SSI spousal deeming ignores a stay in a medical facility, and the couple computation ignores a privately paid one (20 CFR 416.1163(f)(5), 416.1167, 416.1801(c)) #10455

What

The SSI facility inputs ssi_lives_in_medical_treatment_facility and ssi_medicaid_pays_majority_of_care set the $30 rate. When Medicaid pays for one spouse's stay, ssi_couple_computation_applies also computes each spouse on their own income (416.414(b)(3)). Spousal income deeming (is_ssi_spousal_deeming_applies, ssi_income_deemed_from_ineligible_spouse and the earned and unearned parts) and the couple test (ssi_claim_is_joint, ssi_couple_computation_applies) do not otherwise look at a facility stay. Three gaps follow.

1. A claimant on the $30 rate still has spousal income deemed

416.1163(f)(5): "If you become a resident of a medical care facility and the $30 Federal benefit rate applies, we do not deem your ineligible spouse's income to you to determine your eligibility for SSI benefits beginning with the first month for which the $30 Federal benefit rate applies." For the payment, "we use only your own countable income in a prior month, excluding any income deemed to you in that month from your ineligible spouse." POMS SI 01320.400 C.1 lists the same exception.

Household (2026): a claimant aged 70 with no income lives in a Medicaid-paid nursing facility. The spouse, aged 60, lives at home with a pension of $1,200 a month.

• main: $1,200 exceeds $497, so $1,200 − $20 = $1,180 is deemed, and SSI is $30 − $1,180, floored at $0.
• Rule: nothing is deemed, so SSI is $30.

Eligibility matters beyond the $30: state supplements and Medicaid read SSI receipt. The Texas supplement already removes deemed income for its own test (PR #10145).

2. A spouse who is not aged, blind or disabled and lives in a facility is still deemed

416.1163 deems the income of "an ineligible spouse who lives in the same household". 416.1167(a): "During a temporary absence, we continue to consider the absent person a member of the household. A temporary absence occurs when— (1) You, your ineligible spouse, parent, or an ineligible child leaves the household but intends to and does return in the same month or the month immediately following". POMS SI 01310.165 A.1 says the same. The open-ended facility rule in 416.1167(a)(2) covers only the claimant ("You enter a medical treatment facility and are eligible for either benefit payable under § 416.212"). An ineligible spouse who stays in a facility past the following month therefore leaves the household, whoever pays, and nothing is deemed. is_ssi_ineligible_spouse and the deemed-income variables read only the marital unit and tax roles.

Household (2026): a claimant aged 70 lives at home with Social Security of $600 a month. The spouse, aged 45 and not disabled, has been in a Medicaid-paid facility for several months and has a pension of $1,200 a month.

• main: countable income is $600 + $1,200 − $20 = $1,780, above the $1,491 couple rate, so SSI is $0. A privately paid stay gives the same result.
• Rule: SSI is $994 − ($600 − $20) = $414.

3. A privately paid stay keeps the couple computation

ssi_couple_computation_applies separates a couple only when one spouse's arrangement is MEDICAL_TREATMENT_FACILITY, which requires ssi_medicaid_pays_majority_of_care. During a privately paid stay of any length, the couple stays joint and both spouses' income is pooled. Case 4 of ssi_couple_computation_applies.yaml pins this.

• 416.1801(c), "Eligible spouse" (3)(iii): an eligible spouse lives in the same household with the other spouse on the first day of the month, and "An individual is considered to be living with an eligible spouse during temporary absences as defined in § 416.1149".
• 416.1149(c)(1)(i) makes a stay temporary "regardless of the length of your stay in the facility" only "If you enter a medical treatment facility where you are eligible for the reduced benefits payable under § 416.414", that is, where Medicaid pays more than half. Any other stay is temporary only under 416.1149(a)(2): you "intend to, and do, return to your permanent living arrangement in the same calendar month in which you (or you and your spouse) leave, or in the next month."
• POMS SI 00835.040 C.1.b lists the Medicaid stay as the only medical exception to that time limit: "temporary absence from a federal LA, due to confinement in a medical facility where Medicaid pays more than half the cost of care".
• POMS SI 00501.154 B: "Sharing a room in an institution is not living in the same household. The temporary absence of a couple member from a household does not affect the applicability of couple computation rules."
• POMS SI 02005.050 D.2: when a couple's absence from home is not temporary, the spouses are "two eligible individuals (i.e., each has a $2000 resource limit, each person's own income is used in determining eligibility ...)".

Household (2026): a claimant aged 70 lives at home with wages of $3,277 a month. The spouse, aged 70, has been in a privately paid facility for several months and has a pension of $520 a month.

• main: the couple's countable income is ($520 − $20) + ($3,277 − $65) / 2 = $2,106, or $1,053 for each spouse against $745.50, so SSI is $0 for both.
• Rule: two individuals. The claimant's ($3,277 − $20 − $65) / 2 = $1,596 exceeds $994, so the claimant gets $0. The facility spouse gets $994 − ($520 − $20) = $494.

