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SSI Ineligibility - Substantial Gainful Activity - Iowa

Medicaid coverage may be available to some former SSI recipients who no longer qualify for SSI cash benefits because they perform "substantial gainful activity" (as determined by the Social Security Administration) and they have sufficient total countable income to cause their cash benefit to decrease to zero.

Eligibility may exist for people in this group if the person:

·           Continues to be blind or have a disabling impairment.

·           Meets all other SSI requirements except for earnings.

·           Would be seriously inhibited from continuing to work if Medicaid eligibility was terminated.

·           Earns income that is not a reasonable equivalent to the benefits the person would have, including SSI, State Supplemental Assistance and Medicaid, if the earnings did not exist. This level is determined by the Social Security Administration.

This coverage group is also known as the "1619b" group. For purposes of Medicaid eligibility, a person meeting these criteria is considered to be an SSI recipient, even though no SSI cash benefit is received.

NOTE: Under the provisions of the new Medicaid for Employed People with Disabilities (MEPD) program, individuals with too much income to be included in the "1619b" group may be able to retain their Medicaid coverage by paying a sliding-scale premium.

The Social Security Administration determines initial and continuing eligibility for this coverage group.

See Also:

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees’ Manual

Title 8 Medicaid

·                        Chapter F, Coverage Groups, SSI-Related Coverage Groups, Due to Substantial Gainful Activity (1619b Group)

Legal reference: 20 CFR 416.2101, 42 CFR 435.120

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