The purpose of this guide is to educate New Yorkers with disabilities who receive SSI about how they can go to work and keep their Medicaid

Golden, Thomas P

Lopez-Soto, Edwin J.

English

DigitalCommons@ILR

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) Mapping Your Path to Work
Answers To Your Work Questions 
From New York Makes Work Pay
Keeping Your Medicaid While You Work
Medicaid & Work
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  MEDICAID & WORK 1
1 Effect of Medicaid on Work
2 How the 1619(b) Benefit Can Work for You
3 What are the 1619(b) Eligibility Criteria?
3 Beneficiary Earns Above the Threshold
4 How Does a Beneficiary Ensure That the 
Transition to 1619(b) Proceeds Smoothly?
4 Are There Any Other Benefits to the 1619(b) 
Program?
4 What Does Expedited Reinstatement (EXR) Mean 
for People on SSI?
5 What if I Have Questions About How My Benefits 
will be Impacted by Going Back to Work?
This booklet is part of a series of New York Makes Work Pay 
publications that help New Yorkers with disabilities plan a 
path to employment.
In This Guide
The purpose of this guide is to educate New 
Yorkers with disabilities who receive SSI about 
how they can go to work and keep their Medicaid.
  MEDICAID & WORK 1
Effect of Medicaid On Work
+
In New York State, Supplemental Security Income 
(SSI) beneficiaries who receive at least $1 in SSI 
automatically qualify for Medicaid. One of the 
biggest concerns SSI beneficiaries have about 
going to work is the possibility of losing Medicaid 
coverage should they become ineligible for SSI. 
Section 1619(b) allows an individual, who loses the 
right to a cash benefit through the receipt of wages, 
to automatically continue Medicaid eligibility in 
most cases.
There is an earnings threshold or earnings limit in 
every state for 1619(b) which is annually adjusted. 
In New York, the earnings threshold is $43,957 
per year in 2010. There are some exceptions to this 
earnings threshold which will be discussed later in 
this guide.
  MEDICAID & WORK 22 MEDICAID & WORK 33
How the 1619(b) Benefit Can Work for You 
Beneficiary Receives SSI Only and Works
Example: Hugo is a New York State resident who lives alone and 
receives SSI benefits of $761 per month (i.e., the 2010 living alone 
rate). He goes to work and earns $1,800 gross per month ($21,600 
per year). Using SSI’s formula for budgeting income , Hugo’s 
monthly countable income will be $857.50 ($1,800 - $20 (general 
income disregard) - $65 (earned income disregard) = 1,715/ 2 = 
$857.50). Since this is more than the $761 SSI rate, he will lose his 
SSI check. Hugo keeps his Medicaid through 1619(b), since his an-
nual income of $21,600 is less than New York’s threshold of eligibil-
ity ($43,957 per year in 2010).
Beneficiary Receives SSDI and SSI and Works
Example: Maria resides with her two young children and receives 
$570 in SSDI benefits and $147 in SSI benefits. She goes to work 
part time and earns $465 per month in gross wages. She will lose 
her SSI cash benefits. This is because she has $750 of monthly 
countable income, i.e., $550 of her SSDI ($570 - $20 (general income 
disregard) and $200 of her wages ($465 - $65 (earned income disre-
gard) = $400/2 = $200), which will be counted against New York’s 
2010 SSI living with others rate of $697. 
Under these facts, Maria keeps her Medicaid through 1619(b). This 
is because she lost her SSI due to wages and her annual income 
from wages ($5,580) is less than New York’s 2010 1619(b) threshold 
for eligibility ($43,957).
  MEDICAID & WORK 22 MEDICAID & WORK 33
What are the 1619(b) Eligibility Criteria?
Individuals having established both a loss of SSI due to wages and 
annual wages less than the state’s 1619(b) threshold would also have 
to meet additional 1619(b) criteria:
 ; continue to be blind or disabled;
 ; have been eligible for either an SSI payment or 1619(b) Medicaid 
coverage for one month prior during the past 12 months;
 ; have unearned income and resources that are within SSI limits; 
 ; meet a Medicaid use test (i.e., has used Medicaid during the last 
12 months; expects to use Medicaid during the next 12 months; 
or would be unable to pay unexpected bills in the next 12 
months without Medicaid).
In some cases, a New Yorker with a disability can establish 1619(b) 
eligibility at income levels higher than $43,957 per year under an 
“individualized threshold” of eligibility. An example of how to es-
tablish an individualized threshold is described below.
Beneficiary Earns Above the Threshold
Example: Harry, an SSI beneficiary who has a spinal cord injury, 
goes to work and earns $50,000 per year. Since Harry lives in New 
York where the 1619(b) general threshold is $43,421 per year in 2010 
and since his annual wages are more than $43,957, he will not be 
