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Recommendation: You may be able to establish an individualized threshold

Although you have Gross Earned Income greater than the State Threshold Amount, you may be eligible for an individualized threshold if you have one or more of the following:

· Medical expenses greater than the average per capita Medicaid expenditure cost in your State.

· Blind Work Expenses (BWE)

· A Plan to Achieve Self-Support (PASS)

· Publicly funded attendant or personal care (not funded by Medicaid – since that would be reflected in the first item)

For more information see Individualized 1619(b) Threshold Amounts.

Action Steps:

1. Determine how much of your work expenses and/or employability investments can be included in an IRWE, BWE or PASS.

2. Determine the amount of your Individualized Threshold. Since doing so is somewhat complicated, you may want to contact your SSA Claims Representative or an experienced Benefits Specialist. Or, you can follow the instructions in Individualized 1619(b) Threshold Amounts.

3. Create a New Situation based on the situation in which the Recommendation appears.

4. Type a name for the new situation such as "Individualized Threshold" (optional) and press <Enter>.

5. Scroll down to the question in the Earned Income section and select the answer box for the question on Individualized Threshold. Change the answer from NO to YES and press <Enter>.

6. Enter the amount of your individualized threshold and press <Enter>.

7. Check your Text Results. If the Individualized Threshold is greater than the Gross Earned Income, then no Alert should appear warning of a loss of Medicaid coverage (and/or no Recommendation to establish an individualized threshold).

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