SI NY01730.006 (New Jersey) Medical Cessation And 1619B

When an SSI recipient is found no longer disabled, based on a continuing disability review (CDR), the payment status code that a field office normally inputs to reflect this on the SSIRD is N07. If the recipient then requests "statutory benefit continuation" (see DI 12027.001 and DI 28080.025), the recipient is entitled to continue to receive benefits until the recipient's appeal is decided by an Administrative Law Judge (ALJ).

SSI policy dictates that this "statutory benefit continuation" also applies to 1619B recipients. A 1619B recipient represents a working disabled or blind individual, whose earnings (alone or in combination with other income), make them ineligible for SSI regular 1611 or 1619(a) cash payments (POMS SI 02302.010B), but eligible for Medicaid. 1619B cases require a payment status code of N01.

At this time, the system cannot handle a case where an SSI recipient is found to be medically ceased, is in 1619B status and files for "statutory benefit continuation."

If the N07 is input to the system, the 1619B eligibility for Medicaid only is no longer reflected on the SSR. This is because the 1619B "Medicaid Eligibility Test" data can only be reflected on a record with a payment status code of N01.

In order to ensure that these individuals continue to receive Medicaid eligibility, FOs should take the following actions in these cases:

1. 1. 

   Do not input the N07, but maintain the record in N01 payment status.

2. 2. 

   Indicate in the remarks section of the SSIRD that the case should be in N07, but is not due to 1619B eligibility.

3. 3. 

   Make sure when the recipient comes in for redetermination, and address the status of the recipient's appeal and work status.

4. 4. 

   Add Appeal Data through MSSICS or Direct SSR Update and update the APPE segment of the SSR.