Section 1619(b) in 2026: How Working SSI Recipients Keep Medicaid After the Cash Check Stops, the State Threshold Table, and the Individualized Threshold Trick

By Anthony Albert, Benefits Research Director at Disability Exchange. Published June 2, 2026.

If you're on SSI and thinking about going back to work, the biggest fear isn't usually the paycheck math. It's losing Medicaid. Medicaid pays for your medications, your therapy, your specialist visits, your equipment, sometimes your attendant care. Lose it, and the value of any new job collapses fast. Section 1619(b) of the Social Security Act exists for exactly this reason. It lets you keep Medicaid even after your SSI cash check drops to zero because of work.

Most SSI recipients have never heard of 1619(b). When they ask their local field office about going back to work, they get a vague "you might lose your benefits" answer that scares them off. So they stay home, don't take the job, and Medicaid keeps paying full freight on their care. The waste is huge on both sides. SSA built 1619(b) to fix this, but nobody talks about it. Let's go through how it actually works in 2026, who qualifies, the state threshold table everyone needs, and the individualized threshold path that pushes the earnings ceiling much higher when you've got real medical expenses.

What 1619(b) actually does

SSI is a needs-based program. When you start earning, SSA subtracts countable income from the federal benefit rate. The first $65 of earned income each month is excluded, plus the general $20 income exclusion, plus half of the rest. So earnings have to climb past the break-even point (around $1,914 a month for an individual in 2026 after exclusions) before your SSI cash check is reduced all the way to zero.

Once cash hits zero, most needs-based programs would call you ineligible and shut everything down. But Section 1619(b), enacted as a permanent provision in 1986 and codified at 42 U.S.C. 1382h(b), says no. It says SSA must treat you as if you're still receiving SSI for Medicaid purposes only, as long as you meet the five tests. Your file status changes to what SSA calls "N02" (income over the limit) but you stay on the Medicaid rolls in your state.

This is technically called "stop payment status," not suspension. That matters because suspension is a punishment and stop payment is just a math situation. If your earnings drop later, your cash benefit picks back up automatically, with no new application. POMS SI 02302.010 calls this automatic re-entry.

1619(a) vs 1619(b): the difference matters

Section 1619 has two parts. People mix them up all the time. Here's the clean version:

Provision	What it covers	SSI cash?	Medicaid?
1619(a)	Working SSI recipient earning at or above SGA (over $1,690 a month non-blind in 2026), but still under the break-even point	Yes, reduced amount	Yes
1619(b)	Working SSI recipient whose earnings push cash to zero but who's below the state's Medicaid threshold	No	Yes
Full SSI	Not working, or working below SGA with low total income	Yes, full FBR ($994 in 2026)	Yes

The genius of the structure is that you slide between these three states without ever filing a new application. If you take a job, earn $1,700 a month, you're 1619(a). Get a raise to $3,000 a month, you become 1619(b). Lose the job, you go back to full SSI. SSA recomputes your status monthly using the wages you report.

The five qualifying tests under 1619(b)

POMS SI 02302.020 lays out the five things you have to satisfy:

1. Prerequisite month. You have to have been eligible for an SSI cash payment in at least one month during the recent period. If you've never received SSI cash, you can't claim 1619(b) on your first job. You need the prior cash month to "anchor" your 1619(b) status.
2. Continuing disability. Your medical condition still meets SSA's disability standard. Earnings alone don't trigger a medical Continuing Disability Review. Your CDR happens on its normal schedule (every 3 or 7 years depending on your prognosis). If you medically improve, 1619(b) ends.
3. Meets all other SSI non-disability rules except earnings. Resources at or below $2,000 for an individual or $3,000 for a couple. U.S. residency. No prohibited transfers. Still living in the country. The only test you don't need to pass is the income test, because earnings are exactly what kicked you out of cash status.
4. Medicaid Use Test (SI 02302.040). You have to need Medicaid coverage to keep working. SSA presumes you do if you used a Medicaid-covered service in the past 12 months, used one in the past 24 months and expect to need one again, or have a documented ongoing need (prescriptions, regular therapy, attendant care, equipment).
5. Threshold Test (SI 02302.045). Your gross earnings have to be below your state's threshold amount. If you cross the threshold, you don't automatically lose Medicaid. You can still keep it through the individualized threshold under SI 02302.050 if your real expenses justify it.

