TN 6 (08-91)

SI 02005.084 MMSS Eligibility and Payment Computations Under RMA

A. POLICY

MMSS payments are always computed using countable income received in the CM. To be eligible for MMSS, an individual's MIL must be greater than the sum of:

  • CM FCI/SCI;

  • In-kind income in the CM, if any; and

  • Federal eligibility amount.

B. DEFINITIONS

1. Federal Eligibility Amount

The Federal eligibility amount is the difference between the CM FBR and the CM FCI.

2. Value Of The One-Third Reduction (VTR)

The Value of the One-Third Reduction (VTR) is the income value assigned (for Federal purposes) to in-kind support and maintenance received by an SSI recipient when living in the household of another during the CM. (See SI 00835.200 ff. and SI 02005.084D.2.)

3. In-Kind Income

In-kind income is the value assigned to in-kind support and maintenance for MMSS purposes only. It may or may not be the same amount as the VTR.

C. PROCEDURE

1. MMSS Eligibility

Use the following formula to determine an individual's MMSS eligibility: MMSS eligibility = MIL - (CM Federal eligibility amount + CM FCI/SCI + CM in-kind income).

2. MMSS Payment Computation

  1. Use the following formula to compute an individual's MMSS payment: MMSS payment = MIL - (CM Federal payment + CM FCI/SCI + CM in-kind income).

  2. The difference represents the MMSS payment. Compare that amount to any optional State supplementation (OSS) payable and pay the higher amount. If the two payments are equal, pay the OSS.

NOTE: Always perform MMSS computations separately for each recipient, even for members of an eligible couple. The MIL and the income used in eligible couple cases are affected by both members; but the computation to determine eligibility and payment is performed separately.

D. EXAMPLES

There are three different methods to apply the MMSS eligibility and payment computation formulas depending on the individual's living arrangement in December 1973 and his CM Federal living arrangement (FLA). FLA's are defined in SI 01415.001. Use the chart below to decide which method applies.

December 1973 Federal Living Arrangement

      
    A  B  C  D
CM FLAAMethod 1Method 1Method 1Method 1
 BMethod 2Method 1Method 2Method 2
 CMethod 1Method 1Method 1Method 1
 DMethod 3Method 3Method 3Method 1

1. Method 1 — Basic MMSS Computations

  1. This is the basic MMSS computation. Use it when neither the VTR nor the FBR payment limit for living in a title XIX facility applies, with two exceptions. Do not use this formula for:

    • Recipients converted in the household of another and currently subject to the VTR (whether or not the individual was continually subject to the VTR). The VTR has already been taken into account in the MIL, and it is unnecessary to consider it again in the computation. Follow method 2 for recipients currently subject to the VTR who were not converted in FLA-B.

    • Recipients converted in a title XIX institution and currently residing in a title XIX institution (whether or not the individual was continually in FLA-D). Follow method 3 for recipients residing in a title XIX facility who were not converted in FLA-D.

  2. Example

    • Basic Computation

      Franklin Hightower has a MIL of $400. In January 1990, his income is a $120 per month private pension. In November and December 1989, in addition to the pension, he received rental income of $139.70 per month. FCI may be used in place of SCI in the computation. Compute his MMSS for January 1990.

    • The Eligibility Test

$400MIL in January
-100FCI in January ($120 pension - $20 general exclusion)
-286Federal eligibility amount based on January FCI ($386 FBR - $100 FCI)
$ 14He is eligible for MMSS
  • The Payment Computation

    The amount of Mr. Hightower's January Federal SSI benefit is based on his income from November, the Federal BM.

$386.00FBR in January
-239.70FCI in November ($120 pension +$139.70 rent - $20 general exclusion)
$146.30Federal payment due for January

The amount of Mr. Hightower's MMSS is based on his Federal payment and FCI for January.

$400.00MIL in January
-100.00FCI in January
-146.30SSI for January
$153.70MMSS for January

If he is due an OSS payment equal to or greater than $153.70, pay the OSS instead of the MMSS.

2. Method 2 — Individual Subject To The VTR For Federal Purposes

  1. Use method 2 when an eligible individual or couple:

    • Were converted to SSI in FLA-A, C, or D (but not B); and

    • Begin living in the household of another and receiving food and shelter (i.e., subject to the VTR).

  2. The MMSS VTR can never exceed the value of one-third of the A FBR in effect at the time that the most recent move into FLA-B became effective. When only one member of a couple meets the above requirements, the amount of the MMSS VTR is limited to one-sixth of the couple's FBR at the time that the most recent move into FLA-B became effective.

  3. Follow these steps to determine the amount of the in-kind income for MMSS purposes.

    • Step (1): Subtract the computation month's FCI (never use SCI) from the FBR in effect at the time of the most recent change to the household of another. If this results in an amount of zero or less, no in-kind income for MMSS purposes exists.

