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.

Appalachian Trail

Hi Ben!

I had a question recently about State-Only 1619(b) and assets. In getting the answer I was told State-Only 1619(b) works “just like federal 1619(b)” yet I am unclear exactly how that works as well. So, my question is this: If a person is receiving Medicaid under 1619(b) and goes over $2,000 in assets one month but then is back under $2,000 three months later can that person go back onto 1619(b)?

Thanks for all your help, Ben! Enjoy whatever destination you find yourself in next! Terri

Terri,

The short answer to your question is: yes, the person in the situation you described would regain 1619(b) status.

The reason has to do with the distinction between “suspension” of SSI and “stop payment” of SSI.

Suspension occurs when a person becomes ineligible for SSI; for example, having excess resources at the beginning of a calendar month. Generally an SSI recipient has twelve (12) consecutive months after the effective date of suspension to be reinstated (without a new application) if eligible again.

More from the Appalachian Trail!

Stop payment status is an interruption in SSI payments and not the loss of eligibility; 1619(b), not receiving payments due to work earnings, is a stop pay situation so eligibility continues. Cash payments may be reinstated on a stop pay record regardless of how long the recipient has been in non-pay.

If a recipient becomes ineligible during a stop pay period (such as in your case), the payments are suspended and the principle stated above applies: the recipient has 12 consecutive months to be reinstated to pay status or stop pay status (1619b) if eligible again. Of course, to regain 1619(b) eligibility, the person would also need to meet the other 1619(b) requirements. (POMS SI02301.201)

To put it another way, an SSI recipient who does not meet a nondisability requirement in a month (other than excess income due to work) goes into suspense status and stays there until the first month within the next 12 in which all requirements are met for 1619(b) or regular payments. (POMS SI 02302.010E.1)

I’m responding to you from Max Patch (near Hot Springs, NC); I am hiking on the Appalachian Trail where the mountains are high and smoky. I was playing a little mandolin (see Mom I do practice!) and these two fellow hikers stopped to listen for a while!

Ben