S.C. Code Regs. § § 114-1920

Current through Register Vol. 48, No. 11, November 22, 2024

Section 114-1920 - Eligibility Determination

A. Individuals or couples shall be eligible for OS payments if they meet the following requirements:

(1) Have been determined to be aged, blind or disabled by the Social Security Administration (SSA) or by the agency in accordance with SSA criteria;

(2) Reside in a RCF licensed by either the Department of Social Services or the Department of Mental Health;

(3) Have resources that do not exceed the resource reserve limitations set by the SSI Program;

(4) Receive an SSI payment, which when combined with other countable income gives them total income less than the NIL appropriate to their living situation, or

(5) Receive countable income that exceeds the SSI payment standard, but is less than the NIL appropriate to their living situation.

B. When an RCF charges an amount for its services which is greater than the rate established by the agency, and if such amount is paid by an individual to the RCF for an OS individual's or couple's care, the amount shall be counted as income to the individual or couple in computing the OS payment.

C. OS recipients who lose their eligibility for OS payments due to cost-of-living increases in Social Security Title II benefits shall continue eligible for Medicaid.

D. For an individual, the OS payment shall be the deficit determined by subtracting the CI from the NIL, rounded to the next higher dollar amount.

E. Eligibility in a couple case is determined by measuring a couple's combined countable income against a combined NIL. However, an OS payment must be made to each spouse in a couple case. The OS payment shall be the deficit, rounded to the next higher dollar amount, determined by subtracting each spouse's own income from the NIL for an individual. If one spouse receives all of the couple's income, their income shall be divided evenly between them and their OS payment shall be the deficit, rounded to the next higher dollar amount determined by subtracting the allocated income to each spouse from the NIL for an individual.

F. Eligibility for OS cases shall be reestablished every twelve months or more frequently as specified by the agency.

G. When a change that might affect a couple's or individual's eligibility is reported, a redetermination of eligibility and grant adjustment shall be made promptly.

S.C. Code Regs. § 114-1920