452-12      RETROACTIVE APA BENEFIT CALCULATIONS

There are two situations in which retroactive APA benefits can be paid.  Retroactive APA benefits may be issued when:

• Converting an Interim Assistance case to APA; and
   

• Approving APA benefits for an application received in the office before July 1, 2004, for an individual who did not receive Interim Assistance because they were either not eligible or chose not to receive it.

Refer to manual section 410-11 for policy on when APA payments begin.

Calculate retroactive APA benefits using the countable income received by the applicant for the retroactive month(s).  SSA and SSI payments for a retroactive month are counted as income for that month.  Retroactive payments from other types of benefit programs, such as retroactive VA payments, are counted as income in the month they are received. IA payments also count in determining the amount of the retroactive payment.

Note:  Depending on the amount of countable income received in the retroactive month, an individual may, or may not, be eligible for a retroactive APA payment.  Also, the APA payment limit in APA manual section 452-5 applies to retroactive benefits.

452-12 A. RETROACTIVE APA BENEFIT CALCULATIONS FOR IA RECIPIENTS

IA recipients qualify for an APA payment when they are approved for SSA or SSI and their case is converted to APA.  IA recipients who apply for APA before July 1, 2004 may also qualify for a retroactive APA benefit for any month they are not eligible for both IA and SSI benefits.  For example, when SSI is not paid because of PFD income or when an applicant is approved for SSA but not SSI.

Calculate a retroactive APA payment for an IA case conversion by subtracting the countable income from the APA maximum payment standard.  Then subtract the IA payment.

Example 1: IA Recipient applied for assistance on or after July 1, 2004  (based on 2004 payment standards)

Applicant applies for both APA and SSI benefits on July 15, 2004.  IA benefits are approved beginning with the benefit month of July.  On October 29, the Social Security Administration notifies the applicant that SSI payments are approved back to the benefit month of August.

Because it is too late to stop the IA payment for November, the IA case is closed effective November 30, 2004, and an APA case is opened beginning December 1.  Since the applicant was notified of SSI eligibility in October, the applicant is eligible for APA benefits beginning November 1.  The retroactive APA payment for November is calculated as follows:

$ 926   APA Maximum Payment Standard
-  564   SSI Income Standard
$ 362   APA Payment

$ 362   APA Payment
-  280   Monthly IA Payment
$   82   Retroactive APA Payment for November

Example 2: IA recipient applied for assistance before July 1, 2004  (based on 2004 payment standards)

An SSI applicant applies for APA benefits on March 1, 2004, and IA benefits are approved beginning with the benefit month of March.  On August 10, the Social Security Administration notifies the IA recipient that he is not eligible for SSI benefits, but is eligible for Social Security Disability Insurance benefits of $600 per month beginning February 1, 2004.

Because the applicant applied for APA before July 1, 2004, and was not determined eligible for SSI, he is eligible for retroactive APA back to the date of his APA application, March 1, 2004. Close the IA case effective August 31, open an APA case beginning September 1, and issue retroactive APA payments for March 2004 – August 2004.

Calculate the retroactive APA payment for past months as follows:
$ 926   APA Maximum Payment Standard
-  580   Net Countable SSA Income  ($600 - $20 Disregard = $580)
$ 346   APA Payment

$ 346   APA Payment
-  280   Monthly IA Payment
$   66   Retroactive APA Payment for each month

452-12 B. RETROACTIVE APA BENEFIT CALCULATIONS FOR NON-IA RECIPIENTS

Individuals who do not receive IA may also qualify for retroactive APA payments.  This occurs when the APA application is pended for an SSA/SSI or DDS decision.

To issue a retroactive APA payment, check the benefit start date on EIS to ensure it shows the correct date APA is to begin.  If necessary, adjust it to reflect the date eligibility begins according to section 410-11.

Calculate the retroactive APA payment for each month by subtracting countable income and allowable deductions from the APA maximum payment standard.  

Note:  EIS can be used to calculate the retroactive payment for each eligible month.

Example 1: Application received after July 1, 2004  (based on 2004 payment standards)

APA application received on July 15, 2004 from an individual who has applied for SSA disability insurance.  Because he receives a monthly pension of $600, the individual is not eligible for SSI or IA.  On October 29, the Social Security Administration notifies the applicant that SSA disability payments are approved in the amount of $232/month back to the benefit month of February 2004.  The client reports this change on December 8, 2004.

Change the benefit start date in EIS to November 1, 2004, the month after the SSA decision was issued, and open the APA case beginning November.  APA benefits are not paid back to July 15, 2004 because the application was received after July 1, 2004 when APA policy changed.  Issue the retroactive APA payment for December as follows:

$ 926   APA Maximum Payment Standard
-  600   Pension Income
-  212    SSA ($232 - $20 Disregard)
$ 114   Retroactive APA Payment for November

Example 2: Application received before July 1, 2004  (based on 2004 payment standards)

APA application received on February 1, 2004 from an individual who has applied for SSA disability insurance.  Because he receives a monthly pension of $600, he is not eligible for SSI or IA.  On October 29, the Social Security Administration notifies the applicant that SSA disability payments are approved in the amount of $232/month back to the benefit month of February 2004.  The client reports this change on December 8, 2004.

Change the benefit start date in EIS to February 1, 2004, the date the APA application was received, and open the APA case beginning February.  APA benefits are paid back to February 1, 2004 because the application was received before July 1, 2004. Issue retroactive APA payments for February - December as follows:

$ 926   APA Maximum Payment Standard
-  600   Pension Income
-  212   SSA ($232 - $20 Disregard)
$114   Retroactive APA Payment for each month