Rule 5160:1-3-02.5 | Medicaid: supplemental security income (SSI) recipients qualifying under section 1619 of the Social Security Act for continued medical assistance coverage.

(A) This rule describes the eligibility criteria for continued medical assistance coverage for an individual who is receving SSI benefits under section 1619 of the Social Security Act.

(B) Section 1619 of the Social Security Act (as in effect October 1, 2022) comprises two basic provisions:

(1) Section 1619(a) extends special SSI cash to individuals whose earnings preclude eligibility for regular SSI cash benefits. Individuals in 1619(a) status may still receive an SSI cash benefit in addition to the individual's earned income.

(2) Section 1619(b) extends medicaid coverage to individuals whose earnings, although high enough to preclude eligibility for regular SSI cash benefits or special SSI cash benefits under section 1619(a), may not be enough for medical care.

(C) To determine initial medicaid eligibility for sections 1619(a) and 1619(b), the administrative agency shall verify that the individual is currently in 1619(a) or 1619(b) status, as determined by the social security administration.

(D) Protection of benefits under 1619 status.

(1) An individual who has been determined eligible for medicaid because of 1619 status is protected from losing medicaid benefits under this provision as long as the individual remains in 1619(a) or (b) status.

(2) The individual may have income or resources in excess of the medicaid standards and remain eligible for medicaid under the 1619 provisions.

(3) When the individual's 1619 status ends, the individual's medicaid protection is lost.

Last updated May 30, 2025 at 9:17 AM