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FAQs

What is the Threshold Amount and How is it Determined?

SSA uses a threshold amount to measure whether individuals earnings are high enough to replace his/her SSI and Medicaid benefits. This threshold is based on the amount of earnings that would cause SSI payments to stop in a person’s home State and average Medicaid expenses in that State. Each state’s threshold is calculated in this manner:

  • Multiply the annual State supplementation rate (if any) by 2
  • Add to this the current SSI break-even point (FBR x 2 +$85)
  • Add the average per capita Medicaid expenses by State
  • The total amount equals the State Threshold Amount

Threshold amounts for each State are shown in the POMS SI 02302.200. These threshold amounts are revised on an annual basis. The standard threshold amounts are used for most situations, but where special needs exist an individualized calculation is made. If the individual’s gross earned income for the 12-month period being determined is equal to or less than the threshold amount shown on the chart, he/she meets this threshold requirement.

How are Earnings Counted During Threshold Determination?

Threshold determinations are made prospectively for the 12-month period beginning with the month 1619(b) status begins – meaning when the person first hits the break-even point. The Claims Representative estimates future earnings using the standard procedures described in POMS SI 00820.150 - Estimating Future Wages. If the estimated annual earnings are under the current threshold amount, the person is eligible for 1619(b). If estimated earnings are over the standard state threshold amount, the Claims Representative checks to see if an individualized threshold amount can be established. When estimating future earnings, SSA generally uses the amounts earned in the past few months are often the best guide. However, SSA may consider any indication given by the recipient that a change in earnings is anticipated.

Earnings are reviewed annually during the 1619(b) re-determination, as are all other forms of unearned income, resources and other relevant eligibility information. In addition to the annual re-determination required for Section 1619(a) and (b) cases, earned income and exclusions from earned income must be verified at least quarterly, although local Field Offices (FO) may chose to do this more frequently. Each FO with section 1619 recipients in its service area receives a monthly listing of sec-tion 1619 recipients by name, social security number, and the reason for the selection (either “1619(a) payment” or “1619(b) status”). The listing is issued monthly to aid those FO’s that verify earnings on a more frequent than quarterly cycle. It is important to reassure recipients that 1619(b) eligibility is not re-determined under the threshold test each quarter; earnings are merely being verified against the original estimate.

Individualized Threshold Amounts

If an individual has gross earnings higher than the threshold amount for the State, SSA can figure an individual threshold amount. The object of the individualized threshold calculation is to determine if the individual has earnings sufficient to replace all the benefits that he/she would actually receive in the absence of those earnings.

Calculating a Base Amount
What is included as part of the individualized threshold calculation will depend on the person’s situation. Like with the charted thresholds for each state (see SI 02302.200), the break-even point for SSI plays a part, as does any state supplement. If the state where the person lives has no supplement, the SSA will use the base amount shown in the chart in SI 02302.200.
This base amount is calculated using the following formula:
  • State supplement (if any)
  • + applicable FBR
  • multipled by two
  • + $85 (representing the general and earned income exclusions)
  • multiply all that by 12
If the state has a supplement, SSA will use the charted amount if the person would receive the same supplement regardless of their situation. In some states, however, the supplement varies depending on the person’s living arrangement, their marital status, their disability, and whether or not they have high medical needs. For those states, the SSA will only use the base rate on the chart if the person receives the same, or a lower state supplement than the one used in the chart. If, because of the living arrangement, blindness, or exceptional medical needs, the person receives a higher supplement, the SSA will use the actual supplement in the calculation. Once the base rate is calculated, the SSA will add all of the following to arrive at the individualized threshold.
  • The higher of the individual’s actual Medicaid expenditures for the past 12 months or the average per capita Medicaid expenditure shown in the POMS state threshold chart
  • Any Impairment Related Work Expenses (IRWE) or Blind Work Expenses (BWE) the person has;
  • Amounts of income excluded under an approved PASS, and
  • The value of publicly-funded personal/attendant care which the individual receives.
NOTE: Because of these additional expenses, the SSA may calculate an individualized threshold even if Medicaid costs aren’t exceptionally high, but other costs or deductions would make the individualized threshold higher than the charted threshold.
Attendant Care Services and Individualized Threshold Amounts
SSA recognizes that some SSI recipients may require attendant care services to assist with essential work-related and/or personal functions. For purposes of determining Section 1619(b) eligibility, attendant care (including personal care and other domestic assistance and supportive services) means assistance with:
  • work-related functions; and
  • personal needs such as bathing, communicating, cooking, dressing, homemaking, eating, and transportation, regardless of whether such needs are work-related.
The cost to the governmental entity of providing such services is considered when performing the individualized threshold calculation if:
  • Assistance was/is provided by a person who is paid under a publicly-funded program other than Medicaid; and
  • The SSI individual would no longer qualify for attendant care service due to earnings in an amount that causes ineligibility for SSI benefits.
Attendant care services paid for by Medicaid, that are already included in the state’s annual per capita Medicaid average used to determine the standard Threshold amount, may not be counted again as publicly funded attendant/personal care services in individualized threshold calculations. The cost of attendant care may only be counted once. Medicaid expenses and attendant/personal care costs used in making individualized threshold determinations are assessed for the 12-month period preceding the determination.

POMs Resources:

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.