eligible under the general 1619(b) threshold. However, he can keep 
Medicaid under an individualized threshold if his Medicaid costs 
are high enough. If we assume Medicaid would pay $35,000 per 
year for medical expenses (most of this would be for home health 
care), that amount would be added to a ”base amount” of $19,284 
and Harry’s “individualized” 1619(b) threshold for 2010 would be 
$54,284 ($19,284 + $35,000). Since his $50,000 salary is below that 
figure, Harry remains eligible for Medicaid.
  MEDICAID & WORK 44 MEDICAID & WORK 55
How Does a Beneficiary Ensure That the 
Transition to 1619(b) Proceeds Smoothly?
A beneficiary should report their earnings to the Social Security 
Administration (SSA) on a monthly basis. At the time that the SSI 
cash payments stop due to reaching the Break Even Point (the point 
when earnings cause the SSI check to go to zero), the SSA computer 
will automatically determine eligibility for 1619(b), and inform the 
beneficiary of their eligibility for this Medicaid protection. This in-
formation will be sent electronically to the local district office (DO) 
of the Department of Health (DOH). 
Are There Any Other Benefits to the 1619(b) 
Program?
The other benefit of 1619(b) is that by continuing to qualify for 
Medicaid, the disabled individual retains their contact with the SSI 
program. This means that should the working 1619(b) beneficiary 
either lose their job or reduce their wages to below the break-even 
point, they could go to the SSA office and request that their SSI 
benefit be reactivated. The SSI check will start again. Thus, it is very 
important to always report earnings to Social Security each month 
to have the SSI benefit adjusted accurately.
What Does Expedited Reinstatement (EXR) 
Mean for People on SSI?
EXR is an important work incentive in the SSDI program. It allows 
individuals who have lost the right to SSDI checks due to signifi-
cant earnings, to return to benefit status when their earnings stop 
or are significantly reduced.
  MEDICAID & WORK 44 MEDICAID & WORK 55
EXR is not as important a work incentive for SSI beneficiaries. SSI 
beneficiaries are able to move back and forth between SSI cash 
payments with Medicaid and non-cash payments with Medicaid 
[1619(b)] with no time limit even when no longer receiving an SSI 
check. In the rare case that an individual is no longer eligible for 
both SSI cash and Medicaid because of earned income (or earned 
and unearned income), the individual may apply for a reinstate-
ment of benefits, within 60 months of becoming ineligible for ben-
efits, without going through a completely new application process.
What if I Have Questions About How My 
Benefits will be Impacted by Going Back  
to Work?
If you have any questions about how your benefits will be impact-
ed by going back to work, you can contact specialists to assist you 
toll-free at 1-888-224-3272. The hotline is available during business 
hours Monday through Friday, except on holidays. Every effort will 
be made to return calls the same day or within one business day.
Additionally, SSA has contracted with local organizations to pro-
vide work incentive and planning services for Social Security SSDI 
and SSI beneficiaries. The Work Incentive Planning Assistance 
(WIPA) agencies have people who have been specially trained to 
help individuals with disabilities considering returning to work or 
returning to work. You can get a list of the WIPA’s in New York at: 
https://secure.ssa.gov/apps10/oesp/providers.nsf/bystate
www.N YMA K E SWO R K PAY . o r g
Development of the “Map Your Path to Work” guides is made 
possible by a Comprehensive Employment Services Medicaid 
Infrastructure Grant funded by the U.S. Department of Health 
and Human Services, Centers for Medicare and Medicaid Services 
(CMS) to the New York State Office of Mental Health (OMH) 
and its management partners the Burton Blatt Institute (BBI) at 
Syracuse University and the Employment and Disability Institute 
(EDI) at Cornell University.
Employment and Disability Institute
Cornell University
201 Dolgen Hall
Ithaca, New York  14853
voice:  607-255-7727
fax:  607-255-2763
tty:  607-255-2891
email:  nymakesworkpay@cornell.edu
web:  www.nymakesworkpay.org


Medicaid & Work: Keeping your Medicaid While You Work

The purpose of this guide is to educate New Yorkers with disabilities who receive SSI about how they can go to work and keep their Medicaid.SS44_PDF.pdf: 6499 downloads, before Oct. 1, 2020.0-SS44_TXT.txt: 140 downloads, before Oct. 1, 2020

Golden, Thomas P.

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https://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1271&amp;context=edicollect

Medicaid & Work: Keeping your Medicaid While You Work

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