Section 1619(a) cases are those cases where a disabled individual (DI) remains eligible for Supplemental Security Income (SSI) payments even though their earnings exceed the substantial gainful activity (SGA) amount. Cases that meet the 1619(a) requirements are selected for redetermination annually. These cases may meet high-error (HEP), middle-error (MEP), or low-error (LEP) criteria. For an explanation of 1619(a) status, see DI 13005.016.

Section 1619(b) cases are those cases where a DI retains Medicaid eligibility even though they in non-payment status due to excess income (N01). Cases that meet the 1619(b) requirements are selected annually as profile (W) 1619(b) MEP RZ cases. For an explanation of 1619(b) status, see DI 13005.016.

The SSI system will identify 1619(a) and 1619(b) initial and status change events with an A1 (1619 initial eligibility) or an A2 (1619 potential status change) diary. For an explanation of A1 and A2 diaries, see DI 13005.016. If an A1 or A2 diary is present when conducting an RZ, follow instructions in DI 13005.018. If instructions require a CDR, attempt to schedule both the CDR and the RZ interview at the same time.

Conduct a personal contact RZ in the Consolidated Claims experience (CCE) or on the, “Statement for Determining Continuing Eligibility for Supplemental Security Income Payments” (Form SSA-8203-BK or Form SSA-8202-BK), depending on the profile of the case. Attempt to conduct a telephone interview as the recipient is working and a face-to-face interview may be inconvenient. For instructions on completing an RZ when the recipient has gross earnings at or above SGA level, see SI 02302.030 and SI 02305.071.

Under the 1619(b) provision of the Act, individuals who we determine to be blind or disabled are eligible for SSI payments in a subsequent month if the individual receives SSI payments for one month and is rendered ineligible for payments in a subsequent month because of their earned income.

To determine the individual’s eligibility for Medicaid, take the following actions:

1. a. 

   Review the record to see if there is a pending CDR diary on the Title XVI record or an established Title II record and check the CDR Entitlement (ECDR) on DCF, #32 on the Main Menu to see if there is a pending CDR. For instructions on the DCF file, see DI 13005.020. If there is a pending CDR conduct both the CDR and RZ. Complete full RZ to determine if individual meets all non-disability requirements except for earned income. For coordinating RZs and CDRs, see SI 02305.016E.

2. b. 

   Attempt to contact the recipient by phone as the recipient is working and a face-to-face interview may be inconvenient.

3. c. 

   Obtain proof of earnings. Develop and document impairment related work expenses (IRWEs) or blind work expenses (BWEs) as appropriate. For developing work expenses during an RZ interview, see SI 02305.097 for IRWEs and SI 00820.535 for BWEs. For work expense development and documentation, see SI 00820.550.

4. d. 

   Determine whether the individual continues to be eligible under Section 1619(b). For Section 1619 process and procedures, see SI 02302.030.

5. e. 

   Apply the Medicaid Use Test and Threshold Test at each 1619(b) redetermination. For instructions on the tests, see SI 02302.040 through SI 02302.045.

6. f. 

   For non-MSSICS cases, input the results of the Medicaid Use and Threshold Tests using the Status Indicator for Title XIX/XX (SI) field. For the SI field, see SM 01305.975.

7. g. 

   Review the record to see if there is potential entitlement to Title II on their own work record including lag year earnings. Run the Disability Insured Status Calculator Online (DISCO) for determining entitlement to Title II disability (DIB). For information on accessing DISCO, go to the Toolbar Support Page and click on DISCO from the Active Tools menu.

8. h. 

   If there is potential Title II entitlement, follow the protective filing and closeout procedure in SI 02305.110I.

9. i. 

   If you discover that any of the following events have occurred, consider whether a full RZ (MSSICS without recaps or SSA-8203) is necessary:

   • •

     A change of marital status. For developing marital status during the RZ interview, see SI 02305.083;

   • •

     A change in address or individuals with whom they live. For developing residence status during an RZ interview, see SI 02305.084;

   • •

     Recipient spent a full calendar month in a hospital, nursing home or other institution. For developing institutionalization during the RZ interview, see SI 02305.086;

   • •

     Unreported or non-posted unearned income information. For general rules for developing incomes issues during an RZ interview, see SI 02305.094. For the Post Eligibility Menu, see MS 08104.008.

   Close all RZ events and build transactions to the SSR. For more information on closing the RZ, see SI 02305.071.

Take the following actions if the recipient is no longer eligible under 1619(b):

1. a. 

   Document the 1619(b) ineligibility on a Statement of Claimant or Other Person (SSA-795), Person Statement page, or in the Report of Contact page using MS 08122.010.

2. b. 

   On the documentation, explain that the individual does not need Medicaid in order to work. Include on the document the name and type of other medical coverage the individual uses (e.g. HMO, other private health insurance).

3. c. 

   For non-MSSICS cases, input finding of ineligibility per SM 01305.975.

4. d. 

   Review the record to see if there is potential entitlement to Title II on their own work record including lag year earnings. Run the Disability Insured Status Calculator Online (DISCO) for determining entitlement to Title II disability (DIB). For information on accessing DISCO, go to the Toolbar Support Page and click on DISCO from the Active Tools menu.

5. e. 

   If there is potential Title II entitlement, follow the protective filing and closeout procedure in SI 02305.110I.

6. f. 

   Close all RZ events and build transactions to the SSR. For more information on closing the RZ, see SI 02305.071.