How
does 1619(b) apply to Benefits Planning Assistance and Outreach
(BPAO) activities?
Section 1619(b) of the Social Security Act provides one of the most
powerful work incentive currently available for SSI recipients:
continued Medicaid eligibility for working individuals whose earned
income is too high to qualify for SSI cash payments, but not high
enough to offset the loss of Medicaid. It is important for Benefits
Specialist to know:
Consideration
of 1619(b) must be integrated into all benefits analysis and advisement.
For Example:
Does
a person’s living arrangement affect 1619(b) eligibility?
Yes,
in some cases a change in living arrangement may cause a person’s
1619(b) eligibility to change. Living arrangements involving
in-kind support and maintenance may add unearned income into
the equation, or may lower the person’s break-even point.
Moving in to a hospital or institution may also cause ineligibility,
although some exceptions are made for temporary institutionalization.
Living arrangement determinations can get complex. Assistance
from SSA personnel may be required.
Does
someone have to keep reporting income when they are on 1619(b)?
It
is essential that people who are on 1619(b) let the SSA know
about any fluctuations in income as soon as possible. If there
is a drop in income, the individual may be due an SSI payment,
instead of just Medicaid. Even if 1619(b) is stopped because
of excess earnings or unearned income, a drop in income within
12-months may permit the person to become eligible again for
SSI or 1619(b). To minimize error, it is recommended that
all wage reporting be done in writing and sent directly to
the Claims Representative who handles the person’s SSI
case. Recipients should keep a copy of all correspondence
sent to SSA.
How
does 1619(b) work for someone who received in-kind maintenance
and support?
A
person receiving partial in-kind support and maintenance (in
PMV status) merely has a specific form of unearned income
to take into an account. This means that the person will have
a lower break-even point. As long as earned income is involved
in the equation, and the person would otherwise be SSI eligible
if the earned income were disregarded, the recipient will
be entitled to 1619(b). When recipients receive full in-kind
support and maintenance (in VTR status) meaning that they
contribute nothing to the cost of their food, clothing or
shelter, they have a base SSI rate which is reduced by one
third. Once again, this would lower the person’s BEP,
but would not preclude 1619 (b) eligibility.
How
do you know what your costs are when trying to establish an
individualized threshold?
It is the SSA’s responsibility to contact the state
Medicaid agency to get the person’s total Medicaid costs
for the period in question. The SSA should also have on record
any information relating to income excluded in a PASS, or
IRWE that apply. If the person has other costs that may be
included, for example attendant care not paid by Medicaid,
the Claims Representative should discover this. It may be
helpful for people requesting individual thresholds, however,
to be informed ahead of time about what could go into the
calculation. That way, they may take any necessary documentation
to the SSA and make sure that all costs are considered. Is
1619(b) automatic?
What
happens if the State Medicaid Agency stops coverage, even
though an individual is eligible for 1619(b)?
SSA
is responsible for making 1619(b) eligibility determinations
and communicates this information to the state Medicaid agency
by making a notation in the State Data Exchange (SDX) computer
system. If an eligible individual fails to receive extended
Medicaid coverage after BEP, resolution to this problem begins
with the local SSA Field Office.
Are
there any differences in 1619(b) for persons who are blind?
Yes,
there are a few differences. First, blind SSI recipients have
the ability to claim Blind Work Expenses (BWEs) to both lower
countable earned income and to establish an individualized
threshold amount. Secondly, some states have different state
threshold amounts for blind persons (California, Nevada, Oregon,
Iowa, and Massachusetts). See POMS
SI 02302.200 - Charted Threshold Amounts.
FAQ
Disclaimer: The VCU-BARC FAQ Pages are general information provided
as a public service. The contents do not necessarily represent the
policy, interpretations or opinion of the Social Security Administration
(SSA). The information contained here is intended to inform readers
of issues that may affect Social Security and/or other public assistance
benefits. Because individual circumstances differ, the reader should
not rely on any information here as being specifically applicable
to an individual's situation.