All five tests are run each year, and any of them can knock you out. The two that catch people most often are the resource test (because they let savings stack up) and the threshold test (because they don't know about the individualized option).

The 2026 state threshold table

SSA recalculates the state thresholds every January. They reflect the average annual Medicaid expenditure for disabled SSI recipients in that state, plus the federal break-even point, plus the state SSI supplement if any. States with high per-capita Medicaid spending have higher thresholds. States with low spending have lower ones. Here are the 2026 disabled thresholds for all 50 states and DC, sourced from SSA's official 1619(b) page:

State	2026 disabled threshold	State	2026 disabled threshold
Alabama	$40,026	Montana	$49,174
Alaska	$73,070	Nebraska	$56,282
Arizona	$59,182	Nevada	$47,006
Arkansas	$40,366	New Hampshire	$50,485
California	$66,078	New Jersey	$63,400
Colorado	$63,454	New Mexico	$54,557
Connecticut	$55,480	New York	$68,654
Delaware	$60,163	North Carolina	$51,178
District of Columbia	$73,901	North Dakota	$60,145
Florida	$42,946	Ohio	$50,138
Georgia	$41,927	Oklahoma	$46,831
Hawaii	$51,832	Oregon	$47,856
Idaho	$53,625	Pennsylvania	$55,023
Illinois	$47,756	Rhode Island	$46,819
Indiana	$47,397	South Carolina	$44,963
Iowa	$53,732	South Dakota	$53,537
Kansas	$54,547	Tennessee	$41,797
Kentucky	$48,099	Texas	$53,165
Louisiana	$44,804	Utah	$54,668
Maine	$56,143	Vermont	$52,699
Maryland	$62,929	Virginia	$63,537
Massachusetts	$52,015	Washington	$73,897
Michigan	$42,987	West Virginia	$42,379
Minnesota	$84,208	Wisconsin	$51,711
Mississippi	$43,992	Wyoming	$51,244
Missouri	$55,181

Minnesota leads the table at $84,208, followed by DC at $73,901, Washington at $73,897, and Alaska at $73,070. The lowest in the country is Alabama at $40,026. Most states cluster between $45,000 and $60,000, which works out to roughly $3,750 to $5,000 in gross monthly earnings before threshold problems start.

If you're blind under SSA's statutory definition, four states use a separate (higher) blind threshold for 2026: California at $68,103, Iowa at $54,260, Massachusetts at $52,864, and Nevada at $49,629. In every other state, the disabled and blind thresholds are the same.

The Medicaid Use Test in practice

POMS SI 02302.040 is one of the most misunderstood pieces of the 1619(b) rule. SSA does not require you to prove you'd lose your job if Medicaid stopped. It just requires you to show that you use Medicaid and need it to maintain your work effort. The bar is low. SSA presumes the test is met if any of these apply:

• You used a Medicaid service (doctor visit, prescription, therapy session, equipment, hospitalization) in the past 12 months
• You used Medicaid in the past 24 months and expect to use it again
• You have a documented ongoing prescription, therapy schedule, or condition that requires Medicaid

Almost every SSI recipient passes this without thinking about it. The exception is someone who hasn't used any Medicaid services in years (rare for an SSI recipient) or someone whose entire treatment is privately funded. Save pharmacy printouts, EOBs, and any specialist appointment confirmations. If SSA asks for proof, this is the documentation they want.

The individualized threshold and why it matters

This is the part most claimants never hear about. POMS SI 02302.050 says if your gross earnings exceed the state threshold, SSA will calculate an individualized threshold based on your actual situation. The formula:

Individualized threshold = Federal break-even point + actual Medicaid expenses + IRWEs + BWEs + PASS exclusions + publicly-funded attendant care costs

Each piece is real money that pushes your earnings ceiling higher:

• Impairment-Related Work Expenses (IRWEs): Out-of-pocket costs related to your impairment that let you keep working. Service animal care, transportation modifications, attendant care, specialized equipment, certain medications. SI 00820.540 lists what counts.
• Blind Work Expenses (BWEs): If you're blind, almost any expense connected to working is excluded. Taxis to work, federal income tax, FICA, professional dues, attendant care. SI 00820.535 is the rule.
• PASS contributions: Money set aside under a written Plan to Achieve Self-Support, used to pay for education, equipment, or business start-up. SI 00870 covers the plan structure.
• Publicly-funded attendant care: Personal care, home health, or attendant services funded by state Medicaid or another public source.
• Actual Medicaid expenses higher than the state average: If your real Medicaid spend (prescriptions, specialist care, surgeries) is documented above the average used to set the state threshold, the difference is added.

