Medicaid & Work
Case Studies
Case Study 1: Christina’s Work Hours Change
Christina was earning $885 gross per month and getting a monthly SSI payment of $543 plus automatic Medicaid in her state. She began working more hours and earning $2,085 per month gross. Her countable income is now $1,000. Because her countable income is more than the $943 SSI maximum for her state, she no longer qualifies for an SSI payment.
However, Christina continues to be eligible for Medicaid through 1619(b). This is because her disability continues, her need for Medicaid continues, her eligibility for SSI if her wages were ignored continues, and her annual income remains less than her state’s unique eligibility threshold.
|
Explanation |
Calculation |
|---|---|
|
Christina’s Gross Earned Income |
$2,085 |
|
Subtract the $20 General Income Exclusion |
$2,085 – $20 = $2,065 |
|
Subtract the $65 Earned Income Exclusion |
$2,065 – $65 = $2,000 |
|
Divide by 2 to compute the Countable Earned Income |
$1,000 |
|
The SSI Federal Benefit Rate (2024) is less than Christina’s Countable Earned Income |
$943 < $1,000 |
Christina has worked her way from a reduced SSI payment to Medicaid-only status, through 1619(b), as her wages have increased.
However, after Christina works for several months at $2,085 gross wages per month, her employer’s business slows down and her hours are cut. Her gross wage is now $1,085 per month.
Think about it. What needs to happen?
As always, Christina needs to report her change in monthly income to the SSI program. The SSI program will process her new SSI payment—without the need for a timely new application process! Here is how her payment is computed:
|
Explanation |
Calculation |
|---|---|
|
Christina’s Gross Earned Income |
$1,085 |
|
Subtract the $20 General Income Exclusion |
$1,085 – $20 = $1,065 |
|
Subtract the $65 Earned Income Exclusion |
$1,065 – $65 = $1,000 |
|
Divide by 2 to compute Christina’s Countable Earned Income |
$1,000/2 = $500 |
|
Subtract Christina’s Countable Earned Income from the SSI Federal Benefit Rate (2024) to compute Christina’s SSI payment |
$943 – $500 = $443 |
Christina is now eligible for an SSI payment of $443 per month.
The takeaway
SSI beneficiaries can easily transition from SSI-based Medicaid to 1619(b) Medicaid and back again as their wages increase or decrease. They do not have to reapply for SSI or for Medicaid.
Case Study 2: Gene’s Individualized Threshold
Gene has cerebral palsy, is a full-time wheelchair user, and gets an SSI payment of $943 per month with automatic Medicaid in his state. Gene will soon graduate from college and take a job earning $42,000 per year. This will be too much earned income to qualify for 1619(b) as it exceeds his state’s $41,830 section 1619(b) threshold (made up from a $22,956 base amount and a $18,874 Medicaid amount). Gene verifies that Medicaid paid for $32,000 in medical expenses for him during the past year (with personal care services costing more than $25,000) and expects a similar or higher amount of medical expenses in the upcoming year.
Gene verifies that Medicaid paid for $32,000 in medical expenses for him during the past year (with personal care services costing more than $25,000) and expects a similar or higher amount of medical expenses in the upcoming year.
Think about it. What needs to happen?
Gene requests a $4,579 individualized 1619(b) threshold:
He adds the $32,000 of actual Medicaid expenses to the $22,956 base amount to get an annual individualized threshold of $54,956, which is $4,579 per month. Since his annual earnings, expected to be $42,000, will be below that figure, he will be eligible for 1619(b) Medicaid.
The takeaway
Even if an individual earns more than their state’s 1619(b) threshold, they can request an individualized threshold to keep Medicaid eligibility while working.