BASIC (11-02)

SI 02009.050 Eligible Individual With Essential Person(s)

A. Policy -- general

When a qualified individual (see SI 00501.100) with­out an eligible spouse has an essential person(s), the FBR is increased by an increment for each essential person (see SI 02001.020 for incremental amount). The qualified in­dividual will continue to be entitled to the essential per­son increment until there is a loss of the essential person status (SI 00501.110).

B. Policy -- qualified individual in LA “B”

If the qualified individual is subject to a one-third re­duction for living in the household of another and receiv­ing support and maintenance in-kind, (SI 02001.015B.1) the essential person increment is also reduced by one-third. Thus, it is necessary to add the full increment for each es­sential person to the basic FBR (SI 02001.020) and then reduce the entire amount by one-third.

C. Policy -- qualified individual in LA “D”

When a qualified individual is in a medical facility for an entire month and Medicaid pays more than 50 percent of the cost, the full essential person increment(s) may be added to the qualified individual's FBR ($25/month) for a period of up to and including 6 months, provided the confinement in the facility is temporary (see SI 02001.015B.4). If it is determined the confinement will not be temporary, the essential person increment(s) may no longer be included in computing the benefits effective the month after the month of the determination.

D. Policy -- qualified individual institutionalized – not LA

When a qualified individual continues to be eligible for SSI while institutionalized, the addition of the essential person increment(s) follows the same rules as described in SI 02009.050C. . If the qualified individu­al is ineligible for payment because he is an inmate of a public institution, the essential person increment may be permanently lost depending on the length of stay, (see SI 00501.110).

E. Procedure - - payment computation steps

  1. Determine the FBR due the eligible individual in accordance with the chart in SI 02001.020 (note SI 02009.050B. if the one-third reduction is applicable);

  2. Add the essential person increment(s) for the period (see SI 02001.020);

  3. If the one-third reduction applies, reduce by one-third;

  4. Subtract the countable income including that deemed from the essential person(s), see SI 01320.800. This leaves the amount due the eligible individual for the quarter.

  5. Divide the quarterly amount due by 3 to obtain the monthly payment amount to the eligible individual. No payment is made to the essential person.

NOTE: when there is a change in the living arrangements within the quarter the computation procedure follows the steps described above and those in SI 02009.015.

Example:

Elvia Fuentes is an eligible individual living in her own household with her essential person. The only income, other than SSI, is the essential person's VA pension check of $50 per month. On July 5, 1981, they move into the household of Elvia's sister. Neither contribute to the household expenses. The computation for the third quar­ter of 1981 is:

For July, Elvia and her essential person are living in Elvia's household. Thus, the FBR of $264.70 plus the es­sential person increment of $132.60 is used equaling $397.30.

For August and September they are living in the house­hold of another and thus, subject to one-third reduction. $264.70+ $132.60= $397.30 (1/3 $397.30)=$264.87. This is a regular computation in that 1/3 of countable in­come is subtracted from each monthly FBR.

Countable Income

$150.00

Essential persons VA pension

$ 90.00

In-kind support and maintenance for July (Elvia rebutted the maximum presumed value of $152.43)

$240.00

 

$ 60.00

General exclusion

$180.00

Monthly countable income