Section 1619(b) Medicaid Thresholds 2026: All 51 State Caps and How to Keep Medicaid While Working on SSI

By Anthony Albert, Benefits Research Director - Updated May 5, 2026

The biggest fear SSI recipients have about going back to work isn't the paycheck. It's losing Medicaid. That fear is usually misplaced. Section 1619(b) of the Social Security Act lets you keep your Medicaid even after your earnings push your SSI cash payment to zero, as long as you stay under your state's threshold.

SSA updated the 2026 thresholds in January 2026. They range from a low of around $40,000 in a handful of states to $84,208 in Minnesota and $73,901 in Washington, D.C. Most people don't know these numbers exist. If you're on SSI and thinking about work, or already working part-time, these numbers control whether you keep Medicaid without a spend-down.

Here's the full 2026 table, how the math works, what happens if you earn above the threshold, how to request an individualized threshold, and the traps that knock people off 1619(b) by accident.

What Section 1619(b) Actually Does

Section 1619(b) is a Medicaid protection for SSI recipients who start working. It kicks in when your gross earnings are high enough that your SSI cash payment drops to zero, but you'd still be SSI-eligible on every other basis (you're still disabled, you still have the resource cap of $2,000 single or $3,000 couple met, you still need Medicaid to keep working).

When that happens, SSA's system flags you as a 1619(b) recipient. You get a zero-dollar SSI check, but you keep your Medicaid eligibility as if you were still getting SSI. No spend-down. No reapplication. No gap in coverage.

This matters because for most SSI recipients, Medicaid is worth more than the cash benefit. A $994 a month SSI check is $11,928 a year. Medicaid, if you're using it for specialty care, mental health, prescriptions, dental, transportation, and personal care attendants, can easily run $25,000 to $100,000 a year in equivalent private insurance cost. Losing Medicaid because you took a job is often the single biggest disincentive in the work incentive system, and 1619(b) exists to remove it.

The Four Rules You Have to Meet

To qualify for 1619(b) Medicaid protection, SSA requires all of these:

• You were eligible for an SSI cash payment for at least one month before your earnings pushed SSI to zero.
• You still meet the SSI disability standard (your impairment hasn't medically improved).
• You still meet all other non-disability SSI rules (resources under $2,000 single or $3,000 couple, citizenship, living arrangement).
• You need Medicaid to continue working, and your earnings aren't high enough to replace the combined value of SSI cash, Medicaid, and any publicly funded attendant care.

That last rule is the threshold test. SSA compares your gross annual earnings to the threshold for your state. If you're under the threshold, you pass automatically. If you're over, SSA has to check whether you qualify for an individualized threshold, which is a higher cap based on your specific medical costs.

The 2026 1619(b) Threshold Table

These are the gross earnings caps for disabled (non-blind) SSI recipients in 2026. Stay under your state's number and you keep Medicaid automatically without any extra paperwork.

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

Four states use separate, higher thresholds for blind recipients in 2026: California ($68,103), Iowa ($54,260), Massachusetts ($52,864), Nevada ($49,629). If you're blind and in one of those four states, use the blind threshold instead of the disabled threshold.

Washington, West Virginia, Wisconsin, and Wyoming follow the same formula as the other 47 jurisdictions. If your state isn't in the snapshot above because of how SSA's 2026 posting was laid out, check POMS SI 02302.200 directly or call your local field office. The formula is always twice the annual state supplement (if any) plus twice the federal benefit rate plus the $85 earnings disregard annualized plus the state's average Medicaid expense per capita. States with higher Medicaid spending and higher SSI state supplements end up with higher thresholds.

How the Math Breaks Down

Take Texas as an example. The 2026 Texas threshold for disabled individuals is $53,165. SSA builds that number from three pieces:

• Twice the annual state SSI supplement: $0 (Texas has no SSI state supplement)
• Base amount (twice the 2026 federal benefit rate plus $85 monthly earnings disregard annualized): $24,876
• Average per-capita Medicaid expense in Texas: $28,289 (roughly)

Add those together and you get $53,165. That's the ceiling. If you live in Texas and you earn up to $53,165 gross in a year, you keep your Medicaid as a 1619(b) recipient. Earn more than that and SSA does a fresh look to see if you qualify for an individualized threshold.

The base amount ($24,876) is the same in every state. What changes is the state supplement (zero in most states, but positive in California, Massachusetts, New York, and others) and the Medicaid per-capita number. High-Medicaid-cost states like Minnesota ($84,208), Alaska ($73,070), and D.C. ($73,901) let you earn much more before losing protection. Low-cost states like Alabama ($40,026), Arkansas ($40,366), and Georgia ($41,927) have tighter ceilings.

