Month: June 2025

Optional State Supplementation (OSS), also referred to as State Supplementary Payments (SSP), in coordination with the federal Supplemental Security Income (SSI), provides financial assistance for low-income older adults, blind, and disabled individuals in the United States. 

Services and Benefits

OSS/ SSP services are usually direct cash payments that aim to cover basic living expenses. 

• Increased Cash Assistance
  • A higher monthly income than Federal SSI, allowing eligible individuals to afford housing, food, utilities, and clothing. 
• Support for Specific Living Arrangement
  • Most OSS programs cover residential care in assisted living, adult family care homes, residential care communities, and mental health residential treatment communities. 
• Reduced Burden on Individuals/ Families
  • OSS provides additional financial support, helping beneficiaries with their financial burdens. 
• Alternative to Institutional Care
  • OSS helps older adults from nursing homes, especially those with a lower level of care needed. 

Although OSS is not a Medicaid program, some states allow recipients to be eligible for Medicaid. 

Eligibility

• Characteristics
  • Applicants must be 65+, blind, or disabled, as per the federal guidelines. 
• Low Income
  • Most states follow the federal SSI income limit of 125% of the federal Poverty Guidelines for SSI. 
  • Although some states may have higher income limits for those who are not eligible for federal SSI.
• Asset Limit
  • Individual applicants have a $2,000 asset limit, while couples have $3,000. 
• Residency
  • Applicants must be residents of the state they are applying for OSS. 
• Living Arrangement
  • Those living in a residential care home, including assisted living and adult foster care, may receive higher benefits compared to those living independently at home, depending on the state. 
• Functional Need
  • Those needing additional support for activities of daily living (ADLs) and those who require assistance for physical or mental conditions are subject to assessment. 
• Application Process
  • For states administered by SSA, application to federal SSI is also an application for OSS. While in state-administered programs, residents should apply to the state’s social services or human resources department. 

The Senior Community Service Employment Program (SCSEP) is a program created to help those 55+ who are low-income and unemployed, to help them gain work experience, hone skills, and transition into unsubsidized employment. 

Services

• Subsidized Part-Time Community Service Assignments
  • Eligible participants are tasked with part-time training assignments with an average of 20 hours per week at a local non-profit organization or public institutions, including schools, hospitals, day-care centers, and senior centers. This serves as the heart of the program. 
• Skill Enhancement and Training
  • Participants are provided with training that includes:
    • Basic academic skills, such as reading, writing, and computation. 
    • Computer skills
    • English as a Second Language (ESL)
    • “Soft skills” include communication and team building. 
    • Resume building and interview preparation
    • Specialized vocational training
• Individual Employment Plan (IEP) Development
  • A personalized care plan is created to highlight the participants’ career goals, possible challenges, and further steps until unsubsidized employment. 
• Job Search and Placement Assistance
  • The program helps participants connect with local employers. 
  • Referrals to American Job Centers and workshops on job search strategies. 
• Paid Training
  • During their community service assignment, participants receive a stipend or training wages. 
• Supportive Services
  • To cope with barriers, the program also provides:
    • Transportation assistance
    • Work attire assistance
    • Health check-up referrals. 
• Ongoing Support
  • Participants receive assistance throughout the process, from initial assessment to job placement and maintaining it. 

Eligibility

• Age – Participants should be 55+. However, priority is given to those 65+. 
• Must be unemployed at the time of application. 
• Has a family income limit that does not exceed 125% of the Federal Poverty Guidelines, per the U.S. Department of Health and Human Services. 
• Must be a resident of the SCSEP’s service area. 
• Be legally able to work with a completed I-9 form. 

Priority

Individuals with the following qualities are prioritized for enrollment:

• Veterans and qualified spouses. 
• Those 65+ above
• Those with a disability, but can still function. 
• Those with low literacy skills. 
• Those coming from rural areas. 
• The homeless or those at risk of homelessness. 
• Those who have failed to find employment, even with the One-Stop delivery system. 
• Individuals who are previously incarcerated, or under supervision from release in prison within five years. 

The Program of All-Inclusive Care for the Elderly (PACE) is coordinated by an interdisciplinary team of healthcare professionals, aiming to provide a wide range of services.