Summary (2026, monthly SSI)

PR #10141, PR #10146 and PR #10383 leave all three rows unchanged. Under PR #10141's 416.1163(e)(2) rule, rows 1 and 2 pay the lesser of a negative amount and the no-deeming amount, which floors at $0.

Already handled

• When Medicaid pays for one spouse's stay, main computes each spouse on their own income (416.414(b)(3); PR Add ssi_couple_computation_applies for Title XIX facility separation #8004 for ssi_claim_is_joint does not implement Title XIX couple separation (20 CFR 416.1149) #8003).
• PR Derive SSI facility status from Medicaid residence #10383, for Derive SSI's medical treatment facility inputs from is_in_medicaid_facility #10193, derives the two SSI facility inputs from is_in_medicaid_facility. It does not change deeming or the couple test for a privately paid stay. Derive SSI's medical treatment facility inputs from is_in_medicaid_facility #10193 lists both "Temporary vs permanent separation (POMS SI 02005.050)" and "An ineligible spouse at home (deeming)" as out of scope; items 2 and 3 here are those.
• The Texas supplement applies 416.1163(f)(5) to its own income test (PR Pay CO, TX and NM SSI supplements to both members of an SSI couple #10145).

Suggested fix

• Item 1. Remove income deemed from a spouse in months when the claimant's arrangement is MEDICAL_TREATMENT_FACILITY. Remove it from ssi_countable_income too: Louisiana's la_oss reads that variable, which is why PR Apply 416.1163(e)(2) to deemed SSI and identify SSI couples by marriage, not tax roles #10141 dropped an earlier payment-only version. The arrangement is monthly and the deeming variables are yearly on main, so this fits PR Limit SSI spousal-deeming child allocations to the couple's co-resident children #10146's monthly deeming variables.
• Item 2. Treat a spouse who is not aged, blind or disabled and is in a medical facility as outside the household for deeming, whoever pays. Document that a stay ending in the month of entry or the next month is a temporary absence under 416.1167(a)(1), during which the spouse is still deemed.
• Item 3. Separate an aged, blind or disabled couple when one spouse is in a privately paid facility. This couple is no longer an eligible couple at all, so ssi_claim_is_joint, which state supplements read as the claim type, should turn false as well. A Medicaid-paid stay differs: 416.1149(c)(1)(i) keeps that couple joint, which is why PR Add ssi_couple_computation_applies for Title XIX facility separation #8004 left ssi_claim_is_joint unchanged.
• PR Apply 416.1163(e)(2) to deemed SSI and identify SSI couples by marriage, not tax roles #10141 moves the spouse tests to _ssi_spouse_index, so items 2 and 3 fit there.
• Add the three households above as YAML cases.

Open design questions

• POMS SI 02005.050 B.3: when one member of an eligible couple is temporarily absent in a Title XIX facility, "they are considered an eligible couple. Determine SSI eligibility by subtracting the couple's combined countable income from the full FBR for a couple. If they are eligible, determine the amount of their SSI payment based on each person's own income." main drops the couple computation for both eligibility and payment. A combined-income eligibility test would deny SSI to some facility spouses whose spouse at home has high income.
• 416.1149(c)(1)(i) and SI 02005.050 also turn on intent to return. main has no input for it, and the comment in ssi_couple_computation_applies.py says so.

Related

• SSI: deemed benefit is capped at the individual rate instead of the no-deeming amount, and couples are identified by tax roles #10138 names item 1 in its "Related" line, and PR Apply 416.1163(e)(2) to deemed SSI and identify SSI couples by marriage, not tax roles #10141, which fixes SSI: deemed benefit is capped at the individual rate instead of the no-deeming amount, and couples are identified by tax roles #10138, lists item 1 under "Known limitations (follow-ups)". This issue keeps item 1 tracked after SSI: deemed benefit is capped at the individual rate instead of the no-deeming amount, and couples are identified by tax roles #10138 closes.
• In PR 8017, Iowa's State Supplementary Assistance stops deeming for a facility stay on its path for applicants working above the SGA level (Iowa test Cases 96 and 99). Its path for anyone SSI counts reads SSI's countable income and inherits these gaps.

Sources

• 20 CFR 416.1163(f)(5)
• 20 CFR 416.1167(a)(1) and (a)(2)
• 20 CFR 416.1149(a)(2) and (c)(1)(i)
• 20 CFR 416.1801(c), "Eligible spouse" (3)(iii)
• 20 CFR 416.414(b)(3)
• POMS SI 01320.400 C.1, Deeming of Income from an Ineligible Spouse
• POMS SI 01310.165 A.1, Deeming Concept - Temporary Absence
• POMS SI 00835.040 C.1.b, Temporary Absence from a Federal Living Arrangement
• POMS SI 00501.154 B, Determining When Couple Computation Rules Apply
• POMS SI 02005.050 B.3 and D.2, Member(s) of an Eligible Couple Temporarily Absent from Home in a Title XIX Facility

Found while reviewing PR 8017 (Iowa State Supplementary Assistance).