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VA 1619(b) Status

The 1619(b) work incentive provides continued Medicaid coverage for Supplemental Security Income (SSI) recipients when their earnings become too high to allow an SSI cash payment.

The Social Security Administration (SSA) determines 1619(b) status.

In Virginia, the Department of Social Services (DSS) enrolls people in 1619(b) Medicaid.

If you are an SSI recipient with a disability and begin earning wages that will cause you to lose your SSI cash payment, you can probably still qualify for continued Medicaid coverage. However, you may need to help make sure this happens, as your Medicaid may not be continued automatically.

As soon as you realize that your earnings may become high enough to jeopardize your SSI payment, you should contact SSA and DSS to inform them of that fact. See the following topics for additional information, sample letters, and contact information you can use to make the notification:

· SSA Sample 1619(b) Referral Letter

· VA DSS Sample 1619(b) Referral Letter

If you think you have been inappropriately denied Medicaid (1619b status) benefits and are at-risk of losing your job due to a loss of Medicaid benefits or are unable to take a job because of the denial of 1619b status then contact the Virginia Office for Protection and Advocacy immediately.

Details

Information in this section is provided primarily for advocates and agencies, in order to provide operational details about how the various agencies and offices interact during the determination of a person's 1619(b) status. Most consumers will not find this useful, although the sheer complexity of the process may be of interest.

Social Security Administration (SSA)

SSA is the agency responsible for the determination of 1619(b) eligibility. Claims Representatives (CRs) ask the Medicaid use questions and input the 1619B SI field to annotate whether the Medicaid use test is met. CRs enter the effective or beginning date for 1619(b) eligibility. This posts the 1619(b) data to the Supplemental Security Record file. SSA sends Virginia the State Data Exchange (SDX) tape and provides access to the State Verification System (SVES) file.

State Department of Social Services (DSS)

State DSS provides access to the SDX and SVES for all local DSS agencies.

Local Department of Social Services (DSS)

Determines whether a 1619(b) recipient continues to be eligible for Medicaid. Local DSS offices may receive a 1619(b) referral from case workers or the 1619(b) recipient. Eligibility workers send a SVES request to SSA to verify 1619(b) status. The eligibility workers look for a code of A, B, or F in the field "Medicaid Test Indicator" on the State Verification Exchange System (SVES). If there is a code of A, B, or F, the individual has 1619(b) status. The "Current Pay Status Effective Date" field on the SVES screen shows the first month of the 1619(b) status. The eligibility worker determines if the 1619(b) recipient is eligible for the Medicaid 1619(b) protected group. The eligibility worker follows the procedures outlined in the Medicaid Eligibility Manual, (§ M0320.105, Volume XIII).

VR Case Workers, CSB Case Managers, Employment Specialists, and other Advocates

Assists recipients in obtaining 1619(b) eligibility from SSA and Medicaid eligibility as a protected 1619(b) status from DSS. Sends referral letter to local SSA office when they identify a SSI recipient potentially eligible for 1619(b). Sends referral letter to local DSS office after SSA has confirmed 1619(b) eligibility.

Virginia Office for Protection and Advocacy

Provides information and referral, technical assistance, advocacy and/or legal representation to consumers who are having difficulty accessing or have been inappropriately denied 1619(b) benefits. Provides information and technical assistance to providers, case managers, advocates, etc. seeking to assist consumers in obtaining 1619(b) benefits. See the VA Office for Protection and Advocacy (VOPA) topic for additional information.

Back to:

VA Medicaid Eligibility

VA Medicaid Covered Groups

VA Medicaid Overview

VA Benefit Information System Welcome and Introduction

Source

Information for this topic was drawn from the DMAS website at:
http://www.dmas.virginia.gov/mb-1619(b).htm

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