What Counts as "Gross Earnings"

Gross earnings for 1619(b) purposes means wages from work, net earnings from self-employment, and any in-kind compensation that has cash value. Before SSA compares it to the threshold, they deduct a few categories:

• Impairment-Related Work Expenses (IRWEs) such as specialized transportation, medications, attendant care needed to work
• Blind Work Expenses (BWEs) for blind recipients, which is broader than IRWEs
• Funds being set aside under an approved Plan to Achieve Self Support (PASS)
• Amounts paid for publicly funded personal or attendant care, if applicable

If you've got documented IRWEs (say, $300 a month in paratransit and $200 a month in prescription co-pays tied to your disability), you deduct $6,000 a year from the gross figure before comparing to the threshold. That's another way to stay under the cap if you're close.

Unearned income (SSDI, pension, dividends, gifts) doesn't count toward the 1619(b) earnings threshold. The threshold is an earned-income ceiling. Unearned income affects whether you still get a zero SSI check or not, but it doesn't knock you out of 1619(b) Medicaid protection by itself.

Individualized Threshold: Earning Over the Cap and Still Keeping Medicaid

If you earn more than the standard threshold for your state, 1619(b) doesn't automatically end. SSA runs an individualized threshold calculation to see if your specific medical costs justify a higher cap.

SSA computes an individualized threshold if you have one or more of the following:

• Impairment-Related Work Expenses (IRWEs)
• Blind Work Expenses (BWEs)
• An approved Plan to Achieve Self Support (PASS)
• A publicly funded personal attendant
• Documented medical expenses above the state's per-capita Medicaid average

If any of those apply, SSA replaces the state's average Medicaid expense with your actual Medicaid expense, and replaces the base amount with your earnings-free-of-IRWE/BWE/PASS figure. The result can push the ceiling much higher.

A concrete example: you live in Georgia (state threshold $41,927) and you earn $50,000 a year gross. Without an individualized threshold, you'd lose 1619(b). But you have $8,000 a year in documented IRWEs (specialty therapy, medication, adaptive equipment) and your actual Medicaid expenses run about $32,000 a year (well above the $17,051 Georgia average). SSA builds an individualized threshold incorporating those numbers and ends up with a ceiling closer to $60,000. You keep Medicaid protection even though you're above the state average.

Individualized thresholds don't happen automatically. You have to request them or SSA has to flag the case. Call your local field office if your earnings cross the standard threshold. Ask for a 1619(b) individualized threshold review and document your IRWEs and medical expenses.

What Ends 1619(b)

You lose 1619(b) status if any of these happen:

• Your earnings exceed the standard threshold and you don't qualify for an individualized threshold
• You're no longer disabled (medical improvement found at CDR)
• Your resources go above $2,000 single / $3,000 couple
• You stop needing Medicaid (meaning no Medicaid claims for a sustained period, or you get private insurance that fully substitutes)
• You fail any other non-disability SSI rule (citizenship, living arrangement, etc.)

The resource trap catches more people than the earnings trap. A savings account that crosses $2,000 knocks you off SSI and 1619(b) at the same time. Many people going back to work save the wage money into regular checking and savings without moving it to an ABLE account or PASS account, and then find out they've broken the resource limit. Set up an ABLE account or a PASS plan before you start earning, not after.

How 1619(b) Interacts With Other Work Incentives

1619(b) doesn't work in isolation. It stacks with the other SSI work incentives.

• 1619(a): The step before 1619(b). 1619(a) keeps your SSI cash going at a reduced rate when your earnings exceed SGA but haven't yet zeroed out SSI. You shift from 1619(a) to 1619(b) when the cash hits zero.
• Ticket to Work: Protects you from medical CDRs while you're using the ticket. Pairs cleanly with 1619(b). Read more on the Ticket to Work program.
• Trial Work Period (TWP): TWP is an SSDI concept. If you're on both SSDI and SSI (concurrent), TWP protects your SSDI during the earnings ramp while 1619(b) protects Medicaid on the SSI side.
• IRWEs / BWEs: These reduce your countable earnings for both the standard and individualized 1619(b) thresholds. Document them carefully.
• PASS: Money set aside under a PASS plan doesn't count against the threshold. For high earners who still need Medicaid, PASS plus 1619(b) is the strongest combination.
• ABLE: ABLE account funds don't count as income or resources for SSI and don't reduce your 1619(b) eligibility. Use ABLE to stockpile savings that would otherwise break the $2,000 resource rule.

