9.5 Other Important Topics

Question 1

What is Substantial Gainful Activity (SGA) for blind beneficiaries in 2024?

Answer 1

Answer: “$2,460 per month.”
Explanation: “Blind beneficiaries have a higher SGA threshold compared to non-blind beneficiaries.”
Source: SSA Annual SGA Thresholds.

Question 2

What is a continuing disability review (CDR)?

Answer 2

Answer: “A periodic review conducted by SSA to determine whether a beneficiary continues to meet the disability criteria.”
Explanation: “CDRs occur every 3–7 years for most beneficiaries but may occur sooner if improvement is expected.”
Source: CFR §404.1594

Question 4

Case Scenario: Lisa, an SSI recipient, starts earning $3,000 per month, which exceeds SSI income limits. She requires Medicaid to manage her diabetes and worries about losing coverage.

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

Answer 4

Answer: Yes, Lisa can retain Medicaid under Section 1619(b) if her earnings exceed SSI limits but remain below her state’s Medicaid threshold, and she continues to meet disability criteria.

Legal Explanation: Section 1619(b) allows SSI recipients to keep Medicaid coverage if their earnings exceed SSI limits but remain within the state-specific Medicaid threshold.
Key Resource: CFR §416.264 – Medicaid continuation under Section 1619(b).

Key Takeaway: Section 1619(b) enables SSI recipients to retain Medicaid coverage even if their earnings exceed SSI limits, provided they meet state-specific thresholds.

Question 5

Section 1619(b):

Answer 5

Medicaid coverage can continue for SSI recipients who earn above SSI limits but remain within state thresholds.