Eligibility requirements are as follows.

1. (1) Clients are eligible for Title XIX benefits as SSI-cash clients if they live in approved Title XIX long-term care facilities and if their countable income does not fully meet the appropriate SSI-standard payment amount.
2. (2) Under SSI policy, an individual is eligible for the full standard payment amount in the month of entry to a Title XIX long-term care facility. The individual must have been living in a noninstitutional setting or in a private institution in which Medicaid made no substantial payments for any part of that month. For any subsequent month in which the individual lives in the facility throughout the month, department uses the reduced SSI payment standard.

3. (3) The reduced SSI payment standard applies to all subsequent months if the client continues to live in the Title XIX long-term care facility throughout the month. An individual is entitled to the reduced SSI payment standard for the month of entry into a Title XIX long-term care facility only if:

   1. (A) he was living in a public institution or in a Title XIX medical treatment facility for every day of the month of entry before the date of admission to the long-term care facility; and
   2. (B) Medicaid was paying more than half his cost of care.
4. (4) The reduced SSI payment standard also applies to all subsequent months if the client continues to live in the Title XIX long-term care facility throughout the month.

5. (5) Effective July 1, 1988, Public Law 100-203 allows SSI clients who meet certain requirements to continue receiving their SSI benefits while they are temporarily confined to a medical facility. These continued benefits may be made for up to three months after the month of entry if:

   1. (A) the individual notifies SSA that he expects to be in a medical facility for at least a full calendar month but less than 90 days;
   2. (B) SSA receives a physician's certification not later than 10 days after the close of the month of admission that the individual is likely to leave the facility no less than the 91st consecutive day after admission; and
   3. (C) SSA receives evidence not later than 10 days after the close of the month of admission that the individual needs to maintain and provide for the expenses of the home or living arrangement to which he may return.
6. (6) A couple may be eligible under the full SSI payment standard for a couple during the month one or both spouses enter a Title XIX medical treatment facility in which Medicaid is expected to make substantial payments.

Source Note:The provisions of this §358.510 adopted to be effective April 17, 1989, 14 TexReg 1083; transferred effective September 1, 2004, as published in the Texas Register September 17, 2004, 29 TexReg 9013.