S.C. Code Regs. § § 126-920

Current through Register Vol. 48, No. 10, October 25, 2024

Section 126-920 - Eligibility

A. An individual must meet the following requirements in order to be eligible for OSS benefits:

(1) Be a resident of the State of South Carolina;

(2) Has been determined by the Social Security Administration (SSA) or by the State in accordance with applicable SSA criteria to be aged, blind, or disabled;

(3) Has countable resources that do not exceed the eligibility limitations for resources set by the federal Supplemental Security Income (SSI) Program;

(4) Meets one of the following four conditions with respect to countable income:

(a) Receives an SSI payment, which when combined with other countable income gives the individual total countable income that is less than the applicable net income limitation of the OSS Program; or

(b) Receives countable income that exceeds the SSI payment standard, but is less than the applicable net income limitation of the OSS Program; or

(c) Receives countable income that is less than the SSI payment standard and has applied for SSI benefits; or

(d) Receives countable income that is less than the SSI payment standard, but has not applied for SSI benefits or has been denied SSI benefits for the sole reason that the community residential care facility in which the applicant resides is considered by the SSI Program to be a public institution;

(5) Meets all other eligibility criteria to receive benefits under the SSI Program, with the allowable exception of meeting a condition described in (4)(b) or (4)(d) above;

(6) Resides in a community residential care facility that has executed a "Facility Participation Agreement for the South Carolina Optional State Supplementation (OSS) Program" with the Department of Health and Human Services; AND

(7) Has applied for all benefits, public or private, to which he or she may be legally entitled.

B. When both members of a couple reside or wish to reside in a community residential care facility and apply for benefits from the OSS Program, the eligibility determination process shall treat both members as individuals beginning in the month of admission to the community residential care facility, even if both members occupy the same room.

C. Under the terms of a contract between the Department of Health and Human Services and the Department of Social Services (DSS), determinations of OSS Program eligibility are conducted by the county DSS offices. An individual seeking OSS benefits must file an application with his or her county DSS office. Changes that might affect the eligibility of an individual or a couple must also be reported to the county Department of Social Services.

D. OSS Program eligibility shall be re-established every twelve (12) months, or more frequently as may be necessary.

E. Changes that might affect the eligibility of an individual or a couple must be reported to the Department of Social Services within ten (10) days of the change. When such a change is reported, a redetermination of eligibility and benefit payments shall be made promptly.

F. The OSS Program is not part of the South Carolina Medicaid Program, but all OSS recipients are eligible for Medicaid because of their participation in the OSS Program.

G. A community residential care facility participating in the OSS Program may not charge an OSS recipient or the recipient's family any additional amount for services included in the OSS facility rate. Failure to adhere to this requirement may subject the OSS recipient to a loss or reduction of OSS benefits and/or a loss of Medicaid eligibility because such additional payment is considered to be additional countable income. The imposition of additional charges for services included in the OSS facility rate also constitutes grounds for termination of the facility's OSS participation.

H. OSS recipients who lose their OSS eligibility as the result of cost-of-living increases in Social Security Title II benefits [Retirement, Survivors, or Disability Insurance (RSDI)] may continue to be eligible for Medicaid through a pass along category of eligibility (Category 16).

S.C. Code Regs. § 126-920

Added by State Register Volume 24, Issue No. 3, eff March 23, 2001.