suffolk and Westchester Counties 531 435 966 796 1,136 1,932

A D

Rest of State 531 405 936 796 1,076 1,872

Congregate Care Level III - School for the Mentally RetardedNew York City 531 482.96 1,013.96 796 1,231.92 2,027.92

A E

Rest of State 531 458.96 989.96 796 1,183.92 1,979.92


4 70 4

A Z (see below) 5 531 0 531 796 0 796

Minimum Personal Needs Allowances Limits on Countable Resources Revised 25 July 2001q Congregate Care Level I - $102 q Individuals $2,000

q Congregate Care Level II - $119 q Couples $3,000 Statutory Reference: Chapter 470 of the Laws of 2000q Congregate Care Level III - $82

1 The combined federal and State SSI benefit provided to eligible individuals and eligible couples with no countable income.2 The Living With Others category includes recipients whose federal benefit has been reduced by the "value of the 1/3 reduction" (VTR) due to the federal determination that they are both:

a) living in someone else's household, and b) receiving some amount of free or subsidized food and shelter (room and board).3 Applies when an SSI recipient is residing in a medical facility, is not expected to return home within 3 months, and Medicaid is paying for at least 50% of the cost of care.4 Recipients in nursing homes licensed by DOH receive an additional monthly grant of $20 issued by OTDA called a State Supplemental Personal Needs Allowance (SSPNA).5 This zero State supplement applies: a) when an SSI recipient is residing in a private medical facility and Medicaid is paying for less than 50% of the cost of care, or b) when a recipient resides


'S-)7l5.L (R.v. Ill") SSI BBNBPIT L~LS .ffective JaDuary 1, 2000 (Reflect. a 2.4\ Pederal COLA)

I I Level II - .eaid_tial Car. I I III 1 1 I III I.) DOli cerUfi.d Adult Care r.cilitie. I I II

A I D I b) 0IIII, OIIItDD, or OAIAS c.rtified C~ity ••aid.nc•• , OASU c.rtifiedl I III I ••ddetial Sub.taDce Abu.e Trea«=-a.t 'rogr... , aDd 0IIII certified I I III I ••dduti.l Car. C.nten for Adult. I I II1 I 1 1 III Inc, 1I••••u, Suffolk, ....tch••t.r, • Rockland Countie. I 512 I U5 II '41 III I 1 1 II III I _.at of stat. I 512 I t05 II 917 II1 I I 1 II II

INDIVIDUALt I I

'so ISTAn I ICiA Isup. 1 1 I:-OD8 ICOOK I LIVING AUAHGaDT I rllDDAL I STAn II

1 1 1 I IIA I A I LivinG Alone I 512 I 1I7 II

I I 1 1 II", c I 8 I Living wi tJl OtJler. I 512 I II

I 1 I I 23 II(81 I (P) I (Living in llou..hold of AD.otJl.rl/ ) I (In.34) I 11

I 1 1 1 II1 1 ......, I ••.-ill Cor. 1 1 III I I I III I a) OCI'S e.rtified P..Uy Typ. IIc.e. I I II

A I c I b) OIIB or OIIRDJ) certified raaily Car. Bcae. I I II1 1 I I III Inc, •••••u, Suffolk. We.tcbe.ter, • )lockland Counti.. I 512 I 266.41 II1 I I I III I a •• t of St.te I 512 I 221.41 II1 1 1 1 II

TOTAL

'"'"

()U.34)

"1.41

740.41

t .1rmKJtAL I STAT. " TOTJ.L H

I II II76' I lOt II 1173 "

I II II••• I II '" n

1 .. II II(512.") 1 II (5..... ' II

1 II II1 II II1 II I1 II III II III II II

•., I '11." II 1.'..... II1 II II

••• 1 ",." II 1.'"0." "1 II II1 II II1 II II1 II II1 II III II II1 II II1 II II

••• I 1,115 II 1.... III II II

76t I 1,065 II 1.1134 II

1 II II

II

I 1 Lev.l III - Scbool. for the Xut.lly Retard.d I I II III I I I II II

" I K I If_ York City I 512 I 412.9& II "4.9& III 1 I I I II I a.at of St.te I 512 I 4511.9& II nO.9& II

-1-1-+1-------------;;;---------+-1----IIf---;-;--Il-I--~-111D I Q I Titl. :III: IMedicaid c.rtifi.d) In.tituU01la21 I 30 I 531 II J53/ II

---11--+1----:-:--------------------1I----II---~I!_1----111A I I 1 (1.. '1 b~'_l 1 '12 I 0 II '12 II

I , ' I JI .,

1 II II1 II II

76' I 1.220.'2 II 1.'lIt.'2 Il

f----+I-----1I!_1-------11176' I 1.172.'2 II 1.'41.'2 II

f----t-I---:--:---jIlf--_-111.. 1 10'1 II '0'1 II

f----+-I-----jIlf----111•., I 0 II •., II

I

Tb. -livill9 witJl oth.r.- category include. the r.cipienta who.. federal bu.fit b. be. r.duc.d by the ·".lu. of 1/3 reducti01l (VTR)· due to the feder.ldet.ralaatioa that they ar., .) living in .oaeon. eh.'. hou.ehold. and b) r.c.iving .c.e .-aunt of both frea or .ubddiz.ed food aad .h.1ter (aupport aad..i.t....a.). Th. VTR i. '170.6' for an i.4ividu.l aDd '25'.33 for. coupl•.

App1h. wh... aD .dult recipiut .p...d. a full calea.4ar _th in the In.titution. i. not expect.d to return h....ithin 3 ..,ntha. and Titl. XIX (Medicaid) paye for atat l ••at 50' of the coat of car•.

Recipi...t. in Titl. XII: Inatitutioaa lic.....d by tba KY8 Depar~t of He.lth r.c.i". an additional grant of $20 p.r .anth called a St.te Suppl..-nta1 Peraon.1Meeda Ulowaa.ce (SSPXA). 88'KA check. ar. I..ued directly to the r.cipient by the KY. Offic. of Te-por.ry and Dhability A..I.tanc•.

"PpUea wbau the r.cipient ap...de a full c.lendar IIOIlth in a private Title XIX In.titutiOll and M.dicaid p.y. for 1.a. tban 50' of tb. coat of c.r.. wil_ thereeipi...t r ••ide. in c.rtain publicly op.rated c~ity ba••d r ••ideDtial f.ciliti•• , or while the recipi_t r ••idea ill • public "'rgeDcy ab.1ter for aix (I)cal...dar -emu.. during. nin. (t) -oAth p.riod.

1) Th. alaiau. peraOll.1 na.da allowaDc•• IPNA) I Le"el X - .', L."el II - $1152) Th. Ii_ita OIl countable r.aourc.a, $2000 for an individual and $3000 for a couple)) An ••••nti.l paraon rac.iye. $257.

a.farellc•• ,Chaptar 201 La•• of 1'"Chapter 514 La•• of 1'"

•

IRevised 11/1/99

GJl.Ot1Jl

pooe STAMPS

LIVING BUDQIT DATAl IrPICTIVB JANUARY 1. 2000IAppllc&bl. for SSI/RSCI Recipient. ODly)

Living Arrang..-nt

Ne. York City1fMS btezual

Budget SbelterType Code

Upatat.WXS UIL

Shelter'l"yp. Cod..

SSI Bea.eU t

I1551 Living with Others Benefit

IN/A N/A $535.00

OMH/OMRDD CertifiedFamily Care Homes

NYC, Nassau, Suffolk and WestchesterRest of State

IILevel I - Family Care

IIIIIII

1528

1515

$778.48$740.48

OMH!OMRDD Certified Facilityor DSS Certified Enriched Housing

NYC, Nassau. Suffolk and WestchesterRest of State

IILevel II - Residential Care

IIIIIIII

16,3129.32

10,16,1710,16,17

$947.00$917.00

The following monthly allowances and costs pertain to eligible residents of group living arrangements.

Board·Food

IIState (OMH/OMRDD) OperatedICommunity Residences

I

IILevel I- NYC, Nassau, SuffolkI and WestchesterILevel I - Rest of State

I

17

Minimum PersonalNeeds Allowance*

$99.00$99.00

Personal Care Costs(Income Exclusion)

$243.48$205.48

13

Shelter Costs·

$309.00$309.00

$512.00

III

(Thrifty) I

Plan) II

$127.00$127.00

$115.00

IILevel II - NYC, Nassau, SuffolkI and WestchesterI OMH/OHRDD Certified FacilityI or CSS Certified Enriched HousingILevel II - Rest of State $115.00I OMH/OMRDD Certified FacilityI or DSS Certified Enriched HousingI

$412.00

$382.00

$293.00

$293.00

$127.00

$127.00

The budget data and procedures above apply to residents receiving RSDI/SSI or to disabled residentsnot receiving RSDI!SSI or PA. Other budget data and procedures apply to residents who can participateand who are not receiving RSDI/SSI but Who are receiving PA. No special procedures apply for residentswho can participate and who do not receive PA or RSDI!SSI.

$127.00$270.00

The client keeps the personal

$0$115 .00

IIState (OMH/OMRDD) OperatedICommunity ResidencesIjThe payment to the Group Home equals the personal care costs + shelter + board.I needs allowance + they may keep part of their unearned or earned income.II·personal needs and/or board amounts may be higher at some residences. If 90, shelter costs are reduced by thelamount of the difference between the minimum above and the actual amount allowed. Total SSI benefits andIPersonal Care Costs are not changed.IINOTE:

III,

DSS·3T15EL (Rw. 10/911)I

SSI BEII£FIT'UlIEU.-£ffFrnW _T I, 1m (ReHoell e 1.n Fodorel COlA)

FED STAYEL/A SUPPCllDf COOE L1YIIG N1RAJ1GEMEIT FEDERAL

JlIllYIDUAL

STATE TOTAL FEDERAL

ClllPLE

STATE TOTAL

A A Living Alone 500 87 751 104

A,e • liyjng .Ish Otber. 500 23 523 751 46 797

(500.671 1546.671

751 781.96 1,532.96

751 705.96 1,456.96

751 1,119 1,870

751 1,059 1,810

751 1,214.92 1,965.92

751 1,166.92 1,917.92

301

II) IF) ILlving In "OUIehold of Another, /) 1333.34) 1356.34)

level I • Feef1y Core

I) OSS certified F_ily Type """"A e b) OM" or OHROD c.rtlfied F_lly elr. "0101

NYC, N.S.BU, SUffolk' Westchester Counties 500 266.48 766.48

Rest of Stlt, 500 228.48 728.48

level II - Re'1dential Cere

e) OSS certified Adult elr. Focilitle.A D b) OMH, tMlOO, or CASAS c:ertHied COMU1tty Residences, GASAS certified

Residential $U:)i:Sance Abuse Treat.ent Progr8tM, and (J(H certiftedResidential Cere Centers for Adults

NYC, N...IU., Suffolk It ,,"Schnter CotIttfu 500 435 935

Reet of Stete 500 405 905

level III • Schools for the ","t'lly Retarded

A E Nev York City 500 482.96 982.96

Rest of State 500 458.96 958.96

0 G Title XIX (Hedlclid certified) Insti tut lone2

60ro.,/

f----f--l1---------------+----+-------jf-----11 1-1--+--+----1I A I z I lsee

41 below) 500 0 500 I...J 751 0 7511

1/ The ·lIving with oth...• cltegory includee the reclplenll ........ f_11 benefit hOI been reduced by thl ·volue of 1/3 reea.ctlon (VYR)" due to the fodorlldet...lnotion thet they Ir.: I) I tving in 1_ el••,. houeehold, end b) recoivlng .010 -..t of both free or l<bIidiled food end .heltor (support and_lnt-..e). The VTR i. $166.66 for en indlvi_1 and $250.33 for 0 couple.

21 Appli.. _ en edult recipient spende e full cetendor -.th in the lnotitution WId TItle XIX (Ilediceld) _ for It lout 50X of the coat of ClCI.

3/ Reclplen" In Title XIX lnotltutione licensed by the ITS OeportllOnt of _lth receive en edditionol grent of $20 per -.th celled e Stete s.,.>pl_tel Pe..onel

_ AlI_ (SSI'IIA). SSI'IIA chKk• • r. I.sued dlr..tly to tM r..lpl...t by tM NYS Office of T_r.ry one! DI ....1l1 ty A••I.t......

" Ajlplles the ....Ipl ...t opondo • full c.londor _th In • prlv.te Title XIX hwtltutlon one! Modlc.ld pays for les. than 50X of tM coat of c.re, ""... tMr..lpl t resldn In cert.ln pibll.ly _r.ted ._Ity booed resldantl.1 facilities_ or .... Il. the r.. lpl ...t resldn In. pibllc __ wlter for .IA (6)c.londor _tho during. nine (9) .....th porlod.

_ltl ....1 Notes, 1) The .Inl.... por.....1 need••11......" (PNA), level I • 597, level II • 5112,2) The II.ito on •.,..,table resourc..' S2000 for on Individuol one! S300D for. couple3) An ...enti.l por.on receives SZ50.

level III • sn. R.ferenc..:Chopter 58 l_ of 1998

DSS-~TlI£L (I... 11'91) SSI 101111 LEVILS EfffellVE """"'1 '. 1998 (hflocl•• 2.ll Fedtrol COLAI

Ihl -living whh otllt,.· ClltlJory ioch.del till recipients !lihue ftder.l benefit hIS been red.Jc~ by the "wlh.te.. Qf 1/) rtdJttlon (VlI)· cUt to thl filllWrlldeter.inuion th8t OIlY ate: .) liowh,. in • .-eone dUll tlousehald. It'd bl ret'hlnt 10ll1!! anIIO\Ilt at bol~ fre. or IlJbsldlud fortd .., shllter l~r': A'ld..lnl.OOI1<1). Iho VI. il 1164.66 I.. on Irdl.ldull nll241.OO 'or • <cuple.

U AppliH when., adJlt rtelplent lpenda • f1Jll ,.Ierdar month In I~. 1001hutlon am 1l(lt Xll{ {Mtdfuld) p.r' for It lun 501 of the c:osl of cue,

JI ItdplenU in Htle XIX fnllltutiClOl IIcemed by the HU Deplrucnt of Hull" rterin an Idditionel gralll of lZO per ....th ulled. StiU Sl4JPItftf1111 Perl4nllliet'Cit AllDtllnte nSPM). 'SVItA checb ere IIlutd dlre<:tly to th, ree:lpttnt by Ih. NYS Dtplrt~t of Social Sltrvictl.

4/ ¥PIIII whtn 1M r.clplent lpadl • full celtndlr IIOnth fn I priw.H ritl~ XIIt Institution and KtdiCiid plY' for Inl thin SOl ot thol COlt of CUt. Ioilm tMrulptent relldo In terr.tn p..bllcly opIrttld ~ily blstd rtlldenthl hell itie-t, or WIll. the rrclplmt fH'des. In I pbllc e-rgtney ,heltt' 'Of' silt (61nlmdlr _lh. 6Jr1..... nino ,,, oon'~ ".rlod.

'EO SIlIE IIIlIVIOUAI. m.PlEIII SIJPIlCOOl CIlOf LIVI.G AII"'E~MI FEOERIL SlllE 10rAl r[(lUAl SlllE lD1Al.

I A li vlns 8' ern 494 Il6 !IO 141 102.50 841.50

I,e I LlyfOl '11th Ot"~r, 494 21 !17 741 45 1M

" (m.341 (m.l'l (4941 (5391It! (II (LI.lng In Housohold 01 loothor )

ltYrl I . f.lly Clre

0) IISS certified '.lIy Iypo H_sI C b) lIUI ... lIItDO certl fled ,.il., Cart KCIftS

N1C. hstlu. SUffott .. Wufches\u CDl6Itiu 494 266.48 76D.48 741 779.9& 1,~20.9&

"n of. State 494 22•• 4. m.41 741 703." 1,4«."

lrys' II • e!J'dpnSl'l C".

AI DSS c.rtlfled AdUlt C.r. faci'itie5I 0 b) 0lIl, 1JlIDO. ,r W,SAS ctrtlflcd COftIU1ltr _.. Ident,s. tMSA$ certified

••• Idlntl.~ ·lubItenc. Abuse lreal~t 'rotr.....nd on" certi't~

lot tdlf" 101 caro Contorl lor 111""

.nt, Jt••IU. SUffolk & VtltchllUf tot.ntil. 494 435 om 7'1 1,117 1,1158

IKI 0' SUli 494 40S m 741 1,0'11 I,m

l,v,' 111 • Seh99" for !he ","tilly .tt,rdld

I £ .... lork CI,y 494 482.96 916.9& 141 1,212.92 1,953.92

.nt of Slu. 494 4S8.96 952.96 74' 1,164.92 1,~.9Z

0 G Title XU (HMtcald entltted> Inltitutlont21 10 Sl/ 3~ 60 10" 7i1'A 1 (Slo 4' IMI ..l 494 0 494 141 u 141

I

Iddi,I_1 No'"' I) Ihi .Inl_ pl"'-' .-do ollClllOnC" (PIIA): LtV.1 I . 196, l ...1 II - "".l) 'M ".1" on cCMlt.... retoUrc": IlOOO fOf' an Indlvilbll ard 13000 for • coupl.]) ..., ,Utflt,.l pl!rlcrn rcerfvet 1247.

L....l JII ••16. h'trtne••:ChOfllor 189 lows of 1991

'.

~,

DSS'3715EL (Rev, 10/96) SSI BENEFIT LEVELS EFFECTIVE JANUARY 1, 1997 (Reflects a 2.9% Federal COLA)Attachment C

FED STATE INDIVIDUAL COUPLEL/A SUPPCODE CODE LIVING ARRANGEMENT FEDERAL STATE TOTAL FEDERAL STATE TOTAL

A A living Atone 484 86 570 726 102.50 828.50

A,C B living with Others 484 23 507 726 45 771

(B) (F) (Living in HousehoLd of Another1/ ) (322.67) (345.67) (484) (529)

Level I - Family Care

a) OSS certified Family Type HomesA C b) OMH or OMRDD certified Family Care Homes

NYC, Nassau, Suffolk &Westchester Counties 484 266.48 750.48 726 774.96 1,500.96

Rest of State 484 228.48 712.48 726 698.96 1,424.96

level II - Residential Cere

e) DSS certified Adult Care FacilitiesA D b) OMH, OMRDO, or OASAS certified Community Residences, OASAS certified

Residential Substance Abuse Treatment Programs, and OMH certifiedResidential Care Centers for Adults

NYC, Nassau, Suffolk &Westchester Counties 484 435 919 726 1,112 1,838

Rest of State 484 405 889 726 1,052 1,778

Level III - Schools for the MentaLly Retarded

A E New York City 484 482.96 966.96 726 1,207.92 1,933.92

Rest of State 484 458.96 942.96 726 1,159.92 1,885.92

0 G Title XIX (Medicaid certified) Institutions~1 30 5'/ 35'/ 60 10'/ 70'/

A Z (See 4/ below) 484 0 484 726 0 726

The "living with others lt category includes the reclplents whose federal benefit has been reduced by the "value of 1/3 reduction (VTR)1l due to the federaldetermination that they are: a) living in someone else's household, and b) receiving some amount of both free or subsidized food and shelter (support andmaintenance). The VTR is $161.33 for an individual and $242.00 for a couple.

