SSR 76-7: SECTION 1611(e)(1)(A) and (B) (42 U.S.C. 1382(e)(1)(A) and
(B)) -- SUPPLEMENTAL SECURITY INCOME -- ELIGIBILITY DUE TO INSTITUTIONAL
20 CFR 416.231
The claimant for Supplemental Security Income (SSI) was converted from
the disability rolls of her local State welfare to the Federal rolls as of
January 1974. Since that time, she has been a resident of a county owned
and operated rest home, receives or has available treatment and/or
services which are appropriate, and has not been absent from the home in
any month for a period of more than 14 consecutive days. Held,
since the claimant is in residential care rather than in a capacity
requiring treatment normally furnished by a hospital, an extended care
facility, a nursing home or an intermediate care facility; and the home is
not receiving payments on her behalf under a plan approved under Title XIX
of the Social Security Act as amended, the claimant is ineligible for her
The general issue before the Hearing Examiner is whether the claimant is
eligible to receive Supplemental Security income benefits under Title XVI
of the Social Security Act, as amended. The claimant was converted to the
Supplemental Security Income rolls on January 1, 1974. She was notified by
the Social Security Administration that because she resided in a public
institution Supplemental Security Income checks could not be paid to
Applicable law in this case is section 1611(e)(1)(A) of the Act, which
provides the following: "Except as provided in subparagraph (B), no person
shaLl be an eligible individual . . . for purposes of this title with
respect to any month if throughout such month he is an inmate of a public
institution." Subparagraph (B) provides:
(B) In any case where an eligible individual . . . is, throughout any
month, in a hospital, extended care facility, nursing home, or
intermediate care facility receiving payments (with respect to such
individual or spouse) under a State plan approved under title XIX, the
benefit under this title for such individual for such month shall be
(i) of $300 per year . . . in the case of an individual who does not have
an eligible spouse;
(ii) at a rate not in excess of the sum of the applicable rates specified
in Subsection (b)(1) and the rate of $300 per year . . . in the case of an
individual who has an eligible spouse, if only one of them is in such a
hospital, home, or facility throughout such month; and
(iii) at a rate not in excess of $600 per year . . . in the case of an
individual who has an eligible spouse, if both of them are in such a
hospital, home, or facility throughout such month . . .
The question to be resolved in this decision is whether the claimant is
an inmate in a public institution. Section 416.231 of Regulations No. 26
-- which implements § 1611(e)(1)(B) of the Social Security Act is
applicable herein and provides in pertinent part:
(1) Except as provided in subparagraph (2) of this paragraph, no person
shall be eligible individual or eligible spouse for purposes of title XVI
of the Act with respect to any month and throughout such month person is
an inmate of a public institution . . .
(2) . . . Where an eligible individual . . . is throughout any month in a
hospital . . . skilled nursing facility . . . or intermediate care
facility . . . receiving payments (with respect to such individual) . . .
under title XIX . . . title XVI . . . shall be payable: a) at rate of $300
per year. . . .
(b) Definitions. For purposes of this part, the following
definitions shall apply:
(1) An 'institution' is an establishment which furnishes (in single or
multiple facilities) food and shelter to four or more persons unrelated to
the proprietor and, in addition, provides some treatment or services which
meet some need beyond the basic provision of food and shelter.
(2) a 'public institution' is an institution that is the responsibility
of a governmental unit, or over which a governmental unit exercises
(3) An 'inmate of a public institution' is a person who is living in a
public institution and receiving treatment and/or services which are
appropriate to the person's requirements. A person is not considered an
inmate when he is in a public educational or vocational training
institution, for purposes of securing educational or vocational
(4) Being in an institution 'throughout a month' means a continuous stay
involving 24 hours of every day in a calendar month. Brief periods of
absence . . . lasting not more than 14 consecutive days, would not
interrupt a continuous stay in the institution.
The claimant's representative testified that the claimant resides at a
health facility licensed by the State Board of Health and it is a
residential and comprehensive health care facility. He also stated that
the home is not a privately owned institution, it is supported through tax
monies from the county taxpayers and is under the direct operation and
supervision of the county Commissioners. He further testified that the
home does not receive donations in the form of money from any private
individual or sources.
The representative said that there are medical facilities at the home
that provide 24-hour-a-day nursing services, that a physician is employed
by the facility and the physician treats any and all residents there
without regard to race, color, or creed or national origin as the need may
arise. The facility also dispenses medication to the residents if ordered
by the physician and they are taken out into the community for prescribed
medial treatment if so prescribed by the doctor.
The representative also testified that although the claimant is residing
in the facility, she is not an inmate of the facility as defined under
section 1611(e)(1)(A) of the Act. He stated that "the people residing in
the facility are . . . not committed by a court or any action of anyone
for their living arrangements." The claimant, as well as other residents
of the facility, were free to leave the home at any time, they could come
and go as they wished, they were not restricted in any way regarding their
freedom of egress and ingress at the facility.
The representative further stated that the facility is licensed to
participate in title XIX under the Social Security Act, but the claimant
is not involved in the benefits of that title in this instance because she
is not receiving intermediate or skilled nursing care.
The Hearing Examiner in summarizing the facts set out:
(1) the claimant resides at the facility and also that the facility is an
establishment which furnishes in multiple facilities, food and shelter to
more than four persons who are unrelated to the proprietor. In addition,
the facility provides treatment and services which are available to meet
needs of the claimant that are beyond the basic provisions of food and
(2) the facility is a public institution under the Act in that it is an
institution that is the responsibility of a governmental unit (the county)
and that governmental unit exercises administrative control over the
(3) the claimant is an inmate of a public institution and is living in
the facility, a public institution (and receiving services there in which
are appropriate to the claimant's requirements.) The claimant is not
residing in a public educational or vocational training institution nor is
the claimant residing in the facility for the purposes of securing
educational or vocational training.
The claimant, because she is an inmate of a public institution under the
Act, is precluded from eligibility for Supplemental Security Income
benefits, with respect to any complete month she resides at the home.
Periods of absence not more than 14 consecutive days on the part of the
claimant while continuing in the status of an inmate of the facility, do
not interrupt a continuous stay in the facility in any one month.
The evidence fails to show that the claimant is or has throughout any
month been in a hospital, extended care facility, nursing home or
intermediate care facility receiving payments with respect to the claimant
under a State plan approved under title XIX of the Social Security Act.
Hence, the claimant is not eligible for partial payments under the Act for
any complete month that the claimant resides at the home.
It is the decision of the Hearing Examiner that the claimant, is
ineligible for Supplemental Security Income benefits under the provisions
of title XVI of the Social Security Act as amended, and such ineligibility
will continue until such times as the claimant ceases to be an inmate of a
public institution under the Act.
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