TN 14 (09-01)
SI 02005.008 Proration After Period of Ineligibility
1. Effective Date - 10/82 or later
Although proration for initial claims ceased 9/1/96, proration still applies after periods of ineligibility. The effective date of proration after a period of ineligibility is the day a person reattains eligibility after a month or more of ineligibility. The benefit due for the month of reattainment of eligibility is prorated. There can be only one proration date in a month.
2. Period of Ineligibility Defined
A month of ineligibility, when applying proration to the benefit for a subsequent month is a month for which a person is ineligible for any Federal Supplemental Security Income (SSI) benefit or federally administered State supplementary payment. Ineligibility means not passing the “eligibility test” for these programs. Eligible but not payable (payment status code “E01”) is not ineligibility.
A person reattains eligibility when, after a month of ineligibility, he/she becomes eligible for a Federal SSI benefit or federally administered State supplement. Eligibility means that the person passes the “eligibility test” for either program. Eligible but not payable (payment status code “E01”) is eligibility.
3. When Proration Applies
Proration applies when eligibility is reattained on a date other than the first day of a month.
When there is Optional State Supplement (OSS) involvement, proration applies to Federal and OSS payments for the same number of benefit days.
Proration does not apply when a recipient eligible for only a Federal payment (including recipients who are eligible but due no payment) becomes eligible for an OSS payment.
EXAMPLE: A recipient in a Title XIX institution who is paid only a Federal payment (or who is eligible but receives no payment (E01) while in the institution) will not be subject to proration of the Federal or OSS payment when he/she leaves the institution regardless of the day of the month.
4. Factors Which Cause Proration
Ineligible for Federal and OSS Payments as a Resident of a Public Institution Throughout a Month (i.e., PSY N02 or N22)
The person reattains eligibility as of the day he/she is discharged. (See SI 00520.001.)
EXAMPLE: A recipient enters the public institution on 1/2/90. If he/she is discharged on 3/2, the benefit for March is prorated because he/she was suspended for February. If he/she leaves the institution on 2/25, the benefit for February is not prorated because he /she was not ineligible in January; i.e., was not in a public institution throughout a month.
Absent from the United States Throughout a Month or for 30 Consecutive Days (i.e., PSY N03)
Following absence of 30 consecutive days or more, the person reattains eligibility the day after the 30th consecutive day of presence in the United States. If the person was absent throughout a month but less than 30 days (only possible for February), he/she reattains eligibility the day he/she returns to the United States. (See SI 00501.410 or SI 02301.225.)
Not a resident of the United States (i.e., PSY N23)
Not a resident of the United States but later gains status as a United States resident. (See GN 00303.700 and GN 00303.740.)
Did Not Meet the Definition of Citizen, “lawfully admitted alien” or Permanent Resident Under Color of Law
The person reattains eligibility the day he/she regains his/her status in one of these categories. (See GN 00303.001.)
Failure to Comply with the Requirement to File for Other Benefits (i.e., PSY N06)
The person re-attains eligibility the day he/she complies. (See SI 00510.001E.2.)
No Longer Disabled (PSY N07)
This is unusual in a posteligibility situation, but it does happen as illustrated by the following example: Joe is receiving SSI, and a medical improvement CDR by the DDS found him not disabled any longer (PSY N07). He appeals, and the ALJ agrees that the DDS was correct, but also finds that Joe is again disabled beginning with the date of his decision (12/23/00). Therefore, proration applies in December 2000.
Use the formula in SI 02005.007B. to compute proration after a period of ineligibility.