SSI AND CONTINUED MEDICAID COVERAGE

WHEN YOU WORK

UNDER  SECTION 1619(b)

David Linney

There are a number of individuals with bleeding disorders who receive Supplemental Security Income (SSI) disability benefits.  SSI recipients receive monthly checks and Medicaid.  Medicaid, for many, is their only health insurance.

Many SSI recipients would like to try to work, but are afraid that work income will result in a loss of SSI and, most importantly, Medicaid.  Without Medicaid, many would have no coverage to pay for their medical care and very expensive factor products.

Social Security has a provision, Section 1619(b), which can help.  1619(b) allows SSI disabled recipients to work and keep Medicaid, even after the cash benefits stop because income is too high, so long as certain requirements are met.  To qualify for continuing Medicaid, a person must:

·         Continue to meet the Social Security requirements for disability when working.

The Social Security Medically Determinable Impairment for Adults is listed as follows:

7.08  Coagulation Defects (hemophilia or a similar disorder) with spontaneous hemorrhage requiring transfusion at least three times during the 5 months prior to adjudication.

·         Continue to meet other non-disability requirements (for example, asset limits and spousal income limits).

·         Need Medicaid benefits to work.

·         Have gross earnings that would not be enough to replace SSI cash benefits and medical expense dollars paid by Medicaid.

If these requirements are met, an individual can have gross earnings up to the following threshold amounts listed by state and still qualify for Medicaid under a Special SSI Recipient Status:

2005 1619(b) THRESHOLD AMOUNTS FOR DISABLED SSI BENEFICIARIES

For individuals who work despite meeting Social Security disability requirements and earn less gross dollars than the allowable threshold amount for the state in which they live, Medicaid eligibility under 1619(b) should be ongoing.  SSI dollars will stop, but Medicaid will be continued.  Social Security will then continue to monitor income and disability status (as well as non-disability requirements) and certify the individual to continue to receive Medicaid under 1619(b).

Eligibiliy for Medicaid Continuation under 1619(b) if Income Exceeds the Threshold Amount

If a SSI recipient has gross earnings that exceed the threshhold amount, an individualized

threshold can be calculated.  The object of an individualized threshold calculation is to determine if the individual has earnings sufficient to replace all the benefits he/she would actually receive in the absence of those earnings.  An individualized threshold will include any of the following amounts:

·         Impairment-related work expenses

·         Cost of a plan for achieving self-support

·         Medical expenses above the average state amount

As annual factor product costs often run over one hundred thousand dollars, such medical expenses can be used to establish an individualized threshold.  Individuals would be able to earn considerably more than the threshold limit and still be eligible for Medicaid through the SSI program under the Special 1619(b) Recipient Status.  However, note that as income increases, it will become important to keep within SSI’s allowable asset limits.

Individualized thresholds need to be calculated and approved by Social Security case workers through the local Social Security office.  Contact the local office to make an appointment and bring along documentation for approved deductible expenses (listed above).

For more information about Section 1619(b), contact Social Security by phone (800) 772-1213 or on the web at http://policy.ssa.gov/poms.nsf/aboutpoms (Go to “Table of Contents” and then “SI 02302”)

The issue of work and ongoing Medicaid eligibility for SSI recipients is important for those individuals who would like to try to work.  1619(b) can help.  For questions, contact Social Security representatives to carefully review requirements.  For help and guidance, contact: a local hemophilia treatment center; a local/state chapter of NHF; NHF’s information and resource center, HANDI; other hemophilia/bleeding disorder organizations, the reimbursement department of a homecare vendor; and, the reimbursement department of manufacturers.