SI 02005: Computation of Benefits - SSI
TN 14 (09-01)
A. Policy - proration in initial claims prior to 09/1/96
1. Effective Date
The proration of payment in initial claims went into effect 10/1/82 and ceased 9/1/96. (See SI 00601.009.) For applications filed on or after August 22, 1996 the earliest possible date for which benefits can begin is 9/1/96.
2. Benefit Days
The benefit for the first month of eligibility is based on the number of days in the month from the date the claimant first meets all eligibility factors, the “proration date,” through the end of the month. The date the claimant first meets all factors is counted as one of the days for which he/she is due a benefit.
3. When It Applies
Proration applies to:
Both Federal and Optional State Supplement (OSS) payments. Mandatory Minimal State Supplement (MMSS) payments are not prorated.
The $30 ($60 for certain couple situations) Federal payment limit for Federal Living Arrangement (FLA) “D”.
4. Factors Which Do Not Cause Proration
Proration only applies if a factor of eligibility is first met after the first day of the month. Certain factors cannot be attained after the first of the month and cannot cause proration because we determine eligibility based on those factors for the entire month or as of the first day of the month. These factors are:
a. Income
A person is either eligible or ineligible based on the income he/she receives throughout the entire month.
b. Resources
Resources for the month are determined as of the first moment of the first day of the month.
c. Filing for other benefits
The individual is ineligible for a benefit for the month he/she fails to comply with this factor.
5. Factors Which Cause Proration
a. Date (day) of Filing
b. Attainment of Age 65
A person attains age 65 as of the day preceding his/her 65th birthday. (See GN 00302.400.)
c. Date of Onset of Disability/Blindness
d. No Longer a Resident of a Public Institution
A person meets this factor as of the day he/she is discharged and leaves the institution. (See SI 00520.001.) In initial claims, if the claimant is ineligible as an inmate of a public institution on the day he/she meets all other factors of eligibility (including the filing of an application), he /she is not eligible until the day of discharge or until circumstances change (e.g., Medicare, Medicaid begins paying more than 50 percent of the cost of care). (See SI 00520.001C.1.) This prohibition applies even if he/she is not an inmate of a public institution throughout the month and regardless of the length of the individual's stay in the institution. (See SI 00520.001C.1.c. for exceptions to ineligibility for residents of public institutions.)
EXAMPLE: The claimant was living in his own apartment as of 9/1/94. He entered a public institution on 9/10/94 — and none of the exceptions to ineligibility for residents of public institutions applied. He filed an application with an effective filing date of 9/15/94 and subsequently was discharged and actually left the institution on 9/25/94. Proration would apply as of 9/25/94, the day of discharge.
e. Residence in the United States
See GN 00303.700 and GN 00303.740.
f. Presence in the United States
See SI 00501.410 and SI 02301.225.
g. Citizenship
For status as an alien lawfully admitted for permanent residence or permanent residence under color of law, see GN 00303.420 and SI 00501.420.
h. Presumptive Disability and Blindness Payments
If the PD/PB finding is made in the month of application, the proration date is the filing date (as long as all non-disability factors of eligibility are met as of the filing date). If the PD/PB finding is made in a subsequent month, there is no proration, i.e., benefits are payable from the first day of the subsequent month (assuming all factors are met as of the first day of the month).
EXAMPLE: Claimant filed on 3/13/96. The State agency made a PD/PB decision on 5/15/96. The PD/PB payment was established as of 5/1/96, when all factors of eligibility were met. The claim was finally allowed on 8/31/96. SSI was paid for the past due benefits from 3/13/96 through 4/30/96 and from 9/96 on. If the case was denied the SSI PD/PB payments would stop. (See DI 11055.230).
B. Procedure - formula
Follow the procedure below to compute proration.
|
Step |
Action |
|---|---|
|
1 |
|
|
2 |
Identify the “proration date.” |
|
3 |
Count the number of “benefit days.” NOTE: The number of benefit days is not affected by “ineligibility” that occurs after the proration date. If the proration date is 1/15, it is irrelevant to the calculation of the number of benefit days that the claimant enters a public institution on the 16th or died on the 20th. |
|
4 |
FORMULA Unprorated Benefit x Benefit Days = Amount Due Days in Month
REMINDER: If you use a calculator, set it for at least 4 decimal places to make sure the third decimal place is correct. NOTE: Proration does not change the rule that if a payment (combined Federal SSI and federally administered State supplement) is more than $0 but less than $1, we raise it to $1. |
|
5 |
NOTE: The prorations for the Federal and OSS payments must be based on the same number of benefit days. |
C. Example - initial claim, no proration
1. Rates/Information
This is an example of an aged couple, both members age 80.
