4.6 Section 1619(b)

Question 1

“What is Section 1619(b)?”

Answer 1

“A provision allowing SSI recipients to continue receiving Medicaid coverage even if earnings exceed SSI limits, provided they remain disabled.”
Explanation: “This ensures that recipients can maintain access to essential healthcare while working.”
Source: CFR §416.264.

Question 2

“What are the requirements for Section 1619(b) eligibility?”

Answer 2

Answer:
“1. The individual must have been eligible for SSI in at least one prior month.”
“2. Their disability must continue.”
“3. Earnings must not exceed the state-specific Medicaid threshold.”
Explanation: “The program prevents a healthcare cliff effect for low-income workers.”

Question 3

Case Scenario: Lisa, an SSI recipient, begins earning $2,500 per month in 2025, which exceeds SSI’s financial eligibility limits. Lisa requires Medicaid to manage her diabetes.

Question: Can Lisa retain Medicaid coverage under Section 1619(b)?

Answer 3

Answer: Yes, Lisa can retain Medicaid coverage under Section 1619(b) because her earnings exceed SSI limits but are within her state’s Medicaid threshold for continued coverage.

Legal Explanation: Section 1619(b) allows SSI recipients to keep Medicaid coverage if:

They remain disabled.
They need Medicaid to work.
Their earnings are below the state-specific threshold for Medicaid eligibility.
This provision ensures access to essential healthcare while encouraging work.

Question 4

Ticket to Work Program:

Answer 4

Encourages vocational training and employment without fear of losing benefits.

Question 5

Key Takeaways for Section 4

Answer 5

Trial Work Period (TWP):

Up to 9 months of testing work ability without losing benefits.
2025 TWP threshold: $1,050/month.

Extended Period of Eligibility (EPE):
36-month period after TWP where benefits are reinstated if earnings fall below SGA.

Expedited Reinstatement (EXR):
Allows reinstatement without reapplication within 5 years of benefit cessation.

Ticket to Work Program:
Encourages vocational training and employment without fear of losing benefits.

Impairment-Related Work Expenses (IRWEs):
Reduces countable earnings for SGA determinations.

Section 1619(b):
Retains Medicaid coverage for SSI recipients earning above SSI limits.

Question 6

Section 1619(b):

Answer 6

Retains Medicaid coverage for SSI recipients earning above SSI limits.