You know, when considering employment as an option,
              many individuals with disabilities have made it clear
              over the years that while I can deal with a reduction
              or even a loss of my SSI cash benefit, I simply can't
              afford to lose access to my healthcare coverage under
              Medicaid.
                 Well, a major step to addressing this concern was
              taken in 1987 when section 1619 was added to the Social
              Security act.
                 Now, prior to 1987, if an individual received SSI
              and went to work and experienced earnings over the SGA
              level, not only would the person lose their SSI cash
              benefit, but they'd lose their Medicaid coverage as
              well.
                 Recognizing this major disincentive, Section 1619
              was added to the Social Security act and essentially it
              eliminated the substantial gainful activity level for
              SSI.
                 So in other words, when you go to work, once you're
              determined eligible, when you go to work and experience
              earnings over that SGA level, you won't automatically
              or right away lose your SSI cash benefit.
                 Instead, individuals will continue under Section
              1619(a), the first part of the provision, to receive a
              special SSI cash benefit and their Medicaid.
                 Now, 1619(b), the second part of this section, goes
              a step further in extending that safety net for
              individuals with disabilities by enabling them to
              continue Medicaid coverage if, in fact, their earnings
              are so high that they're not eligible for an SSI cash
              benefit, but they're not high enough to replace the
              Medicaid and any personally funded attendant care
              services that the person receives.
                 Individuals are considered for eligibility for
              Section 1619(b) when their earnings reach the point --
              they've become so high that it reduces their SSI cash
              benefit to zero, and this is referred to as the
              individual's "break-even point."
                 Now, each person's break-even point may be different
              depending on if unearned income is received.
                 Now, if there's no unearned income received, then
              the break-even point for an individual can be
              calculated fairly simply by reversing that countable
              income formula that Jenn reviewed with you a little bit
              earlier.
                 So we're not only going to ask you to learn it
              forward, but now we're going to make you do it backward
              as well.
                 So essentially what you would do in calculating the
              break-even point for this current year is you would
              start with the federal benefit rate, you would multiply
              that by two, and then you would add the 20-dollar and
              the 65-dollar exclusions.
                 So again, you're simply reversing that countable
              income formula.
                 So as you can see, the break-even point for 2002,
              the current year, is $1,175.
                 Now, again, this is only the break-even point for
              individuals who have no unearned income.
                 If there is any unearned income received at all,
              including deemed income or in-kind support and
              maintenance, then the individual will have a lower
              break-even point than this amount.
                 Now let's take a minute to look at how the 1619(b)
              provision works.
                 As I mentioned, at the point in time that a person
              reaches their break-even point and SSI cash benefits
              stop, an individual is determined for eligibility for
              1619(b).
                 Once they're determined eligible, the Social
              Security Administration disregards their earned income.
                 This allows the person to be continued to be
              considered as an active SSI recipient in spite of the
              fact that they're not getting a cash benefit due to
              their earnings.
                 This active SSI case standing allows them to
              continue their Medicaid eligibility.
                 So again, they're just deemed by law as SSI
              recipients, even though no cash benefit is received.
                 And this active case status continues for Medicaid.
                 Now, let's look at 1619(b) eligibility.
                 It's important to recognize that not all individuals
              with -- who lose their SSI cash benefits are going to
              be eligible for continuing Medicaid under 1619(b).
                 There are a number of specific criteria that have to
              be met.
                 First of all, the individual must continue to meet
              the SSA's definition of "disability" that we -- I
              talked about a little bit earlier in that first
              segment.
                 The section 1619(b) does not provide any protection
              at all from continuing disability reviews, nor does it
              extend Medicaid coverage for folks who are determined
              to be medically recovered.
                 So if a person is determined medically recovered,
              they will not be afforded protection under 1619(b).
                 Now, the second criteria that individuals must have
              been eligible for at least one month of a regular SSI
              cash benefit before being determined eligible for 1619.
                 What this means, very simply, is that 1619(b) is not
              meant to provide extended Medicaid for individuals who
              were not previously eligible for SSI based on
              disability or blindness.
                 The third requirement is that the individual must
              continue to meet all other nondisability requirements
              for the SSI program.
                 So in other words, the only reason the person is not
              receiving an SSI cash benefit is due to their earnings
              over the break-even point.
                 The person must continue to have resources below the
              allowable limits.
                 They must also have unearned income that is less
              than the federal benefit rate after the exclusions
              apply to that.
                 Now, the fourth criteria is that the individual must
              need Medicaid in order to work.
                 And this is a fairly straightforward test.
                 The Social Security Administration uses a test
              called the Medicaid use test and it consists of three
              questions.
                 First of all, has the person used Medicaid in the
              last 12 months?
                 Do they intend to use it in the next 12 months?
                 And finally, if the person had unexpected medical
              expenses, would they need their Medicaid to cover these
              expenses in the next 12 months?
