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SSI Work Incentive - 1619(b)

Continued Medicaid Coverage:

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.

NOTE: Medicaid eligibility in most states is based on SSI eligibility criteria. Some states require that you have fewer resources or have other more restrictive criteria for Medicaid eligibility.

However, even if you live in a State that has more restrictive criteria for Medicaid eligibility, if you have Medicaid coverage during the month before your earnings become too high, then 1619(b) guarantees continued Medicaid coverage if the criteria above are met and if other factors, such as your resources, do not change so as to make you ineligible.

NOTE ALSO: In States with more restrictive criteria, you should make sure that your State agency administering Medicaid is informed of your 1619b status.

Medicaid Need Test

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.)

NOTE: In the 2001 and 2002 versions of its "Red Book," the Social Security Administration (SSA) began using the term "Employment Supports" in place of "Work Incentives." See the SSA Red Book topic for additional information. The latest version of SSA's Red Book on Employment Support is available at: http://www.socialsecurity.gov/redbook/

See Also:

SSI Work Incentives

Work Incentives Overview

WorkWORLD™ Help/Information System

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