Iowa

Iowa Department Of Human Services
SSI-Related Coverage Groups

People Ineligible for SSI (or SSA) Title 8
Medicaid
July 2, 1996
Chapter F Coverage Groups

Due to Substantial Gainful Activity (1619b Group)

Legal reference: 20 CFR 416.2101, 42 CFR 435.120

Medicaid coverage may be available to some former SSI recipients who no longer qualify for SSI benefits because they perform "substantial gainful activity" (as determined by the Social Security Administration). See 8-C, Substantial Gainful Activity.

Eligibility exists for people in this group if the person:

Continues to be blind or have a disabling impairment.

Meets all other SSI requirements except for earnings.

Would be seriously inhibited from continuing to work if Medicaid eligibility was terminated.

Earns income that is not a reasonable equivalent to the benefits the person would have, including SSI, SSA and Medicaid, if the earnings did not exist. This level is determined by the Social Security Administration.

This coverage group is also known as the "1619b" group. For purposes of Medicaid eligibility, a person meeting these criteria is considered to be an SSI recipient, even though no SSI benefit is received.

The Social Security Administration determines initial and continuing eligibility for this coverage group. Information about these clients appears on the SDX. See XIV-E for SDX codes to identify eligibility due to substantial gainful activity.

The ABC aid type is the same as for regular cash SSI-eligible persons. See Summary of Aid Types and Fund Codes.

State Contact Person:

Elaine Monaghan
Division of Medical Services
Eligibility Bureau
Phone: 515-281-8635
Fax: 515-281-7791

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Kansas

The Kansas' Public Assistance Manual

Rev.2,7-97
5320-5324 SSI
Medical Assistance
Section 5
(State Supplements,1619 Status)

NOTE: For persons who have applied or been approved for SSI disability, Form DD-1106 may be submitted to DDRS in order to determine the medical onset date of disability. This date would be necessary if retroactively claiming FFP on medical expenditures or determining eligibility prior to the effective date of SSI eligibility. DDRS will return the completed original with the onset date information.

5324 1619 Status — Individuals eligible for SSI under the Provisions of section 1619 of the Social Security Act are eligible for medical assistance as indicated above. Section 1619 permits disabled individuals to work at the "substantial gainful activity" level (currently defined as receiving gross earnings in excess of $700/month) without jeopardizing their SSI disability status.1619(a) eligibles continue to receive a cash benefit as their earnings do not exceed the SSI benefit levels. They are identified on the State Data Exchange Interface (SDX) as in current pay status. 1619(b) eligibles do not receive a cash benefit as their earnings exceed SSI benefit levels but continue to be eligible for medical assistance. They are identified on the SDX Interface as terminated individuals with a Medicaid Indicator code of "B." However, this code will only be reflected at the time SSI benefits are terminated and will not otherwise be reflected on an ongoing basis. It may be necessary to verify 1619(b) status with SSA.

5325 Persons with Drug Addiction or Alcoholism — Based on the drug addiction and alcoholism provisions of the SSI program, SSI benefits are not available to individuals whose drug addiction or alcoholism is a contributing factor to the determination of disability (i.e. would not be found disabled if the drug abuse and/or alcohol abuse were to stop). These provisions became effective as of March 29, 1996. Medical eligibility under the SI or MS program shall not be provided in such instances. However, SSI beneficiaries whose benefits are terminated due to these provisions and who are medical recipients shall continue to be eligible for Medicaid if they timely appeal the SSI decision and are otherwise eligible except for the disability determination. Such eligibility continues throughout the appeal process. Verification from SSA that the appeal was filed timely is required.

5326 Loss of Recipient Status — Upon the loss of SSI recipient status (other than that noted in 5324 and 5325), case action must be effective no later than the end of the month following the month of such loss allowing for timely and adequate notice. However, persons whose benefits are terminated due to loss of disability status and who timely appeal the SSI decision (defined as within 90 days of notification of termination) shall continue to be eligible for medical assistance if they are otherwise eligible except for the disability decision. Such eligibility continues throughout the appeal process. Verification from SSA that the appeal was filed timely is required. Those who appeal within 10 days of notification can choose to continue SSI benefits during the appeal process and would still be considered SSI recipients.

For persons whose SSI benefits are suspended for a month due to excess income, medical assistance shall continue provided there is SSI eligibility in the following month and all other eligibility factors are met.

Contact Person:

Linda Kramer
Policy Specialist
SRS IM/EPS
Docking State Office Building
681 W
915 Harrison Topeka, KS 66612-1570
Phone: 785-296-3349
Fax: 785-296-0146

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Missouri

Missouri Department of Social Services

Family Support Division
Income Maintenance Manual

http://www.dss.mo.gov/fsd/iman/medasst/0850-000-00_0850-020-00.html - links to eligibility requirements and resources

Contact Persons:

Sarah Sergent
Program Development Specialist
sarah.sergent@dss.mo.gov

Kim R. Evans
Program Development Specialist
kim.r.evans@dss.mo.gov

Family Support Division
P.O. Box 2320
Jefferson City, MO 65102
Phone 573-751-3507
Fax 573-751-3677

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Nebraska

Nebraska Department Of Social Services Manual

Health and Human Services System
Rev. July 29, 1996
Manual Letter #47-96

AABD
469 NAC 4-001.02A

4-001.03 (Reserved)

4-001.04 Blind or Disabled Recipients Eligible for MA: A blind or disabled recipient who has earned income is eligible for MA without regard to excess income if s/he meets the guidelines in 469 NAC 4-001.04A or 4-001.04B. If a blind or disabled person reaches the age of 65, SSA may continue 1619(b) eligibility.

4-001.04A Current and Former SSI Recipients: A blind or disabled recipient who has earned income is eligible for MA without excess income if s/he —

1. Received MA in the month before the month in which this reference applies and continues to receive SSI (regular SSI payments or special SSI payments under section 1619(a) of the Social Security Act); or

2. Received MA and SSI in the month before the month in which this reference applies but whose SSI payment stopped due to the level of earnings and who is determined by SSA to have special Medicaid status under section 1619(b) of the Social Security Act. The 1619(b) status can be verified from the State Data Exchange (SDX6, Special Medicaid Status field).

It is not necessary to compute Form DA-3M.

If SSA reviews the client’s disability and determines that s/he is no longer disabled, the case must be closed in the first month possible considering the ten-day notice requirement.

Contact Person:

Joyce Snyder
Program Specialist
Nebraska Health and Human Services System
PO Box 95044
Lincoln, NE 68509-5044
Phone: 402-471-9752
Fax: 402-471-9597

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Missouri Department of Social Services

Family Support Division Income Maintenance Manual

Family Support Division
Income Maintenance Manual