State-Specific Notes for 1619(b) in 2026

• California: Separate blind threshold of $68,103 is the highest in the country for blind workers. California's State Supplementary Payment (SSP) pushes the disabled threshold to $66,078, seventh-highest. California also has extensive Medi-Cal managed care, so the "need Medicaid to work" test is easy to satisfy if you use any specialty care.
• Texas: $53,165 threshold. No state supplement. Texas HHSC reports a small but growing number of individualized threshold approvals as Texans with higher medical costs request them. Texas attorneys report that the form SSA-8203 alongside a provider letter works best.
• New York: $68,654 threshold, fourth-highest in the country. Combined with New York's SSP and high Medicaid spending, it's one of the most forgiving states for SSI recipients returning to work.
• Florida: $42,946 threshold, on the lower end. Florida Medicaid is thin compared to other states, so many 1619(b) recipients with high medical needs end up going through the individualized threshold process.
• Pennsylvania: $55,023 threshold. Pennsylvania's Medical Assistance for Workers with Disabilities (MAWD) can be an alternative path for people earning above the 1619(b) cap. MAWD lets you keep Medicaid by paying a sliding-scale premium.
• Minnesota: $84,208, the highest threshold in the country because of high Medicaid spending and a generous state supplement. Minnesota's MA-EPD (Medical Assistance for Employed Persons with Disabilities) works as a back-up program for those who cross the 1619(b) ceiling.

Common 1619(b) Mistakes That Cost Medicaid

• Not reporting earnings. SSA has to know you're working. Failing to report wages can trigger overpayment notices and, in rare cases, fraud referrals. Report monthly through my Social Security or the SSI Mobile Wage Reporting app.
• Crossing the resource limit. Moving wages into a regular savings account without using ABLE or PASS is the top reason people accidentally lose SSI and 1619(b) the same month.
• Letting Medicaid lapse. 1619(b) requires that you continue to need Medicaid. If you don't use Medicaid services for an extended stretch, SSA may close the 1619(b) status. Use Medicaid at least annually even if you don't need much, so the "need" rule stays satisfied.
• Assuming your state threshold is your individual threshold. If you have significant medical expenses, ask for an individualized threshold before you cross the state cap. Don't wait for SSA to find it.
• Not stacking IRWEs. IRWEs lower your countable earnings and extend how long you can stay under the threshold. Track and document every expense tied to working with your disability.
• Moving to a state without confirming the new threshold. Thresholds vary by tens of thousands of dollars. A move from California ($66,078) to Arkansas ($40,366) can knock you off 1619(b) even if your earnings didn't change.

How to Apply for 1619(b)

There's no separate application for 1619(b). It kicks in automatically when your SSI cash hits zero because of earnings, as long as you meet the four rules. SSA's Title XVI system reruns your eligibility each month. When your SSI drops to zero because of wages, the system checks your earnings against the state threshold. If you pass, you're auto-flagged as 1619(b).

What you should do when you start working:

1. Report your job start to SSA the first month you earn anything.
2. Continue to report wages monthly using the my Social Security portal, the SSI Mobile Wage Reporting app, or by mail.
3. Keep pay stubs and any IRWE receipts for at least 2 years.
4. If your earnings approach your state's threshold, call your local field office and ask about an individualized threshold and IRWE documentation.
5. Check your Medicaid card each time you use it. If coverage lapses unexpectedly, contact your local office and your state Medicaid agency immediately.

Free Help With 1619(b) and Work Incentives

If any of this feels confusing, you don't have to figure it out alone. Federal law funds free help specifically for SSI and SSDI recipients considering work.

• WIPA (Work Incentives Planning and Assistance): Every state has WIPA offices. Call 1-866-968-7842 to reach the Ticket to Work Help Line, which connects you to your local WIPA. WIPA counselors help you model your earnings, plan for thresholds, and file the right forms with SSA.
• PABSS (Protection and Advocacy for Beneficiaries of Social Security): Free legal help for any SSI or SSDI work-incentive question. Contact your state P&A agency. They handle individualized threshold disputes, IRWE denials, and overpayment cases.
• State Vocational Rehabilitation: State VR agencies can fund training, equipment, and job coaching that counts as IRWE or PASS expenses.
• Centers for Independent Living (CILs): Local community-based disability organizations can help with benefits planning and referrals to WIPA or legal help.

Bottom Line

1619(b) is the single most important work protection SSI has, and most recipients never hear about it until they're already working and getting a zero check. The state threshold in 2026 is the ceiling for automatic protection. If you're close to or above that number, ask about an individualized threshold before you lose coverage. If you're nowhere near it yet, use this time to set up an ABLE account so your savings don't break the $2,000 resource rule once your wages add up.

A zero-dollar SSI check with Medicaid protection is often worth far more than a full SSI check alone. Plan for 1619(b) at the start of your return to work, not after something goes wrong.