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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.

    View all eligibility requirements

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).