2/ Applies when the recipient spends a full calendar month in the Institution and Title XIX (Medicaid) pays for at least 50% of the cost of care.

3/ Recipients in Title XIX Institutions licensed by the NYS Department of Health receive an additional grant of $20 per month called a State Supplemental PersonalNeeds Allowance (SSPNA). SSPNA checks are issued directly to the recipient by the NYS Department of Social Services.

4/ Applies when the recipient spends a full caLendar month in a private Title XIX Institution and Medicaid pays for less than 50% of the cost of care, when therecipient resides in certain publicly operated community based residential facilities, or while the recipient resides in a public emergency shelter for six (6)calendar months during a nine (9) month period.

Additional Notes: 1) The minimum personal needs allowances (PNA): Level I - $94, Level II - $109,2) The limits on countable resources: $2000 for an individual and $3000 for a couple3) An essential person receives $242.

Level I II - $74. References:Chapter 213 Laws of 1996

(

ATTACHMEHT 0

FOOD STAMPSGROUP LIVING BUDGET DATA: EFFECTIVE JANUARY 1, 1997

(Appl icable for SSI/RSDI Recipients only)

UpstateNew York City \lMS ABEL

WMS Externa l Shel terBudget Shel ter Type Code

Living Arrangement Type Code SSI Benefit

SSJ living with Others Benefit N/A N/A $507.00

level J - Family Care


NYC, Nassau, Suffolk and ~estchester 15 15 $750.48Rest of State 28 15 $712,48

level II - Residential Care

OMH/OMRDD Certified Facilityor oss Certified Enriched Housing

NYC, Nassau, Suffolk and Westchester 16,31 10,16,17 $919.00Rest of State 29,32 10,16,17 $889.00

State (OMH/OMRDD) OperatedCommunity Residences 17 13 $484.00


Minimum Personal Personal Care Costs Board* CThri fty)Needs Allowance* (Income Exclusion) Shel ter Costs* Food Plan)

Level J- NYC, Nassau, Suffolkand Uestchester $94.00 $243,48 $293.00 $120.00

Level I - Rest of State $94,00 $205.48 $293.00 $120.00

Level II - NYC, Nassau, Suffolkand Uestchester $109.00 $412.00 $278,00 $120.00OMH/OMRDD Certified Facility

or OSS Certified Enriched HousingLevel II . Rest-of State $109.00 $382,00 $278,00 $120.00

OHH/OMRDD Certified Facilityor DSS Certified Enriched Housing

State COMH/OHRDD) OperatedCommunity Residences $109.00 $0 $255.00 $120.00

The payment to the Group Home equals the personal care costs + shelter + board. The cl ient keeps the persona lneeds allowance + they may keep part of their unearned or earned income.

*Personal needs and/or board amounts may be higher at some residences. If so, shelter costs are reduced by theamount of the difference between the minimum above and the actual amount allowed. Total sst benef its andPersonal Care Costs are not changed.

NOTE: The budget deta and procedures above apply to residents receiving RSDI/SSI or to disabled residentsnot receiving RSDJ/SSI or PA. Other budget data and procedures apply to residents who can participateand who are not receiving RSDI/SSI but who are receiving PA. No special procedures apply for residentswho can participate and who do not receive PA or RSDI/SSI.

ATTACHMENT EPage 1 of 2

Personal Needs Allowances (PNAs) In Non-Medical FacilitiesEffective January 1, 1997

Authori ty Faci 1i ty Type Certifying Agency Funding Source Monthly PNA(per person)

55194 15SL 131-0, Congregate Care DSS, OMH, or

level I OHRDD HR or AOC

Congregate Care DSS, OMH, 5511091Level II OMRDD, or OASAS

HR or AnC18HYCRR352.8(c)(1) Congregate Care

74 1(i i) Level III OHRDO 551

State operatedMHL 31.29, RCCA or Commun- OHH OMH di reet $109

ity Residence payment

MHL 33.08 State operated OHRDD 55I or other $109Coom.Jnity incomeResidence

room and board not State HR, Ane or EAF $45situations certified

non-medical18HYCRR faci lit i es other

EAF2352.8(c)(1)(i) than Congregate DSS, CASAS, HR, ACe, $45Care level I, II not State or SSIor III certified,(including or othermaterni ty home,Shelter forVictims ofDomesticViolence, andcertain privateshel tel'S forthe homeless)

18HYCRR Shel ter for DSS EAf, ADC HR, or $633900.17(a) Fami lies - 551

Tier I J

5SL 194.8 P..ubl ic Home operated by a Public Up to $104

city or county Institutional Care

This PNA is the minimum established in Social Services Law for 551 recipients. Any income disregarded indetermining the amount of a recipient1s SSJ grant is included as part of the PNA. 55I disregards the first$20 of unearned income; disregards for earned income include the first $65 plus one-half of the remainder.Thus, 55J recipients receiving Social Security benefits will have PNA's of $20 more than the amountsnoted on this chart. Recipients with earned income can have significantly larger PNA1s.

2

3

4

A PA funded PNA is not provided to residents of hospitals or publicly operated facilities.

This allowance is called a llspecial needs allowance" and applies only when the Tier II facility provides3 meals a day.

The facility can provide each resident with up to $10 for work performed by the resident.


Personal Needs Allowances (PNAs) In Medical FacilitiesEffective January 1, 1997

Authori ty Fae il ity Type Certifying Agency Funding Source Monthly PNA(per person)

SSt + State $55 ($30 +SSL 209.2-a payment $25 SSPNA 5)

Hospital Department ofSSL Nealth (MA-Only persongl366.2(a)(10), needs allowance) $50

18NYCRR SSt + State $55 ($30 +352.8(c)(1)(0 payment $25 SSPNA 5)360-4.9(a) Nursing Home Department of

$402(SNF, HRF) Health HR

(MA'Only persongl $50needs allowance)

551 + 551 Statesupplement;

Psychiatric OMH or DAM di reet StateCenter Payment; Or $35

SSL 366.2(a) (Hospital), MA-Only persona!(10) Inpatient needs allowance

SSL 209.2-a Alcohol ismFacil ity

18NYCRR SSt + SSJ State $35352.8(c)(1)(;), supplement; or360-4.9(0) MA-Only personal

reF-DO's needs(Developmental OMRDD allowance6

Center, free-$402stancHng ref) HR

SSL 209.3 Free·Standing S51 (footnote?)Alcohol ism DAM

$402Facil ity (FNP HRMedicaid)

18NYCRR (MA-Only com-(footnote 7)352.8(c)(1)(;), ""ni tYf.leeds

360.5(e)(2) level )

5

6

7

SSPNA is the "State Supplemental Personal Needs Allowance" provided to SSl recipients withoutother income in residential health care facilities. SSt recipients residing in medical facilitiesreceive $5 in Federally-administered State Supplementation and, if they reside in a facility licensedby the Department of Health, an additional $20 in State-administered direct SSPNA payments.

The MA-Only personal needs allowance is the amount of the client's own income that he or she retains forpersonal needs while in chronic care status.

Since these programs are not Title XIX certified, an SSI recipient in a privately operated free-standingAlcoholism Facility would receive SSI at the IIliving alone ll rate provided to SSI recipients in the COl'lTWflity.An MA-Only recipient would be budgeted as though he or she were temporarily absent from his or her residence.

ATTACHMENT C

DSS-3715El (Rev. 10/95) SSI BENEFIT lEVELS EFFECTIVE JANUARY 1. 1996 (RefLects a 2.6% FederaL COLA)

The I'living with others" category includes the recipients whose federal benefit has been reduced by the "value of 1/3 reckJction (VTR)'I due to the federal determinationthat they are: a) living in someone else's household, and b) receiving some 8ITIOLrit of both free or subsidized food and shelter (s~rt and maintenance). The VTR is$156.66 for an individual and $235 for a couple.

2J Applies when the recipient spends a full calender month in the Institution and Title XIX (Medicaid) pays for at least SOX of the cost of care.

3/ Recipients in Title XIX Institutions licensed by the IIYS Department of Health receive an additional liIrant of 520 per month called a State Supplemental Personal NeedsAllowance (SSPNA). SSPNA checks are issued directly to the recipient by the NYS Department of Social Services.

4/ Applies when the recipient spends a full calendar -xlth in a private Title XIX Institution and Medicaid pays for less than SOX of the cost of care, when the recipientresides in certain publicly operated community based residential facilities, or while the recipient resides in a public emergency shelter for six calendar months during anine month period.

FED STATE INDIVIDUAL CCXJPlEl/A SUPPCODE CODE lIVING ARRANGEMENT FEDERAL STATE TOTAL FEDERAL STATE TOTAL

A A Living Alone 470 86 556 7D5 102.50 807.50

A,C B living with Others 470 493 705 75D

(Living in Household of Another'/,23 45

(B) (F) (313.34) (336.34) (470) (515)

Level J - Family Care

8) OSS certified Family Type HomesA C b) a4H or CW4RDD certified Family Care Homes

NYC, Nassau, Suffolk &~estchester Counties 47D 266.48 736.48 7D5 767.96 1,472.96

Rest of State 470 228.48 698.48 705 691.96 1,396.96

level 11 - Residential Care

8) ess certified Adult Care FaciLitiesA D b) OMH, OMRDD, or DAAA certified COCnJI.I"Iity Residences, DSAS certified

Residential Substance Abuse Treatment Programs, and OHH certifiedResidential Care Centers for Adults


Rest of State 470 405 875 705 1,045 1,750

level III ~ Schools for the Mentally Retarded

A E New York: City 470 482.96 952.96 7D5 1,2DD.92 1,905.92

Rest of State 470 458.96 928.96 705 1,152.92 1,857.92

D G Title XIX (Medicaid certified) Institutions~ 30 5~1 35~1 60 1031 7031

A Z (See 41 beLow) 470 0 470 705 0 705

1

Additional Notes: 1) The mininun personal needs allowances (PNA): Level I • $91, Level II • $106,2) The limits on cOlIltable resources: $2000 for an individual and $3000 for a c~le

3) An essential person receives $235

Level I II - $72 References:Chapter 649 laws of 1995

ATTACHMENT D (revised 16Jan96)


(Applicable for SSI/RSDI Recipients Only)

UpstateNew York City \.loiS ABEL

WHS External Shel terBudget Shel ter Type Code

Living Arrangement Type Code SSI Benefit

SSI living with Others Benefit N/A N/A $493,00

level I - Family Care

OHH/OHRDD CertifiedFamily Care Homes

NYC, Nassau, Suffolk and Westchester 15 15 $736.48Rest of State 28 15 $698.48

Level II - Residential Care

OHH/OHRDO Certified Facilityor DSS Certified Enriched Housing

NYC, Nassau, Suffolk and Westchester 16,31 10,16,17 $905.00Rest of State 29,32 10,16,17 $875.00

State (OHH/OHRDD) OperatedCommunity Residences 17 13 $470.00


Mininun Personal Personal Care Costs Board" (Thri tty)Needs Allowance* (Income Exclusion> Shel ter Costs* Food Plan)

Level I- NYC, Nassau, Suffolkand Westchester $91.00 $243.48 $283.00 $119.00

level I . Rest of State $91.00 $205.48 $283.00 $119.00

Level II - NYC, Nassau, Suffolkand \.lestchester $106.00 $412.00 $268.00 $119.00OMH/OMROD Certified Facility

or DSS Certified Enriched Housinglevel II • Rest of State $106.00 $382.00 $268.00 $119.00

OHH/OHRDD Certified Facilityor DSS Certified Enriched Housing

State (OHH/OMROD) OperatedCommunity Residences $106,00 $0 $245.00 $119.00

The payment to the Group Home equals the personal care costs + shelter + board. The cl ient keeps the personalneeds allowance + they may keep part of their unearned or earned income.

·Persona( needs and/or board amounts may be higher at some residences. If so, shelter costs are reduced by theamount of the difference between the minimum above and the actual amount allowed. Total SSI benef i ts andPersonal Care Costs are not changed.

NOTE: The budget data and procedures above apply to residents receiving RSDI/SSI or to disabled residentsnot receiving RSDJ/SSI or PA. Other budget data and procedures apply to residents who can participateand who are not receiving RSDI/SSI but who are receiving PA. No special procedures apply for residentswho can participate and who do not receive PA or RSDI/SSI.



Authority FecH ity Type Certifying Asency Ftxldfng Source Monthly PNA(per person)

55191 1SSt 131-0, Congregate Care DSS, ttlH, or

level I OHROO HR or APe

Congregate Care 055, OMH, 5511061level II OHROD, or CASAS

HR or APe18NYCRR352.8(c)(1) Congregate Cere

721(i l) Level JII OHROO 551

State operatedHHL 31.29, RCCA or COOI1U'I" OHH OHH direct 5106

Ity Residence p8)'1118f1t

HHL 33.08 State operated OHROO SSI or other 5106COOI1U'IitY IncomeResidence

room and board not State HR, ADe or EAF 145situations certified

non-medical18NYCRR feci( ities other

EAF2352.8(c)(1)(0 than Congregate 055, CASAS, HR, Ane, 145Care Level I, II not State or SS!or III certified,( Including or othermaterni ty home,Shel ter forVictims ofDomesticViolence, BOOcertain privateshet ters forthe homeless)

18HYCRR Shel ter for OSS EAF, Ane HR, or $633900.17(a) Fami lies - SSI

Tier II

SSL 194.8 PlJJlfc Home operated by a PlJJl ic Up to 5104

city or cOl.llty Institutional Care

2

3

4

This PNA is the minimum established in Social Services Law for 551 recipients. Any income disregarded indetermining the amount of a recipientls SSt grant is included as part of the PHA. SSI disregards the first$20 of unearned income; disregards for earned income include the first $65 plus one-half of the remainder.Thus, 5S1 recipients receiving Social Security benefits will have PHA's of $20 more than the amountsnoted on this chart. Recipients with earned income can have significantly larger PHA's.

A PA funded PHA is not provided to residents of hospitals or publicly operated facilities.

This allowance is called a IIspecial needs allowance" and appl ies only when the Tier II tacH ity provides3 meals a day.

The facility can provide each reaident with up to 510 for work performed by the resident.


Personal Needs Allowances CPNAs) In Medical FacilttiesEffective January 1, 1996

Authority Fac; l i ty Type Certifying Agency Funding Source Monthly PNA(per person)

55l + State $55 ($30 •SSL 209.2-a payment $25 SSPNA 5)

Hosp; tal Department ofSSL Health (MA'Only persongl366.2(a)(10), needs ellowance ) $50

18NYCRR SSI + State $55 ($30 •352.8(c)(1)(;) payment $25 SSPNA 5)361)-4.9(a) Nursing Home Department of

$402(SNF. HRF) Health HR

(MA'Only persongl $50needs allowsnce )

SSI • SSI StatesLWlement;

Psychiatric OMH or DAM di reet StateCenter Payment; or $35

SSL 366.2(a) (Hospital), MA'OnIy persona!(10) I"",tient needs allowance

SSL 209.2-a Alcohol ismFocll Ity

18NYCRR SSI • SSI State $35352.8(c)(1)(I), S"4'Plementi or361)-4.9(a) MA'OnI y personal

ICF'DD's needs 6(Davelopnental OMROO allowanceCenter, free-

$402standing ICn HR

SSL 209.3 Free'Standing SSI (footnote7 )Alcohol Ism DAM

$402Faclll ty (FNP HRMedicaid)

18NYCRR (MA'Only c...•(footnote 7)352.8(c)(1)(1), lIU'llty~

361).5(e)(2) level )

5

6

7

SSPNA is the liS tate SupplementaL Personal Heeds Allowance" provided to sst recipients withoutother income in residentiaL health care facilities. 551 recipients residing in medical facilitiesreceive $5 in Federally-administered State Supplementation and, if they reside in a facility licensedby the Oepartment of Health, sn additional $20 In State'adminlstered direct SSPNA payments.

The MA-only personal needs allowance is the amount of the clientls own income that he or she retains forpersonal needs while in chronic care status.

Since these programs are not Title XIX certified, an 5S1 recipient in a privately operated free~standfng

Alcohol ism Faci l ity would receive 551 at the III iving alone ll rate provided to SSI recipients in the contrU'lity.An MA'Only recipient would be OOdgeted as though he or sha ware t_rarlly absent fr... his or har rasldencs.

DSS·3715EL (Rev. 10/94) SSI BENEFIT LEVELS EFFECTIVE JANUARY 1. 1995 (Reflects a 2.8% Federal COLA)

ATTACHMENT C

FED STATE INDIVIDUAL COOPLEL/A SUPPCODE COOE LIVING ARRANGEMENT FEDERAL STATE TOTAL FEDERAL STATE TOTAL

A A Living Alone 458 86 544 687 102.50 789.50

A,C B Livins with Others 458 481 687 732

(Living in Household of Another1!)23 45

(B) ( F) (305.34) (328.34) (458) (503)


a) DSS certified Family Type HomesA C b) CMH or OMRDD certified Fem; ty Care Homes

NYC, Nassau, Suffolk &~estchester Counties 458 266.48 724.48 687 761.96 1,448.96

Rest of State 458 228.48 686.48 687 685.96 1,372.96

level II - Residential Care

a) DSS certified Adult Care FacilitiesA 0 b) CMH, OMRDD, or DAM certified Cormunity Residences, DSAS certified

Residential Substance Abuse Treatment Programs, and OMH certHiedResidential Care Centers for Adults


Rest of State 458 405 863 687 1,039 1,726

Level III - Schools for the Mentally Retarded

A E New York. City 458 482.96 940.96 687 1,194.92 1,881.92

Rest of State 458 458.96 916.96 687 1,146.92 1,833.92

0 G Title XIX (Medicaid certified) Institutions21 3D 53/ 353/ 60 103/ 703/

A Z (See 4/ below) 458 0 458 687 0 687

,-) The llliving with othersll category includes the recipients whose federal benefit has been reduced by the IIvalue of 1/3 reduction (VTR)II due to the federaldetermination that they are: a) living in someone else's household, and b) receiving some amount of both free or subsidized food and shelter (support andmaintenance). The VTR is $152.66 for an individual and $229 for a couple.

2/ Applies when the recipient spends a full calendar month in the Institution and Title XIX (Medicaid) pays for at least SOX of the cost of care.

3/ Recipients in Title XIX Institutions licensed by the NYS Department of Health receive an additional grant of $20 per month called a State Supplemental PersonalNeeds Allowance (SSPNA). SSPNA checks are issued directly to the recipient by the NYS Department of Social Services.

4/ Applies when the recipient spends a full calendar month in a private Title XIX Institution and Medicaid pays for less than 50% of the cost of care, when therecipient resides in certain publicly operated community based residential facilities, or while the recipient resides in a public emergency shelter for six calendarmonths during a nine month period.

