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SSA Sample 1619(b) Referral Letter

Shown below is a sample letter you can send to your Claims Representative at the Social Security Administration (SSA). You can use this letter to inform SSA of your need for continued Medicaid coverage under section 1619(b) when your earnings become high enough to cause your Supplemental Security Income (SSI) benefits to stop.

To continue your Medicaid coverage, you must:

·          Have been eligible for an SSI cash payment for at least one month;

·          Still meet the disability and non-disability requirements;

·          Need Medicaid in order to work (see Medicaid Need Test); and

·          Have earnings below a specified threshold level. Usually, SSA uses your State's 1619(b) Threshold Amount when deciding 1619(b) eligibility. Alternatively, you may be able to establish a higher Individualized 1619(b) Threshold Amount if any of the following are true:

o    your personal medical expenses are high,

o    you receive certain types of State SSI Supplements,

o    you use publicly-funded personal/attendant care, or

o    you have an IRWE, BWE, or PASS.

See the Contacting the Social Security Administration topic if you don't know who your SSA Claims Representative is, you need to discuss Individualized Thresholds, or you need other contact information for your local SSA Field Office.

Every State has a Protection and Advocacy Agency that operates the Protection & Advocacy for Beneficiaries of Social Security (PABSS) program. This agency can provide you with free information and referral, technical assistance, advocacy and/or legal representation if you are having difficulty accessing or have been inappropriately denied 1619(b) benefits.

Please remember that this letter is intended to increase the likelihood that 1619(b) eligible individuals will continue their Medicaid coverage. Use of the sample letter does not guarantee Medicaid coverage.

NOTE: In the sample letter below, replace everything in brackets [example] with your specific information.

Image of horizontal red colored lines, used to seperate topic sections.


[Claims Representative's Name]
Social Security Administration

Dear [Claim Representative's Name]:

I am [Your full name] and my Social Security Number is [SSN].

I am writing to inform you of my recent employment.

I started working on [date] at [Employer’s name and address and telephone number].

I will be making [hourly rate] and will be working ____ hours per week. My first payroll check will be distributed on [date], and I will be paid [Your payroll schedule]. My earnings will negate my SSI monthly income.

I [choose one of the following options: 1) do not have impairment related work expenses; 2) have the following impairment related work expenses (list the type and amount of expenses)].

I have complied with the following Medicaid use test criteria, in order to be placed in 1619(b) status and continue to receive Medicaid:
[choose any of the following options that apply: 1) I have used Medicaid in the past 12 months; 2) I will need Medicaid in the next 12 months to cover expected medical expenses; or 3) I would need to use Medicaid if there are unexpected medical expenses].

The purpose of this letter is to proactively communicate with all concerned parties to ensure there is not a lapse in Medicaid benefits for me, which might jeopardize my job placement.

Thank you for your assistance in this matter. Please feel free to contact me at [Your telephone number] if there is any other information you need to facilitate this process.

Sincerely yours,

[Your signature]

[Your Name]
[Your address and telephone number]

Image of horizontal red colored lines, used to seperate topic sections.

Additional Information

This sample letter was adapted for consumer use from an example provided by the Virginia Department of Medical Assistance Services (DMAS). For a similar sample letter worded for use by an advocate or agency on behalf of a consumer, see the DMAS web page at:


Information for this topic was drawn from the DMAS website at:

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