Section 1619(b) Medicaid eligibility lets you keep Medicaid coverage after your earnings grow too high to qualify for Supplemental Security Income (SSI) cash payments. For 2026, gross annual earnings between roughly $40,000 and $84,000 still qualify, depending on the state you live in.1Social Security Administration. Continued Medicaid Eligibility (Section 1619(B)) The cash payment stops, but the medical coverage continues.
Who Qualifies Under 1619(b)
To keep Medicaid under 1619(b), every one of the conditions in 42 U.S.C. ยง 1382h(b) has to be satisfied:2Office of the Law Revision Counsel. 42 USC 1382h – Benefits for Individuals Who Perform Substantial Gainful Activity Despite Severe Medical Impairment
- You received at least one SSI cash payment as a disabled or blind individual before your earnings ended those payments.
- Your original disabling condition still exists, which the Social Security Administration (SSA) verifies through continuing disability reviews.
- Your countable resources stay at or below $2,000 as an individual or $3,000 as a couple.3Social Security Administration. Who Can Get SSI
- You still meet the other non-disability SSI rules on citizenship, residency, and similar criteria.
- You need Medicaid to keep working.
- Your earnings are not enough to replace the value of your SSI payments, Medicaid services, and any publicly funded attendant care combined.
The last two conditions are the ones SSA actually tests with a number, not a narrative. You do not have to argue them. The agency runs your gross earnings against a state-specific threshold, and if you fall at or below it, you pass automatically.4Social Security Administration. SI 02302.045 The Threshold Test for Section 1619(b) Eligibility
2026 State Earnings Thresholds
SSA publishes a threshold chart each year. Each state’s number is the annual earned income that would zero out an SSI cash payment in that state, plus the average annual Medicaid spending per recipient there. States with higher Medicaid costs or state SSI supplements end up with higher thresholds.4Social Security Administration. SI 02302.045 The Threshold Test for Section 1619(b) Eligibility
For 2026, the thresholds range from $29,412 in the Northern Mariana Islands to $84,208 in Minnesota. A few examples across the middle:1Social Security Administration. Continued Medicaid Eligibility (Section 1619(B))
- Alabama: $40,026
- California: $66,078
- Florida: $42,946
- Minnesota: $84,208
- New York: $68,654
- Texas: $53,165
A few states publish separate, slightly higher thresholds for blind beneficiaries. In 2026 that includes California ($68,103), Iowa ($54,260), Massachusetts ($52,864), and Nevada ($49,629).1Social Security Administration. Continued Medicaid Eligibility (Section 1619(B))
If your gross annual earnings are at or below your state’s number, you keep Medicaid. Nothing extra required. SSA applies the check with the earnings information it already has.
Earning More Than the Chart Threshold
Crossing the state number does not automatically end your coverage. SSA then runs an individualized threshold calculation, starting from the state figure and adding costs tied to your disability and your job. If the adjusted total meets or exceeds your gross earnings, you stay on Medicaid.5Social Security Administration. SI 02302.050 Individualized Threshold Calculation
What SSA can add in:
Impairment-related work expenses. Out-of-pocket costs for items or services you need because of your disability so that you can work. Medications, medical devices, service animals, attendant care that gets you ready for work or helps you on the job, vehicle or home modifications, and specialized transportation all count. Regular public transit does not. The expense has to be disability-related, necessary for work, and not reimbursed by anyone else. Something like a wheelchair still qualifies in full even if you also use it outside of work; it does not have to be work-exclusive.6Social Security Administration. Spotlight on Impairment-Related Work Expenses
Blind work expenses. If you are blind, SSA deducts any earned income you spend in order to work, whether or not the expense relates to blindness. That is broader than impairment-related work expenses. Transportation to and from work, income taxes, and special equipment all qualify.7Social Security Administration. Understanding Supplemental Security Income (SSI) Work Incentives
Plan to Achieve Self-Support (PASS). A written plan, approved by SSA, that lets you set aside income or assets toward a specific vocational goal such as education, training, or starting a business. Amounts excluded under an approved PASS also raise your individualized threshold.8Social Security Administration. SSI Spotlight on Plans to Achieve Self-Support
The calculation can also fold in publicly funded attendant or personal care costs and your actual Medicaid expenditures when they run higher than the state average. SSA only needs to develop enough of these items to push the threshold above your gross earnings, so the field office stops adding once you clear.5Social Security Administration. SI 02302.050 Individualized Threshold Calculation
Reporting Earnings While on 1619(b)
Coverage depends on accurate, timely earnings reports. When you start or stop working, or when your earnings change, you must tell SSA no later than the 10th of the month after the change. A job that starts May 22 needs to be reported by June 10, and each following month’s earnings by the 10th of the month after.9Social Security Administration. Spotlight on Reporting Your Earnings to Social Security
Late or missed reports carry penalties. SSA can reduce your SSI payment by $25 to $100 each time you fail to report a change on time. Knowingly false statements or deliberate omissions trigger sanctions that suspend payments for six months on a first offense, twelve on a second, and twenty-four on a third.10Social Security Administration. Understanding Supplemental Security Income Reporting Responsibilities Late reports also tend to create overpayments; if you do not repay within 30 days of the notice, SSA withholds 10% of your SSI payment each month until the balance is recovered.11Social Security Administration. Resolve an Overpayment
Annual Redetermination and Appeals
SSA selects everyone on 1619(b) for a redetermination each year to confirm continuing eligibility.4Social Security Administration. SI 02302.045 The Threshold Test for Section 1619(b) Eligibility These can happen by telephone, in person, or by mail. The review compares your gross earnings against the current threshold and confirms you still meet resource limits and the other non-medical rules.12Social Security Administration. Understanding Supplemental Security Income Redeterminations
If SSA decides you no longer qualify, you get a written notice. You have 60 days from the day you receive it to appeal in writing. SSA presumes receipt five days after the date printed on the notice, which puts the practical deadline at 65 days from that printed date.13Social Security Administration. Understanding Supplemental Security Income Appeals Process Miss the window and the appeal gets much harder.
Getting Back on Benefits After a Loss
If earnings eventually clear both the chart threshold and the individualized calculation, 1619(b) ends. You can still get back in through expedited reinstatement if you act within five years of the month your benefits stopped. The stop has to have been earnings-related, not medical improvement. You need the same disability (or a related one) that qualified you for SSI originally, and your current earnings must be below the substantial gainful activity level: $1,690 a month for 2026, or $2,830 a month if you are blind.14Social Security Administration. Expedited Reinstatement (EXR)15Social Security Administration. Substantial Gainful Activity
Expedited reinstatement is faster than filing a new application, and you can receive up to six months of provisional benefits while SSA processes the request, so coverage does not fully drop out during the review.
If You Are Above the 1619(b) Ceiling
Section 1619(b) is not the only route to keep Medicaid while working. Most states run Medicaid Buy-In programs under the Ticket to Work and Work Incentives Improvement Act, letting working people with disabilities pay a premium to keep Medicaid when their income or assets sit above standard limits. Buy-In income ceilings are often meaningfully higher than 1619(b) thresholds, and asset limits tend to be more generous. If your earnings are climbing past your state’s 1619(b) threshold, ask your local SSA field office or state Medicaid agency what a Buy-In program in your state would require.