Additional Notes: 1) The minimum personal needs allowances (PNA): Level I - S89, Level II ~ $103,2) The limits on countable resources: $2000 for an individual and $3000 for a couple3) An essential person receives $229

Level III . $70 References:Chapter 460 Laws of 1994

ATTACHMENT 0


(Applicable for SSI/RSOI Recipients Only)

Upstate WMS ABELNew York City

WMS External PA ShelterBudget Shel ter Type Code

living Arrangement Type Code SSI Benefit

SSI Living with Others Benefit N/A N/A S4B1,00


OMH/OMROO CertifiedFamiLy Cere Homes

NYC, Nassau, Suffolk and Westchester 15 15 S724.4BRest of Stete 28 15 $686.48

level II - ResidentiaL Care

OMH/OMROO Certified Facilityor DSS Certified Enriched Housing

NYC, Nassau, Suffolk and Westchester 16,31 10,16,17 $893.00Rest of State 29,32 10,16,17

$863.00

State (OMH/OMROO) OperatedCommunity Residences 17 13 S458.00


Minimum Personal Personal Care Costs Board* (Thrifty)Needs Allowance* (Income Exclusion) Shel ter Costs· Food Plan)

Level 1- NYC, Nassau, Suffolkand Westchester $89.00 S243.48 S277.00 S115.00

level I - Rest of State $89.00 S205.48 S277 .00 S115.00

level II - NYC, Nassau, Suffolkand Westchester S103.00 S412.00 S263.00 S115.00OMH/OMROO Certified Facility

or OSS Certified Enriched HousingLevel II - Rest of State S103.00 S382.00 S263.00 S115.00

OHH/OMROO Certified Facilityor DSS Certified Enriched Housing

State (OHH/OMROO) OperatedCommunity Residences S103.00 SO S240.00 S115.00

The payment to the Group Home equals the personal care costs + shelter + board. The client keeps the personalneeds allowance + they may keep part of their unearned or earned income.

*Personal needs and/or board amounts may be higher at some residences. If so, shelter costs are reduced by theamount of the difference between the minimum above and the actual amount allowed. Total SSI benefits andPersonal Care Costs are not changed.

NOTE: The budget data for residents of Level II OHH/OHRDD Certified Community Residences are the same forresidents in receipt of SSJ/RSDJ that reside In level JI authorized drug/alcohol treatment facilities.

For residents of Level II authorized drug/alcohol treatment facilities or enriched housing not in receipt ofSSI/RSOI other budgeting procedures apply


Personal Heeds Allowances (PNAs) In Non-Medical facilitiesEffective January 1, 1995

Authort ty Foeil i ty Type Certifying Agency Funding Source Monthly PNA(per person)

551891SSL 131-0, Congregate Care DSS, C»4H, or

Level I OMROO HR or ADC

Congregate Care DSS, OMH, 5511031level t I ()tROD, or OASAS

HR or ADC18NYCRR352.8(c)(1) Congregate Care

701(i i) Level I II OMROO 551

State operatedMHL 31.29, RCCA or ConmJn- OMH OMH dl rect 5103

ity Residence pa)1ll8nt

MHL 33.08 State operated OMROO SSt or other 5103COIIIIlJOity incomeResidence

room and board not State HR, ADC or EAF 545situations certified

non-medical18NYCRR tacH ities other

EAF2352.8(c)(1)(0 than Congregate DSS, OASAS, HR, ADC, 545Care Level I, II not State or 551or (I I certified,(including or othermaternity home,Shelter forVictims ofDomesticViolence, andcertain privateshel ters forthe homeless)

18NYCRR Shel ter for 055 EAF I ADt HR, or $633900.17(a) Families - 551

Tier II

SSL 194.8 Publ ic Home operated by a Publ ic Up to 5104

city or county Institutional Care

This PNA is the minimum established in Social Services law for SSI recipients. Anyincome disregarded in determining the amount of a recipient's S51 grant is incLudedas part of the PNA. S51 disregards the first $20 of unearned income; disregardsfor earned income include the first $65 plUS one-haLf of the remainder. ThUS, SSIrecipients receiving SociaL Security benefits wiLL have PNA's of $20 more than theamounts noted on this chart. Recipients with earned income can have significantLylarger PNA's.

2

3

4

A PA funded PNA Is not provided to residants of hospitals or publicly operatedfacilities.

This allowance is called a lIspeciaL needs aL Lowance" and appl ies onLy when the TierII faciLity provides 3 meaLs a day.

The facility can provide each resident with up to $10 for work performed by theresident.


Personal Needs Allowances (PNAs) In Medical FacilitiesEffective January 1, 1995

Authori ty facility Type Certifying Agency Funding Source Monthly PNA(per person)

SSJ + State 555 (530 +SSL 209.2-a payment 525 SSPNA 5)

HospitaL Department ofSSL Health (NA-Only persongl366.2(a)( 10), needs allowance) 550

18NYCRR 5S} + State 555 (530 +352.8(0)(1)( i) payment 525 SSPNA 5)360-4.9(a) Nursing Home Oepartment of

$402(SNF, MRF) Health HR

(NA-Only persongl 550needs at·l owance )


Psychiatric OMH or DAM di reet StateCenter Payment; or 535

SSL 366.2(a) (Hospital), NA-Only persona6(10) Inpatient needs allowance

SSL 209.2-a Alcohol ismFacility

18NYCRR SSI + 551 State 535352.8(0)(1)(;), suppLement; or360-4.9(a) HA-Only personal

rCF-OD's needs 6(Devalo_ntal OHRDD allowanceCenter, free-

$402standing ICn HR

SSL 209.3 Free-Standing 551 (footnoti)ALcohol ism DAM

$402Facll Ity (FNP HRMedicaid)

18NYCRR (NA-Onl Y com'(footnote 7)352.8(c)(1)(I), """I tYfleeds

360.5(e)(2) level )

5

6

7

SSPNA is the "State Supplemental Personal Needs Allowance ll provided to SSIrecipients without other income in residential health care facilities. SSIrecipients residing in medical facilities receive $5 in Federally-administeredState Supplementation and, if they reside in a facility licensed by the Departmentof Health, an additional $20 in State-administered direct SSPNA payments.

The MA-Only personal needs allowance is the amount of the client1s own income thathe or she retains for personal needs while in chronic care status.

Since these programs are not Title XIX certified, 8n SSJ recipient in a privatelyoperated free-standing Alcoholism Facility would receive SSt at the IIliving slonell

rate provided to SSI recipients in the community. An MA-Only recipient would bebudgeted as though he or she were temporarily absent from his or her residence.

~

ATTACHMENT C

DSS-3715EL (R, lD/93) SSI BENEFIT LEVELS EFFECTIVE JANUARY 1. 1994 (Reflects a 2.6% Federal COLA)

FED STATE INDIVIDUAL COUPLEL/A SUPPtalE talE LIVING ARRANGEMENT FEDERAL STATE TOTAL FEDERAL STATE TOTAL

A A Llvlns Alone 446 86 532 669 lD2.50 771.50

A,C B living with Others 446 469 669 714

(Living In Household of Another1/)23 45

(B) (F) (297.34) (320.34) (446) (491)

level [ - Famf Ly Care

a) DSS certified Family Type HomesA C b) OIIH or OIIROO certified Family Care Homes

NYC, Nassau, Suffolk & Yestchester CCU'lti es 446 266.48 712.48 669 755.96 1,424.96

Rest of State 446 228.48 674.48 669 679.96 1,348.96


a) DSS certified Adult COre FacilitIesA D b) OIIH. OIIROD. or DAM certifIed CCMIIIU'llty Residences. DSAS certifIed

Residential Substance AbJse Treatment Programs, and OMH certifiedResidential COre centers for Adults

NYC, Nassau, SUffolk & Westchester Counties 446 435 881 669 1,093 1,762

Rest of State 446 405 851 669 1,033 1,702

level lIt - Schools for the Mentally Retanded

A E New York City 446 482.96 928.96 669 1,188.92 1,857.92

Rest of State 446 458.96 904.96 669 1,140.92 1,809.92

D G Title XIX (Medicaid certified) Instltutlons2/ 30 53/ 353/ 60 103/ 703/

A Z (See 4/ below) 446 . 0 446 669 0 669

/ The -lfving with othersll ClItegOry includes the recipients whose federal benefit has been reduced by the "velue of 113 reduction (VTR)" due to the federaldetermination that they are: a) l tving in someone else's household, and b) receiving some amount of both free or subsidized food and shelter (support andmaIntenance). The VTR Is $148.66 for an IndivIdual and $223 for a c_le. .

21 Applies when the recipient spends 8 full calendar month in the Institution and Title XIX (Medicaid) pays for at least SOX of the cost of care.

3/ Recipients in Title XIX Institutions licensed by the NYS Department of Health receive 8n additional grant of $20 per month called a State Supplemental PersonalNeeds Allowance (SSP:NA).. SSPNA checks are issued directly to the recipient by the NYS Department of Social Services.

4/ Applies when "the recipient spends a full calendar month in a private Title XIX Institution and Medicaid pays for less than SOX of the cost of care, wh~ therecipient resides in certain publicly operated community based residential faCilities, or while the recipient resides in a public emergency shelter for six calendarmonths during 8 nine month period.

Additional Notes: 1) The minimum personal needs allowances (PNA): Level I - $87, Level II - $100,2) The limits on countable resources: $2000 for an individual and $3000 for 8 couple3) An essential person receives $223

Level Il I - S68 References:Chapter 401 Laws of 1993

)

ATTACHHEHT D

FOOD STAMPSGROUP LIVIHG BUDGET DATA: EFFECTIVE JAHUARY I. 1994

(Applicable for SSI/RSQI Recipients Only)

Upstate \/HS ABELNew York City

\/HS External PA Sheltar FS GroupBudgat Shelter Type Code Living

Living Arrangement Type Code Type Code 551 Benefit

SSI Living with Others Benefit N/A N/A N/A $469.00

Level I • Family Care

OHH/OHRDD CertifiedFamily Care Homes

NYC, Nassau, Suffolk and Westchester 15 15 1 S712.48Rest of State 28 15 1 5674.48

Level II - Residential Cere

OHH/OHRDD Certified Facilityor OSS Certified Enriched Housing

NYC, Nassau, Suffolk and Westchester 16,31 10,16,17 2,4 S881.00Rest of State 29,32 10,16,17 2,4

$851.00

State (OHH/OHRDD) OperatedCOfJJTOnt ty Res idenees 17 N/A 3 $446.00


Mfninun Personal Personal Care Costs Board" (Thrifty)Needs Allowance· (Income Exclusion) Shelter Costs· Food Plan)

Level J- NYC, Nassau, Suffolkand Westchester $87.00 S243.48 S270.00 S112.00

Level I • Rest of State $87.00 S205.48 S270.00 S112.00

Level II . NYC, Nassau, Suffolkand Westchester S100.00 $412.00 S257.00 S112.00OHH/OHROO Certified Facilityor DSS Certified Enriched Housing

Level II . Rest of State S100.00 S382.00 S257.00 S112.00OHH/OHROO Certified Facilityor DSS Certified Enriched Housing

State (OHH/OHRDD) OperatedCommunity Residences S100.00 SO S234.00 S112.00

The psyment to the Group Home equals tha personal care costs + shelter + board. The Client keeps the personalneeds allowance + they may keep part of their t.nesrned or earned income.

'Personal needs and/or board amounts may be higher at some rasldences. If 80, shelter costs are reduced by theamount of the difference between the minimum above and the actual amount allowed. Total 5SI benefits andPersonal Care Costs are not changed.

NOTE: The budget data for residents of Level II OMH/OHROD Certified Community Residencas are the same forresidents in recaipt of SSI/RSDI thst reside in Level II authorized drug/alcohol treatment fscillties.

For residents of Level II authorized drug/alcohol treatment facilitiea or enriched housing·not tn receipt ofSSI/RSDI other budgeting procedures apply

)

ATTACHMEHT EPage 1 of 2

Personal Needs Allowances (PNAs) In Non-Medical FacilitiesEffective January', 1994

Authority FacH ttv Type Certifying Agency Funding Source Monthly PHA(per person)

SSI871

SSL 131-0, Congregate Care DSS, OHH, orLevel I OHRDD HR or ACC

Congregate Care DSS, a-lH, SSI1001Level II OHRDO, or OASAS

HR or ACC18HYCRR352.8(c)(1 ) Congregate Care

681(Il) Level II I OHRDD SSI

State operatedMHL 31.29, RCCA or COfmUl- OHH OHH dl rect S100

Ity Residence payment

MHL 33.08 State operated OHRDO SSI or other S100COOJIUllty IncOOleResidence

room and board not State HR, ACC or EAF 145altuations certified

non-medical18HYCRR facilities other 2352.8(c)(1)(1) than Congregate DSS, CASAS, HR, ACC, E~F 145

Care Level I, II not State or SSIor III certified,( Including or othermaternity home,Shelter forVictims ofOOOlestlcViolence, andcertain privateshal ters forthe hOOleless)

18HYCRR Shel ter for DSS EAF, ADC HR, or $633900.17(a) Families - SSI

Tier II

SSL 194.8 Publ ic HOOle operated by a Publ ic Up to S104

city or c04..Ilty Institutional Care

This PHA Is the minimum established in Social Services Law for SSI recipients. AnyIncOOle diaregarded in determining the amount of a reclpient'a SSI grant Is Includedes part of the PHA. SSI disregards the flrat S20 of unearned IncOOle; disregardsfor earned incOOle include the first 165 plus one-half of the remainder. Thus, SSIreclplenta receiving Social Security beneflta will have PHA'a of S20 more thsn theamounts noted on this chart. Recipients with earned incOOle can have signifIcantlylarger PNAls.

2

3

4

A PA funded PHA is not provIded to residents of hospItals or pubI icly operatedfacilities.

This allowance is called a "specIal needs allowance- and applies only when the TierII facility provides 3 meals a dey. .

The facility can provide each resIdent with up to S10 for work performed by theresident.

AtTACHMEHT EPage 2 of 2

Peraonal Needs Allowances (PNAs) In Medical FacilitiesEffective January 1, 1994

Authority Facility Type Certifying Agency Funding 'Source Monthly PNA(per person)

SSI + State 555 (530 +SSL 209.2-a payment 525 SSPNA 5)

Hospital Department ofSSL Health (HA-only peraongl366.2(a)(10), needs allowance) 550

18NYCRR 55. + State 555 (530 +352.8(c)(l)( i) payment 525 SSPNA 5)360-4.9(a) Nurs ing Home Department of

5402(SNF, HRF) Health HR

(HA-only persongl 550needs allowance )

SSI + SSI Statesupplement;

Psychiatric OHH or DW di reet StateCenter Payment; or 535

SSL 366.2(a) (Nospltal), HA-only personaA(10) Inpatient needs allowance

SSL 209.2-a Alcohol IsmFaci! Ity

18NYCRR SSI + SSI State 535352.8(c)(I)(I), 8L4JPlement; or36O-4.9(a) HA-only personal

ICF-OD's needs(Developmental OHRDD sllowsnce6

Center, free-5402standing ICF) HR

SSL 209.3 Free-Stending SSI (footnote7)Alcoholism ow

5402Fscility (FNP HRMedicaid)

18NYCRR (HA-only COllI-(footnote 7)352.8(c)( 1)(1), llU1i tyi.'""""

36O.5(a)(2) laval )

(

5

6

7

SSPNA Is the "State Supplemental Personal Needs Allowancen provided to SSIrecipients without other incOlll8 in residential haalth care facillti... SSIrecipients rasidlng In nedlcal facllitl .. receive 55 In Federally-admlnlstaredStata Supplementation and, If they raslde In a facility licensed by the Departmentof Health, an additional 520 In Stata-admlnlstared direct SSPNA payments.

The HA·only personal needs allowance Is tha """,,",t of tha client's own Inc_ thsthe or she retains for personal needs while In chronic cara status.

Since th..e progr.... are not Title XIX cartlfled, an SSI recipient In a privatelyoperlted fr..·.tandlng Aicoholllll facility MOUld receivi 551 It thl "living Ilone"rata provided to SSI recipients in the cOllllU1lty. An HA-only recipient would bebudgeted as though ha or she ware t_rarlly aboent frOlll his or her ~..idenca.

-ATTACHMENT C

OSS-3715EL (Rev. 10/92) SSt BENEFIT lEVELS EFFECTIVE JANUARY 1. 1993 (Reflects a 3.0% Federal COLA)


A A living Alone 434 86 520 652 102.50 754.50

A,C 8 Living with Others 434 457 652 .-697

(Living in Household of Another'!)23 45

(8) (F) (289.34) (312.34) (434.67> (479.67)


8) DSS certified Family Type HomesA C b) OMH or OMRDD certified Family care Homes

~

NYC, Nassau, Suffolk &~estchester Counties 434 266.48 700.48 652 748.96 1,400.96

Rest of State 434 228.48 662.48 652 672.96 1,324.96


8) DSS certified Adult Care FacilitiesA 0 b) OMH, OMRDD, or OAAA certified COl1'I1lJnity Residences, DSAS certified


NYC, Nassau, Suffolk &Yestchester Counties 434 435 869 652 1,086 1,738

. Rest of State 434 405 , 839 652 1,026 1,678


A E New York. City 434 482.96 916.96 652 1,181.92 1,833.92

Rest of State 434 458.96 892.96 652 1,133.92 1,785.92

0 G Title XIX (Medicaid certified) Institutions21 30 53/ 353/ 60 103/ 703/

A 2 (See 4/ below) 434 0 434 652 0 652

17 The "l iving with others" category includes the rec;pients whose federal benefit has been reduced by the "value of 1/3 reduction (VTR)II due to the federaldetermination that they are: a) living in someone else's household, and b) receiving some amount of both free or subsidized food and shelter (support andmaintenance). The VTR is $144.66 for an individual and $217.33 for a couple.

21 Applies when the r~ipient spends a full calendar month in the Institution and Title XIX (Medicaid) pays for at least SOX of the cost of care.

31 Recipients in Title XIX Institutions licensed by the NYS Department of Health receive an additional grant of $20 per month called a State Supplemental PersonalNeeds Allowance (SSPNA). SSPNA checks are issued directly to the recipient by the NYS Department of Social Services.

41 AppUes when the recipient spends a full calendar month in a pdvate Title XIX Institution and" Medkaid pays for less than SOX of the cost of care, when therecipient resides in certain publicly operated community based residential facilities, or while the recipient resides in a public emergency shelter for six calendarmonths dudng a nine month pedod.

Additional Notes: 1) The minimum personal needs allowances (PNA): Level I • $85, Level II - $97,2) The limits on countable resources: S2000 for an individuaL and $3000 for a couple3) An essential person receives $217

Level III • S66 References:Chapter 292 Laws of 1992

ATTACHHEHT 0

FOOD STAMPSGROUP LIVING BUDGET DATA: EFFECTIVE JANUARY I. 1993

(Applicabla for SSI/RSDI Recipients only)

; Upstate lollS ABELNew York City

lollS External PA Shel tor FS GroupBudget Shelter Type Code Living

living Arrangement Type Code Type Code SSI Benefit

SSI Living with Others Benefit N/A N/A N/A $457.00

Level I . Family Cere

OHH/OHRDD CertifiedFamily Cara Nomes

NYC, Nassau, Suffolk and Westchester 15 15 I $700.48Rest of State 28 15 1 1662.48

Lavel II . ResIdential Care

OHH/OHRDD CertIfied FacIlityor DSS Certified Enriched Housing .NYC, Nassau, Suffolk and Westchester 16,31 10,16,17 2,4 $869.00Rest of State 29,32 10,16,17 2,4

$839.00

State (OHH/OHRDD) OperatedCommunity Residences 17 N/A 3 $434.00

The followIng monthly allowancea end costs pertain to eligible resident. of group living arrengements.

