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Plan for new living situations with a Social Security attorney

Many people who collect Social Security Disability benefits will require nursing home care at some point. As any Social Security attorney can explain, nursing home stays do not affect eligibility for SSD benefits. However, people who collect disability benefits through the Supplemental Security Income program may lose their benefits during nursing home stays, depending on the nature of the facility and duration of the stay.

Differences between facilities

People who stay at nursing homes that accept Medicaid payments may lose all or part of their disability benefits. The Social Security Administration distinguishes between the following types of care facilities:

  • Facilities accepting Medicaid — beneficiaries lose their eligibility if Medicaid pays for more than half the cost of living and care at one of these facilities.
  • Private facilities declining Medicaid — beneficiaries can theoretically keep their benefits while staying at one of these facilities. However, people who can pay for private care independently may not be eligible for SSI based on personal income.
  • Public facilities — even if Medicaid addresses less than half the cost of care at one of these facilities, beneficiaries lose SSI eligibility.

The SSA makes exceptions for children staying in facilities that accept Medicaid and children with private insurance to cover half the cost of nursing home care. These SSI beneficiaries may still collect a reduced benefit of $30 per month.

If two spouses collect Social Security benefits and one spouse enters a nursing home, the other spouse’s eligibility for SSI or SSD benefits is not affected. However, the spouse living outside the nursing home will start receiving individual payments, rather than couple’s payments.

Shorter-duration stays

The SSA makes an exception to the above rules when a beneficiary’s nursing home stay is not expected to exceed 90 days. Beneficiaries may continue collecting full benefits during a period of “temporary institutionalization.” However, beneficiaries must inform the SSA in writing that they need ongoing benefits to maintain a permanent place of living during the stay. Beneficiaries also must document the expected length of the stay with a statement from a doctor.

If temporary institutionalization unexpectedly extends beyond 90 days, beneficiaries should inform the SSA immediately. The SSA will stop benefits at this point. However, beneficiaries may be eligible for quick reinstatement of disability benefits upon leaving the nursing home, if they use the SSA’s prerelease procedure.

The prerelease procedure is available to beneficiaries who apply for reinstated benefits months prior to leaving the nursing home. These individuals must prove their medical conditions are likely to qualify for benefits.  Beneficiaries who use the prerelease procedure may receive their regular disability payments as early as 30 days after release from the nursing home.