Sections 1619 A and B of the Social Security Act allow certain disabled individuals who have lost SSI eligibility due to income from employment to remain Title XIX (MO HealthNet) eligible. Section 1619 individuals continue to meet the SSI disability requirements.
To qualify for MO HealthNet based on Section 1619 status, the following eligibility requirements must be met:
The Social Security Administration (SSA) determines who meets SSA 1619 eligibility criteria.
SSA will notify State Office of individuals eligible for 1619 status. SSA also notifies the participant that s/he is 1619 eligible.
If a participant notifies the Eligibility Specialist that s/he is SSA 1619 eligible, obtain verification from SSA of the date the participant attained 1619 status so the Eligibility Specialist can determine whether the individual received MO HealthNet in the month immediately preceding the month 1619 status was obtained. If the Eligibility Specialist is unable to obtain the information from SSA, send an e-mail to the IM Program and Policy Unit. Include the participant’s name, DCN, Social Security number, and month employment began.
NOTE: When it is reported by a MO HealthNet recipient that he/she has lost SSI benefits and obtained employment, staff is required to review 1619 status.
The claimant must have received Title XIX MO HealthNet in the month immediately preceding the month of attaining SSA 1619 status.
If the participant did not receive Title XIX in the month immediately preceding attaining SSA 1619 status, the participant is not eligible for Title XIX MO HealthNet under 1619 criteria. Determine continued eligibility in accordance with the December 1973 eligibility factors.
The Section 1619 resource maximums are the same as the SSI resource maximums. Currently, the SSI resource maximums are:
Consider as resources anything that is considered available under the December 1973 eligibility requirements for aged and disabled persons. Refer to Section 1030.000.00. Consider the resources of both spouses when determining eligibility under this factor.
SSA establishes a "threshold amount" for each state to determine income eligibility for 1619 individuals. SSA only uses gross earned income to determine eligibility under 1619 criteria.
The threshold amount is only used by FSD to identify 1619 cases in FAMIS. When determining continued MO HealthNet eligibility, there is no income limit for participants who are granted SSA 1619 status.
As of January 1, 2019, the current monthly threshold amount for Missouri is $3141.
If an individual is SSA 1619 eligible, do not consider the income of other household members.
If each spouse is SSA 1619 eligible, consider each spouse an individual case.
If only one spouse is SSA 1619 eligible, and the other is applying or receiving MHABD, consider the income and medical expenses of the 1619 individual in determining eligibility for the non-1619 spouse.
If a claimant is determined eligible for Medicaid under 1619 criteria, the worker will:
Reviews of MO HealthNet Section 1619 Status cases are to be done annually. The requirement is the same as for other MO HealthNet cases. Refer to Section 0840.005.00.
When notified a claimant loses SSA 1619 status, the Eligibility Specialist will: