CN Tower, Toronto, Ontario, Canada

Hi Ben,

I have a question about 1619b, earning and CIP1b funding. If a single adult on SSI earns approximately $20,000 per year and has the option of taking company “private” insurance would this person be ineligible for Medicaid (1619b)? Let’s consider this person meets all other eligibility requirements for MA. Also, If this person private insurance covers all medical costs, but MA is needed to cover CIP1b waiver services would he be in jeopardy to loose his waiver services?

I want to make sure my client does not loose his CIP1b waiver services if he would receive private insurance through his employer.

Thank you,
Brian

Hi Brian,

Your question is an excellent one. Hopefully you will be able to attend the WDBN webcast featuring Social Security Administration’s Bob Monahan and Connie DaValt next month on September 17th – go to the WDBN Training page for more information. They will be talking about 1619(b) in their presentation.

In the meantime, let’s take a look at your question.

Individual’s who have Medicaid are able to have private insurance simultaneously. 1619(b) does require that a person need Medicaid in order to work, and that can still be done even though the primary payer is the Private Health Insurance. It is quite often that an individual will still need Medicaid to pay for some services that the Private Insurance does not.

Also, the individual is getting CIP1b which shows that the individual needs Medicaid.

As long as the person you are working with continues to have a disability and have assets under $2,000, he should be eligible for 1619(b). Also, he must have earnings below the annual threshold. In 2009 that is $32,156 or $34,459.48 for someone who receives the E-Supp, or higher yet for someone who has an individualized threshold. He will remain eligible for CIP1b in Financial Group A and have no cost share.

If he is interested in having assets higher than $2,000 he may want to consider MAPP. He could have MAPP and CIP1b. In this situation, he would not have a cost share, and with his projected earnings from your example, he would have a premium of $25 (unless he has IRWE or MRE). Remember with MAPP, if he stops working and wishes to return to SSI, he would first need to spend down his assets. You can have him contact his local MAPP/HEC Specialist if he is considering this.

The last option I can think of is that he doesn’t take the private health insurance. I have seen this happen with no negative impact. The gentleman you are working with can review the services he needs and compare that to what he receives with Medicaid. It is important to investigate the costs that he may incur with Private Health Insurance before taking it. In some cases, the costs of Private Health Insurance are higher with no additional services.