You know, when considering employment as an option, many individuals with disabilities have made it clear over the years that while I can deal with a reduction or even a loss of my SSI cash benefit, I simply can't afford to lose access to my healthcare coverage under Medicaid. Well, a major step to addressing this concern was taken in 1987 when section 1619 was added to the Social Security act. Now, prior to 1987, if an individual received SSI and went to work and experienced earnings over the SGA level, not only would the person lose their SSI cash benefit, but they'd lose their Medicaid coverage as well. Recognizing this major disincentive, Section 1619 was added to the Social Security act and essentially it eliminated the substantial gainful activity level for SSI. So in other words, when you go to work, once you're determined eligible, when you go to work and experience earnings over that SGA level, you won't automatically or right away lose your SSI cash benefit. Instead, individuals will continue under Section 1619(a), the first part of the provision, to receive a special SSI cash benefit and their Medicaid. Now, 1619(b), the second part of this section, goes a step further in extending that safety net for individuals with disabilities by enabling them to continue Medicaid coverage if, in fact, their earnings are so high that they're not eligible for an SSI cash benefit, but they're not high enough to replace the Medicaid and any personally funded attendant care services that the person receives. Individuals are considered for eligibility for Section 1619(b) when their earnings reach the point -- they've become so high that it reduces their SSI cash benefit to zero, and this is referred to as the individual's "break-even point." Now, each person's break-even point may be different depending on if unearned income is received. Now, if there's no unearned income received, then the break-even point for an individual can be calculated fairly simply by reversing that countable income formula that Jenn reviewed with you a little bit earlier. So we're not only going to ask you to learn it forward, but now we're going to make you do it backward as well. So essentially what you would do in calculating the break-even point for this current year is you would start with the federal benefit rate, you would multiply that by two, and then you would add the 20-dollar and the 65-dollar exclusions. So again, you're simply reversing that countable income formula. So as you can see, the break-even point for 2002, the current year, is $1,175. Now, again, this is only the break-even point for individuals who have no unearned income. If there is any unearned income received at all, including deemed income or in-kind support and maintenance, then the individual will have a lower break-even point than this amount. Now let's take a minute to look at how the 1619(b) provision works. As I mentioned, at the point in time that a person reaches their break-even point and SSI cash benefits stop, an individual is determined for eligibility for 1619(b). Once they're determined eligible, the Social Security Administration disregards their earned income. This allows the person to be continued to be considered as an active SSI recipient in spite of the fact that they're not getting a cash benefit due to their earnings. This active SSI case standing allows them to continue their Medicaid eligibility. So again, they're just deemed by law as SSI recipients, even though no cash benefit is received. And this active case status continues for Medicaid. Now, let's look at 1619(b) eligibility. It's important to recognize that not all individuals with -- who lose their SSI cash benefits are going to be eligible for continuing Medicaid under 1619(b). There are a number of specific criteria that have to be met. First of all, the individual must continue to meet the SSA's definition of "disability" that we -- I talked about a little bit earlier in that first segment. The section 1619(b) does not provide any protection at all from continuing disability reviews, nor does it extend Medicaid coverage for folks who are determined to be medically recovered. So if a person is determined medically recovered, they will not be afforded protection under 1619(b). Now, the second criteria that individuals must have been eligible for at least one month of a regular SSI cash benefit before being determined eligible for 1619. What this means, very simply, is that 1619(b) is not meant to provide extended Medicaid for individuals who were not previously eligible for SSI based on disability or blindness. The third requirement is that the individual must continue to meet all other nondisability requirements for the SSI program. So in other words, the only reason the person is not receiving an SSI cash benefit is due to their earnings over the break-even point. The person must continue to have resources below the allowable limits. They must also have unearned income that is less than the federal benefit rate after the exclusions apply to that. Now, the fourth criteria is that the individual must need Medicaid in order to work. And this is a fairly straightforward test. The Social Security Administration uses a test called the Medicaid use test and it consists of three questions. First of all, has the person used Medicaid in the last 12 months? Do they intend to use it in the next 12 months? And finally, if the person had unexpected medical expenses, would they need their Medicaid to cover these expenses in the next 12 months? An answer of "yes" to any of these three questions is an indication that the person needs Medicaid in order to work. Now, the final requirement for 1619(b) is that the individual must have gross annual earnings below certain threshold amounts. So let's look at what these threshold amounts are. Okay? Threshold amounts are certain annual income amounts that are used to measure whether a person's earnings are high enough to replace his or her SSI as well as their Medicaid benefits. If an individual exceeds the threshold amount, they're considered to have earnings that are sufficient to replace these benefits and, as a result, are not going to be eligible for SSI. Now, each state has its own threshold amount, and these vary greatly from state to state. The state threshold amounts are based on the amount of earnings that would cause the SSI benefit to stop in that state, as well as the average Medicaid expenses in that state. Now, it's not anybody else's job other than SSA's to calculate what those state threshold amounts are, and what we're going to take a look at the formula, just so you can see what goes into that. You start with the state's annual state supplement rate, if in fact there is a state supplement, and multiply this by two. Then you add to this the current SSI break-even point times 12. Again, that's an annualized SSI break-even point for the state. And then you add the average per capita Medicaid expense for that state. And that will provide you with the state's threshold amount. Now, again, these amounts -- you don't have to really about the calculation too much because Social Security provides that for us, and you can access that on the SSA website in the POMs and we do have a citation for that, how to access the website in the packet there. Now, let's talk about threshold determinations. The initial determination, again, for 1619(b) is made when earnings exceed the break-even point. This determination, the initial one for 6 -- the threshold, is made for the 12-month period beginning with the month in which 1619(b) starts. In conducting the review, the SSA will determine if the estimated earnings for the individual for the 12-month period that's being determined are equal to