Services

• Adult Day Health Care
  • Provides centralized medical care, rehabilitation, social activities, and meals. Transportation to and from the PACE center is typically included.
• Home Care
  • Assistance with daily activities and personal care at home.
• Hospital Care
  • PACE covers hospital stays and helps with care during and after hospitalization, whenever necessary.
• Nursing Home Care
  • If health declines to the point where nursing home care is necessary, PACE covers and coordinates nursing services, ensuring continuity of care.
• Primary Care
  • Usually includes regular doctor and nursing services, check-ups, and ongoing health monitoring.
• Other Medically Necessary Services
  • PACE covers any other services deemed necessary by the team to improve and maintain overall health and allow a safe living. 

Eligibility

• Applicants must be 55+.
• Must be within the service area of the PACE organization.
• A nursing home level of care is required. 
• Applicants should not be enrolled in a separate Medicare Advantage Plan, Medicare Prepayment Plan, the Medicare Hospice Benefit, or Medicare prescription drug plan. 

Financial Eligibility

• Medicaid Eligible
  • Eligible Medicaid beneficiaries do not have to pay for the long-term care portion of the PACE benefit. 
• Medicare Only
  • For Medicare beneficiaries without Medicaid, payment for a monthly premium is required for long-term care and Medicare Part D. Co-payments and deductibles are not feasible. 

Medicare Savings Programs (MSPs), also known as Medicare Buy-In Programs or Medicare Premium Payment Programs, fundamentally act as a bridge between Medicare and Medicaid. 

Types of MSPs

1. Qualified Medicare Beneficiary (QMB) Program

• Has the most coverage, including:
  • Medicare Part A premiums (if you don’t qualify for premium-free Part A)
  • Medicare Part B premiums
  • Medicare Part A and Part B deductibles
  • Medicare Part A and Part B coinsurance and copayments
• Providers are prohibited from billing QMB beneficiaries for Medicare Part A or B deductibles or co-insurance, similar to a Medicare Supplement (Medigap) policy. 

2. Specified Low-Income Medicare Beneficiary (SLMB) Program

• Pays for Medicare Part B premiums. 

3. Qualifying Individual (QI) Program

• Pays for Medicare Part B premiums. 
• Priority is often given to those who received the benefit from the previous year. Additionally, those who are eligible for full Medicaid benefits cannot qualify for QI. 

4. Qualified Disabled Working Individual (QDWI) Program

• Covers Medicare Part A premiums only. 
• Specifically for those with disability under age 65 who are not eligible for Medicaid. 

Eligibility

• Medicare Part A
  • Must be eligible for Medicare Part A. 
• Limited Income and Assets
  • Income and asset limits vary by program and by state. 

Income and Asset Limits (Federal Guidelines 2025)

While states have the freedom to disregard certain income or assets, the general guidelines are based on a percentage of the Federal Poverty Level (FPL) and updated yearly. 

• Income Disregards
  • MSPs include a $20 general income disregard, wherein the first $20 of monthly income is not counted. 
• Excluded Assets
  • Assets, including the following, are not counted
    • Primary home
    • One car
    • Household goods and personal effects
    • Burial plots
    • Up to $1,500 per person in burial funds
    • Life insurance with a cash value of less than $1,500
• State Flexibility
  • Some states may have higher income or asset limits than the federal guidelines. Moreover, states like California, Alabama, Arizona, Connecticut, Delaware, Louisiana, Mississippi, New Mexico, New York, Oregon, Vermont, and the District of Columbia have removed the asset limit for MSPs.  

Low-Income Subsidy-LIS

• Beneficiaries of QMB, SLMB, or QI programs automatically qualify for Medicare’s Extra Help (Low-Income Subsidy – LIS) program, lessening the burdens of prescription drug costs under Medicare Part D, including:
  • Monthly Part D plan premiums
  • Annual Part D deductibles
  • Part D copayments and coinsurance

Respite care programs are services that provide temporary relief to primary or family caregivers, typically of older adults or those with a chronic illness or disability. 

