TN 11 (09-92)

SI 02302.045 The Threshold Test for Section 1619(b) Eligibility

A. Policy - Determinations

1. General

To be eligible under section 1619(b), an individual cannot have earnings sufficient to replace SSI cash benefits, Medicaid benefits, and publicly-funded personal or attendant care that would be lost due to his/her earnings.  SSA has constructed the “threshold” concept to measure whether an individual has sufficient earnings to replace these benefits.  This means that we only look at income from earnings in making this determination; unearned income is not considered.

2. When to Make Determination

a. Initial Determination

The initial sufficiency of earnings (i.e., threshold) determination is made at the time the individual reports earnings which will cause ineligibility for cash payment.

EXCEPTION: If this would require an additional contact with the recipient (e.g., the earnings were reported by mail), the determination is deferred until the next scheduled redetermination.

b. Subsequent Determinations

The individual's sufficiency of earnings must be recalculated at each 1619(b) redetermination. Individuals eligible for section 1619(b) will be selected for an FO redetermination every year. (See SI 02305.016 for information about section 1619 redeterminations.)

3. Time Periods for Determinations

Threshold determinations are made for the 12-month period beginning with the month 1619(b) status begins. However, if the determination is deferred per the exception in 2, above, the beginning month is the month the redetermination is initiated.

Prorate the charted threshold amount when necessary for partial years. For example: If the redetermination initiation date is 5/04, divide the 2004 threshold amount by 12 then multiply by 8 to arrive at the prorated threshold for 2004. Compare that to the individual's earnings for 5/04 - 12/04. Thereafter, perform the threshold calculation for each full calendar year.

B. Process - Thresholds

1. Charted Thresholds

  1. Threshold amounts for each State are shown in the charts in SI 02302.200. These thresholds are used for most situations but, where special needs exist an individualized calculation is made. (See 2., below.)

  2. The charted threshold is calculated for each State by adding:

    • the annualized gross earned income amount which would reduce SSI cash benefits to zero for an individual with no other income (taking into account the State's supplementary payment level, if any); and

    • the State's average annual per capita Medicaid expenditures.

  3. If the individual's gross earned income for the 12-month period being determined is equal to or less than the threshold amount shown on the chart, he or she meets this requirement.

2. Individualized Threshold

If the individual is not eligible using the charted threshold amount, the FO will determine whether the individual would be eligible under an individualized threshold calculation per SI 02302.050.

C. Procedure

Follow this procedure each time a threshold determination is made:

StepAction
1 Calculate the individual's annual gross earned income per SI 00820.150 and place the calculation in the folder.
2 If the individual's annual gross earned income is less than the appropriate threshold in SI 02302.200, transmit eligibility under the sufficiency of earnings test per SM 01305.975.
3 If the individual is not eligible using the threshold chart and has any of the expenses listed in SI 02302.050 C.1, follow the instructions in SI 02302.050 to determine if the individual would be eligible under an individualized thresh