States which make supplementary payments (mandatory or optional, Federal or State administration) have the option of making supplementary payments to individuals eligible under section 1619(a).

Medicaid While Working (1619(b) eligibility) only applies to the working individual. To qualify for Medicaid While Working, an individual must:

1. a. 

   Continue to be blind or have a disabling impairment; and

   NOTE: Effective May 1, 1991, a person who is age 65 or older may establish eligibility under section 1619(b) provided that they are determined to be either blind or disabled. See SI 02302.030C.7. for instructions on obtaining a disability determination for aged individuals.

2. b. 

   Meet all non-disability requirements for regular benefits except for earnings (i.e., the individual would be eligible under section 1611 if they had no countable earned income); and

3. c. 

   Meet the prerequisite month requirement as explained above; and

4. d. 

   Need Medicaid coverage to continue working (see SI 02302.040 for Medicaid Use Test); and

5. e. 

   Not have sufficient earnings to replace SSI cash benefits, Medicaid benefits, and publicly-funded personal or attendant care that would be lost due to the person's earnings (see SI 02302.045 for Threshold Test).

Section 1619(b) provides Medicaid While Working protection only for the working individual. Therefore, a non-working SSI eligible spouse has no protection under 1619(b) and loses Medicaid when the earned income of their SSI spouse causes ineligibility for a 1611 or 1619(a) payment.

However, 1619(b) provides Medicaid protection when a working individual’s total countable income, both earned and unearned (including deemed income), is too high for a cash payment. Therefore, both members of an SSI couple will be eligible for Medicaid if they are both working and their total combined income causes ineligibility for payment, even if individually, each person’s earned income wouldn’t be enough to trigger non-payment status.

1. a. 

   1619(b) is a stop payment status and not a suspension status (SI 02301.201B.2.).

2. b. 

   Recipient status under 1619(b) protects reinstatement rights under all SSI provisions (i.e., regular 1611 or 1619(a) cash benefits, or 1619(b) benefits).

3. c. 

   Individuals eligible under section 1619(b) are reinstated to cash benefit status if countable income drops below the applicable breakeven point (as explained in SI 00810.350) and all other eligibility criteria are met.

4. d. 

   Reinstatement is possible at all times in all States, unless the individual's eligibility is terminated. Therefore, 1619(b) eligibility development is required in all States.

A recipient who does not meet a non-disability requirement in a month (other than income), is placed in suspense until the next month in which all requirements can be met for 1619(a), 1619(b), or regular 1611 benefits.

If, at any time, an SSI eligible is found to no longer have a disabling impairment, their disability is ceased effective with the month of that determination. Regular 1611 or 1619(a) cash benefits or SSI recipient status under 1619(b) continue(s) for that month and the following 2 months (i.e., the grace period) if all non-disability criteria are met. The individual's eligibility is terminated after the grace period and a new application, a new disability determination, and a new prerequisite month are required for a blind or disabled individual to reestablish eligibility.

Prior to December 1999, an MFR was required on 1619(a) and 1619(b) cases to determine whether a medical CDR was needed.

The system will identify 1619(a) and 1619(b) cases for review with an A1 or an A2 diary (see DI 13005.016). Follow instructions in DI 13005.018 to determine when a CDR is required based on the A1 or A2 diary.