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State Supplementation Overview

State Supplementation Overview. What You Need to Know to Authorize State Supplementation. What is State Supplementation?. Payments from state funds are available to eligible individuals to pay for Personal Care Homes (PCH), Family Care Homes (FCH) or Caretaker Services (CS).

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State Supplementation Overview

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  1. State Supplementation Overview What You Need to Know to Authorize State Supplementation

  2. What is State Supplementation? • Payments from state funds are available to eligible individuals to pay for Personal Care Homes (PCH), Family Care Homes (FCH) or Caretaker Services (CS). • The Grant (payment) is paid monthly to either the PCH, FCH or to the individual for Caretaker Services. • Medicaid also pays the SMI premium for all SSP recipients with Medicare Part B.

  3. Who is Eligible for SSP? • Aged, blind or disabled individuals who have insufficient income to meet special needs for care in a licensed PCH or FCH, or to purchase Caretaker Services to prevent institutionalization. • SSI Individuals already meet resource eligibility requirements for SSP. • Non-SSI individuals must meet SSI/AMA technical and resource eligibility requirements.

  4. What are PCH and FCH? Personal Care Home • Provides general supervision and residential care for individuals unable to manage normal activities of daily living, and need monitoring to ensure health related services are carried out. • A rest home is an example of a PCH. Family Care Home • Provides 24-hour protective and personal care in a residential home for 2 or 3 individuals who do not have an illness or injury requiring nursing care, but need help with self-care.

  5. PCH and FCH • Personal Care Homes (PCH) and Family Care Homes (FCH) must be licensed by the Certificate of Need and Licensure Board. • KAMES Inquiry for State Supplementation is selection “H”. • A PCH directory can be found on KAMES Inquiry. • An FCH directory can be found online at: http://chfs.ky.gov/NR/rdonlyres/0129B7AC-A7A7-4BF2-913F-29EAA96B60EA/0/FCHDirectory.doc

  6. Caretaker Services CS may be as simple as someone hired to come and clean house, or prepare meals for the individual. Services provided by a caretaker must: • Enable the individual to remain safely and adequately at home, in some other family setting or a room and board situation. • Prevent institutionalization • Be provided at regular intervals Services may be provided by a live-in attendant, or one or more persons hired to come to the home.

  7. More on Caretaker Services Caretaker payments are not made if: • The individual is taken daily or periodically to the caretaker’s home (sitter arrangement) • The caretaker is the recipient’s spouse, parent or adult child, living with recipient Contact the caretaker to verify: • Service prevents institutionalization • How often service is provided • Payment made for services

  8. SSP Providers and Allowances Utilize KAMES Inquiry to obtain current allowances • Personal Care Home - $_____ • Family Care Home - $_____ • Caretaker Services for a single individual in their own home or receiving room, board and care - $_____ • Personal Needs Allowance (included in allowances above) Personal Care Home - $____ Family Care Home - $____

  9. SSP Payment Determination The SSP payment is the difference between the standard and the countable income. Using the current income scale, what would be the grant payment amount if the income was $880.00 per month? (Allowance minus Income = Payment)

  10. SSP Procedures • Process all SSP applications within 30 days on KAMES using category codes FP, GP, or HP for non SSI SSP cases and AP, BP, or DP for SSI SSP cases. • Review living situation and income every 12 months, and adjust payment, if appropriate.

  11. Conclusion • SSP is a money payment, referred to as a “Grant” payment • Services covered by SSP are PCH, FCH, or Caretaker Services • SSI Individuals already meet SSP technical and financial eligibility requirements • The SSP payment amount is the standard cost of care, minus countable income.

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