People with expensive specialty drugs can push their individualized threshold dramatically. A medication that costs $14,000 a year through Medicaid, on top of monthly therapy and quarterly specialist visits, can add $20,000 to $40,000 to the individualized threshold. That means you can earn well above the state cap and still keep Medicaid.

Worked example: Carla in California

Carla is 34, lives in Oakland, has been on SSI since age 22 after a serious car accident left her with chronic pain and a partial paralysis affecting her left side. She's been receiving the full SSI federal benefit rate plus California's state supplement, plus Medi-Cal (California's Medicaid program). In 2025 she finishes a certificate program in graphic design and lands a remote contract job paying $4,800 a month gross.

Step one, the cash math. Gross earnings of $4,800. Subtract the $20 general exclusion and the $65 earned income exclusion: $4,715. Divide by 2: $2,357.50. That's her countable earned income. Subtract from California's combined SSI/state supplement ($994 federal plus the supplement). Countable income way exceeds the benefit rate. Cash benefit drops to zero.

Step two, the 1619(b) tests. She had been receiving cash in May 2025 (prerequisite month satisfied). Her medical condition hasn't improved. Resources are $1,800 (under the $2,000 cap). She uses Medi-Cal monthly for pain management and physical therapy (Medicaid Use Test satisfied). Her gross earnings of $57,600 a year are below California's 2026 threshold of $66,078 (Threshold Test satisfied). She qualifies for 1619(b) and keeps Medi-Cal.

Step three, what happens at year-end. SSA re-tests in January 2027. If her earnings stayed the same, she stays in 1619(b). If she gets a raise to $5,800 a month ($69,600 a year), she's above the state threshold and would normally lose Medicaid. But her Medi-Cal records show $9,000 a year in pain medications and $4,200 a year in physical therapy that's above the state average. She applies for an individualized threshold. SSA approves it at $79,278 (state threshold of $66,078 plus $13,200 in documented excess Medicaid expenses). She's still covered.

Carla's situation isn't rare. The math is the math, but most SSI recipients never get this far because they don't know the rule exists. Read more about how Medi-Cal interacts with SSI on our California state benefits page.

Worked example: Marcus in Texas

Marcus is 41, lives in Houston, became eligible for SSI in 2019 after major depression and a connective tissue disorder kept him out of work for several years. In 2026 he takes a part-time call center job paying $3,200 a month gross.

His annual earnings are $38,400. Texas's 2026 threshold is $53,165. He's well below the cap. His resource balance is $1,400 (under the limit). He's been receiving SSI cash benefits continuously since 2019 (prerequisite month is fine). His disability still meets SSA's standard. He used Texas Medicaid in the past 12 months for prescription refills (Medicaid Use Test satisfied).

Marcus passes 1619(b) easily. His cash benefit goes to zero because his earnings exceed the break-even point. He keeps Medicaid. He reports wages each month using the SSI mobile wage reporting app. SSA recomputes monthly. If his hours get cut to 20 a week, his cash benefit comes back automatically under 1619(a), no new application needed.

If Marcus lived in Mississippi instead, with a threshold of $43,992, he'd still be fine at $38,400. If he lived in Alabama at $40,026, he'd be in the gray zone, just $1,626 below the cap. A small raise could push him over, at which point he'd need to apply for an individualized threshold or risk losing Medicaid. For Texas-specific resources, see our Texas disability benefits guide.

The 209(b) state quirk

Most states are "1634 states" under section 1634 of the Social Security Act. In those states, SSI eligibility automatically means Medicaid eligibility, and 1619(b) directly preserves Medicaid. Ten states are "209(b) states" instead, using their own Medicaid eligibility rules that are at least as restrictive as the SSI rules in effect on January 1, 1972.

The 209(b) states in 2026 are Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia. If you live in one of these states, you still get 1619(b) Medicaid protection, but your state Medicaid agency may apply additional rules. You may have to file separate paperwork with the state. The federal SSI office doesn't automatically transmit eligibility to the state agency the way it does in 1634 states.

If you're in a 209(b) state and you transition to 1619(b), call your state Medicaid agency within the first month to confirm your file has been correctly coded. Don't assume the federal-state hand-off worked automatically. People lose Medicaid in 209(b) states because of paperwork failures more often than because of substantive ineligibility.