Hlnlmum Personal Personal eire Costs Boerd" (Thrifty)Needs Allowance- (Inc_ Exclusion) Shelter Costs· Food Plan)

Levell- NYC, Nassau, Suffolkand Westchester $85.00 $243.48 $261.00 $111.00

Level I . Rest of State $85.00 $205.48 $261.00 $111.00

level 11 . NYC, Nassau, Suffolkand Westchester $97.00 $412.00 $249.00 $111.00· .OHH/OHRDD Certified Fecllityor DSS CertIfied Enriched HousIng

Level II . Rest of State $97.00 $382.00 $249.00 $111.00OHH/OHRDD Certified Facilityor DSS Certified Enriched Housing

Stete (OHH/OHRDD) OperatedCommunity Residences $97.00 SO $226.00 $111.00

The payment to the Group Home equals the personal care costs + shelter + board. The client keeps the persona~

needs allowance + they may keep part of their unearned or earned income.

*personaL needs and/or board amounts may be higher at some residences. If so, shelter costs are reduced by theamount of the difference between the mininun above and the actual 8InOl6't allowed. Total SSI benefits andPersonal Care Costs are not changed.

NOTE: The budget date for residents of Level II OHH/OHRDD certIfied Community Residences ere the same forresidents in receipt of SSI/RSOI that resIde in Level II authorized drug/elcohol treatment facILities.

For residents of Level II euthorlzed drug/alcohol treatment facilities or enriched housing not In receipt ofSSI/RSDI other budgeting procedures epply

)

ATTACHHEHT EPage 1 of 2

Personal Needs Allowsnces (PNAs)'ln Noo-Hedlcal FscliltlesEffectIve January I, 1993

Authorhy Filc H Ity Type Certifying ASencY Fl.I'dlm Source MOOthly PNACper person)

SSI $85'SSL 131-0, Congregate Cere DSS, OMH, or

Level I OMRDD HR or ADC $85

Congregate Care 05S, a4H, SSI $97'Level II OHRDD, DAM, or

DSAS HR Or ADC $9718NYCRR352.8(c)(l) Congregate Care

$661(II) Level III OMRDD SSI

State operatedMHL 31.29, RCCA or COII1IUl- OMH OMH direct $97

Ity ResIdence payment

HHL 33.08 State operated OMRDD SSI or other $97COOJ1IJIlI ty Inc_Residence

room end board not State HR, ADC or EAF 545situations certifIed

non-medical18NYCRR fscilltles other 2352.8(c)(I)(1) than Congregate DSS, OW, HR, ADC, EAF 545

Care Levell, II not State or SSIor III certifIed,(Including or othermaternity home,Shelter forVictims ofD_stlcVIolence, andcertain privateshel ters forthe homeless)

18NYCRR Shelter for DSS EAF, AnC HR, or $633900.17(a) Fernl lies - SSI

Tier II

SSL 194.8 Public Home operated by e Plbllc Up to $104ci ty or cOlI'lty InstitutIonal Cere

This PNA is the minimum establIshed In SocIal ServIces Law for SSI recIpients. Anyincome disregarded In determining the amount of a recipIent's SSI grant Is includedas part of the PNA. SSI disregsrds the fIrst $20 of unearned inc_: dlsregsrdsfor earned Inc_ include the first 565 plus one-hslf of the remainder. ThUS, SSIrecipients receiving Soclel SecurIty benefits will have PNA's of $20 more thsn theamounts noted on this chart. Recipients with earned income can have significantlylarger PNAls.

)

2

3

4

A PA funded PNA Is not provided to residents of hospltels or plbllcly operatedfscH Itles.

ThIs allowance Is called a "speclel needs ellowence" end applIes only..non tha TierII facility provides 3 meals a day.

The facility csn provide each resIdent wIth up to $10 for work performed by theresident.


PersQn81 Needs Allowances (PNAs) In Medical FacilitiesEffective January I, 1993

Authority f~cll tty Type Certifying AgencY fwdioq Source Monthly PNA(per person)

55I + State $55 ($30 •SSL 209.2-a payment $25 SSPNA 5)

Hospital Department ofSSL Health (MA-Dnl y parsongl366.2(a)(10), needs allowance) $50

18NYCRR SSI • Statl $55 ($30 •352.8(c)(1)(I) pa)WOt $25 SSPNA 5)360-4.9(a) Nura tr19 Home Department of

$402(SNF, HRF) Hellth HR

(MA-Dnly paraongl $50needa allowance)

-SSI • SSI Statesupplement;

Psychiatric OHH or DAM dl rect StateCenter Payment; or $35

SSL 366.2(a) (Hospital), MA-Dnl y parsona~(10) Inpatient needs allowance

SSL 209.2-a AlcoholismFacll Ity

18HYCRR SSI • SSI Statl 535352.8(c)(l)( l), lupplement; or36O-4.9(a) MA-Dnly personal

ICF-DD's needs 6(Devalopmental OHRDD .llowanceCenter, free~

$402standing ICF) HR

SSL 209.3 Free-Standing SSI (footnotl)Alcoholism DAM

$402Facility (FNP HRMedicaid)

18NYCRR (MA-Dnly com-(footnote 7)352.8(c)(1)(I), llU1!ty~

360.5(e)(2) level )

5

6

7

SSPNA is the "State SuppLemental Personal Needs Allowance" provided to 551recipients without other income in residential health care facilities. SSIrecipients residing in medicaL facilities receive $5 in Federally·adminfsteredState Supplementation and, if they reside in a facility licensed by the Departmentof Health, an additional $20 In State-administered direct SSPNA payments.

The HA-Only personal needs allowance Is the 8IIlOU'lt of the client's own income thsthe or she retains for personal needs while in chronic care status.

Since these programs are not Title XIX certified, an SSI recipient In a privatelyoperated free-standing Alcoholism Facility would reclivl SSI et the "living alone"rate provided to SSI recipients in the community. An MA-Dnly recipient would bebudgeted as though he or she were temporarily absent from his or her resldenca.

DSS-3715EL (Rev. 10/91) SSI BENEFIT LEVELS EFFECTIVE JANUARY 1, 1992 (Reflects a 3.7% Federal COLA)


•A A Livins Alone 422 86 508 633 102.50 735.50

A,C B living with Others 422 445 633 678

(Living in Household of Another'/)23 45

<i (B) (F) (281.34) (304.34) (422) (467)

~ l~vel I • Family Care

a) DSS certified Family Type HomesA C b) OMH or OMRDD certified Family Care Homes

NYC, Nassau, Suffolk &Westchester Counties 422 266.48 688.48 633 743.96 1,376.96

Rest of State 422 228.48 650.48 633 667.96 1,300.96

level It - Residential Care

8) DSS certified Adult Care facilitiesA 0 b) OHH, OHRDD, or DAAA certified Coarrunity Residences, DSAS certified



Rest of State 422 405 827 633 1,021 1,654

leveL III - Schools for the Mentally Retarded

A E New York. City 422 482.96 904.96 633 1,176.92 1,809.92

Rest of State 422 458.96 880.96 633 1,128.92 1,761.92

0 G Title XIX (Medicaid certified) Institutionsl/ 30 55/ 355/ 60 105/ 705/

A Z (See 4/ below) 422 0 422 633 0 633

1/ The "living with othersl • category includes the recipients whose federal benefit has been reduced by the IIvalue of 1/3 reduction (VTR)· due to the federaldetermination that they are: a) living in someone else·s household, and b) receiving some amount of both free or subsidized food and shelter (support andmaintenance). The VTR is $140.66 for an individual and $211.00 for a couple.

2J Applies when the recipient spends a full calendar month in the Institution and Title XIX (Medicaid) pays for at least 50X of the cost of care..

3/ Recipients in Title XIX Institutions licensed by the NYS Department of Health receive an additional grant of $20 per month called a State SUpplemental PersonalNeeds Allowance (SSPNA). SSPNA cheCKS are iSSUed directly to the recipient by the NYS Department of Social Services.

4/ Applies when the recipient spends 8 full calendar month in a private Title XIX Institution and Medicaid pays for less than SOX of the cost of care, when therecipient resides in certain publicly operated cOll1Wl1ity based residential facilities, or while the recipient resides in a public emergency shelter for six calendarmonths during a nine month period..

Additional Notes: 1) The minimum personal needs allowances (PNA): Level I - $83, Level II - 594,2) The limits on countable resources: 52000 for an individual and 53000 for a couple3) An essential person receives 5211

Level III • S64 References:Chapter 201 Laws of 1991

,-~,

ATTACHMENT 0

FOOO STAMPSGROUP liVING BUDGET DATA: EFFECTIVE JANUARY 1, 1992


Upstate \.JMS ABELNew York City

\JMS External PA Shelter FS GroupBudget Shel ter Type Code living

Living Arrangement Type Code Type Code 551 Benefit

SSt Living with Others Benefit N/A N/A N/A $445,00

Level I • family Care

OMH/OMROO CertifiedFamily Care Homes

NYC, Nassau, Suffolk and ~estchester 15 15 1 $688,48Rest of State 28 15 1 $650,48

level II - ResidentiaL Care

OMH/OMRDO Certified Facilityor DSS Certified Enriched Housing

NYC, Nassau, Suffolk and \.Jestchester 16,31 10,16,17 2,4 $857,00Rest of State 29,32 10,16,17 2,4

$827,00

State (OMH/OMRDD) OperatedCommunity Residences 17 N/A 3 $422.00


Minimum Personal Personal Care Costs Board* (Thri fty)Needs Allowance* (Income Exclusion> Shel ter Costs* Food Plan>

Level )- NYC, Nassau, Suffolkand \.1estchester $83.00 $243.48 $251.00 $111.00

Level I - Rest of State $83.00 $205.48 $251.00 $111.00

Level II - NYC, Nassau, Suffolkand \.1estchester $94.00 $412.00 $240.00 $111.00OMH/OMRDD Certified Facility

or DSS Certified Enriched Housinglevel IJ - Rest of State $94.00 $382.00 $240.00 $111.00

OMH/OMRDD Certified Facilityor DSS Certified Enriched Housing

State (OMH/OMROO) OperatedCommunity Residences $94.00 $0 $217.00 $111.00

The payment to the Group Home equals the personal care costs + shelter + board. The client keeps the personalneeds allowance + they may keep part of their unearned or earned income.

*Personal needs and/or board amounts may be higher at some residences. If so, shelter costs are reduced by theamount of the difference between the minimum above and the actual amount allowed. Total SSI benefits andPersonal Care Costs are not changed.

NOTE: The budget data for residents of level II OMH/OMRDD Certified Community Residences are the same forresidents in receipt of SSI/RSDI that reside in level It authorized drug/alcohol treatment facilities.

For residents of level II authorized drug/alcohol treatment facilities or enriched housing not in receipt ofSSI/RSDI other budgeting procedures apply

i,.

ATTACHMEHT EPage 1 of 2


Author; ty Faci 1i ty Type Certifying Agency Funding Source Monthly PNA(per person)

SSI $83'SSL 131-0, Congregate Care DSS, OMH, or

Level I OMRDD HR or ADC $83

Congregate Care DSS, OMH, SSI $94'Level II OMRDD, DAAA, or

DSAS HR or ADC $9418HYCRR352.8(c)(1) Congregate Care

$64'(i i) Level I II OMRDD SSI

State operatedMHL 31.29, RCCA or Corrrnun- OMH OMH di reet $94


MHL 33.08 State operated OMRDD SSI or other $94Corrrnuni ty incomeResidence

room and board not State HR, Ace or EAF $45situations cert ified

non-medical18HYCRR faci lit i es other

HR, ADC, EAF 2352.8(c)(1)(1) than Congregate DSS, DAAA, $45Care level I, II not State or SStor 11 I certified,( including or othermaterni ty home,Shel ter forVictims ofDomesticViolence, andcertain privateshel ters forthe homeless)

18HYCRR Shelter for DSS EAF, ADC HR, or $633

900.17(8) Farni lies - SSITier II

SSL 194.8 Publ ic Home operated by a Public Up to $'04

ci ty or county Institutional Care

This PNA is the minimum established in Social Services Law for SSI recipients. Anyincome disregarded in determining the amount of a recipient's sst grant is includedas part of the PNA. SSI disregards the first $20 of unearned income; disregardsfor earned income include the first $65 plus one-half of the remainder. ThUS, SStrecipients receiving Social Security benefits will have PNA1s of $20 more than theamounts noted on this chart. Recipients with earned income can have significantlylarger PNAls.

2

3

4

A PA funded PNA is not provided to residents of hospitals or publicly operatedfacilities.

This allowance is called a "special needs allowance" and applies only when the TierII facility provides 3 meals a day.

The facility can provide each resident with up to $10 for work performed by theresident.


Personal Needs Allowances (PNAs) In Medical facilitiesEffect ive January 1, .1992

Authori ty Facit ity Type Certifying Agency Funding Source Monthly PNA(per person)

SSI + State $55 ($30 +SSl 209.2-a payment $25 SSPNA 5)

Hospital Department 01SSl Health (MA-Only persongl366.2(a)(10), needs allowance) $50

18NYCRR 551 + State $55 ($30 +352.8(c)(1)(;) payment $25 SSPNA 5)360-4.9(a) Nursing Home Department 01


(MA-Only persongl $50needs allowance)


Psychiatric OMH or DAAA di rect StateCenter Payment; Or $35

SSl 366.2(a) (Hospi tal), MA-Only persona!(10) Inpst ient needs allowance

SSl 209.2-a Alcohol ismFecit i ty

18NYCRR 551 + SSI State $35352.8(c)(1)(I), suppl ernent j or360-4.9(a) MA-Only personal

ICF-DDls needs 6(Developmental OMROD allowanceCenter, free-

$402standing reF) HR

SSl 209.3 Free-Standing SSI (Iootnot/)Alcoholism DAM

$402Facil ity (FNP HRMedicaid)

18NYCRR (MA-Only com-(footnote 7)352.8(c)(1)(;), munitY7needs

360.5(0)(2) level )

5

6

7

SSPNA is the IlState Supplemental Personal Needs Allowance ll provided to S51recipients without other income in residential health care facilities. 551recipients residing in medical facilities receive $S in Federally-administeredState Supplementation and, if they reside in a facility licensed by the Departmentof Health, an additional $20 in State-administered direct SSPNA payments.

The MA-Only personal needs allowance is the amount of the client's own income thathe or she retains for personal needs while in chronic care status.

Since these programs are not Title XIX certified, an SSI recipient in a privatelyoperated free-standing Alcoholism Facility would receive 551 at the Illiving alone ll

rate provided to sst recipients in the community. An MA-Only recipient would bebudgeted as though he or she were temporarily absent from his or her residence.

C,)

Eo<

I!;;l

D55·3715 '(Rev. 10/90)

SSI BENEFIT LEVELS: EFFECTIVE JANUARY I. 1991FED STATE FEDERAL BENEFIT RATE STATE SUPPLEMENTATION RATE COMBINED PAYMENT LEVEL

UA SUP? LIVING ARRANGEMENTCODE CODE INDIVIDUAL COUPLE INDIVIDUAL COUPLE INDIVIDUAL COUPLE

A A Living Alone 407 610 86 102.50 493 712.50

A,C B Living with Others 407 610 430 65523 45

(B) (F) (Living in Household of Another 1£) (271.34) (406.67) (294.34) (451.67)


a) DSS certified Family Type HomesA C b) OMH or OMRDD certified Family

Care Homes

NYC, Nassau, Suffolk & Westchester counties 407 610 266.48 736.96 673.48 1,346.96

Rest of State 407 610 228.48 660.96 635.48 1,270.96

Level II - Residential Carea) DSS certified Adult Care Facilities

A D b) OMH. OMRDD, or DAAA certifiedCommunity Residences, DSAS certified ResidentialSubstance Abuse Treatment Programs, and OMHcertified Residential Care Centers for Adults

NYC, Nassau, Suffolk & Westchester counties 407 610 435 1,074 842 1,684

Rest of State 407 610 405 1,014 812 1,624


A E New York Citv 407 610 482.96 I 169.92 889.96 1.779.92

Rest of State 407 610 458.96 I 121.92 865.96 I 731.92

D G Title XIX (Medicaid certified) Institutions 31 30 60 5 31 10 31 35 !.! 70 ~

A Z (See ~ below) 407 610 0 0 407 610

11 The "living with others" category includes the recipients whose federal benefit has been reduced by the "value of \/) reduction (VTR)" due (0 tht: federal determination that they are: a) livingin someone else's household. and b) receiving some amount of both free or subsidized food and shelter (support and maintenance). The VTR is $135.66 for an individual and $203.33 for acouple.

1d Applies when the recipient spends a full calendar month in the Institution and Title XIX (Medicaid) pays for at least 50% of the cost of care.11 Recipients in Title XIX Institutions licensed by the NYS Department of Health receive an additional grant of $20 per month called a SIate Supplemental Personal Needs Allowance (SSPNA).

SSPNA checks are issued directly to the recipient by the NYS Depanment of Social Services.!! Applies when the recipient spends a full calendar month in a private Title XIX Institution and Medicaid pays for I~ Ihan 50% of the cost of care, when the recipient resides in certain public

ly operated community based residential facilities, or while the recipient resides in a public emergency shelter for six (6) calendar months during a nine (9) month period.

Additional Notes: I) The minimum personal needs allowances: Level I - $80. Level 11 ~ $90. Level III • $612) The limits on countable resources: $2000 for an individual and $3000 for a couple3) An essential person receives $204

· ATTACHMENT D

FOOD STAMPSGROUP LIVING BUDGET DATA:. EFFECTIVE JANUARY I. 1291


New York CityUpstate Iot4SABEL

WMS External PA Shelter FS GroupBucfget Shel ter TYJlO Code Liying

Living Arrangement 'Type Code Type Code SSI Benefit

SSI Liying with Others Benefit N/A N/A N/A $/030.00---Level t • family Cefe


NYC, Nassau, Suffolk end Westchester 15 15 I $673.48Rest of Stete 28 15 1 $635.48

Leyel II • Residenti.l C.re

OMH/OMRDO Certified Fecilityor DSS Certified Enriched Housing

NYC, Nassau, Suffolk and Westchester 16,31 10,16,17 2,4 S842.00Rest of State 29,32 10,16,17 2,4 $812.00

St.te (OMH/OMRDD) Oper.tedCommunity Residences 17 N/A 3 $/007.00


Minimum PersonalNeeds Allow.nce-

Personal Care Costs(Income Exclusion) Shel ter Costs·

BOBrd*

(Thrifty Food Plan)

level I- NYC, Nassau, Suffolkand Westchester $80.00 5243.48 ~245.00 5105.00

Level I • Rest of State $8D.OO 5205.48 5245.00 5105.00

Level 11 - NYC, Nassau, Suffolkand Westchester 590.00 $/012.0D 5235.DD 5105.00OMH/OMRDD Cartlfled F.cility or

DSS Certified Enriched NousingLeyel II • Rest of St.te 590.00 5382.00 5235.00 5105.00

OMH/OHRDD Certified F.cllityor DSS Certified Enriched Nouslng

St.te (OHH/OHRDO) Oper.tedCommunity R.sidences 590.00 SO 5212.00 5105.00

The payment to the Group HOMe equals the personal c.re costs + ahelter + board. The client keeps the personal needsallow.nce + they _y keep part of their .....rned or a.rned income.

