Special Medical is a group of categories that allow clients to continue receiving medical assistance despite their income when specified increases in income are received. All the categories require client to have received the State Supplemental Payment (SSP) at a specified point but are no longer receiving it because their income has increased. Keep in mind that only the income from the categories below is disregarded. The individual must meet the individual resource standard of $2,000. If the individual starts receiving any other income, it must be counted in re-determining eligibility.
There are several categories in which individuals considered Special Medical can be placed in. This article is specific to the 1619B.
- 1619B– an individual who once received SSI, but now has earned income which makes them ineligible for SSI, Social Security Administration still recognizes them as disabled, must have received Medicaid month prior to 1619B classification, and meets all other factors of eligibility.
- IMS Indicator: B.70=B
- SDX Screen: page 2, Medicaid Test Indicator will have a code of A, B, or F.
Scenarios:
Roseanne Carter is receiving $783 of SSI and was certified for the SSP on 01/15/2020. On 02/20/2020, her SSI was closed for income due to a new job. She works at Small World Travel Agency and is earning $2600 a month. SDX shows a N01 in the block 04 Payment Status as well as an “F” in the block 40 Medicaid Test Indicator. She received the SSP for at least the month before SSI closed her for benefit and decided she is eligible for 1619b. She is now eligible for Special Medical under 1619b.
Travis Clark has been on QMBP for three years. He has been receiving an SSI benefit of $783 but declined the SSP. SDX now shows his SSI has closed for income. He is working at the Hard Rock Store making $2400 a month. The block 40 Medicaid Test indicator shows an “A”. He was on QMBP for at least a month before SSI closed his benefit and made the decision, he was eligible for the 1619b program. He is now eligible for Special Medical under 1619b.
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