What 1619(b) does not protect

1619(b) preserves Medicaid only, not the cash benefit. If you need both, you stay in 1619(a). 1619(b) does not protect against:

• Medical improvement. If a CDR finds you've improved enough to no longer meet the disability standard, 1619(b) ends. The protection runs alongside continuing disability, not in place of it.
• Exceeding the resource cap. If your bank balance hits $2,000.01 for an individual or $3,000.01 for a couple at the first moment of any month, the resource test fails and Medicaid ends. ABLE accounts up to $100,000 don't count, and most other SSI exclusions still apply. Read our SSI resource limit guide for the full list.
• Long absences from the country. SSI rules generally require U.S. presence. Travel outside the country for 30 consecutive days breaks SSI eligibility, including 1619(b) protection.
• Marriage to a high-resource spouse. Deeming rules can knock you out if your spouse's resources push the household over the limit.

How to apply for 1619(b)

There's no application form. 1619(b) status is automatic once you meet the tests. SSA recomputes your status each month based on your wage reports. If you've been receiving SSI cash, and your earnings push the cash to zero, SSA should automatically transition you to 1619(b) and keep your Medicaid alive.

In practice, things go wrong. Wage reports get lost. Field office staff miscode the file. State Medicaid agencies don't update their records. If you start working and notice your Medicaid coverage has been canceled, here's the fix:

1. Call SSA at 1-800-772-1213. Tell them you're a former SSI recipient who lost cash benefits because of earnings and you want to confirm 1619(b) status.
2. Ask them to verify your file shows N02 (income over the limit) and not N01 (suspended). N01 means they suspended you, which is wrong if you should be in 1619(b).
3. If your state Medicaid agency dropped you, call them and ask them to verify your 1619(b) status directly with SSA. Provide your BNC (Beneficiary Notice Control) number from any recent SSA letter.
4. If they say you've exceeded the state threshold, ask SSA to run an individualized threshold determination under POMS SI 02302.050 using your actual medical expenses.

Reporting wages each month

Monthly wage reporting is what keeps 1619(b) running smoothly. The options:

• SSI Telephone Wage Reporting: Call SSA's automated line and report monthly wages by phone. Available 24/7.
• my Social Security mobile app: Easiest option. Reports wages directly into SSA's system. Confirmation email goes out automatically.
• Form SSA-1719B (paper wage report): Mail in physical wage stubs. Slower but works if you don't trust the digital options.
• In-person at the field office: Bring your pay stubs to your local SSA office and have them entered directly.

Report by the 10th of each month for the prior month's earnings. Keep copies of every pay stub for at least 5 years. SSA can audit your wage history and recompute past months. Missing reports are the single most common reason for 1619(b) overpayments. Overpayments can stack up to thousands of dollars and force a clawback that knocks you out of Medicaid eligibility temporarily.

What happens when you stop working

The automatic re-entry rule is the quiet hero of 1619(b). If your job ends, your hours drop, or your earnings fall below the break-even point ($1,914 a month for an individual in 2026), SSA automatically slides you back into either 1619(a) (cash plus Medicaid at a reduced amount) or full SSI (no work earnings, full FBR). No new application. No reapplication wait. No medical CDR triggered.

The catch is you have to have been reporting wages all along. If your wage record at SSA shows zero earnings in months where you were actually working, the system can't make accurate calculations. Late reporting can cause months of missing cash benefits that you have to fight to recover.

This is also one reason 1619(b) is far better than Expedited Reinstatement (EXR) under section 1631(p) of the Act. EXR requires you to have been off SSI completely for more than 12 months but less than 60. It comes with a 6-month provisional benefits period, then a fresh medical determination. 1619(b) doesn't require any of that. As long as you're in 1619(b) status, you can drop back into cash status automatically.

The interaction with SSDI and Medicare

People who get both SSI and SSDI (concurrent claimants) have a more complicated situation. SSDI has its own work incentives (Trial Work Period, Extended Period of Eligibility, Extended Medicare). 1619(b) only applies to the SSI side. If you're concurrent and your work pushes you off SSI cash, you may still qualify for 1619(b) Medicaid even though SSDI may have separate rules about what happens to your Medicare.