·Personal nHds end/or board IIm04.Ilts MY be higher at lome residences. If so, Ihelter costs are reckJeed by the amou'ltof the difference between the .inimum aboye .nd the .ctuel amount .llowed. Tot.l SSI benefits .nd Personel C.re Costsare not changed.

NOTE: The budget dot. for r.sidents of Leyel II OMH/OMRDD Certified Community Residences Ire the a... for residentsIn receipt of SSI/RSDI th.t reside in Leyel II authorized drug/.lcohol tre.tment f.cilities.

For residents of LaYel II authorized drug/Ilcohol treatment f.cllities or enriched housing not in receipt of SSI/RSDIother budgeting procedJres Ipply.

~E

Page 1 of 2

PersonaJ. Needs Allowances (:PNl\s) In Non-Medica1 F>!qj1itiesEffective JlIDUal:Y 1, 1.991

Authority Facility TYpe certifyim .l\f;;I!tW;V F1m";m Sogrce Montbly 1'tm.(per person) .

55I $801

SSL 131-0, QJIJJl:egate care tsS, C!oIH, orLevel I GlRDD HR or ADC $80

COIJ:jl:egate care tsS, C!oIH, 55I $901

Level IT GlRDD, DlIM, orI:6AS HR or ADC $90

18NYCRR352.8 (c) (1) ConpoeJO.te care

$611(ii) Level III GlRDD 55I

state operatedMHL 31.29, RCCA or o-mmnm- C!oIH C!oIH direct $90

ity Residence paynent

MHL 33.08 state operated GlRDD 55I or other $90o-mmnmity i.nc::cxIeResidence

roan an:i l:xJard nat state HR, ADC or EAF $45situations certified

non-medical18NYCRR facilities other

HR, ADC, ~352.8 (c) (1) (i) than Co119Legate tsS, DlIM, $45care Level I, IT nat state or 55Ior III certified,(includ:in;r or othermateLnity hcllre,Shelter forvictilns ofIlc:Jnr2sticViolence, an:icertain privateshelters forthe hcllreless)

18NYCRR Shelter for tsS EAF, ADC HR, or $633

900.17 (a) Families - 55ITier IT

SSL 194.8 Public :Hc:me operated by a Public Up to $104

city or ccunty Institutional care

1 '!his mA is the min:i.nnl:m established in Social SerVices law for 55I recipients. Arrji.nc::c:me disregaLded in detennini.n:J the am:JUIIt of a recipient's 55I grant is includedas part of the mAo 55I disregards the first $20 of uneamed i.nc::cxIe: disregards foreaI:ned i.nc::cxIe include the first $65 plus one-half of the remai.rDer. 'Ihus, SSIrecipients receivin;r Social security benefits will have mA's of $20 lIX>re than theanounts noted on this chart. Recipients with eamed i.nc::cxIe can have significantly

.'M.'rAC!IMENl' EPaqe 2 of 2

Perscmal NeedS Allowances (1'Nl\S) In Medical FacilitiesEffective Jauuuy 1, 1.991

Authority Facility Type certifyim AMuyy p'nlll'!;m Source !bltbly~(per person)

SSI + State $S5 ($30 + 5SSL 209.2-a payment: $25 SSENA )

Hospital Department ofSSL Health (MA-only~366.2 (a) (10) , needs alla.rcmce ) $SO

18NYCRR SSI + State $S5 ($30 + 5352.8(c) (1) (i) payment: $25 SSENA )36Q-4.9(a) Nursin3" Hc.1IIe Department of


(MA-only~ $SOneeds alla.rcmce )

SSI + SSI StateSlWleuen:t;

Psychiatric am: or Ill\AA direct Statecenter Payment:; = $35

SSL 366.2 (a) (Hospital) , MA-only~(10) Inpatient needs alla.rcmce

SSL 209.2-a AlcoholismFacility

.

18NYCRR SSI + SSI State $35352.8 (c) (1) (i) , SlWleuen:t; or36Q-4.9(a) MA-only personal

ICF-DO's needs 6(Develq;:m=nt:al CMRDD alla.rcmcecenter, free-

$402st:.andin3' ICF) HR

SSL 209.3 Free-St:an:liIr;J SSI (footnote7

)Alcoholism Ill\AA

$402

Facility (FNP HRM2dicaid)

18NYCRR (MA-only can-(footnote 7)352.8 (c) (1) (i) , .ty~

360.5(e) (2) ~ )

5 SS:ENA is tJ:lI; "State St.g;llemental Personal Needs Alla.rcmce" provided to SSI:recipients without other :inc:aIe in residential health care facilities. SSI:recipients residi.n;J in nedi.cal facilities receive $5 in Federally-administered StateSt.g;lleuen:tation ani, if they reside in a facility licensed by the Department ofHealth, an additional $20 in State-administered direct SS:ENA payments.

~.~

!! The "liying with olhers" category includes the recipients whose federal benefit has been reduced by the "value of Vi reduction (VTR)" due to the federal determination that they are: a) livingin someone e1se's household. and b) receiving some amount of both free or subsidized food and sheller (support and maintenance). The VTR is SI28.66 for an individual and $193 for acouple.

Y Applies when lhe recipienl spends a full calendar monlh in the Institution and Tille XIX (Medicaid) pays for at leasl SO.,., of the cost of care.11 Recipients in Title XIX Instilutions licensed by the NYS Department of Health reteive an additional grant of S20 per month called a State Supplemental Personal Needs Allowance (SSPNA).

SSPNA checks are issued directly 10 Ihe recipient by the NYS Department of Social Services.!! Applies when the redpienl spends a full calendar month in a private Title XIX Instilution and Medicaid pays for lesS than SO". of the cost of care, when the recipient resides in certain public.

Iy operaled comrnunily based residenlial facililies. or while the recipient resides in a public emergency shelter for six (6) calendar months during a nine (9) month period.Additional Notrs: I) The minimum personal needs allowances: lAovd I ~ 515. I~vtl II - SIS. lAovd III ~ SS7

2) The limils on countable resources: 52000 for an individual and S3000 for a couple3) An essenlial person receives $193

n

:>-........III

"§(1)

"....

EFIT LEVELS: EFFECTIVE JANUARY 1. 1990055·3715 IRev. '0189)...,....... - ..

FEDERAL BENEFIT RATE STATE SUPPLEMENTATION RATE COMBINED PAYMENT LEVEl

FED STATEUA SUPP. LIVING ARRANGEMENT INDIVIDUAL COUPLE INDIVIDUAl. COUPLE INDIVIDUAL COUPLE

CODE CODE

A A Living Alone 386 579 86 102.50 472 681.50

A,C 8 Living wilh Others 386 579 409 624

23 45

(8) (F) (Living in Household of Another ~) (257.34) (386) (280.34) (431)

Levell· Family Care

a) DSS certified Family Type Homes

A C b) OMH or OMRDD certified FamilyCare Homes

NYC, Nassau, Suffolk & Westchester counties 386 579 248.96 690.92 634.96 .1,269.92

Rest of State 386 579 210.96 614.92 596.96 1,193.92

Level II • Residential Carea) DSS cerrified Adult Care Facilities

A 0 b) OMH, OM ROD, or DAAA certifiedCommunity Residences. DSAS certified ResidenlialSubstance Abuse Treatment Programs. and OMHcertified Residential Care Centers for Adults

NYC, Nassau, Surrolk & Westchester counties 386 579 435 1,063 821 1,642

Rest of State 386 579 405 1,003 791 1,582

Level III • Schools for the Mentally Retarded

A E New York Citv 386 579 482.96 1 158.92 868.96 1 737.92

Rest of State 386 579 458.96 1 110.92 844.96 1 689.92

D G Tille XIX (Medicaid certified) Institutions 21 30 60 5 3/ 10 3/ 35 3/ 70 3/

A Z (See Y below) 386 579 0 0 386 579

Attllchmerit D

-.I~t

n~.LiviJlq

'fype~

a IIbeltM'fype~

_ Yo"" city_ I:I<tamal

JIudi;jet libeltM'fype~

lOOl> S'l'JlMPSGRXJP I.IV'DP lIUOOET DM?.i WWllYE J»«JMY i. 1990

(AR>licab1e for SSIfRSD1 Recipients only)

~~_NIIlL

LiviJlq~ t

,I

SSl Livin;l with Others _it N/A NIA N/A $409.00 :

Level I - f'llmily care

lHVQlRlD O>rtifiedf'llmily care !laDes

NYC, Nassau, SUffolk and~!lest of state

1528

1515

I1

$634.96$596.96

Level II - Residential care

lHVQlRlD certified Facility~ a;s certified Enrid:led Housin;l

NYC, Nassau, SUffolk aRllIestchester!lest of state

16,3129,32

10,16,1710,16,17

2,42,4

$821.00$791.00

state (CHVQlRlD) ~tedCl:mIIJnity Residences 17 N/A 3 $386.00

'!he follcwin;lllD1thly allcwaroes and costs pertain to eligible residents of~ livin;l arrarqE!III!r11.

Mini•• Pe.rIcmal Pe.rIcmal care o:.tI__ lIll-.r •• (~ Illlcluaicll) -.Itc __

_.('ftlritty .- flail)

Level 1- NYC, Nassau, SUffolkand westdlester

Level I - !lest of state$75.00$75.00

$225.96$187.96

$235.00$235.00

$99.00$99.00

Level II - NYC, Nassau, SUffolkand westdlester $85.00lHVQlRlD certified Facilityor a;s certified Enriched Housin;l

Level II - Rest of state $85.00CMVQlRlD certified Facilityor a;s OOrtified Enriched Housin;l

$412.00

$382.00

$225.00

$225.00

$99.00

$99.00

State '1CMVCMRID) Operata!Cl:mIIJnity_~ $85.00 $0 $202.00 $99.00

'!he pll)'E'1t to tM~ _ ~ tM pencnal care ccst:a + Ihaltc + tarcl. !m clUnt loMp the~ _aU"""""" + they -t Iooop part of thair~ or eam-l~.

o!'lerlla>al .-is anljar tarcl -=unts _y be hit#ler at __ res~. U." Ihaltc ccst:a IIrIl rdJcIcl ~ the -.mof the difference -.. the IIiniaD _ and the a:tual -.m All""'. 'IOtal SSI bmafita anl -.oJ. CIIR o..taare net dlarqecI.

IDlE: '!he tulget data far residonta of x-l II lM\flHllD llortified Qmlunity_~ .... the _ tor rMidorJtain receipt of SSI,/llSlll that ..-ide in x-l II IIIJtharir&I dru;ilalCllhol_~ fc1litiM.

!'Or residents of l....-el. II 1IlJthariz«! dru;ilalCIlhol_~ fc1litiM or onridwd bcuain9 nct in receipt of SSI,/IlSIllother tulgetin;l~ lIA'1y.

AT'12lCIIMENT EPage 1 of 2

Personal. Needs Allowances (l'Nlls) In Non-Medi.caJ. Faci1.itiesEffective Januazy 1, 1990

Authority Faci1.ity Type certifyi!YI 1\qffl!gy Ftmdim source Monthly~<per person)

SSI $751

SSL 131-0, " "Congl:~te care I:6S, alH, or""::l.level I GlRDD HR or ADC $75

OJIfjl:egate care I:6S, alH, $851

SSILevel II GlRDD, DAM, or

I:6AS HR or ADC $85lSNYCRR

"352;S(c) (1) Congl:egate care$57

1(ii) . Level III GlRDD SSI

state operatedMHL 31.29, RCCA or Ccmnmm- alH alH direct $85


MHL 33.0S state operated GlRDD SSI or other $85 "Ccmmmity inca:neResidence

rocm am. board not state HR, ADC or FAF $45situations certified

non-m=dicallSNYCRR facilities other352.S (c) (1) (i) than Col'3l:e;jate I:6S, DAM, HR, ADC, ~ $45

care Level I, II not state or SSIor III certified,(iIcluding or otherIDaternity home,Shelter forVictims ofIlc:IIesticViolence, am. .certain privateshelters forthe homeless)

lSNYCRR Shelter for I:6S FAF, ADC HR, or $633

900.17 (a) Families - SSITier II

55L 194.S Public Home operated by a Public Up to $104

city or o:>UIrt::y Institutional care

i

1

2

3

4

'Ihi.s~ is the miniInum established in Social se:tvioes law for 55I recipients. Anyincome disregarded in deter.mining the am:xmt of a recipient's 55I grant is includedas part of the mAo 55I disregards the first $20 of unea:rned income; disregards forea:tned income include the first $65 plus one-half of the remainder. 'Ihus, 55I:recipients receiving Social security benefits will have mA's of $20 more than theam:xmts noted on this chart. Recipients with ea:tned income can have significantlylarger mA's.

A PA furrled mA is not provided to residents of hospi~ or ];clllicly operatedfacilities. .'Ihi.s allowance is called a "special needs allowance" am. awlies only when the TierII facility provides 3 IOOals a day.

The facility can provide residents with up to $10 for work perfoJ:IOOd by theresident.

M'l2lCBMEN1' EPage 2 of 2

Personal Needs Allowances (mAs) rn Medical Facilities.Effective JClIIU2I%Y 1, 1990

Authority Facility Type certi.fyjm lB!!"l'!Y Fnncllj 'I!T Source Monthly~<per person)

. -

- SS1+ state· $55' ($30 + 5SSL 209.2-a paynent $25 SSmA )

Hospital ~of

SSL - Health (MA-only personal366.2 (a) (10), incidental

6$50

allowance )

18NYCRR SS1 + state $55 ($30 + 5352.8 (c) (1) (i) paynent $25 SSmA )

Nursin:J Harne ~of

$402(SNF, HRF) Health HR •

(MA-only personal $50incidentalallowance 6)

SS1 + SSI state $35 ($30 +supplement $5 state 5

Psychiatric CMI or Ill\AA supplement )center direct(Hospital) , state Paynent $30Inpatient

SSL 209.2-a Alcoholism (MA-only personal $33.50Facility incidental

6allowance )

18NYCRR SS1 + SS1 state $35 ($30 +352.8 (c) (1) (i) , supplement $5 state 5360.5 (e) (2) supplement )

1CF-DO's$402(Developzental CMRDD HR

center, free-st.arxiin:J 1CF) (MA-onJ.y personal $33.50

incidentalallowance 6)

SSL 209.3 Free-stan:lin3' SS1 (footnote7)Alcoholism Ill\AA

$402Facility (Fm' HR

Medicaid)18NYCRR (MA-onJ.y can-

(footnote 7)352.8 (c) (1) (i), 'ty~

360.5(e) (2) ~ )

5

6

7

SSPW'. is the "state Supplemental Personal Needs Allowance" provided to· SS!recipients without other income in residential health care facilities. SSIrecipients residin:J in medical facilities receive $5 in Federally-administered stateSupplementation arrl, if they reside in a facility licensed by the Deparbrent ofHealth, an additional $20 in state-administered direct ssmA paynerrt:s.

'lhe M1<-onJ.y personal incidental allowance is the am::urrt: of the client's own incomethat he or she retains for personal needs 1Nhile in d1roni.c care status.

since these programs are not Title XIX certified, an SS1 recipient in a privatelyoperated free-st:aOOing Alcoholism Facility would receive SS1 at the "livin:J alone"rate-provided to SS1 recipients in the ccmm.mity. An M1<-onJ.y recipient would be-budgeted as t:hoogh he or she were ~rarily absent fran his or her residence.

;.-

~,..,,..,III(l"..3C\)

",..,

~

SSt BEN..:t'1T U:VEI.S: EI'·k-.£TlVE JANUARY I. 1989JB)

I he "living willi 1I"'l'r," category include:.. Ille recipicflIs whn,c federal henefil has becn rcduced by lhe "value of 'II reduction (VTH.)'· du(.· 10 Ihe fe:deral delcrminaliun Ihal Ihey arc: a) li\-ingIII \OUlCOIlC chc's htlll\choid. and II) recciving !'lome amounl uf bUlh free or suh!'lidi/ed f(li)d :U1d sheller (support and mainlenance:). I'he V"I H. is S122.66 for ',i1n individual alul SIH... .H flU ao.:oilpkAjlplil'\ whell the ~l'\'ipicnl srendlo a full calendar munth ill the InSlilulion alld Title XIX (Ml"dkaidl pa~ for al leasl 5(10;0 uf Ihe co!ot uf c;ue.H.el'ipicllt\ in I itle XIX Imlilluionlo li~ensed by Ihe NYS Deparlmenl uf lIealih rCl"cive an addilional granl of $20 rer llIuulh l":llIcll a S'"le Slipplemcnlall~ersonalNeed!'> Alluwallce lSSPNA).SSI'NA ,.:hl',.:b arc i!'>\ucd directly 10 thc recipielll hy Ihe NYS Deranment of So..:ial Servkcs.Applic\ WhCll the rcdpicni !'>pcnds a full calendar muulh in a private Tille XIX Inslitution and Medicaid rays for less Ihan '\(1% ()f the COlot of carc. when Ihe recipielll rel>i.. I(', in l'cltain pllhli..··Iy np("l:lled COIlUllllllilY ha\cd IC!'lidenlial fadlitic\. ur while Ihe rel"irienl resides in a public cmergclll"y sheller for six (6) ('akllll:u IIWIllhs during a uine (<)) mUlllh IX"I iud.

