Section 1619(b) State Thresholds in 2026: How Working SSI Recipients Keep Medicaid After Cash Payments Stop

Published August 10, 2026 by Anthony Albert, Benefits Research Director at Disability Exchange

You started working. Your SSI check dropped to zero. And now you are staring at a letter that says your Medicaid could end too. This is one of the most common panic moments in the disability system, and it is also one of the most misunderstood. Section 1619(b) exists so that working does not cost you healthcare. But you have to know how it works or you can lose the protection by accident.

Here is the full 2026 breakdown. Every state charged earnings threshold, the four tests you have to pass, when to request an individualized threshold, and how Section 1619(a) rolls into 1619(b) once your countable earnings pass the Federal Benefit Rate.

What Section 1619(b) actually does

Section 1619(b) of the Social Security Act, codified at 42 USC 1382h(b), lets an SSI recipient keep Medicaid coverage when their earnings become high enough to end SSI cash payments. The rule was designed for one reason: to remove the work disincentive that made people afraid to take a job because losing Medicaid meant losing everything.

Under 20 CFR 416.264, once you meet the four 1619(b) tests, you keep Medicaid even though you get no SSI check. You stay in "Special SSI" status on SSA's records. That status is what triggers state Medicaid to continue coverage.

The four Section 1619(b) tests

You have to pass all four tests, not just one. Miss any single test and you lose 1619(b) status.

Test 1: You still have a qualifying disability

Your medical condition must still meet SSA's definition of disability. Work activity does not by itself prove medical recovery. SSA uses a two-part rule under 20 CFR 416.994. Medical improvement is judged against the comparison point decision, not against a new SGA analysis.

Test 2: You would still be eligible for SSI cash except for earnings

Non-earnings factors have to keep you SSI-eligible. That means resources under 2,000 dollars if single or 3,000 dollars if married in 2026. Unearned income under the FBR minus 20 dollars. Living arrangement that qualifies.

Test 3: You need Medicaid to work

You have to state that you need Medicaid to continue working. This is answered yes on the SSA-1619(b) questionnaire and rarely gets challenged. If you have any ongoing medical need, prescription regimen, or scheduled therapy, this is a yes.

Test 4: Your gross earnings are under the state charged threshold

This is the test that trips people up. Each state has a charged earnings threshold set annually. The threshold reflects the amount of earnings at which the state's Medicaid cost for you would be canceled out by federal SSI savings. Go above it and 1619(b) ends unless you qualify for an individualized threshold.

2026 state charged earnings thresholds

Thresholds are updated every January by SSA under POMS SI 02302.200. These are annual figures for 2026. Divide by 12 for monthly reference points.

These are gross earnings numbers, not net. And they are the state's default charged threshold, not your personal threshold. If you have unusual medical costs, ask for an individualized threshold.

Individualized thresholds when you have high medical expenses

Under POMS SI 02302.070, SSA can set a personal threshold higher than the state default. This applies when your actual Medicaid usage costs the state more than the average Medicaid recipient. You qualify for an individualized threshold if:

• You use publicly-funded personal care attendant services
• Your Medicaid expenses run higher than the state's average for a working-age disability recipient
• You use durable medical equipment or supplies that exceed typical costs
• You have high-cost specialty medications not on standard Medicaid formularies

To request an individualized threshold, file form SSA-3465 or send a written request to your local SSA office. Include:

• Twelve months of Medicaid Explanation of Benefits statements
• Evidence of monthly attendant care costs
• Any state waiver services documentation
• Prescription cost totals for the past year

The individualized threshold can be set well above the state default. In some cases the threshold exceeds 100,000 dollars annually. There is no statutory ceiling on how high the individualized threshold can go, only the requirement that Medicaid costs exceed federal SSI savings.

How Section 1619(a) transitions into 1619(b)

1619(a) and 1619(b) are two different rules with different mechanics but they connect.

Section 1619(a): Special SSI cash

Under 20 CFR 416.261, if you continue to work and your countable earnings would ordinarily reduce SSI to zero, you can still get a small SSI cash payment under 1619(a) when you meet these conditions:

• Your disability continues
• Your countable earnings would be enough to end SSI otherwise
• You are otherwise eligible for SSI (resources, unearned income, living arrangement)

Under 1619(a), your check drops but does not stop. This kicks in when countable earnings pass the FBR minus 20 dollars.

The transition point to 1619(b)

When your earnings rise past the point where even 1619(a) reduces cash to zero, you shift to 1619(b) status. The shift happens automatically. SSA transitions you from 1619(a) to 1619(b) internally. You keep Medicaid throughout. There is no application to file for 1619(b) transition. It happens because you are already an SSI recipient reporting earnings.

The order is: SSI cash under standard rules, then SSI cash under 1619(a), then no SSI cash but Medicaid under 1619(b), then out of SSI entirely if earnings pass the state charged threshold.

Common mistakes that end 1619(b) status

Failing to report earnings monthly

1619(b) requires that SSA can verify you still meet all four tests. If SSA has no earnings data because you did not report, they cannot verify Test 4. This can trigger a suspension. See our SSDI wage reporting article for the four reporting channels.

Missing the annual 1619(b) redetermination

SSA does an annual redetermination for 1619(b) recipients under POMS SI 02305.033. You get an SSA-8202 or SSA-8203-BK. Failure to return it within the timeframe ends 1619(b) status. SSA does not automatically restart it.

Resources drift above the SSI limit

The 2,000 dollar single resource limit and 3,000 dollar married limit apply during 1619(b). If you save from earnings and cross the resource limit, Test 2 fails. This is a common overpayment source. Consider an ABLE account for savings under 26 USC 529A. ABLE contributions up to 18,000 dollars per year (2026 limit) do not count as resources.