Medicare and Medicaid are separate programs. Medicare comes with SSDI after a 24-month waiting period. Medicaid comes with SSI directly. After the Trial Work Period and Extended Period of Eligibility end on the SSDI side, you can get up to 93 months of Extended Medicare under section 1840(b). 1619(b) handles the Medicaid side of the same earnings situation. Most people don't need to choose between them. They get both.

Common mistakes

Letting savings creep up. The $2,000 resource cap is unforgiving. People in 1619(b) earn more, save more, and don't watch their balance. Cross $2,000.01 at the first moment of any month and you're out of SSI eligibility, including 1619(b). Use ABLE accounts (excluded up to $100,000) or burial accounts (excluded up to $1,500) to absorb extra savings.

Not knowing the individualized threshold exists. When earnings rise above the state cap, the default reaction is to assume Medicaid is gone. It's not. Apply for an individualized threshold first. Many claimants who think they've maxed out actually have headroom of $10,000 to $40,000 or more.

Skipping monthly wage reports. Missing reports lead to overpayments. Overpayments lead to clawbacks. Clawbacks lead to losing Medicaid coverage in the months SSA processes the reconciliation. Keep wage reporting current and digital.

Letting a CDR slide. If SSA opens a Continuing Disability Review and you don't respond, your benefits get terminated. The termination ends 1619(b) along with everything else. Always respond to CDR requests within the deadline.

State-specific considerations

Some states have stronger work supports built around 1619(b). New York's Medicaid Buy-In for Working People with Disabilities (MBI-WPD) picks up where 1619(b) ends, letting you buy Medicaid coverage up to $73,464 a year in 2026 with a small monthly premium. California has a similar program. Many states offer Medicaid Buy-In programs under the Ticket to Work and Work Incentives Improvement Act (TWWIIA). These are not the same as 1619(b), but they extend the same idea past the 1619(b) ceiling.

Florida and Texas, both Medicaid expansion holdouts, have narrower paths. If you're in Florida or Texas, 1619(b) is often the only path to keep Medicaid as a working SSI recipient. Make the individualized threshold a higher priority if your job pushes you toward the state cap.

Illinois, as a 209(b) state, layers state Medicaid rules on top of 1619(b). Coordinate with the Illinois Department of Healthcare and Family Services within the first month of going into 1619(b) status to confirm your case is correctly coded. Run the same check in Hawaii, Minnesota, Missouri, North Dakota, Ohio, Oklahoma, Virginia, New Hampshire, and Connecticut.

FAQ

What is Section 1619(b)?

Section 1619(b) is the SSI work incentive that lets you keep Medicaid coverage after work earnings push your SSI cash check to zero. You stay on Medicaid as long as you still meet SSA's disability standard, need Medicaid to keep working, and have gross earnings below your state's published threshold. The legal basis is 42 U.S.C. 1382h and POMS SI 02302.

What's the difference between 1619(a) and 1619(b)?

1619(a) covers SSI recipients whose earnings are at or above SGA but still produce a reduced SSI cash check plus Medicaid. 1619(b) covers SSI recipients whose earnings push the cash to zero but who still get Medicaid. Both rules are in 42 U.S.C. 1382h.

What is the 2026 state threshold?

The 2026 thresholds for disabled SSI recipients range from $40,026 in Alabama to $84,208 in Minnesota. California is $66,078, Texas $53,165, Florida $42,946, New York $68,654, and Washington $73,897. The full table is published in POMS SI 02302.200.

What is the Medicaid Use Test?

POMS SI 02302.040 says you have to need Medicaid to keep working. SSA presumes you do if you used a Medicaid-covered service in the past 12 months, in the past 24 months and expect to need it again, or have a documented ongoing medical need.

What is the individualized threshold?

POMS SI 02302.050 lets SSA set a higher threshold if your real Medicaid expenses exceed the state average. Add IRWEs, BWEs, PASS contributions, attendant care, and documented medical expenses to the federal break-even point. People with expensive medications often push their threshold tens of thousands of dollars higher.

Do all states handle 1619(b) the same way?

No. Most states are 1634 states, where SSI eligibility automatically means Medicaid eligibility. Ten states are 209(b) states (Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, Virginia) and apply additional Medicaid eligibility rules on top of the federal SSI rules.

What happens if my earnings drop while I'm in 1619(b)?

You slide back into 1619(a) cash status or full SSI without filing a new application. This is the automatic re-entry rule under POMS SI 02302.010. As long as you've been reporting wages each month, the transition is automatic.