Addiliunal Nules: 1)1 hc miJlimulIl PCf!)UH<IIIlCeds allow::r.III':c-s: R.t"~1 ~ - S"H. B~\'eI ~I ~ san. I.en! Mr. _~2)11i(' limits Oil cuulliable reSUIIICCS; $201»0 for au indiviLlual .lUd S3000 fm ~ l.:(m.p~e

1) Au ('\Sellli,,1 pen,ull u"ceivcs 'SU15

41

1/

2111

..fED STATE

FEOERAL BENEFIT RATE STATE SUPPLEMENTATION RATE COMBINED PAYMENT lEVEL

lfA SUPP. LIVING ARRANGEMENTC~UPLE INDIVIDUAL COuPLE INDIVIDUAL COUPLE

CODE CODE INDIVIDUAL

A A Uvinll Alone 368 553 86 102.. 50 454 655.50

A,C Il Uvinll wilh Olhers 368 553 391 59823 45

(Il) (1') (Living in Household of Anolher Ii) (245.34) (368.67) (268.34) (413.67)--

Level I - .·amily Care

:oj [)SS certified Family Type HomesA C hI 011.111 or OMRDD cerlified Family

Care UOlnes

NYC. Nassau, Suffolk & Weslchesler counties 368 553 248.96 680.92 616.96 1,233.92

ReSI of Siale 368 553 210.96 604.92 578.96 1,157.92

Level II - Residential Care0) [)SS cerlified Adult Care Facilities

A D h) 011.111, OMRDD. or DAAA cerlifiedCommunily Residences. OSAS cerlified ResideDlialSubslance Abuse Trealmenl Programs, and OMUl..'cnified Residential Care eeolers for Aduhs

NYC, Nassau, Suffolk & Weslchesler counlies 368 553 435 1.053 803 1.606

ReSI of Slale 368 , 553 405 993 173 1,546, ,

Level III - Schools ror the Menially Retarded

A E New York CilY 368 553 482.96 I 148.92 850.96 1 701.92

Resl of Slale 368 553 458.96 I 100.92 826.96 1 653.92

[) (i Tille XIX (Medicaid eenified) Inslilulions ~I 30 60 5 )1 10.\1 35 !I 70 )1

A Z (Sec ~I below) 368 553 0 0 368 553

DSS..37fS f

!'CXXl S'I7oHP9<aX1P I..IVINJ BmXZ1' t:lt4f\: EPiECIIVE J»«.tMY 1. 1989

(A!'Plicable for SSI/I<?0I Recipients cnly)

~te_Ma.

Attachment B

LiviJlq Ana; t

_£ Livirq Iiitil Othars Bonltit

_ Yodi: c:t.ty_ rztaz:D&l

!III m-ltc :rs <lI:clUpaadqK m-ltc ~ 0CIdIl LiviJlq~ 0CIdIl ~ 0CIdIl 8BI _it

H/A N/A H/A- . $391.00

U!liel I - FDily care

CHVCMlID certifiedFDily care_

NYC, Nassau, suttolJc ani~_ ot state

I.<Mo1 II - _1<Wltial care

CHVa!RID Cllrtitied Facilityor llSS certified Dlri.d>od lbJsirq

NYC, Nassau, suttolJc ani~Rest ot state

state (CHVCMlID) operatedea-m1ty_~

1528

16,3129,32

17

1515

10,16,1710,16,17

N/A

11

2,42,4

3

$616.%$578.%

$803.00$773.00

$368.00

'!hi tollowirq lU1thly all~ ani a:sta pct&in to e11CJ1bJe~ ot grcup livin;~.

Mini..... "~ all •

I.<Mo1 I-NYC, Nassau, suttolkani~ S71.oo

I.<Mo1 I - _ ot state S71.oo

-,vel II - NYC, Nassau, suttolk) ani lolIIsl:a-tar $81. 00

CHV(]oIROO Cllrtitied Facilityor llSS certified Enriched lbIsirq

U!liel II - _ ot state $81.00CHVCMlID Cllrtitied Facilityor llSS certified D1r1ched lbJsil'q

state (CHVa!RID) operatedCl:IIIall\ity~ $81.00

.... ] caN(:rz:aa. ..",.0;;-

$225.%$187.%

$412.00

$382.00

$0

m-ltc a:.tee

$230.00$230.00

$220.00

$220.00

$197.00

~

~raod P1A§)

$90.00$90.00

$90.00

$90.00

$90.00

'!hi~ to the <lI:clUp la. <q>als tile .......141 ouw c:l<Bts + sheltc + _. '!hi cUont I<sop8 the penIalll1 -_allCMll1Cll + they lIBY klIIlp part ot tM.ir ..-rrwI ar elmwI J.na-.

*!'er.Ialel .- ard/ar _ -=unts lIBY be hiqher at ..- res1don::Be. It SCI, sheltar CXlIIts are~ by the 0lIl<:IJl\tof the d.itt........,. _ the~ _ ani the aet:lJel aIIDJl1t aUa-!.. TataJ. SSI bwetits ani l'I!rs<:rAl care a:stsare not~.

oore: '!hi DIdqet elata tar .-idonts ot I.<Mo1 II CHVCMlID certified ea-m1ty _1don::Be are the....... for residsntsin I:'8<leipt ot SSI/IlSDI that .-ide in I.<Mo1 II lIUthorizad druCJlelo::h>1 tna"-'t tacilitiee.

For residents ot I.<Mo1 II lIUthorizad druCJlelo::h>1 tnabwit tacil1tiee ar onr1ched halsil'q not in I:'8<leipt ot SSI/RSOIother bOOgetinq~~y.

Per.ICIl&l _ Allawmces <_, s) In Noll lledical FacilitiesEffecti_ Jamary 1, 19Bi

Attachment C

Page 1 of 2

AIZtIlorlty I lacility Type O!rt.ityiDq lq!pcy PUMi m SCN4"t?! !l!mthly _

(per penonl

551 $71155L 131-0, Cl:i igIeqate care CSS, eMi, CI1"

IAval I CHllXl HR or AD: $71

Cl:i'31eqate care ass, 011, SSI $811

I.Bval II QI!RID, Cf\AA, orI:SAS HR or AD: $11

18N'icm OOi4L¥te care~1352.8(c) (1) I.av1Il W CHllXl SS1

(ii)

state cporatedMHL 31.29, = or Cl::IIIIlln- CHI CHI cIirect $81

ity Residence payortllt

MHL 33.08 state operated CHllXl 551 or ather $81Cl:ml&Ini.ty ino::DeResiclolnc8

llXlIIl ant Ix:luU net state HR, AIX: or E:AF ~5

siwatiaw certified

rat *ical18N'icm taciliti_ ot:hiIr

HR, AD:, EAF2352.8(c) (1) (i) than Cl:i igIeqate r:ss , t:lAAA, ~5

care~ I, II net state or 551-orW certi!illd, -(inclu:l.l..n; or atherIIllltemity halla,SIwlter torVictimo ofea-ticViolence, ant0Bl'tain privatelIhIIl.ten tortha haIlal_)

l8N'iClR SIwlter tor lES EAF, ~, HR, or $833

900. 17 (a) FmDilies - SS1Tic' II

SSL 194.8 Public~ cporated by a Public Up to $104

city or camty InstitutieraaJ. care

I)

1

2

3

4

'Ibis _ is tM minimJm establislw:! in SCcial SCVi.- taw tor SSI recipients. Arrjino::De~ in~ tM lIIIDIrlt ot a l1ICipient's 551 gIant is inclu::ledas part ot tM _. SSI ciisteqatds tM tirst $20 ot uneatI'll!d ino::De; disreqard.s for&am.t ino::De inclucla tM tirst $65 plus aw-haJ.t ot tM I1!IIlain:Ier. 'lhus, 551recipients tw:eivin; SCcial security benefits will Mve _'s ot $20 III:Inl than thelIIII:UIts noted CIl this chart. Recipients with eil%TlIld in:xme can have significantlylat1;Ier _,s.

A PA !un::Ied RIA is net prcvided to residents ot hospitals or p.iblicly CF='te:lfacilities.

'Ibis allC>olal'lCe is call1ld a "special nellds allC>olal'lCe" an:! awlies CIlly when the Tier. II facility prcvicles 3 II8als a day.

'!he facility can prcvido l1!!IIidents with up to $10 for work petionned by thel1!!IIident.

Pu'8ClIl&l _ All<+& s <_, s) In Mer1j cal I"aciliti....Effective J-.ary 1, 1989

Attachment C

Page 2 of 2

A1Jthorig- !M111 t:y Tmt CtiU.Mm !' "'! 1""" M Satgy! l!c!lth.ly -(!lI1' penc!!!l

SSI .. state '" ($30" 5SSL 209.2-a paymnt $25 SSRlA )

Hospital. ~ofSSL lIMlth (lQ.<l'Ily~366.2 (a) (10), ~ $SO

allowance 6) .

18N'lCRR SSI .. state '" ($30" 5352.8(cl (1) (i) paymnt $25 SSRlA )

NlJrsin; Ia. ~of

$402(SNF, llRF) lIMlth IIR

(lQ.-<Inly persalI1l $SOincidentalallowance 6)

SSI .. SSI state $35 ($30 ..'i suppl....m: $5 state 5

PsydUatric a.I or DMA s.q:pl....m: )CIIII'Il:ar direct(li:IIpital.) , state Payment $30Inpati8l'lt

SSL 209.2-a Ala:Xlclislll (lQ.-<rlJ,y perscraJ. $33.50FacilitY i.ncidointal

allowance 6)

18N'lCRR SSI .. SSI state $35 ($30 ..352.8 (cl (1) (i) , suppl....m: $5 state 5360.5(e) (2) supplElllBnt )

ICl'-IXl's$402

(DlIYaI.~ 0lRI:Xl IIRcent:ar, free-standin:! IeF) (lQ.<l'Ily pBrSalal $33.50

incidentalallowance 6)

SSL 209.3 ~ SSI (footnate7)

Ala:Xlclislll DMA$402Facility (m!' IIR

Medicaid)18N'lCRR (lQ.<l'Ily e::m-

(footnate 7)352.8(c) (1) (i), 'ty~360.5(e) (2) ~)

I)

5

,6

7

SSRlA is the "state SUppl..-ntal PIIr.!Ialal NeBls Allowance" prc:III'id8d to SSIt"Ill;:ipients withcut other incaIle in resiclentiaJ. health care facilities. 55Irecipients residinq in IlBUcal, facilities receive $5 in FecIerally-admini.stered stateSlJt:plementation am, if they reside in a facility licensed by the I:lepartD!nt ofHealth, an additional $20 in state-admini.stered diIect SSRlA payments.

'!he M1l.-<Inly persalI1l incidental. allcwance is the aJIDJl1t of the client's c..'rl incarethat he or she retains for pBrSalal nee:ls Iohile in chronic care status.

sin:e these PI.......aaa are r»t Title XIX certified, an 55I recipient in a privatelyq>erated free-5tan1in; Alc:d>clism Facility IoiOUd receive SSI at the "livirq alone"rate prtlVidold to 55I recipients in the cx:IIIIIJnity. An Ml\-<Inly recipient IoiOUd bel::iudgeted as thcugh he or she IMre ~rarily absent: t'raII his or her residen::e.

OS5-3715 (Ae•. 11181)

SSI BFNUTf U:n:LS' EH,'ECnVE JANUARY 1 1988. . •fED STATE FEDERAl BENEFIT RATE STATE SUPPLEMENTATION RATe COMBINED PAYMeNT LEVEL

UA SUPP. L1\1ING ARRANGEMENTCODE CO" INDIVIDUAl , COUPLE INDIVIDUAL COUPLE iNDIViDUAl COUPLE

A A Living Alone 354 532 71.91 92.53 425.91 624.53

A,C B Livin& wilb Olbers 354 532 371.24 572.5317.24 40.53

(8) (F) (living in Household of Anolher U) (236) (354.67) (253.24) (395.20)

Level I - Family Carea) OSS certified Family Type Homes

A C b) OMH or OMRDO cerlified FamilyCare Homes

NYC, Nassau, Suffolk & Weslchesler counlies 354 532 248.96 673.92 6112.96 1,205.92

Resl of Slale 354 532 210.96 597.92 564.96 1,129.92

Level II - Residential Carea) DSS certified Adult Care Facililies

A 0 b) OMH. OMRDD. or DAAA <enilledCommunity Residences. DSAS ceniticd Rt:SidcmialSubstance Abuse Treatment Programs. and OMHccnificd Residential Care Centers for Adulls

NYC, Nassau, Suffolk & Weslchesler counlies 354 532 400 976 754 1,508

Resl of Slale 354 532 370 916 724 1,448

Level III - Schools for tbe Mentally Retarded

A E New York CilV 354 532 482.96 I 141.92 836.96 I 673.92

ReSI of Siale 354 532 458.96 I 093.92 812.96 I 625.92

D G Title XIX (Medicaid cerlified) Inslilulions ~ 25 50 5 1C lOll 30 J/ 601C

A Z (See ~ below) 354 532 0 0 354 532

!l The "living wilh other::.'· calegory includes the rceipicQI); who:.c: feLicral benefit mt.s been ~cl.luced by the ··value of Y) reduclwn (VTk)" due 10 tbe fc:dc:r.u dclc:fmirullion llual they arc: a) li....iD'in someone die':.; bou~old, and b) rcec:ivinl some amount of bolh free or :IOu~iLCd food and :IOhella' (:IOuppon and maiRlCJuuu::c:). The VTR i:t SliS (or an individWll and sin.)) for acouple.

li Applies when tile recipient :.;pends a fuD calendar month in lhe In:.lilulion iJnd Tille XIX (Medicaid) pays for OIl leibl SO"- of lhe CO:.l of couc.11 RecipieDts in Tillc XIX In:atilulions licensed by lhe NYS Dcp<tnmenl of Ucoahh tcccive <an OIddilional IItant of S20 per monlh caUed Of. Stale Suppl~cntalPenorutl N~ Allowance (SSPNA).

SSPNA check.:.; arc issued directly to the recipient by Ibc: NYS OcpanmcDI of Soc.:i.oal Services.if Applies when the recipient :.;pcnd:lO a full COllendar momh in II priv.ue Tillc XIX Illsttiuliun ..nd Medi..:ilid pay:. for less Ihan SO,.. 01' the CO:.I of care. whell Ihe redpiau resides in cenain public

ly operatcd community based re:.idcntilil facililio. or while Ihe recipient resi..tes in it public emergency sheller ftJr ltuce COlIend.l&r months dunna a 12 mOnlh period.

Addilioaal Nol~ l) The minimum pc:rwmtol need:. allowanco; I.nd I - $00&. Le\'clll • $74. l.nd 111 • $oil2) The 19t18 limit:.; on countable re:.ourm: $1900 for .Iln individUOll and $2150 for" couple) An ~nlial penon rcceivC$ S177

FOOD STAMPSGROUP LIVING BUDGET DATA: EFFECTIVE JANUARY 1,1988


The follOWIng monthly allowances and costs pertam to elIgIble resIdents of group IIvmg arrangements.

Living Arrangement Federal Benefit State Supplement Total Benefit

SSI Living with Others Benefit $354.00 $ 17.24 $371.24

Level I - Family Care OMH/OMRDD CertifiedFamily Care Homes

New York City, Westchester, Nassau &: Suffolk $354.00 $248.96 $602.96Rest of State $354.00 $210.96 $564.96


a. DSS Certified Adult Care Facilities

b. OMH/OMRDD Certified Community Residence

NYC, Nassau, Suffolk and Westchester $354.00 $400.00 $754.00Rest of State $354.00 $370.00 $724.00

c. OMH/OMRDD Operated Community Residences $354.00 $ 0 $354.00

. . . . .

Minimum Personal Personal Care Costs Board*Needs Allowance* (Income Exclusion) Shelter Costs* (Thrifty Food Plan)

Level I - NYC $64.00 $231.72 $220.24 $87.00Level I - Rest of State $64.00 $193.72 $220.24 $87.00

Level II - NYC, Nassau, Suffolk and Westchester $74.00 $382.76 $210.24 $87.00DSS/OMH/OMRDD Certified

Level II - Rest of State $74.00 $352.76 $210.24 $87.00DSS/OMH/OMRDD Certified

Level II - State (OMH/OMRDD) Operated $74.00 $ 0 $193.00· $87.00

The payment to the family caretaker/Level II Director/Level II Social Worker equals the personal care costs + shelter + board. Theclient keeps the personal needs allowance + any additional from other unearned or earned income.

*Personal needs and/or board amounts may be higher at some residences. If so, shelter costs are reduced by the amount of thedifference between the minimum above and the actual amount allowed. Total SSI benefits and Personal Care Costs are not changed.

NOTE: The budget data for residents of Level II OMH/OMRDD Certified Community Residences .are the same for SSI/RSDIrecipient residents of Level II authorized drug/alcohol treatment facilities.

ATTACHMENT CPAGE 1

PERSONAL NEEDS ALLOWANCES (PNA's) IN NON-MEDICAL FACILITIESEFFECTIVE JANUARY 1, 1988

Authority Pacillty 'I)pe Certifying Agency Funding Source Monthly PNA!per person)

Congregate Care OSS, OMH, OMROO SSI $641

Level I HR or AOC $64SSL 131-0,

Congregate Care DSS, OMH, OMROO, SSI $74 1

Level II OAA, or OSAS HR or AOC $74

18NYCRR$471352.8 (c)(l)(li) Congregate Care OMROO SSI

Level ill

State operatedRCCA or Community OMH OMH direct $74

MHL 31.29, Residence Payment

MHL 33.08 State operated OMROO SSI or other $74Community ResIdence income

room and board not State certified HR, AOC or EAF $45situatIons

non-medical18NYCRR facilities other352.8 (0)(1)(1) than Congregate 2Care Level I, OSS, DAAA, HR, AOC, EAF , $45

" or 111 (Including not State certified, or SSImaternity home, or otherShelter tor Vlcttmsof Domestic Violence,ana certain sheltersfor the hom eless)

18NYCRR Shelter for Families ,OSS EAF, AOC, $633

900.17(e) - Tier n HR, or SSI

SSL 194.8 Public Home operated by a Public Insti tu- Up to $10 4

cl ty or county tional Care

1 This PNA Is the minimum established In Social ServIces Law for SS! recipients. Any incomedisregaraed In aetermlnlng the amount or a recipient's 5S! grant is inciuaea as part ot the PN A. 5S!disregards the first $20 of unearned income; disregards for earned income Include the first $65 plus tor the remainder. ThUS, SS! recipients receIving Social Security 'benents will have PNA's of $20 morethan the amounts noted on this chart. Recipients with earned income can have significantly largerPNA's.

2 A PA runded PNA is not provided to residents of publicly operated facilities.

3 This PNA applies only when the Tier II racility provides 3 meals a day.

4 The facility can proviae residents with up to $10 for work performed by the resIdent.

ATTACHMENT C

PERSONAL NEEDS ALLOWANCES (PHA's) IN MEDICAL PACILITIESEPPECTIVE JANUARY I, 1188

PAGE 2

Authority Paclll ty Type Certifying AgencY Pwtding Source Monthly PNACPiir person)

SSL 209.2-a 581 + State Payment $50 ($25 +Department $2558PNA5)

Hospital ofSSL Health (MA-only personal $50366.2(a)(10), incidental allowance6)

18NYCRR 581 + State payment $50 ($25 +352.8 (c)(I)(l) $25 58PNA5)

Nursing Home Department$402(SNF, HRF) of HR

Health(MA-only personal $50incidental aIIowance6)

SSI + SSI State $30 (125 +supplement $5 State

supplement)Psychiatric Center OMH or(Hospital), Inpatient DAAA direct State payment $30Alcoholism Facility

(MA-Only personal $33.50SSL 209.2-a, Incidental allowance6)

18NYCRR SSI + 581 State $30 (125 +352.8 (c)(I)(I), supplement $5 State360.5 (e)(2) supplement)

ICF-DD's'$40 2(Developmental Center, OMRDD HR

free-standing ICF)(MA-only personal 6 $33.50incidental allowance )

SSI (foo 100 te7)SSL 209.3 Free-8tandlng

$402Alcoholism Pacl1lty DAAA HR(FNP Medicald)

18NYCRR (MA-only personal $21.50352.8 (c)(l)(i), incidental allowance6)360.5 (e)(2)

5 58PNA is the State Supplemental Personal Needs Allowance provided to SSI recipients without otherIncome In residential health care facilities. 581 recipients residing In medical facilities receive $5 InPederally-adminlstered Slate Supplementation and, If they reside in a facl1lty ilscensed by theDepartment of Health, and additional $20 In State-administered direct 58PNA payments.

