Section 16.03.05.782 - MEDICAID BENEFITS UNDER SECTION 1619(B) OF THE SOCIAL SECURITY ACTA participant may be eligible for Medicaid under Section 1619(b) of the Social Security Act either under federal or state criteria, depending on their circumstances.
01.Federally Qualified Under SSA Section 1619(b). An SSI recipient with a disability, previously eligible for SSI cash, who, because of earnings from employment, no longer meets the financial eligibility requirements for SSI cash, is eligible for Medicaid. SSA determines the qualification for eligibility under Section 1619(b).02.State-Only Qualified Under SSA Section 1619(b). An AABD cash participant with a disability, who, because of earnings from employment, no longer meets the financial eligibility requirements for AABD cash, may be eligible for Medicaid. The Department determines eligibility for State-only Section 1619(b) Medicaid. State-only Section 1619(b) Medicaid is authorized under Section 1905(q) of the Social Security Act.a. A participant must meet all the following requirements to be eligible for State-only 1619(b) Medicaid. The participant:i. Received AABD cash in the month prior to the first month of their eligibility under this rule.ii. Is under age sixty-five (65).iii. Continues to have a disability.iv. Must depend on Medicaid coverage to continue working. An individual depends on Medicaid coverage if they:(1) Used Medicaid coverage within the past twelve (12) months;(2) Expect to use Medicaid coverage in the next twelve (12) months; or(3) Would be unable to pay unexpected medical bills in the next twelve (12) months without Medicaid coverage.v. Is not able to afford medical insurance equivalent to Medicaid, including attendant care. The participant meets this requirement if their earnings are under the limit referred to in Subsection 782.02.a.vii. of this rule.vi. Continues to meet all the non-disability eligibility requirements in these rules.vii. Has annual gross earned income less than the current calendar year's charted threshold for Idaho as developed by SSA for federal qualification for Section 1619(b) Medicaid. The charted threshold for Idaho is SI 02302.200 Charted Threshold Amounts, incorporated by reference in Subsection 002.04.b. State-only Section 1619(b) Medicaid ends when the participant meets one (1) of the following criteria. The participant: i. Is no longer eligible for AABD cash for a reason other than excess earned income;ii. Has gross earned income equal to or more than the current calendar year's annual earnings threshold for Idaho developed by the SSA for federal Section 1619(b) Medicaid;iii. Is age sixty-five (65) or older; oriv. Regains eligibility for AABD cash.Idaho Admin. Code r. 16.03.05.782