Section 1619 (b)
Federal Link:
www.ssa.gov/notices/supplemental-security-income/spotlights/spot-medicaid.htm
What is it: One of the biggest concerns SSI beneficiaries have about going to work is the possibility of losing Medicaid coverage. Section 1619(b) of the Social Security Act provides some protection for these beneficiaries. In most cases, if you are blind or disabled, (age 16-65), and you have Medicaid before you go to work, your Medicaid will continue while you are working as long as your disabling condition still exists.
Who qualifies: To qualify for continuing Medicaid coverage, a person must:
- Be least 16, but less than 65 years of age; and meet state resource and income limits.
- Have been eligible for an SSI cash payment for at least 1 month
- Still meet the disability requirement
- Still meet all other non-disability SSI requirements
- Need Medicaid benefits to continue to work
- Have gross earnings that are insufficient to replace SSI, Medicaid and publicly funded attendant care services
What it covers: Each state has different Medicaid plans and services.
MEDICAID- www.cms.hhs.gov/medicaid/consumer.asp
- Permits working individuals with income above 250 percent of the federal poverty level to purchase Medicaid coverage.
MEDICARE - www.cms.hhs.gov/medicare/
- Expands Medicare coverage to people with disabilities who work.
- It extends Part A premium-free coverage for eight and-a-half years for most Social Security disability beneficiaries who work.
What it costs: Premiums are sliding scale based on income.
CONTINUATION OF MEDICARE COVERAGE
Most people with disabilities who work will continue to receive FREE at least 93 consecutive months of hospital and medical insurance under Medicare. Although cash benefits may cease due to work, you have the assurance of continued health insurance. The 93 months start the month after the last month of your “trial work period.”
www.ssa.gov/OACT/COLA/twp.html
Help With Medicare Part A Premiums
How does it help you? If you are under age 65, disabled, and no longer entitled to free Medicare Hospital Insurance Part A because you successfully returned to work, you may be eligible for a program that helps pay your Medicare Part A monthly premium.
- Some people with disabilities who have returned to work can buy continued Medicare coverage when their premium-free Medicare ends due to work activity.
- States are required to help pay the hospital insurance premiums for some working individuals with disabilities.
To be eligible for this help, you must:
- Continue to have a disabling impairment;
- Sign up for Premium Hospital Insurance (Part A);
- Have limited income;
- Have resources worth not more than $4,000 for an individual and $6,000 for a couple, not counting the home where you live, usually one car, and certain insurance; and
- Not already be eligible for Medicaid.
What kind of Medicare can you buy?
- Premium Hospital Insurance (Part A) at the same monthly cost that uninsured eligible retired beneficiaries pay, $316 for 2003; and
- Premium Supplemental Medical Insurance (Part B) at the same monthly cost that uninsured eligible retired beneficiaries pay, $58.70 for 2003; or
- Insurance separately without Supplemental Medical Insurance. You can buy Supplemental Medical Insurance only if you also buy Hospital Insurance.
You may qualify for a reduction in the monthly amount of your premium for Hospital Insurance ($174 for 2003), if you:
- Have 30 or more quarters of coverage on your earnings record; or
- Have been married for at least 1 year to a worker with 30 or more quarters of coverage; or
- Were married for at least 1 year to a deceased worker with 30 or more quarters of coverage; or are divorced, after at least 10 years of marriage, from a worker who had 30 or more quarters of coverage at the time the divorce became final.
Impact for YOUTH: This is another access to health care coverage that often is available after the youth has worked for 30 or more quarters.
How to Apply: Contact State Medicaid/Medicare Office.
MEDICAID- www.cms.hhs.gov/medicaid/consumer.asp
MEDICARE - www.cms.hhs.gov/medicare/
To find out more about this program, contact your local, county, or State social services or medical assistance office. Ask about the Medicaid buy-in program for Qualified Disabled and Working Individuals (QDWI).
Guides:
SOCIAL SECURITY ADMINISTRATION
OFFICE OF DISABILITY AND INCOME SECURITY PROGRAMS
A Summary Guide to Employment Support for People With Disabilities Under the Social Security Disability Insurance and Supplemental Security Income Programs
SSA - 2003 RED BOOK, SSA Pub. No. 64-030, ICN 436900, January 2003
www.socialsecurity.gov/work/ResourcesToolkit/redbook.html#IRWE
Rule book on work incentives from SSA includes explanation and laws on public funded health insurance.
Resources:
SOCIAL SECURITY ADMINISTRATION
2003 1619(b) Threshold Amounts for Disabled SSI Beneficiaries
www.socialsecurity.gov/work/ResourcesToolkit/Health/1619b.html
2003 threshold amounts for each State for disabled and blind beneficiaries.
(Five States have separate threshold amounts for blind beneficiaries.)
COMPILATION OF THE SOCIAL SECURITY LAWS
Benefits For Individuals Who Perform Substantial Gainful Activity
Despite Severe Medical Impairment
www.ssa.gov/OP_Home/ssact/title16b/1619.htm
Language from the law SEC. 1619. [42 U.S.C. 1382h]
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