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 STATUS

20 CFR 416.231

SSR 76-7

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

her.

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:

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:

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.

t 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:

ay 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:

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.