Optional State Supplementation (OSS)
A state-funded program designed to help low-income persons meet basic living needs not fully covered by the Federal Supplemental Security Income (SSI) program provided in licensed Community Residential Care Facilities (CRCFs). OSS is not a Medicaid program.
To receive OSS, a person must meet all of the following criteria:
- Be age 65 or older, blind, or disabled.
- Have income and financial resources within certain limits.
- Be a citizen of the United States of America or meet certain citizenship requirements.
Be a resident in a licensed and enrolled CRCF and have an authorized slot.
When completing an OSS application, the following forms are needed:
- Form 3401 – No active Medicaid
- Form 3400A – has active Medicaid
- Form 1728 – only receiving SSI.
- Medicaid Eligibility Fax – (888) 820-1204
We will also need a:
- 30-day bank statement from the previous month.
- Life Insurance Policy (cash value and dividends) as of the 1st of the month.
- Burial Contract.
- Sign Authorized Representative form. (English) (Spanish)
- Form 943* (Information for Release Form), with the client’s signature.
- Health Insurance Card (Medicare, VA and/or Pension) and award amounts.
- Current recurring income amount from SSA/Pension.
- Property owner to have the correct address and tax notice (intent to return home).