The states pay the remaining costs and they are given wide discretion about whom to cover and what benefits to provide. There is a single state agency in charge of the program in each state, but many states have the program administered by county and city governments. These categories of aliens were set in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. States must provide Medicaid for eligible residents. States cannot place length of stay residency requirements.
States vary depending on the options they have elected.
States may use a higher income standard, up to three times the SSI benefit amount for an individual living at home. CT under a waiver allows spend down for institutionalized care and has an income cap for home care. CT under a waiver allows spend down for institutionalized care and has an income cap for home care. Income cap states limit income to three times the SSI benefit level. No spend down is allowed and any excess will disqualify the individual in these states.