or less than the threshold amount. If the answer is "Yes," the earnings are less than or equal to the threshold amount, then this requirement is met for 1619(b) eligibility. Now, keep in mind that SS only looks at earned income. Unearned income is not considered in making these threshold determinations. Now, following the initial determination, threshold determinations are made annually as part of the 1619(b) redeterminations. During these annual redetermination reviews for 1619(b), not only does the SSA look at does the person meet the threshold requirement but they look at all of the other eligibility criteria as well for 1619(b) to make sure the person still meets, you know, all the criteria to be in 1619(b). In addition to these annual reviews, the SSA will, on a quarterly basis, at least, update earning and earning exclusion information for individuals in 1619(b) status. Now, in most cases, the standard state threshold amounts are used to determine a person's eligibility for 1619(b). However, if an individual has unusually high medical expenses and/or other expenses that meet certain criteria, then the SSA can establish an individualized threshold amount for this individual. At the point in time that the individual's gross annual earnings exceed their state threshold amount, the SSA will take a look at the person's situation to determine, number one, does the person qualify for an individualized threshold amount, and, number two, if they do qualify, what that threshold amount for the individual will be. The object of the individualized threshold amount is to determine whether the person's earnings are truly sufficient to replace all of the benefits that he or she would have in the absence of those earnings. Now, let's look at how the individualized threshold amount is calculated. In the first step, you start with the base amount, which is essentially the SSI break-even point for the person's state of residence. In step two, we compare the individual's actual Medicaid expenses for the last 12-month period with their state's average per capita Medicaid expense. And whichever amount -- whichever of these two is higher is the amount that's added into the formula. In step three, we add any blind work expense or impairment-related work expenses that the person has. In step four, any amounts of income excluded under the person's plan for achieving self-support are added into the formula. Excuse me. And finally, the value of any publicly-funded attendant care services that the person receives is added in the fifth step. Now, the attendant care services that we're talking about here include both work-related attendant care services as well as personal needs services. However, these attendant care services cannot be added into the formula unless, first -- two criteria have to be met. First of all, they have to be paid for by a public agency other than Medicaid, and secondly, the individual must be in a situation where they're going to lose access to these services as a result of their earnings. So if both of those criteria are met, the publicly funded attendant care services can be added in. Now, once all of these figures are placed into that formula, the end result when you add them all together is the person's individualized threshold amount that they must meet for 1619(b) eligibility. Now let's take a look at an example of an individual that we're calculated an individualized threshold. In this situation, we have a gentleman by the name of John who is starting to work with an annual salary of $31,000. This annual salary is greater than or higher than his state threshold amount. John relies on attendant care services that are paid for through a state program, and in addition, he uses his Medicaid to cover his medical expenses. He also has a number of impairment-related work expenses. So when calculating John's individualized threshold amount, we're going to start with step one, the base SSI rate for his state of residence. In this example, it's Texas, and that's $14,100. In step two, we're going to compare the Texas average per capita Medicaid expense, which is $7,946, with John's own Medicaid expenses during the last 12 months, which were $18,000. Clearly, John's expenses were the higher of the two, so we're going to add in the 18,000-dollar figure into the formula. In step three, we're going to add John's impairment-related work expenses of $6,000. In step four, we're going to skip that because John doesn't have a plan for achieving self-support, so it's not applicable. And finally, in step five, we're going to add the value of John's publicly- funded attendant care services which are $36,000. Now, the total of all of these figures added together is $74,000. I'm sorry, it looks like 74,100 on the monitor there. And that represents John's individualized threshold amount. Clearly, John's annual earnings of $31,000 are less than his individualized threshold, so he does meet the threshold determination to be eligible for 1619(b). Okay. Now what I'd like to do is in the last couple minutes talk about some important 619(b) facts that everybody should be aware of. The first of these have to do with reinstatement of benefits. 1619(b) is arguably one of the most powerful SSI work incentives. It's available to individuals. Not only does it provide extended Medicaid coverage, but in addition, it enables the person to keep a -- stay active on the SSI case rolls, so they have an active case status. What this means is that at any point in time that a person is 1619(b), and experiences a reduction in earnings below the break-even point, then they are eligible right away to be reinstated for an SSI cash benefit without having to reapply. So you have that automatic reinstatement of benefits. It provides something of a safety net there. Now, the second point that has to do with 1619(b) is for eligible couples. Well, 1619(b) is clearly an effective tool for individuals, it doesn't always work to the best advantage of eligible couples. Now, if both members of an eligible couple are working and have some level of earnings, then both members of the couple will be eligible or have access to 1619(b) when earnings exceed the break-even point. But here's the glitch: If only one member of the eligible couple is working and has earnings, when earnings exceed the break-even point, then only the working spouse will have access to 1619(b). The spouse who is not working will lose their Medicaid eligibility unless they're found eligible under another category in their state. Now, that's something that's very important for individuals to be aware of when they're making choices. There has been a legislative proposal submitted by SSA to change the manner in which eligible couples are treated but at the present time, the rules that I just described are the rules that apply. Now, the next point that I want to talk about has to do with 1619(b) and individuals who live in 209(b) states. And your first question is probably, what in the world is a 209(b) state and do I live in one. Well, there are only 11 209(b) states in the country, and these are states that have their own eligibility criteria for Medicaid. In many cases, these criteria are more restrictive than the SSI standards. Now, if a person lives in one of these 209(b) states and is determined eligible for 1619(a) or 1619(b) status, they will keep their Medicaid eligibility as long as they were eligible for Medicaid in the month prior to entering 1619(b) status. So in other words, even if the person does not meet their state's more restrictive criteria for Medicaid, their Medicaid agency must continue their Medicaid eligibility if they were determined -- or if they had Medicaid in the month prior to moving into 1619(b) status.