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Effective: October 1, 2012 |
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03.30.30ar4 - Medical Assistance (MA) for 1619(a) and 1619(b) (Archive) |
Archived: March 1, 2014 |
Employed people with disabilities who received Medical Assistance (MA) the month before the initial month they were certified for special Supplemental Security Income (SSI) status under sections 1619(a) and 1619(b) of the Social Security Act are eligible for MA without regard to income or assets.
For information about how the Social Security Administration (SSA) determines 1619(a) and 1619(b) status, see Supplemental Security Income (SSI).
Note: Persons who only receive Railroad Retirement benefits and SSI cash benefits can also have the status of 1619(a) or 1619(b).
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
Process MA applications within 60 days for people whose eligibility is based on disability.
Follow standard MA guidelines.
People with 1619(a) or 1619(b) status are exempt from six-month renewals because their income is excluded.
Verifications (standard guidelines)
Review 1619(a) or 1619(b) status at application or renewal for any person who is or was on Supplemental Security Income (SSI) and MA concurrently and has earned income.
1619(a) status may exist if the person receives an SSI check and has counted earned income above the Substantial Gainful Activity (SGA). The 2012 SGA is $1,010 monthly.
1619(b) status may exist if the person's SSI cash benefit stopped due to earned income.
Verify 1619(a) or 1619(b) certification as follows:
l On MAXIS:
SSA sends a daily SDX file to MAXIS from which 1619 status is derived.
At the end of each week, the files are combined and MAXIS runs the 1619 job on Saturday. If 1619 information has been derived, a DAIL message is sent including that:
n The person is in 1619 status, or
n The person is no longer in 1619 status, or
n There is an updated 1619 status.
Create a STAT/DISA panel for people who have a disability certification. When there is an active DISA panel, and 1619 status is derived from SDX, the 1619 status field on DISA is automatically updated.
A DAIL message will be issued when 1619 status is terminated. Update the DISA panel when the DAIL message is received. MAXIS will not automatically update DISA.
l On the State Verification and Exchange System (SVES):
n 1619(b) status can be derived from information on the SVES.
n Look at the SVES "Payment Status" field if the person was receiving SSI and is on MA.
n The person has 1619(b) status if the status field equals "CN01 - excess income" and the type is "Earned."
l Through the Social Security Administration (SSA):
Contact your local Social Security Office for help with difficult cases only. SSA will assist with cases involving special excursions, blind work expenses (BWE), impairment related work expenses (IRWE), and plans for achieving self-support (PASS). You can find the nearest Social Security Office by going to the SSA website and entering your ZIP code.
Follow standard MA guidelines.
Follow standard guidelines for federally funded MA.
Residency (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
Refer people with 1619(a) or 1619(b) status who are age 65 or older, and who receive SSI benefits only to the Social Security Administration (SSA) to apply for Medicare if they are not currently enrolled. Send the client the Medicare Buy-In Referral Letter (DHS-3439) and a county-addressed return envelope requesting that the client apply within 60 days. Once you receive the confirmation portion of the referral letter or otherwise confirm Medicare eligibility with the SSA, enroll the person in the appropriate Medicare Savings Program.
DHS pays Medicare Part B premiums for people with 1619(a) or 1619(b) status who receive Retirement, Survivors, and Disability Insurance (RSDI) benefits and are enrolled in Medicare through the Medicare buy-in.
Household size does not apply.
Eligibility Method (standard guidelines)
Not applicable. There is no income or asset test, so no evaluation method is needed.
People are eligible without an asset test as long as they retain 1619(a) or 1619(b) status.
People are eligible without an income test as long as they retain 1619(a) or 1619(b) status.
Deductions/Disregards (standard guidelines)
People are eligible without an income test as long as they retain 1619(a) or 1619(b) status.
People are eligible without an income test as long as they retain 1619(a) or 1619(b) status.
Follow standard MA guidelines.
People who are not enrolled in a managed care plan receive services through fee-for-service (FFS).
People under age 65 who are eligible for MA under a 1619 status are excluded from mandatory managed care enrollment. However, people may voluntarily enroll in Special Needs BasicCare (SNBC) if they are:
l ages 18-64 and are eligible for MA with or without Medicare Parts A and B,
l certified disabled by SSA or SMRT, and
l reside in any Minnesota county except Clearwater, Beltrami, Hubbard, or Lake of the Woods.
People age 65 or older who are not enrolled in a managed care plan receive services through fee-for-service (FFS).
People age 65 or older, including people who receive services through the Elderly Waiver (EW), who are not subject to a managed care exclusion will be enrolled in Minnesota Senior Care or Minnesota Senior Care Plus, depending on their county of residence. Most seniors may voluntarily enroll in Minnesota Senior Health Options (MSHO) if they so choose.
Not applicable.
Redetermine eligibility for health care and Medicare Savings programs when a person loses their 1619 status.
Note: MA eligibility is available under this basis when a person later regains 1619(a) or (b) status as long as the person received MA the month before 1619(a) or 1619(b) status was originally certified.
Example:
Joe is certified disabled by the Social Security Administration (SSA) and received MA and SSI. He became employed in June 2005, and was given 1619(a) status in July 2005. In March 2006, he lost 1619(a) status when he lost his job. He again received regular SSI payments and continued receiving MA under a disability basis. Joe began working again in November 2006, and regained 1619(a) status in December 2006.
Action:
Change Joe's basis of eligibility to 1619(a) beginning in December 2006, because he was receiving MA in June 2005, the month before he was originally certified for 1619 status.
People with 1619(a) or 1619(b) status who are enrolled in Medicare are automatically accreted to the Medicare buy-in, so have no need for Medicare Savings Programs eligibility.