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VA DSS Sample 1619(b) Referral Letter

Shown below is a sample letter you can send to your Medicaid Eligibility Worker at the Virginia Department of Social Services (DSS). You can use this letter to inform DSS 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 use publicly-funded personal/attendant care, or

o    you have an IRWE, BWE, or PASS.

See the VA Department of Social Services (DSS) Offices topic if you don't know who your DSS Medicaid Eligibility Worker is 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. See the VA Office for Protection and Advocacy (VOPA) topic for comprehensive information about Virginia's P&A.

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.

[Date]

[Eligibility Worker's Name]
Department of Social Services
[Address]

Re: [Your Name, SSN and Medicaid Identification Number]

Dear [Eligibility Worker's Name]:

I am writing to inform you of my recent employment. As a result of this employment, I may no longer be eligible for a SSI cash payment. If I am placed in 1619(b) status by the Social Security Administration, I should be evaluated to determine whether I continue to be eligible for Medicaid as a protected individual under the provisions of QSII-1619(b). (See § M0320.105, Volume XIII, of the Virginia Department of Social Services Medicaid Eligibility Manual.)

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]

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:
http://www.dmas.virginia.gov/downloads/mb-1619(b)_DSS_referral_letter.doc

See the VA DSS Medicaid Manual On-Line topic for information about accessing § M0320.105, Volume XIII, of the Virginia Department of Social Services Medicaid Eligibility Manual mentioned in the letter.

Also see:

SSA Sample 1619(b) Referral Letter

VA 1619(b) Status

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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