6 The MA-only personal Incidental allowance Is the amount of the cilent's own Income that he or sheretains for personal needs while in chronic care status.

7 Since these programs are not Title XIX certified, an SSI recipient In a privately operated Cree-standingAlcoholism Facility would receive 581 at the "living alone" rate provide to 581 recipients in thecommunity.

0$5·3715 (Re.. 10186) ATTACHMENT A

SSI BENEHT LEVELS: H"'ECTIVE JANUARY I. 1987FED STATE FEDERAL BENEFIT RATE STATE SUPPLEIilENTATlON RATE COMBINEO PAYMENT lEVELLJA SUPP. LIVING ARRANGEMENT

CODE CODE INDIVIDUAL COUPLE INDIVIDUAL COUPLE INDIVIDUAL COUPLE

A A Living Alone 340.00 510.00 71.91 92.53 411.91 602.53

A,C B Living with Others 340.00 510.00 357.24 550.5317.24 40.53

(B) (F) (Living in Household of Another .!L) (226.67) (340.00) (243.91) (380.53)

Level I • Family Care

a) OSS certified Family Type HomesA C b) OMH or OMROD certified Family

Care Homes

New York City 340.00 510.00 243.96 657.92 583.96 1,167.92

Rest of State 340.00 510.00 205.96 581.92 545.96 1,091.92

Level II - Residential CareaJ OSS certified Adult Care Facilities

A D b) OMH. OMRDD. or DAAA certifiedCommunity Residences. DSAS cenified ResidentialSubstance Abuse Treatment Programs. and OMHcertified Residential Care Centers for Aduhs

NYC, Nassau, Suffolk & Westchester Counties 340.00 510.00 395.00 960.00 735.00 1,470.00

Rest of State 340.00 510.00 365.00 900.00 705.00 1,410.00

Level III • Scbools for tbe Menially Retarded

A E New York City 340.00 510.00 482.96 I 135.92 822.96 I 645.92

Rest of State 340.00 510.00 458.96 I 087.92 798.96 I 597.92

D Z Title XIX (Medicaid certified) Institutions 1! 25.00 50.00 l! l! l! l!

A Z (See .1! below) 340.00 510.00 0 0 340.00 510.00

11 The "living with olhers" category includes (he recipients whose federal benefit has been reduced by (he "value of I/J reduclion (VTR)" due to the federal determination that they are: a) livingin someone else's household, and b) receiving some amoum of both free or subsidized food and shelter (support and maimenance). The VTR is 5113.33 for an individual and 5170 for acouple.

Y Applies when the rCX':ipient spends a full calendar month in the Institution and Title XIX (Medicaid) pays for at least SO~, of the cost of care.11 Recipients in certain Title XIX In~litutions (those licensed by the Health Depanmem) receive an additional gram of SIS per month called a State Supplemental Personal Needs Allowance

(SSPNA). The SSPNA check is issued directly 10 the recipiem by the NYS Department of Social Services.!! Applies when the recipiem spends a full calendar month in a privl;ue Title XIX Institution and Medicaid pays for less than 50% of the cost of care, when the recipient resides in certain public~

Iy operated community based residential facilities, or while the recipient resides in a public emergency sheller for three calendar months during a 12 momh period.Addilion.1 Notes: I) The minimum personal needs allowances: Lenl I • SS6. I..evel II • $66. l.evelill • $4S

2) The 1987 limilS on coumable resources: SIIOO for an individual and S2700 for a couple3) An essential person receives 5170 ----



ATIACHMENT B

Living Arrangement Federal Benefit State Supplement Total Benefit

SSI Living with Others Benefit $340.00 $ 17.24 $357.24

Level I - Family Care OMH/OMRDD CertifiedFamily Care Homes

New York City $340.00 $243.96 $583.96Rest of State $340.00 $205.96 $545.96


a. DSS Certified Adult Care Facilities

b. OMH/OMRDD Certified Community Residence

NYC, Nassau, Suffolk and Westchester $340.00 $395.00 $735.00Rest of State $340.00 $365.00 $705.00

c. OMH/OMRDD Operated Community Residences $340.00 $ 0 $340.00


Minimum Personal Personal Care Costs BoardNeeds Allowance* (Income Exclusion) Shelter Costs (Thrifty Food Plan)

Levell -NYC $56.00 $226.72 $220.24 $81.00Level I - Rest of State . $56.00 $188.72 $220.24 $81.00

Level II - NYC, Nassau, Suffolk and Westchester $66.00 $377.76 $210.24 $81.00DSS/OMH/OMRDD Certified

Level II - Rest of State $66.00 $347.76 $210.24 $81.00DSS/OMH/OMRDD Certified

Level II - State (OMH/OMRDD) Operated $66.00 $ 0 $193.00 $81. 00

The payment to the family caretakerlLevel n DirectorlLevel II Social Worker equals the personal care costs + shelter + board. Theclient keeps the personal needs allowance + any additional from other unearned or earned income.

*Personal needs amounts may be higher at some residences. If so, shelter costs are reduced by the amount of the difference betweenthe minimum above and the actual amount allowed. Total SSI benefits and Personal Care Costs are not changed.

NOTE: The budget data for residents of Level II OMH/OMRDD Certified Community Residences are the same for SSI/RSDIrecipient residents of Level n authorized drug/alcohol treatment facilities.

-,

ATrACHYENT C

PERSONAL NBBDS ALLOWANCES (PNA) Effective January I, 1987

Facility Type CerllCying Agen", PundIng Seuree Monthly PNA

Congregate Care DSS, OMH, OMRDD SSI $56·L.vell HR $56

,Congregate Care DSS, OMH, OMRDD, SSI $66·

Level II DAAA, DSAS HR $66

Congregate Car. OMRDD SSI $45·Lev.11II

Title XIX D.partm.nt SSI $25 + $15 SSPNA •• (Withoutother income) I

(Medicaid of HR··· $40

Certified) Health MA-Only $40 (with other Incom.)Income exemption

Facilities

OMH, SSI $25 (without other income)

OMRDD, or HR··· $40

DAAA MA-Only $28.50 (with other Income)Income exemption

Room and Board DSSSituations andNon-Medical HR orFacilities oth.r or ADC $45than CongregateCare I"evel J,II or III Uncertified

Public Hom. Operated by a PUblic Instltu- Up to $10•• ••City. or County tlonal Care

• This PNA Is the minimum established in Social Services Law for SSI recipients. Any incomedisregarded in determining the amount of a r.ciplent's SSI grant is Included as part of the PNA. SSIdisregards the first $20 of unearned Incomel disregards for earned Income include the first $65 plus Iof the remainder. Thus, for .xampl., SSI recipl.nts rec.lvlng Social Security benefits will have PNAof $20 more than the amounts noted on this chart. Recipients with earned Income will havesignificantly larger PNA•

•• SSPNA Is the State-administered State Suppl.menlel Personal N.eds Allowanc. provided to certain SSIrecipients without other Income In resid.ntlal health care facilities as d.fined In Artlcl. 28 of thePublic Health Law•

••• An HR funded PHA Is not provided to residents of hospitals or pUblicly operated facilities.

··.·Th. facility can prOVide the resident with up to $10 for work performed by the resld.nt.

(Revised Octob.r 1986, Bureau of Income Support Programs)

Attachment A055·3715 (111851

SSI BENEFIT LEVELS' EHECnVE JANUARY 1 1986. ,FED STATE FEDERAL BENEFIT RATE STATE SUPPLEMENTATION RATE COMBINED PAYMENT LEVEL

LJA SUPP. LIVING ARRANGEMENTCODE CODE INDIVIDUAL COUPLE INDIVIDUAL COUPLE INDIVIDUAL COUPLE

A A Living Alone 336.00 504.00 71.91 92.53 407.91 596.53


(B) (F) (Living in Household of Another JL) (224.00) (336.00) (241.24) (376.53)


a) DSS certified Family Type HomesA C b) OMH or OMRDD certified Family

Care Homes

New York City 336.00 504.00 123.96 415.92 459.96 919.92

Rest of State 336.00 504.00 85.96 339.92 421.96 843.92

Level II - Residential Carea) DSS certified Adult Care Facilities

A D b) OMH. OMRDD. or DAAA certifiedCommunity Residences and, DSAS certifiedResidential Substance Abuse Treatment Programs

NYC, Nassau, Suffolk & Westchester Counties 336.00 504.00 395.00 958.00 731.00 1,462.00

Rest of State 336.00 504.00 365.00 ·898.00 701.00 1,402.00


A E New York City 336.00 504.00 482.96 I 133.92 818.96 I 637.92

Rest of State 336.00 504.00 458.% I 085.92 794.96 I 589.92

D Z Title XIX (Medicaid certified) Institutions 7-1 25.00 50.00 !I ~J J...! J...!

A Z (See ~ below) 336.00 504.00 0 0 336.00 504.00

.!.! The "living with others" category includes recipients whose federal benefit has been reduced by the "value of VI reduction (VTR)" due to the federal determination that they are: a) living insomeone else's household, and b) receiving some amount of both free food and freesheher (support and maintenance). The VTR is $112 for an individual and $168 for a couple.

11 Applies when the recipient spends a full calendar month in the Institution and Title XIX (Medicaid) pays for at least 500/0 of the cost of care.li Recipients in certain Title XIX Institutions (those licensed by the Health Department) receive an additional grant of $15 per month called a State Supplemental Personal Needs Allowance

(SSPNA). The SSPNA check is issueq directly to the recipient by the NYS Department of Social Services.!.! Applies when the recipient spends a full calendar month in a Title XIX Institution and Medicaid pays for Ies.~ than 50% of the cost of care, or when the recipient resides in certain publicly

operated community based residential facilities.Addition..1 Notes: I) The minimum personal needs allowances: Level I ~ 553. tenl II - 563. l.evel III - $42

2) The 1986 limits on countable resourc~: $1700 for an individual and $2550 for a couple3) An essential person receives $168

Attachment BRXJ)--.;,fJ\MPS

GJUJP L:IVIR; BOI:XiET MTA· f)."f ECrIVE J1\Nt1ARY 1,. 1986.{l\o:)licnblc for '~;I/T"$nI Hccinicnts OnlY'

." .LiviIn enelt Federal Benefit State SUDPlement. Total Benefit .

SS1 Living with Others Benefit $336.00 $17.24 $353.24

Level I - Fanily CareCMi/CMRDD Certified Fanily care

Hanes

New York City $336.00 $123.96 $459.96P,est of State $336.00 $ 85.96 $421.96

Level II - Residential CclrQ.

8. DSS Certified Mult CareFacilities

b. Cfti/CHm ~ied C011IImityResidence

NYC, Nassau, SUffolk andWest.Oilester $336.00 $395.00 . $731.00

Rest of State $336.00 $365.00 $701.00

c. CHi/CMEIDD Operated CamunityResidences $336.00 0 $336.00

'!tie followiJ'q monthly allC7w'anCeS and costs pertain to eligible res~ts of group living .arrangements.

Board('Ihrif~ Foo:l Plan)

80.00S80.00

$80.00

9lelter Costs$220.24$220.24

S210.24

PerSCl'lal Care Costs(Incc:ne Exclusion)

$106.72$ 68.72

S377.76

HinimlJn Persa1alNeeds Allowance·

$53.00$53.00

$63.00

Levell-NYCLavel 1 - Rest of State

Level II - NYC, NassauSuffolk. and Westchester

IES/CMi/CMIDO Certified

Level II - Rest of StateDSS/OMH/OMRDO Cer.tified $63.00 $347.76 $210.24 $80.00

Level.OpeII - State (Olll/a-moo) $63.00 0 $193.00 $80.00rated"'l1le payment to the family caretaker/Level n Director/Level II Socia] Worker equals the persala1 care costs + shelter + toard.'Itle client keeps the personal needs allcwarx:e + any additional fran other unearned or earned incane. .

*Personal needs atUlDlts may be higher at SCIre residences. If so, shelter costs are reduced by the amJUnt of the differerx:ebetween the minim.m above and the acbla1 arrount allowed. Total SSt benefits am Personal Care Costs are not cJ1arxJed.N(m:: The budget d."lta for residents of Level II CMl/Ct1RDD Certified Carrm..mity Residenc:es are the sarrc for SSI!R.SLH

n ..'Cipicnt residents of Level II authorized drug/alcchol treatment facilities.

)

)

)

Attachment C

PB!lSO!lAL IiKI!DS Ai.LowANCBs (PNl\' D) BPPEC'l'IITB JANUARY I, 1986

paeili t Y 'I'ype Certifying Agency Fundiog Source Honthly PNA

Congregate Care DSS, OMH, OMRDD SSI $53*Level I HR $53

Congregate Care DSS, OMH, OMRDD SSI $63*Level II DAM, DSAS HR $63

.'

Congregate Care OMRDD SSI $42*Level III

Title XIX Department SSI $25 + $15 SSPNA** (withoutother income'-

(Medicaid of HR·'· $40

Certified) Health WI-Only $40 (with other income)income exemption

Facilities

OMH SSI $25 (without other income)

or HR·" $40

OMRDD WI-Only $28.50 (with other income)income exemption

Room and Board DSSSituations andNon-Medical HR orFacilities other or ACC $45than CongregateCare Level I,II or III Uncerti f ied

Public Home Operated by a Public Institu- Up to $10****City or County t.iona! Care

·This PNA il the minimum established in Social Services Law for 55J recipients.Any income disregarded in determining the amount of a recipient's 55l grantis included AS part of the PNA. 551 disregards the first $20 of unearned income;disregards for earned income include the first $65 plus 1/2 of the remainder.Thus, for example, SSI recipients receiving Social Security benefits willhave PNA's of $20 more than the amounts noted on this chart. Recipients withearned income will have significantly larger PNA's.

··SSPNA is the State-administered State Supplemental Personal Needs Allowanceprovided to certain SSI recipients without other income in residential healthcare facilities as defined in Article 28 of the Public Health Law.

··-An HR funded PNA is not provided to residents of hospitals or pUbliclyoperated facilities.

e···The facility can provide the resident with up to $10 for work performed by theresident.

(Revised November 1985, Bureau of Income Support)

:S:S1 .IS.tJ'I!UIT L~Ya:s: t;1"l..t;l:;nV~ lan~ 1,1985FED STATE FEDERAL BE"EAT RATE STATE SU?P!.EMEtoTATION RATE COMBl"ED PAVlolEtoT LEVELUA SUPP. UVlHG AIlRANGElolEtoT

CODE CODE IND. COUPLE IND. COUPLE IND. COUPLE

A A Living Alone 325.00 488.00 60.91 76.03 385.91 564.03


(B) (F) (Living in Household of Another Jl) (216.67) (325.34) (224.91) (352.37)

Level I • Family Carea) DSS Certified Family Type Homes

A C b) OMH or OMRDD Certified FamilyCare Homes

New York Citv 325.00 488.00 123.96 409.92 448.96 897.92

Rest of State 325.00 488.00 85.96 333.92 410.96 821.92

Level II • Residential Carea) DSS Certified Adult Care Facilities

A D b) OMH, OMRDD, or DAAA CertifiedCommunity Residences

New York City & Nassau County 325.00 488.00 324.86 8n.72 649 •.86 1,299.72

Rest of State 325.00 488.00 294.86 751.72 619.86 1,239'.72

Level In . Schools for the Mentally Retarded

A E New York City 325.00 488.00 482.96 1,127.92 807.96 1,615.92

Rest of State , 325.00 488.00 458.96 1,079.92 783.96 1,567.92

D Z Title XIX (Medicaid Certified) Institutions 1! 25.00 50.00 1.1 1.1 1.1 1.1

A Z (~ ~ below) 325.00 488.00 0 0 325.00 488.00

U The "living wilh Glhers" category includes rc.::picRls whose federal benefit bas been reduced by !he "value of !IS reduction (VTR)" due 10 the faJera! determination that (bey ar~: aJ livid;in som.:one else's household. ar.d b) receiving some amouId of both Crcc food and f,ce ,het'ef (suppurt and maintenance). The VTR is 'It/i.33for an. individual turtdJ/1.2. '6foe • coup&c. '

2.1 Apf'llio. when the redpienl spends a full ~alcndar month in abe IMi.itution 3Gd Title XIX (Mc;licaidl pays for 181 ktut sotr, or the cost of care.11 Rcdl)icnts in ccr13in Tit1C' XIX IrwitUlions (lhose licensed by lhc Health Dcp;.tnment) receive ..n additional pant of SiS per montb c:aUcd a Slate Supplemental Penc.lRI1 Needs Allowance

(SSPNA). The SSPNA check. is issued directly to the recipient by the NYS Department of Social Services.Y Apl'!ics "'ben the recipient spends a full calendar monlh ill a Tille XIX tnsli.u!ioo and Mediaaid pal~ for '- _ SO~ of Ihc 00it or care, or "hen Ihc recipi<ilt resides in cerlain publi<:ly

operated communilY ba.cd residential facili'ics. $36 23AddilloMlNoru: I)Themill;mumperso... ncedsallow= for Level I: $46.58; for Level II: $56.93; for:reve1 III: •

2) An essential person receives $163.00

'~

1. 1984S5I BENEFIT LEVELS: EFFECTIVE Januar'FED SYAYE FEDERAL BENEfiT HATE STATE SUPPLEMENTATION HATE. COMBlrJl.J) rAy~..~[l-H lE'.'rL

UA SUPP. LIVING ARRANGEMENTCODE CODE IND. COUPUE IND. COUPLE IND. COUPLE

A A Living Alone 314.00 472.00 60.91 76.03 374.91 548.03

A,C B Living with Others 314.00 472.00 I 322.24 499.038.24 27.03

(B) (F) Living in Household of Another 1-") (209.34) (314.67) (217.58) (341.70)

Level I . Famiiy Care I

a) DSS Certified Family Type Homes IA C b) OMH or OMRDD Certified Family

Care Homes

New York City 314.00 472.00 123.96 , 403.92 437.96 i 875.92

II

Rest of State 314.00 472.00 85.96 327.92 399.96 799.92

Level II . Residential Care

Ia) DSS Certified Adult Care FacilitiesA D b) OMH, OMRDD, or DAAA Certified

Community Residences

New York City & Nassau County 314.00 472.00 324.86 805.72 638.86 1,277.72

Rest of State 314.00 472.00 294.86 745.72 608.86 1,217.72

Level HI - Schools for the Mentally Retarded

IAE New York Citv 314.00 472.00 482.96 1 121.92 796.96 U93.92

Rest of State 314.00 472.00 458.96 1 073.92 772.96 1 545.92I I

D Z Title XIX (Medicaid Certified) Institutions .Y) 25.00 50.00 1.1 1.1 l.! 1.../

A Z (See :! below) 314.00 472.00 0 o . 314.00 472.00

li Th~ "living wilh others" category includes rc.::pkms whose federal bendi! has been reduced by lhe "v:lluc of 'l) rc:t.luc!ion (VTR)" due:: to the feJeral ddcrmina:ion Ih~t th~·y :Jfl:: a) livingin ~omNnc else's bOlischolJ. and b) receiving some amount of bOlh free food ..nd free ~hd[cr (support ..nd m:linfcnance). The VTR is $104.66 for an individual and $157.33 for a co'-!plc.

li Aprli('~ when the recipient spends a full calc-odar month in lhe Institution and Title XIX (Medicaid) pays for at least 500/0 of the cost of care.11 Recipients in certain Tille XIX Institutions (those licensed by the Health Department) receive an <tdditional grant of $15 per month called a State Supplemental Personal Needs Allowance

lSSPNA). The SSPNA check is issued directly to the recipient by 1he NYS Department of Social Services.±! Applies when the recipi~nt spends a full calendar month in a Title XIX Institution ant.! Medicaid p:lys for Jess than 50% of the cost of care, or when the recipient resides in ccrt,lin publicly

operated community ba:.eu rcsidenti:ll facilities.

