1619a and 1619b

Under Section 1619, a person who is eligible for continued Medicaid coverage under 1619(b) can begin receiving SSI cash payments without reapplying at any time earnings drop below the break-even point (the point at which after deducting your earned income you would receive an SSI payment).

This means that even if your SSI check drops to $0 because of your earnings, you can restart it at any time if you lose your job or your income decreases.  At one time, SSI recipients who worked were bound by the same concept of SGA that affects working SSDI recipients. This meant that earnings over the SGA amount (currently $900 per month in 2007) usually resulted in loss of benefits. This is no longer the case. As long as working SSI recipients continue to meet all general SSI requirements (disability, resources, other countable income, etc.), SSI eligibility will generally continue unless there is medical improvement.

Section 1619(a) is the part of the Social Security Act that authorizes continued SSI eligibility even when a working SSI recipient grossed over $900 per month in 2007. This provision allows you to try working in supported or competitive employment, or self-employment without fear that your benefits will be stopped as a result of earnings. Within twelve months of the time an SSI recipient grosses over $900 per month and continues to receive benefits due to 1619(a), there may be a medical review to confirm that no medical improvement has taken place.

Section 1619(a) benefits can continue until you turn 65, or medically improve or fail to meet any SSI eligibility criteria, or until your earnings decrease to less than $900 per month. When your earnings are less than $900 per month, you receive regular SSI benefits.

Of course, as your wages increase, your SSI checks will gradually reduce to $0 due per month. Even at this point, however, SSI eligibility is not lost under Section 1619(b). It is just that you have no checks because of the amount of your earnings. The threshold amount when this occurs is $1,326.

1619b – Retention of Medicaid (SSI only)

Medicaid While Working (1619(b) eligibility) only applies to working individuals. Once an individual has reached the earned income limit of $1,326, which zeroes out his/her SSI cash benefit, he/she may be able to retain Medicaid coverage. In Hawaii, an individual can have income of $2,355 per month ($28,260 per year) and still retain Medicaid coverage.
The disabled individual must meet all of the following:

  • Continue to have a disabling condition
  • Need Medicaid in order to work
  • Be unable to afford equivalent medical coverage without assistance
  • Meet all non-disability requirements for SSI payments, other than earnings

When working SSI recipients are not due an SSI check because of the amount of their gross earnings, they do not lose their SSI eligibility and they do not lose their Medicaid. The reason for this is a provision of the Social Security Act known as Section 1619(b).

Section 1619(b) particularly benefits two groups of working SSI recipients:

  1. Persons whose only benefit is SSI and whose earnings in any one or more months exceed “breakeven” amounts and therefore are too great to permit the issuing of any SSI check.
  2. Persons who receive both SSI and SSDI (concurrent recipients), and whose SSDI check is the greater of the two, while their SSI check is relatively small.

In all cases, in order to be eligible for extended Medicaid under 1619(b), an individual must meet all of the following criteria:

  • Be under 65
  • Be blind or have another “severe impairment”
  • Have been eligible to receive either a “regular” or Section 1619(a) SSI cash benefit in the prior month, and you would have continued to receive an SSI check if your earnings had been lower (SSI check is not due when you have earned income beyond the 1619 (a) break-even point);
  • Need Medicaid to work
  • Be unable to afford medical care without assistance.

The 2007 state threshold for Section 1619(b) is $28,260 per year or $2,355 per month

Be careful when assisting individuals in determining Medicare cessation/termination.
These rules are complex and the practitioner should always confirm their findings with SSA.