The 1619(b) incentive provides continued Medicaid coverage for SSI recipients when their earnings become too high to allow an SSI cash payment.
To qualify for this incentive, a person 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, below); and
· Have gross earned income which is either below a predetermined state threshold level or below an individualized threshold.
In order to keep Medicaid coverage you must inform your SSA Claims Representative that you need Medicaid to work. See the SSA Sample 1619(b) Referral Letter topic for additional information and a letter you can use for notification.
When your earnings are high enough that your SSI cash benefit goes to zero, the Claims Representative is supposed to ask you three questions:
· "Have you used any medical care or services in the past 12 months that was paid for by Medicaid (or Medi-Cal, etc.)?"
· "Do you expect to receive any medical care or services in the next 12 months that will be paid for by Medicaid (or Medi-Cal, etc.)?"
· "Without Medicaid (Medi-Cal, etc.), would you be unable to pay your medical bills if you become ill or injured in the next 12 months?"
If you answer "Yes" to any one of those questions, then the Claims Representative is supposed to presume that you need Medicaid in order to work. (The POMS reference is: SI 02302.040.)
SSI Work Incentives
Work Incentives Overview
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