Additional Notes: 1) Thc minimum personal needs allowancejor LpveJ J Is· $45 jor LevellJ • $55 and Level JJI. $15.2) Ar. e~sential person receives $157.00.

-i

SSI BENEFIT LEVELS: l. iECTIVE 'uly 1, 1962)'ED STATE FEDERAL BENEFiT RATE STATE SUPPLEMENTATION RATE COMBINED PAYM.ENT LEVEL

UA SUPP. LIVING ARRANGEMENTCODE CODE iND. COUPLE IND. COUPLE IND. COUPLE

A A Living Alone 264.30 426.40 63.21 79.46 347.51 505.66

A,C 8 Living with Others 264.30 426.40 294.64 456.6610.54 30.46

(8) (F) (Living in Household of Another.Y) (169.54) (264.27) (200.06) (314.75)

Level I· Family Care

a) DSS Certified Family Type Homes

A C b) OMH or OMRDD Certifiad Family CareHomes

New York City 264.30 426.40 126.26 394.72 410.56 621.12

Rest of Stale 264.30 426.40 66.26 316.72 372.56 745.12

Level n . Residential Care

a) DSS Cartified Adult Care Facilities

A D b) OMH, OMRDD, or DAAA Certified.Community Residences

,New York City & Nassau County 264.30 426.40 327.16 796.52 611.46 1,222.92

Rest of Slate 264.30 426.40 297.16 736.52 561.46 1,162.92

Level III • Schools for the MentaDy Retarded

A E New York City 264.30 426.40 485.26 1,112.72 769.56 1,539.12

Rest of Siale 264.30 426.40 461.26 1,064.72 745.56 1,491.12

D Z Title XIX (Medicaid Certified) Instilutions 11 25.00 50.00 ~ ~ :JJ :JJ

A Z (See JI below) 264.30 426.40 0 0 284.30 426.40

IJJ The "living with others" category includes recipients whose federal benerit has been reduced by the "value of 1/3 reduction (VTR)" due to the federal determination that they are: a) living in

someone else's household, and b) receiving some amount of both free food and free shelter (support and maintenance). The VTR is $94.76 for an Individual and $142.13 for a couple.11 Applies when the recipienl spends a full calendar month in the Institution and Title XIX (Medicaid) pays for all 'ea.' 50% of the cost of care.11 Recipients in certain Title XIX Inslitulions(those licensed by the Heallh Deparlment) receive an addilional grant of $15 per month called a Stale Supplemental Personal Needs Allowance

(SSPNA). The SSPNA check is issued directly to the recipient by Ihe NVS Deparlmenl of Social Services..§ Applies when the recipient spends a full calendar month in a Title XIX Institution and Medicaid pays for 'e•• llhan 50% of the cost of care, or when the recipient resides in certain publicly oper-

aled community residences which serve no more than 16 residents (Keyes facilities).Addllllona' I'folle.: 1) The minimum personal needs allowance Ifor Level I Is $40. for Level II • $50 and Level III • $30.

2) An essential person receives $142.50.

SSI BENEFIT LEVELS: _ EFFECTIVE July 1, 1981

f~d IStateL/A Sup!,.

,Federal Benefit State Supplement Total llenefit

~ Code Living Arrangement .!!!.!!:.. Couple Ind. Couple !nd. Co"ple

A I A Living Alone 264.70 397.00 63.21 79.411 327.91 476.48I1.,1: B Living witb Otbers 264.70 ~97.00 275.24 427 .48

------------------------- 10.54 30.48iii IF UVing in ilousebold of Another" 176.47 264 .67 187.01 295.15

Level I - Family Care ,a) DSS Certified Family Type Homes and

I

IFoster Care for Adults

b) OMH-OKRDD Certified Family Care HomesA C

IN"", York City 264.70 397.00 126;26 384.92 390.96 781. 92

.ReSt of Stste 264.70 397.00 88.26 308.92 352.96 705.. 92

! Level II- Residential Care,a) DSS Certified Residential Care

!il. D Facilities for Adultsb) OKII-QMIUlD Certified eo.......nity

Residences.._-_..

New York City & Nassau 264.70 397.00 327 .16 786.72 591.86 1,183.72

-r Rest of State 264.70 397.00 297.16 726.72 561.86 1,123.72. - ...

Level III - Scbool for tbe "entally Retarded.

It. I Ii"'" York City 264.70 ~97.00 485.26 1,102.92 749.96 1,49Q.92IE . .

Rest of State 264.70 397.00 461.26 '1,054.92 725.9& ,l,4.S1,92m ~"~

l) Z Title XIX Institution.... 25.00 50.00 0 0 I 25.00 50.00- ==="-"

ollot a ""parate State Payment Level (SFL). Refers.t9 Deople receiVing both support and maintenance (food and e~ltef) tiboee: feceral benefite ~ve been reduced by one-tbird. .~~A federal benefit of $264.70 for individuals or $097.00 for coupl"" -applies to priv. fac. where Title XIX pay" lees t~n

~O percent of the coet of .care or when the people reside in a public community residence with a capacity of 16 or leee,Theae situations are rare and involve no State supplement.

~!ll'l:IOWl.L ~Iill 1) IlUnilllwll persollal neede ll110wence for Level 1 $36 , Level II $47, Level III $30.2) Essential Derson receives $ 132,60

SSI BENEFIT LEVET-· EFFECTIVE JULY 1, 1980

rea ~tate

L(A Supp. Federal Benefit State Supplement Total BenefitCode Code Living Arrangement Ind. Couple Ind. Couple Ind. Couple

,

A A Living Alone 238.00 357.00 63.21 79.48 301.21 436.48;

A,C B Living with Others 238.00 357.00 248.54 387.48------------------------- 10.54 30.48B F Living in Household of Another* 158.67 238.00 169.21 268.48


a) DSS Certified Family Type Homes andFoster Care for Adults

b) OMH-OMRDD Certified Family Care HomesA C

New York City 238.00 3:>7.00 126.26 356.62 364.26 713.62

Rest of State 238.00 357.00 88.26 280.62 326.26 637.62


a) DSS Certified Residential CareA D Facilities for Adults

b) OMH-OMRDD Certified CommunityResidences 238.00 357.00 257.16 618.42 495.16 975.42

Level III - School for the Mentally Retarded

New York City 238.00 357.00 485.26 1,074.62 723.26 1,431.62A E

Rest of State 238.00 357.00 461.26 1,026.62 699.26 1,383.62

D Z Title XIX Institution** 25.00 50.00 0 0 25.00 50.00

*Not a separate State Payment Level (SPL). Refers to people receiving both support and maintenance (food and shelter) whosefederal benefits have been reduced by one-third.

**A federal benefit of $238.00 for individuals or $357.00 for couples applies to priv. fac. where Title XIX pays less than50 percent of the cost of .care or when the people reside in a public community residence with a capacity of 16 or less.These situations are rare and involve no State Supplement.

ADDITIONAL NOTES: 1) Minimum personal needs allowance for Levels I and III is $10.00, for Level II, $33.332) Essential person receives $119.20

~SSI BENEFIT LEVEL~ EFFECTIVE JULY 1, 1979

~

FedL/ACode

StateStIpp.Code Living Arrangemmt

Federal BenefitInd. Couple

State SupplemmtInd. COuple

Total Benef:::tInd. Couple

A I A Living Alone I 208.20 312.30 I 63.21 79.48 271.41 391. 78 ..

A,C B Living Witll Others 208.20 312.30. 10.54 30.48 218.74 342.78-- ~ . - - - - -. - - - - - - - - - - - - - - -- ----------

B F Living in Ibusehold of Another" 138.80 208.20 10.54 30.48 149.34 238.68


a) DSS Certified Family Type Hares andFoster Care for Adults

A C b) CMl-<:MEIDD Certified Family care Hares

New York City 208.20 312.30 126.26 356.62 334.46 668.92,.

Rest of State 208.20 312.30 88.26 280.62 296.46 592.92 ;.-

Level II - Residential Care /(a) DSS Certified Residential Care

A D Facilities for Adults,.

b) CMl-a1RDD Certified camumity;/,

Residences 208.20 312.30 257.16 618.42 465.36 930.77

I , ..-Level III - SChool for the Mentally Reta...-ded

/

A E New York City 208.20 312.30 485.26 1,074.62 693.46 i,3S6~92

Rest of. State 208.20 312.30 461.26 1,026.62 669.46 1,333.92

D Z Title XIX Institution** 25.00 50.00 0 0 25.00 50,,00

*Nos a separate State Payrrent Level (SPL). Refers to people receiving tot.1} support and maintp..nance (foed and sh=lte:d wmsefederal benefits have been reduced by one-tllird. .

**A federal benefit of $208.20 for individuals or $312.30 tor couples applies to priv. fac. Where Title,XIX pars les~ ~!1an50 percent of the cost of care or when the people :reside in a public ccm:nunity residence witll a capac~ty of .1.6 or l.ess.These situations are rare and involve no State Supplement.

ADDITIONAL NOTES: 1) Mininn.lm personal needs allcr"ance for Levels I a..'1d III is $10.00, for Level II, $29.L.2) Essential persons rer-...eive $104.20.

581 13J::NEEIf U:.VELS: EfFEc:nVE JULY 1, l~ It>

Fed State.L/A Supp.

-- ~~ Living Arrangerrmt Fedcla1 !\endit State Supplcncnt Total Benefit

Ind. Couple Ind. Couple Ind. Couple

A A Living Alone 189.40 284.10 60.85 75.% 250.25 360.04

~,C B Living With Others 189.40 2811.10 8.18 26.94 197.58 311.04

B F Livi.n2 in Household of Another 126.27 189.40 8.18 26.94 134.45 216.34

Level I Family Care

a) Family Jype Hare.

"- b) foster Care for AdultsA C

c) Family Care IIcm~

New York City 189.40 281dO 123.90 Y,2.50 313.30 626.60

Rest of State 189.,,0 28/+.10 85.90 266.50 275.30 550.60

Level II Residential Care

a) DSS Certified FacilitiesA D for Mults 189.t.O 284.10 254.80 6Ot1.30 41"1.20 888.'.0

b) Ccmnmity Residences

Level III School for the }lentallv Retarded

New York City 189.t10 28/1.10 482.90 1.060.50 672.30 134'1.60

A E Dutcl1ess, Orange, Ulster, . _.Sullivan ·<Jnd Westchester 189.1,0 281.•. 10 458.90 1,012.50 (/,8.30 1296.60

Rest of State 189J.0 281+.10 lf13.90 382.50 333.30 666.60-D Z Title XIX Institution 25.00 50.00 0 0 25.00 50.00

-_/

2 includes $1~ Personal Needs AllowanceJ _. z . 5 .~:z .. t Ji .D.3ie,,,:,~,:,,,±:~

Federal Op. StateL/A Supp. -

Living ArrangementCode Code

Federal Benefit State Supplement Total 5S Benei '.t 'Ind. Couple Ind. Couple ~nd. Cc lple-- --

Living Alone A A 177.80 266.70 60.85 75.94 2;;8.65 Y 2.64

Living with Others A,C B 177.80 266.70 8.18 26.94 1t 5.98 29>.64

I

Living in Household of Another B F 118.,54 177.80 8.18 26.94 126.72 20 '.74i

Level I Family Carea} £'amily Type Home A Cb) Foster Care for Adultsc) Family Care Home New York City 177.80 266.70 123.90 3;;6.70 301.701 60 .401

--Rest of State 177.80 266.70 68.90 2;~70 246.701 49. _.401

Level II Residential CareBSW Certified Homes for Adults & A D 218.90 526.70 396.701 791.401

Community J:esidences 177.80 266.70*226.90 *542.70 I *1+04.702 *80 '.402

!

Level III School for the iMentally Retarded A E

New York City 177.80,

660.701 1,32' .401266.70 482.9C 1,054.70i _..- -----

Dutchess, Ora~ge, Ulster,177.80 266.70 458.90 1,006.70 636.701 1 21' 401

Sulliva~ and Westchester ' -'

Rest of State 177.80 266.70 143.90 376.70 321.701 643.401

.. Title XIX Institution D Z 25.00 50.00 0 0:\

25.00 50.00-

~~

t1 includes $1q Personal Needs Allowance] SSI Benefit Levels: effective July 1, 197? (*Effective Oct<)ber 1 1977)

~

',:.:' J(:

);.54

"') r'..L_ .. ,) ••

~

Tot. a1 S; 1.r',,",":' r·.~.

;;".,; ;' > :> ..l,'

State<".uDnlemer.t

L,' ',it'l.:; (,:. _ ..

"'cceral Ben~fit

~ j ~ ,; " . ,~,.....-."

~ ) ..FederalLivingArraneemontCorle

zF

OptionalI>ivin('c~rran,;ement__ _SllPP. Code*

. ~t-\,':li~': .,t,-~i'

.,. T;('35. •... i::-.."1 97:, in t:1(; SDX

Title Xrl Institution

Livi:1g in the ;:ome of Others

'J.l.'1

1 1"1 .,-'Rest of State CA.! 167.80 i 251.80 I 613.901221.60 2.36.70 I:}.~'J.40

:R.es:r:'-':'}~~l C;;re for Nentallv Disabled D A i 167.80! 251.80 '218.')0 j 521.60 : 3867177).-~,-o-_:Ealf-:';8Y Heu se ; jiiost~l j 1!fIS B0a.:d. of ?oeial \'!elfare I ;!

Cert~f~ed domes I: : ,Co~~~~ty Residence ! j ;, I' , I

Residential Treatr:l"lnt Ii! iR":sid~:1tial Treatme::lt I: !F~cility fer Mentally Disabled i' : i :. I' 'I J

l 'e',' Ye~'K C"t'r ~'l'N80; 2-1 ",) I';>') c'" 1049 60 ! ',,~ 7,11 "0" /- :'.n...... ..... i:!.I.'1.! 1)(. ! )"'(;;'14u '<-./V

1

. I O",lv •• L:j-l ... " ..L' i

----------------1 I I '--iDJ.tchr,ss, Orar."e, Ulster, ! I I Ii_ ;Sullhan & "festchester E A I 167.8(, I 2;;1.80 1,58.90 11001.60 : U6."0 ,1;'53.1.(1 !__., '__ ~j .L ._/l( , ... (_:~.... '.... \ I 1'"7 "'0 ')'1 8J 1"~ 0.1 .... ·71 60 ~'l "":""\1 -'~'J ! "\. esr. OI 'ov"ve ~ J I v.v: _;. ",). /'- ,). ; .~'"- oIc,: c~..-'.~lJ I

I I "-- ----...,..-- ......... - ---,---- IB 'Lcl.87: 167.81 6.78 24.81 i ES.65!_:9~.68 1

D 25.0°: 50.00 0 o! :25.C<:!- 5;).00

Ii j I i -I! , I I

. -Ind. I I CauDle 1 !r.'i. - rCouple I Ind.

i,

Living Alon~ A A 1.67.80 251.80 50.75 60.74 ~, 3 5- I!

.::..... .. , I, l.- >---,

107 .. 8;) !L" TJ/Ot· B A,C 167.80 ! 251.80 11.74~Vl.r.g _. tler:; -, , ,,

Fcmil;r Care

I,

, I, iFcmi1y T~~e Home ,roster Car;:) for Adults

I i j

:ra.'TIily C'l.re Home .1:,

:'Jet-: !~ Jrk 8ity C A 'I 167.80 , 251. 80 1123. 'it) ;:31.60 291.70 ' ;:~,

/"it.·.·· ..··:? .. 'r:, !\ ---- .... .:~-....l ;'v(:l:;::::r j!; . )~ .. ' .. ' \

" \.;" r : _.j I .:., ......

I,ivinr: Arral1f,ementOptional

Sunn. Code*

Fedcrol •LivingArrc-TLge-mentCode Fed~rel Benefit

State')1~np1c:ncnt

Total :)5:B('I~I~:iJ-

.~

~

Ind. Couple ~ Couple ~. r:~C:2;~ ILii.."ing Alene A A 167.80 251.80 60.35 75.94 228.65 I 3'.27.74 I,

Living \·/Iathers B A,C 167.80 251.80 8.18 26.94- 175.98 I 278.'74,I,

IFa::1ilv Ca,e IF~~ily Type Home IFQst<:r Care for Adults IF"':1ily Care Home

!~c'l-l York City C A I 167.30 I 251.80 123.90 331.60 291.70 I583.]J) ,,

Rest of State C A 167.80 I 251.80 68.90 1221.60 I 236.70 1:73.40

Resi-:,::,tiBl O"-:-e for Hentallv Disabled D A I 167.80 251.80 218.90 : 521.60 I 386.70 773.1,0

E~lf-1':ay Hm.J.seHostellrIS ucard of Social Welfare

Certified Homes

ICorrmunity Residence .Resi~8ntial Treatment I

P.esid~~tial TreatmentFacility for Mentally Disabled

IHeH York City E A I 167.80 251.80 482.90 1049.60 650.70 1301.1.0

. 1

,Dutchess, Or~~ee, Ulster,

251•80 1458.9011001.60I I

626.7012.253.1,0SulliV<;J1 &. \';cstchester E A 167.80 I I,

~G7.80 I 251.801143.90 371.60 311·'l'l6?3.~Rest of State E A I !- ,""0 OJ --:;;. ",

,111.87 1

, ,Livi~g i~ the Bv~e of others F B I 167. 871 8 lSi 26.9!J. \• I --...:... .. -1 .;,. ;..:.. C.l.

Ti'Lle XI:{ L.--:zti.tution Z D I 25.0°) 50•0°1 oj ° 25.001 50.00- ~'- """1_ ..... .:: ... ..:; ..... ,.., C(7;. i_n the SD..'{ I --, I I r'~I I I

Documents

SSI/SSP Benefit Levels Charts - Empire Justice Center