TN 11 (01-17)
DI 13005.016 Continuing Disability Review (CDR) for Title XVI Section 1619 Recipients
A. Background on Section 1619
Public Law 99-643 (Employment Opportunities for Disabled Americans Act) amended Sections 1619(a) and 1619(b) of the Social Security Act. The law provides that disability benefits for Title XVI recipients will not cease due to performance of substantial gainful activity (SGA). The law eliminated SGA as a basis for cessation, the trial work period (TWP), and extended period of eligibility (EPE) provisions for Title XVI recipients.
Title XVI disability recipients who work will continue to remain eligible for disability when earnings exceed SGA amounts, see SI 02302.200 (unless earnings exceed the State or individual threshold amounts). The law also provides that we must conduct a CDR at certain times to verify continuing disability or blindness eligibility.
The field office (FO) is responsible for determining whether there is a need of a CDR after reviewing the record for a Section 1619 status.
NOTE: We still require SGA determinations on initial Title XVI claims.
B. Policy on Section 1619 diaries
1. Section 1619(a)
Section 1619(a) provides eligibility for cash payments when a Supplemental Security Income (SSI) recipient has earnings over SGA. To be eligible for Section 1619(a) status, a recipient must:
have been eligible for a regular Section 1611 cash payment (or a federally administrated State supplementary payment) for at least one month before he or she performed SGA; and
continue to be disabled and meet all non-disability requirements.
2. Section 1619(b)– Medicaid while working
Section 1619(b) provides eligibility for Medicaid when an SSI recipient’s earnings, either alone or combined with other income, are too high to allow a cash payment. To be eligible for Section 1619(b) status, a recipient must:
have been eligible for a regular Section 1611 cash payment (or a federally administrated State supplementary payment) for at least one month before the income caused a zero payment;
continue to be disabled and meet all non-disability requirements except for earnings;
have earnings below the State threshold amount or the individual threshold amount, see SI 02302.045 – SI 02302.050; and
need Medicaid in order to continue working, see SI 02302.040 regarding the Medicaid Use Test.
C. Processing a Section 1619 diary
The Supplemental Security Record (SSR) will identify Section 1619(a) and Section 1619(b) cases with an A1 diary for initial Section 1619 eligibility or an A2 diary for a Section 1619 status change. In addition, when the system identifies a status change that may require a CDR, the CDR Initiation Type (CIT) field updates with a code of “S,” see SM 01305.992. The FO will determine if we will require a CDR based on the diary and a review of the record.
1. A1 diary for initial Section 1619 eligibility
The SSR generates an A1 diary when:
an individual first enters Section 1619(a) status (for example, earnings over SGA post to the individual’s record); or
an individual first enters Section 1619(b) status (for example, earnings post to the record that results in a zero payment).
Cases in current pay status with an A1 diary will receive selection for a medical review under the normal CDR process. Cases in non-pay status with an A1 diary do not require a CDR.
2. A2 diary for Section 1619 status change
The SSR generates an A2 diary when:
an individual moves from a Section 1619(b) (for example, a non-payment month to a Section 1619(a) or a regular Section 1611 payment month); or
an individual moves from a Section 1619(b) (for example, a non-payment month to a suspense month, then back to a Section 1619(a) or Section 1619(b) month or a Section 1611 payment month).
These cases may also have a CIT of “S” or a Prior CDR Initiation Type (CIP) of “S” in the Disability Information (DISB) field of the SSR, see SM 01305.992 and SM 01601.595. Cases in current pay status with an A2 diary will require a CDR unless certain exclusions apply, see DI 13005.018B.2.