The date of filing is 5/1/94.
The Federal Benefit Rate (FBR) is $669.
2. CI
The couple"s CI in 5/94 = $0
The couple"s CI in 6/94 on = $215 per month
3. Eligibility Test
Nonincome: The couple meets all factors.
Income: The couple meets the test; their CI never exceeds the (FBR).
4. Payment Computation
The payment computation is as follows:
May 1994
|
$669.00 |
FBR in May |
|
- 0.00 |
CI in May |
|
$669.00 |
Payment for couple |
|
$334.50 |
Payment for each member |
D. Example - proration in initial claim
1. Rates/Information
The individual"s date of filing is 1/20/94.
The FBR is $446 per month.
2. CI
The individual"s CI is $220 per month.
3. Eligibility Test
Non income: Individual meets all factors.
Income: Individual passes test; CI does not exceed FBR.
4. Payment Computation for January
The computation follows:
a. Unprorated Benefit
The unprorated benefit would be:
|
$446 |
FBR in January |
|
-220 |
CI in January |
|
$226 |
Unprorated benefit |
b. Benefit Days
The proration date is January 20 — the day he/she first meets all factors of eligibility.
January has 31 days. The 20th through the 31st including the 20th = 12 benefit days.
c. Proration
$226.00 (unprorated benefit) times 12 benefit days = $2712.00.
Divide $2712.00 by 31 days in this month = $87.483
Payment due is $87.49 (Rounded) – Prorated benefit
E. Procedure - ineligible spouse becomes eligible
1. General
When an ineligible spouse becomes eligible the Federal Benefit Rate (FBR) and the OSS rates change and spouse-to-spouse deeming ceases. RMA is also suspended and a new TCC begins the month after “eligible couple status exists”. (See SI 02005.005.)
2. Proration
Prorate the benefit due the newly eligible spouse based on the date the spouse first meets all factors of eligibility, including having filed an application. Generally, the spouse's date of filing is “protected” by the eligible individual's date of filing (See GN 00204.010). However, the proration dates for each member of the newly formed couple are not the same if the protective filing principle does not apply-because the spouse did not meet other factors of eligibility previously (such as attainment of age 65).
3. Formula
|
Unprorated Couple"s Benefit |
= |
Unprorated Benefit of Each Member |
|
Unprorated Bene. of Elig. Ind. x Bene. Days |
= |
Payment Due |
|
Unprorated Bene. of Elig. Sp. x Bene. Days |
= |
Payment Due the Eligible Spouse |
NOTE: In some cases it may be to the advantage of the ineligible spouse to elect an effective filing date of the first day of the month after the month of application. This is most likely when the date of application for the ineligible spouse is late in the month. Although the benefit for the month of filing is computed as an eligible couple benefit, the benefit of the newly eligible spouse is subject to proration. The benefit for the originally eligible member of the couple will be changed from the individual benefit to half the benefit due the couple. The newly eligible member of the couple will be due half the couple benefit reduced because of proration. The total due the couple may then be less than the amount due the eligible individual alone.
F. Example - ineligible spouse becomes eligible and spouse"s benefit is prorated
1. Rates/Information
He has received SSI since 1989.
Ineligible spouse files 6/2/94.
She attains age 65 on 6/16/94.
Couple"s FBR is $669 per month.
2. CI
The couple"s CI is $365.
3. Eligibility Test
Couple meets all factors of eligibility; CI does not exceed FBR.
4. Payment Computation for 6/94
a. Unprorated Benefit
The unprorated benefit would be:
|
$669 |
FBR in June |
|
- 365 |
CI in June |
|
$304 |
Unprorated couple"s benefit |
|
$152 |
Unprorated benefits for each member |
b. Benefit days
The proration date for the spouse is June 16 — the date she first meets all factors of eligibility. June has 30 days. The 16th through the 30th including the 16th = 15 benefit days.
c. Proration
His benefit is unprorated: $152
Her benefit is prorated:
$152.00 (unprorated benefit )times 15 benefit days = $2280.00.
Divide $2280.00 by 30 days in this month = $76.00 (her prorated benefit)