452-5        COMPUTATION OF BENEFITS

452-5 A.   REGULAR APA Adult Public Assistance BENEFIT PAYMENTS

The amount of assistance provided for any month is determined by comparing an individual's or couple's total monthly countable income calculated according to manual section 452-4 with the appropriate APA Adult Public Assistance need and payment standards described in manual section 452-1 and Addendum 1.

1. Payment Limit

Regardless of an individual’s or couple’s total monthly countable income, the APA Adult Public Assistance payment to the individual or couple cannot exceed the amount that would be paid if the individual or couple were receiving SSI Supplemental Security Income benefits.  An APA Adult Public Assistance recipient may not receive any more money than a similarly situated SSI Supplemental Security Income recipient.

Example 1: (based on 2013 payment standards),

Mr. Charlie, an unmarried APA Adult Public Assistance recipient living independently receives a private pension that exceeds the SSI Supplemental Security Income income standard.  His pension income stops suddenly, and Mr. Charlie is advised to apply for SSI Supplemental Security Income benefits.  Except for APA Adult Public Assistance , Mr. Charlie has no other income.  While waiting for his SSI Supplemental Security Income payments to begin, Mr. Charlie may not receive a higher APA Adult Public Assistance payment than he would if he was already receiving a monthly SSI Supplemental Security Income payment.  Mr. Charlie’s APA Adult Public Assistance payment is adjusted to $362 ($1,072 APA Adult Public Assistance maximum payment standard  - $710 SSI Supplemental Security Income income standard  = $362).

Example 2:  (based on 2013 payment standards),

John has a felony charge in Michigan and is not eligible for Social Security benefits due to his fleeing felon status.  Although John has no other income, his APA Adult Public Assistance payment is $362 ($1,072 APA Adult Public Assistance maximum payment standard - $710 SSI Supplemental Security Income income standard = $362).

2. APA Adult Public Assistance Payment Calculations

Except for the payment limit described above, APA Adult Public Assistance benefits amounts are calculated as follows:

a. Income is less than APA Adult Public Assistance maximum payment standard

For individuals or couples whose total monthly countable income is less than the appropriate APA Adult Public Assistance maximum payment standard, the APA Adult Public Assistance benefit amount is the difference between the total monthly countable income and the appropriate APA Adult Public Assistance maximum payment standard.

b. Income equals or exceeds APA Adult Public Assistance maximum payment standard

For individuals or couples whose total monthly countable income equals or exceeds the appropriate APA Adult Public Assistance maximum payment standard, but is equal to or less than the appropriate APA Adult Public Assistance need standard, the APA Adult Public Assistance benefit amount is $1.00.

452-5 B.   INTERIM ASSISTANCE BENEFIT PAYMENTS

1. Regular IA Interim Assistance benefit payments.

Except for institutionalized individuals, IA Interim Assistance payments are set by state regulation at $280 per month per individual, as long as their other countable income, after rounding, is equal to or less than the applicable APA Adult Public Assistance need standard.

If both members of a couple are eligible for Interim Assistance, they each receive $280.  In couple cases where only one spouse is eligible for Interim Assistance, $280 is paid only to that individual.  If one member of a couple is eligible for Interim Assistance and the other member is eligible for regular APA Adult Public Assistance benefits, each member of the couple is budgeted as an individual until Interim Assistance ends.

2. IA Interim Assistance benefit payments to institutionalized individuals
 

Individuals who reside in a Medicaid facility such as a nursing home may not receive the regular $280 Interim Assistance monthly payment.  However, depending on their other countable income, they may receive an Interim Assistance payment which, combined with any other countable income, is equal to the regular $200 APA Adult Public Assistance personal needs maximum payment standard.

452-5 C.   PERSONAL NEEDS BENEFIT PAYMENTS

This section applies to any person who resides in a Medicaid facility such as a nursing home continuously for an entire calendar month, except for individuals who remain eligible for full APA Adult Public Assistance benefits because of temporary institutionalization provisions.  (Refer to section 470-2 for the policy on continued benefits for temporarily institutionalized individuals.)

An individual who is eligible for SSI Supplemental Security Income may receive a monthly payment for incidental personal needs from SSI Supplemental Security Income of up to $30.   APA Adult Public Assistance will provide an additional payment to provide a total amount of $200 for personal needs.

An individual who is ineligible for SSI Supplemental Security Income , but whose countable income is less than the APA Adult Public Assistance personal needs standard, may receive an APA Adult Public Assistance payment.  However, the payment cannot exceed the amount that would be paid to a similarly situated SSI Supplemental Security Income recipient.  See section 452-5A(1) above for more information about this payment limit policy.

An individual whose countable income exceeds $200 is not eligible for an APA Adult Public Assistance payment but may be eligible for Medicaid.  

Note:  

Medicaid eligibility policies pertaining to institutionalized individuals may differ from APA Adult Public Assistance policies.  See Medical Assistance manual section 5600 for policy on Medicaid eligibility for institutionalized individuals.

452-5 D.   ASSISTED LIVING HOME PAYMENTS

Individuals residing in an assisted living home for a full calendar month have their APA Adult Public Assistance eligibility and payment calculated using the assisted living home need and maximum payment standards.  These individuals may receive a monthly APA Adult Public Assistance payment of up to $100.  Individuals who reside in an assisted living home for less than a full calendar month have their APA Adult Public Assistance eligibility and payment calculated using the appropriate need and maximum payment standards for their living arrangement.  See Addendum 1.

SSI Supplemental Security Income Recipient.  Calculate the APA Adult Public Assistance payments for SSI Supplemental Security Income recipients (individual or couple) residing in an assisted living home by subtracting the appropriate SSI Supplemental Security Income payment standard from the assisted living home payment standard, regardless of the amount of the individual’s SSI Supplemental Security Income payment.  

Example 1:   SSI Supplemental Security Income recipient (based on 2013 payment standards)

An APA Adult Public Assistance recipient resides in an assisted living home, and receives an SSI Supplemental Security Income payment of $400.  Use the SSI Supplemental Security Income payment standard for an individual living independently ( SSI Supplemental Security Income ”A” Living Arrangement) to calculate the APA Adult Public Assistance payment.

$  810    APA Adult Public Assistance maximum payment standard for an individual, in assisted living home ( H1E Individual, Living in an Assisted Living Home (APA Household Type) )
-   710   SSI Supplemental Security Income individual, ”A” living arrangement standard
= $100    APA Adult Public Assistance payment

Non- SSI Supplemental Security Income Recipient.  Calculate the APA Adult Public Assistance payment for a resident of an assisted living home (individual or couple) by subtracting the net countable income from the appropriate APA Adult Public Assistance maximum payment standard.  If the net countable income equals or exceeds the appropriate APA Adult Public Assistance maximum payment standard, but is equal to or less than the appropriate APA Adult Public Assistance need standard, the APA Adult Public Assistance benefit amount is $1.  The payment limit described in section 452-5A(1) also applies to assisted living home payments.