Section 1619 Medicaid is for recipients who have lost their Supplemental Security Income (SSI) check due to the earned income of the recipient. Verification from the Social Security office that the recipient is eligible for Section 1619 coverage is required. Once verification is received, Section 1619 eligibility may be processed.
Verification may include a letter from the Social Security office to the recipient stating s/he is eligible for Section 1619 and what date s/he became eligible. Or we may contact the Social Security office by telephone to obtain this verification. If verifying Section 1619 eligibility by phone, ensure you document when you called and the date the recipient became eligible for Section1619 coverage.
Process to take when you do NOT have verification of Section 1619 eligibility: #
Step 1
Locate the customer on FAMIS Program Participation (FAMISPAR/FM0D) by entering a DCN or Social Security Number
Step 2
Select the customer and fastpath to DISABLED/FMMX screen.
Step 3
Type an A on the command line.
Step 4
Select the correct client and tab to the disabled reason code field
Step 5
Change disabled reason to S19 (1619 Status)
Step 6
Tab to Begin Date, enter the date you determined this recipient became eligible for Section 1619
Step 7
Tab to Ver, press the space bar twice. Leave the Ver line blank, DO NOT enter CS. Before leaving the DISABLED/FMMX screen, press F18=COMMENT to enter a comment explaining why this recipient may be eligible for Section 1619.
Step 8
Type EDRES on the command line and press control. Press F14=REQED to request a new Eligibility Determination.
Step 9
Type OUTVERF on the command line and press control. Use F23=FA325 to create and send the recipient a Request for Information, requesting they provide verification from the Social Security office of Section 1619 eligibility.
Process to take when you DO have verification of Section 1619 eligibility: #
Step 1
Locate the customer on FAMIS Program Participation (FAMISPAR/FM0D) by entering a DCN or Social Security Number
Step 2
Fastpath to DISABLED/FMMX
Step 3
Type a A on the command line and select the correct recipient.
Step 4
Tab to the reason code field and update the Disabled reason code to S19 (1619 Status)
Step 5
Update the begin date to the Section 1619 eligibility begin date, verified from Social Security office
Step 6
Enter verification code
-
- If verified with a letter from Social Security, use HC
- If verified with a phone call to Social Security, use TC
Step 7
Press control to save the changes.
Step 8
Select recipient and press F18=COMMENT to document the verification used, when it was received and the date Social Security states the recipient became Section 1619 eligible.
Step 9
Fastpath to Select Income (SELINC/FMX2) screen to confirm the current income information is captured. Use the IIVE and any earned income verification provided by the recipient. If gross earned income is not more than the current SSI maximum, it needs to be updated. Request current income verification from the recipient, via an FA325 Request for Information.
Step 10
Request an Eligibility Determination (EDRES) and begin the authorization process by pressing F14=REQED.
Step 11
Press F18=SELAUTH
Step 12
Press F14=AUTH
Step 13
To approve Section 1619 benefits, the Action should show as INCR and the Category 1619. Press F24=NEXTSEL through each determination month listed.
Step 14
Press F23=AUTH, to authorize benefits.
Step 15
Press F21=RETURN. Review the screen to verify all actions were authorized.