    • Step (2): Subtract the computation month's FCI (never use SCI) from the FBR in effect at the time of the most recent change to the household of another less one-third. If the result is zero or less, use zero in step 3.

    • Step (3): Subtract the result obtained in step (2) from the result obtained in step (1). The remainder is the amount of in-kind income in the month for MMSS purposes.

  4. This example shows the MMSS computation involving the VTR.

    Individual Becomes Subject To The VTR

    Ms. Adams was converted to SSI in an FLA-A with a MIL of $400. She has no income other than SSI. In February 1990, she moves into her nephew's home, and begins receiving both food and shelter. Compute the March 1990 MMSS as follows:

    • In-kind Income Computation:

Step (1):

$386.00FBR in March (effective month of move)
- 0.00FCI in March
$386.00Step (1) Result

Step (2):

$257.33FBR in March less the VTR
- 0.00FCI for March
$257.33Step (2) Result

Step (3):

$386.00Step (1) Result
-257.33Step (2) Result
$128.67In-kind income for March for MMSS purposes
  • MMSS Computation for March 1990:

$400.00MIL
-386.00($ 257.33 March Federal payment +0 FCI/SCI + $128.67 MMSS in-kind income)
$ 14.00MMSS Payment for March

3. Method 3 — MMSS Suspended For Living In A Title XIX Facility

  1. State supplementary payments may be suspended in months during which an individual's Federal payment limit is $30 (effective July 1, 1988) due to his stay in a title XIX facility. Upon discharge from the institution, the individual may again receive federally administered MMSS payments based on the MIL or, if higher, a federally administered OSS.

    NOTE: (1) MMSS payments are not suspended if the individual was converted in December 1973 while residing in a Medicaid facility. (2) The benefits described in section 1619 of the act and sections 1611(e)(1)E and 1611(e)(1)G of the act do not apply to the above discussions about title XIX institutions.

  2. When only one member of an eligible couple resides in a title XIX facility, MMSS computations follow the Federal rule that each member of the couple is treated as an individual. See SI 02005.030C. for Federal and OSS computations under RMA.

  3. Follow these steps to compute the MMSS payment for this couple:

    • Establish separate MIL's for each couple member. Follow the procedures in SI 02005.082D.6.

    • Compute the MMSS payment for the noninstitutionalized member, and the MMSS payment for the institutionalized member if he was converted in FLA-D, independently.

    • From the individual MIL(s) subtract the total of the individual's Federal SSI benefit and his own income.

  4. EXAMPLE: One Member of an Eligible Couple Resides in a Title XIX Facility — Other Member in Own Household

    Mr. Rand and Miss Lakes were converted in the same State as eligible individuals in their own households. Mr. Rand's MIL was established as $450 based on a December 1973 GA of $410 and SCI of $40. Miss Lakes' MIL was established as $300 based on her December 1973 GA of $260 and SCI of $40. Their State of conversion does not elect to maintain supplementary payment levels for passalong purposes. They married in 1975. Their December 1973 incomes and grant amounts were combined to form new MIL's based on couple status.

    MIL Computation:

$410Mr. Rand's December 1973 GA
260Miss Lakes' December 1973 GA
40Mr. Rand's December 1973 SCI
+40Miss Lakes' December 1973 SCI
$750 

$750 divided by 2 = $375 MIL for each couple member.

In September 1990 Miss Lakes enters a nursing home and Medicaid covers the entire cost of her care. For every month that she remains subject to the $30 payment limit, her MMSS payments are suspended.

Mr. Rand remains in his own household. He continues to receive the $55 company pension of which $40 was countable under the State plan. In October 1990 he begins receiving a monthly payment of $10 from his sister. (His State plan would not have counted the $10 had it been received in December 1973 because of the State's unearned income exclusion.)

October 1990: This is the first month throughout which Miss Lakes is residing in the title XIX facility. Compute Mr. Rand's payment as an individual.

Step (1): The MMSS Eligibility Test

$450MIL in October (the original individual MIL)
-341Federal eligibility amount ($55 pension +$10 from sister - $20 general exclusion = $45 FCI. $386 FBR - $45 October FCI = $341)
$109 
- 40SCI for October
$ 69He is MMSS eligible

Step (2): The MMSS Payment Computation

$450MIL in October (the original individual MIL)
-351Federal payment amount ($55 pension - $20 general exclusion = $35 FCI. $386 FBR - $35 August FCI = $351)
$ 99 
- 40SCI for October
$ 59MMSS Payment for October

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502005084
SI 02005.084 - MMSS Eligibility and Payment Computations Under RMA - 07/03/2012
Batch run: 07/03/2012
Rev:07/03/2012