Types of Respite Care

• In-Home Respite Care
  • A professional caregiver delivers care at home, allowing the recipient to age in place. 
• Adult Day Centers
  • Supervised programs in a community provide social activities, meals, and therapeutic services during the day. 
• Residential/Facility-Based Respite
  • For longer rest or higher levels of care, short-term stays are usually offered in an assisted living community or nursing home. 
• Community-Based Respite
  • Usually provided by churches, community centers, or non-profit organizations. 
• Medical Respite Care for the Homeless
  • Dedicated to those who are too frail to recover from illness or injury on the streets but do not require hospitalization, providing safe shelter, clinical care, and aftercare planning. 

Depending on the state, funding for respite care is usually influenced by its type, duration, location, and level of care. Moreover, different agencies for respite care may provide funding, including:

• Medicaid Home and Community-Based Services (HCBS) Waivers
  • Most states offer HCBS waivers that include respite care, especially those that meet Medicaid’s eligibility requirements. 
• National Family Caregiver Support Program (NFCSP)
  • The NFCSP grants states the ability to cover caregiver support services, including respite care, through funds from the Older Americans Act. Local Area Agencies on Aging (AAAs) usually provide aid for caregivers of those 60+ or those with cognitive conditions. 
• Lifespan Respite Care Program
  • Administered by the Administration for Community Living (ACL), this program allows states to create coordinated systems of respite care for family caregivers of any age with special needs.

Home and Community-Based Services (HCBS) Waivers are an umbrella term used to categorize programs provided by the state and Medicaid. These programs often cover long-term care services and support in a home or community setting. HCBS waivers are known differently in each state, such as Georgia’s Community Care Services Program and California’s Home and Community-Based Alternatives (HCBA) waiver. Additionally, each state may offer several HCBS waivers to cover eligible residents’ various needs. 

Services include:

HCBS waivers widely depend on each state, hence, coverage differs. However, common services include:

• Adult Day Health Services – recreational programs and health services in a supervised community setting.
• Behavioral Supports – services related to behavioral changes. 
• Case Management/ Support and Service Coordination – helps with coordinating and planning their care plans. 
• Community Transition Services – assistance for those moving from an institutional setting back to the community.
• Environmental Accessibility Adaptations/ Home Modifications – modifying one’s environment to improve accessibility and safety. 
• Homemaker Services – assistance with household chores. 
• Home Health Aide Services – assistance with daily living activities.
• Home-delivered meals. 
• Respite Care – relief for primary caregivers/ family caregivers.
• Personal Care Services – support to activities of daily living. 
• Private Duty Nursing – skilled nursing at home. 
• Therapies – physical, occupational, speech-language pathology, and respiratory therapies. 
• Transportation – assistance with travel to medical appointments. 

States provide a combination of these services to lessen eligible residents’ financial burdens. Additionally, other services that are not usually covered by Medicaid can be subject to approval if they are cost-effective and necessary to prevent institutionalization. 

Eligibility

1. Medical/ Functional Eligibility (Level of Care)

• A level of functionality is assessed, which qualifies residents for special care, including nursing facility level of care, hospital level, or intermediate care facility for individuals with intellectual disabilities. 
• The ability to perform Activities of Daily Living (ADLs) is evaluated, alongside instrumental activities of daily living (IADLs) and cognitive or behavioral needs. 

2. Financial Eligibility

• Applicants must meet the Medicaid standard of income and asset limits.
  • In Georgia, CCSP eligibility requires income limits of an average of $2,829 per month or 300% FBR per individual in 2025, while asset limits are $2,000 for an individual and $3,000 for a couple. 
  • California, on the other hand, has abolished the asset limit for most Medicaid programs since January 2024. However, income limits still exist at around $1,801 per month in 2025. 
• Spousal impoverishment rules may also come into effect to protect a part of a spouse’s income and assets. 

3. Other Requirements

• Residency
• Citizenship
• Need for Services
• Waiver Capacity
• Depending on the state, HCBS waivers provide services to those 55+ or 65+. 

How to Apply for HCBS Waivers

• Identify HCBS Waiver programs.
  • States may have several HCBS programs; hence, research the right waiver that fits your needs. State Medicaid agencies, Departments of Human Services, or Departments of Aging and Disability provide good resources. 

• Reach out to the Administering Agencies
  • Local agencies provide more detailed information on requirements, eligibility, and the application process.