452-5        COMPUTATION OF BENEFITS

452-5 A.   REGULAR APA 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 need and payment standards described in manual sections 451-3 and 452-1, and shown in Addendum 1.

1. Payment Limit

Regardless of an individual’s or couple’s total monthly countable income, the APA 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 recipient may not receive any more money than a similarly situated SSI Supplemental Security Income recipient.

Example: (based on 2004 payment standards),

Mr. Johnson, an unmarried APA recipient living independently receives a private pension that exceeds the SSI income standard.  His pension income stops suddenly, and Mr. Johnson is advised to apply for SSI benefits.  Except for APA, Mr. Johnson has no other income.  While waiting for his SSI payments to begin, Mr. Johnson may not receive a higher APA payment than he would if he was already receiving a monthly SSI payment.  Mr. Johnson’s APA payment is adjusted to $362 ($926 APA maximum payment standard  – $564 SSI income standard  = $362).

2. APA Payment Calculations

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

a. Income is less than APA maximum payment standard

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

b. Income equals or exceeds APA maximum payment standard

For individuals or couples whose total monthly countable income equals or exceeds the appropriate APA maximum payment standard, but is equal to or less than the appropriate APA need standard, the APA 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 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 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 $75 APA 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 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 Adult Public Assistance will provide an additional payment to provide a total amount of $75 for personal needs.

An individual who is ineligible for SSI Supplemental Security Income, but whose countable income is less than the APA personal needs standard, may receive an APA 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 $75 is not eligible for an APA payment but may be eligible for Medicaid.  

Note:  

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

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

Example 1:  SSI recipient (based on 2004 payment standards)

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

  $664   APA maximum payment standard for an individual,
              in assisted living home (H1E)
-     564   SSI individual, “A” living arrangement standard
= $100   APA payment

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

Example 2:  Non-SSI recipients (based on 2004 payment standards)

A married couple who are both eligible for APA reside in an assisted living home.  The couple’s combined income from Social Security benefits is $920 per month.  After the $20 income exclusion is allowed, the couple’s net countable income is $900.  Use the APA maximum payment standard for an eligible couple and subtract the couple’s net countable income.

$ 1046  APA maximum payment standard for a couple, both
            eligible, in an assisted living home (H2C)
-    900  Net countable income
=$146  APA Payment ($73 to each spouse)