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SSI Cash Payments and Medicaid While Working or Entering a Medical Facility

This guide presents selected U.S. government consumer education from Social Security Administration. References to “we” or “us” in the source material refer to the issuing agency. Source dates and links appear below.

Medicaid While Working – Section 1619(b) (SSI eligible)

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” rate 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.

Note: See link for chart reflecting State Threshold Amounts for People with Disabilities at: secure.ssa.gov/apps10/poms.nsf/lnx/0502302200.

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.

Special SSI Payments for Persons Who Work - Section 1619(a) (SSI eligible)

What Is Section 1619(A)?

You can receive Supplemental Security Income (SSI) cash payments even when your earned income (gross wages and net earnings from self-employment) is at the substantial gainful activity (SGA) level. This provision eliminates the need for the trial work period or extended period of eligibility under SSI.

How Do You Qualify?

You must meet all the conditions listed below to qualify:

  • You have been eligible for an SSI payment for at least 1 month before you begin working at the SGA level.
  • You still have a disability.
  • You meet all other eligibility rules, including the income and resource tests.

How Does It Work?

Your eligibility for SSI will continue for as long as you meet the basic eligibility requirements and the income and resource tests. We will continue to figure your SSI payment amount in the same way as before. If your state provides Medicaid to people on SSI, you will continue to be eligible for Medicaid.

Do You Need To Apply?

You do not need to file a special application. Just keep us up to date on your work activity.

NOTE: People who live in American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands cannot receive SSI.

Special Benefits If You Are Eligible Under 1619 and Enter a Medical Facility (SSI eligible)

How Does It Help You?

If you are working and eligible under section 1619, you may receive a Supplemental Security Income (SSI) cash benefit for up to 2 months while in a facility. This may be a Medicaid facility or a public medical or psychiatric facility.

What Happens If You Enter A Medicaid Facility?

Usually, if you enter a Medicaid facility where Medicaid pays more than 50% of the cost of care, your SSI payment is limited to $30 per month, plus any state supplement. This excludes any countable income. However, if you enter a Medicaid facility while you are eligible under section 1619, we will figure your benefit using the full Federal Benefit Rate for up to 2 months.

What Happens If You Enter A Public Medical Or Psychiatric Facility?

Usually, if you are in a public medical or psychiatric facility, you are not eligible to receive an SSI payment. However, if you enter a public medical or psychiatric facility while you are eligible under section 1619, your SSI cash benefits may continue for up to 2 months. For this provision to apply, the facility must enter an agreement with us that will allow you to keep all your SSI payment.

Reinstating SSI Eligibility Without a New Application (SSI eligible)

How Does It Help You?

If you have been ineligible for Supplemental Security Income (SSI) payments due to your work, you may be able to restart your SSI cash payments again without a new application.

If you have been ineligible for SSI and/or Medicaid for any reason other than work or medical recovery, you may be able to restart your SSI cash payment and/or Medicaid coverage within 12 months without a new application. When your situation changes, contact us and ask about how you can restart your SSI payments and/or Medicaid.

If your cash payment and Medicaid benefits ended because of your earned income, or a combination of earned and unearned income, and you stop work within 5 years of when your benefits ended, we may be able to start your benefits again under Expedited Reinstatement.

Sources and publication details

The federal agency source text is U.S. government work in the public domain. Fynoptic selected, adapted, and formatted it for this guide. No agency endorsement is implied. Follow the linked sources for current program details and the rules applicable to your circumstances.

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