How does it help you?

After you return to work, your Medicaid coverage can continue. This is true even if your earnings (alone or in combination with your other income) become too high for an SSI payment.

How do you qualify?

To qualify, you must meet all the following qualifications:

• You were eligible for an SSI payment for at least 1 month.
• You would be eligible for SSI payments except for earnings.
• You still have a disability.
• You still meet all other eligibility rules, including the resources test.
• You need Medicaid to work.
• You have gross earned income that is insufficient to replace SSI, Medicaid, and any publicly funded attendant care. (See following “threshold amount” discussion.)

The “threshold amount” is the measure that we use to decide whether your earnings are high enough to replace your SSI and Medicaid benefits. Your threshold amount is based on:

• The amount of earnings that would cause your SSI payments to stop in your state.
• The average annual per capita Medicaid expenditure for your state.

If your gross earnings are higher than the threshold amount for your state, we will determine if you are eligible under an individualized threshold calculation. The individualized threshold calculation begins with the base amount from the appropriate state-by-state threshold chart and adds:

• The higher of your actual Medicaid expenditures or the average per capita Medicaid expenditures for your state;
• The higher of the State supplement rate for your actual living arrangement or the “living alone” rage used in the chart;
• Any impairment-related work expenses (IRWE) or blind work expenses (BWE) you may have;
• Amounts of income excluded under an approved Plan to Achieve Self-Support (PASS); and
• The value of publicly funded personal/attendant care which you receive.

Do all states use the same Medicaid eligibility rules?

Most states use our SSI eligibility rules to determine Medicaid eligibility. However, the following states use their own eligibility rules for Medicaid that are different from our SSI eligibility rules:

• Connecticut
• Hawaii
• llinois
• Minnesota
• New Hampshire
• North Dakota
• Missouri
• Virginia

If you live in one of these states, you will continue to be eligible for Medicaid under section 1619(a) or 1619(b) if you were eligible for Medicaid in the month immediately before you became eligible for section 1619.