Marriage or household changes not reported

If you marry or move in with a spouse who has income, deeming rules under 20 CFR 416.1163 can end your 1619(b) status. Report marriage within 10 days.

What to do if you get a 1619(b) termination notice

Termination notices come from either the field office or the SSI system. They arrive as a Notice of Planned Action. You have 10 days from the date on the notice to request Continuing Benefits under 20 CFR 416.1336. This keeps your Medicaid in place while your appeal is pending.

File the appeal on Form SSA-561 (Request for Reconsideration) within 60 days. Include:

• Copy of the termination notice
• Your latest earnings statements
• Any medical expense documentation if requesting individualized threshold
• Statement that you need Medicaid to continue working (Test 3)

The reconsideration decision reversal rate for 1619(b) termination cases runs about 30 percent, roughly double the general SSDI reconsideration rate. Many terminations come from earnings estimation errors or missing paperwork rather than actual ineligibility.

State-specific issues to watch

1634 states versus 209(b) states

Most states are Section 1634 states, meaning Medicaid eligibility follows SSI eligibility automatically. Working SSI recipients get 1619(b) protection without any extra state step. See California, Florida, Texas for examples.

The 11 Section 209(b) states use their own Medicaid rules. In those states, 1619(b) status does not automatically continue Medicaid. You may need to file a separate Medicaid application. The 209(b) states in 2026 include Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia.

Buy-in programs above 1619(b)

If your earnings pass the state charged threshold, some states offer Medicaid Buy-In for Working People with Disabilities (MBI-WPD) programs. Buy-in programs let you keep Medicaid at earnings above 1619(b) limits with a small monthly premium. States with active buy-in programs include New York, Massachusetts, Pennsylvania, and Washington.

Interaction with the OBBBA Medicaid work requirements

The Medicaid work requirements enacted under OBBBA in July 2025 include a disability exemption. If you are on 1619(b), you are already documented as disabled in SSA records. States implementing work requirements under 42 CFR 435.930 should treat you as exempt. See our full Medicaid work requirements article for the full exemption structure and how to confirm your exempt status in writing.

How SSA calculates the state charged earnings threshold

Each state's threshold is not arbitrary. Under POMS SI 02302.200, SSA calculates it annually by dividing the state's average Medicaid expenditure for a working-age disabled adult by the amount of federal SSI expenditure that would be saved if the person left SSI. The formula is roughly:

States with higher Medicaid expenditures per disability recipient (Alaska, Connecticut, Massachusetts) get higher thresholds. States with lower Medicaid expenditures (Alabama, Florida, Mississippi) get lower thresholds. That is why Alaska sits at 91,146 dollars while Mississippi sits at 35,568 dollars.

What counts as earnings for the 1619(b) threshold

The 1619(b) threshold is measured against gross earned income, not countable income. That is important because the SSI countable income formula subtracts a 20 dollar general exclusion, a 65 dollar earned income exclusion, plus half the remainder. Gross earnings is what the threshold looks at.

Included in gross earnings:

• Wages from W-2 employment
• Net earnings from self-employment (Schedule C profit)
• Bonuses, commissions, and tips
• Sick pay and vacation pay

Not included:

• Impairment-Related Work Expenses (IRWE) under 20 CFR 416.976
• Blind Work Expenses (BWE) for statutorily blind recipients
• Plan to Achieve Self Support (PASS) plan set-asides under 20 CFR 416.1180
• Subsidies and special conditions of employment

If you have documented IRWE or BWE, subtract those from gross before comparing to the threshold. A recipient in Georgia with 42,000 dollars gross wages and 5,000 dollars in documented IRWE has effective earnings of 37,000 dollars for threshold purposes. That is under the Georgia threshold of 38,748 dollars.

Documenting Impairment-Related Work Expenses for 1619(b)

IRWE is a work incentive that reduces the earnings SSA counts against you. Anything you pay for that lets you work counts. Standard IRWE examples:

• Prescription medications you would not need if you did not work
• Attendant care services during working hours
• Adaptive equipment (assistive technology, screen readers, ergonomic keyboards)
• Modifications to your vehicle for commuting
• Service animals
• Costs of specialized transportation to work

Keep receipts and a running log. Submit IRWE claims on Form SSA-820 quarterly or at annual redetermination. Under-documented IRWE is one of the biggest reasons recipients cross the state threshold when they should not have.

ABLE accounts as a resource shelter during 1619(b)

The 2,000 dollar resource limit is unforgiving. Working recipients often build savings from earnings faster than they can spend. Once resources cross 2,000 dollars, Test 2 fails and 1619(b) ends.

ABLE accounts under 26 USC 529A solve this. Contributions from earnings can go into an ABLE account and do not count as a resource. 2026 annual contribution limit is 18,000 dollars for most recipients. Working ABLE account holders can contribute additional amounts equal to their earned income up to the federal poverty line, per the ABLE to Work Act.

ABLE account balances up to 100,000 dollars are excluded from SSI resource counting. Above 100,000, only the excess counts. So a working 1619(b) recipient can accumulate significant savings without losing 1619(b) protection.

Redetermination timing and preparation

1619(b) status is reviewed at every annual redetermination under POMS SI 02305.033. Prepare for redetermination 30 days before your scheduled date:

• Gather 12 months of pay stubs organized by employer
• Print earnings statements from my Social Security
• Compile IRWE receipts and calculate annual IRWE total
• Update medical records if you have had significant treatment changes
• Verify your address on file with SSA is current

Redetermination interviews can be in person, by phone, or by mail. In-person interviews produce the fewest errors because SSA can ask follow-up questions and clarify ambiguities in real time.

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