                 An answer of "yes" to any of these three questions
              is an indication that the person needs Medicaid in
              order to work.
                 Now, the final requirement for 1619(b) is that the
              individual must have gross annual earnings below
              certain threshold amounts.
                 So let's look at what these threshold amounts are.
                 Okay?
                 Threshold amounts are certain annual income amounts
              that are used to measure whether a person's earnings
              are high enough to replace his or her SSI as well as
              their Medicaid benefits.
                 If an individual exceeds the threshold amount,
              they're considered to have earnings that are sufficient
              to replace these benefits and, as a result, are not
              going to be eligible for SSI.
                 Now, each state has its own threshold amount, and
              these vary greatly from state to state.
                 The state threshold amounts are based on the amount
              of earnings that would cause the SSI benefit to stop in
              that state, as well as the average Medicaid expenses in
              that state.
                 Now, it's not anybody else's job other than SSA's to
              calculate what those state threshold amounts are, and
              what we're going to take a look at the formula, just so
              you can see what goes into that.
                 You start with the state's annual state supplement
              rate, if in fact there is a state supplement, and
              multiply this by two.
                 Then you add to this the current SSI break-even
              point times 12.
                 Again, that's an annualized SSI break-even point for
              the state.
                 And then you add the average per capita Medicaid
              expense for that state.
                 And that will provide you with the state's threshold
              amount.
                 Now, again, these amounts -- you don't have to
              really about the calculation too much because Social
              Security provides that for us, and you can access that
              on the SSA website in the POMs and we do have a
              citation for that, how to access the website in the
              packet there.
                 Now, let's talk about threshold determinations.
                 The initial determination, again, for 1619(b) is
              made when earnings exceed the break-even point.
                 This determination, the initial one for 6 -- the
              threshold, is made for the 12-month period beginning
              with the month in which 1619(b) starts.
                 In conducting the review, the SSA will determine if
              the estimated earnings for the individual for the
              12-month period that's being determined are equal to or
              less than the threshold amount.
                 If the answer is "Yes," the earnings are less than
              or equal to the threshold amount, then this requirement
              is met for 1619(b) eligibility.
                 Now, keep in mind that SS only looks at earned
              income.
                 Unearned income is not considered in making these
              threshold determinations.
                 Now, following the initial determination, threshold
              determinations are made annually as part of the 1619(b)
              redeterminations.
                 During these annual redetermination reviews for
              1619(b), not only does the SSA look at does the person
              meet the threshold requirement but they look at all of
              the other eligibility criteria as well for 1619(b) to
              make sure the person still meets, you know, all the
              criteria to be in 1619(b).
                 In addition to these annual reviews, the SSA will,
              on a quarterly basis, at least, update earning and
              earning exclusion information for individuals in
              1619(b) status.
                 Now, in most cases, the standard state threshold
              amounts are used to determine a person's eligibility
              for 1619(b).
                 However, if an individual has unusually high medical
              expenses and/or other expenses that meet certain
              criteria, then the SSA can establish an individualized
              threshold amount for this individual.
                 At the point in time that the individual's gross
              annual earnings exceed their state threshold amount,
              the SSA will take a look at the person's situation to
              determine, number one, does the person qualify for an
              individualized threshold amount, and, number two, if
              they do qualify, what that threshold amount for the
              individual will be.
                 The object of the individualized threshold amount is
              to determine whether the person's earnings are truly
              sufficient to replace all of the benefits that he or
              she would have in the absence of those earnings.
                 Now, let's look at how the individualized threshold
              amount is calculated.
                 In the first step, you start with the base amount,
              which is essentially the SSI break-even point for the
              person's state of residence.
                 In step two, we compare the individual's actual
              Medicaid expenses for the last 12-month period with
              their state's average per capita Medicaid expense.
                 And whichever amount -- whichever of these two is
              higher is the amount that's added into the formula.
                 In step three, we add any blind work expense or
              impairment-related work expenses that the person has.
                 In step four, any amounts of income excluded under
              the person's plan for achieving self-support are added
              into the formula.
                 Excuse me.
                 And finally, the value of any publicly-funded
              attendant care services that the person receives is
              added in the fifth step.
                 Now, the attendant care services that we're talking
              about here include both work-related attendant care
              services as well as personal needs services.
                 However, these attendant care services cannot be
              added into the formula unless, first -- two criteria
              have to be met.
                 First of all, they have to be paid for by a public
              agency other than Medicaid, and secondly, the
              individual must be in a situation where they're going
              to lose access to these services as a result of their
              earnings.
                 So if both of those criteria are met, the publicly
              funded attendant care services can be added in.
                 Now, once all of these figures are placed into that
              formula, the end result when you add them all together
              is the person's individualized threshold amount that
              they must meet for 1619(b) eligibility.
                 Now let's take a look at an example of an individual
              that we're calculated an individualized threshold.
                 In this situation, we have a gentleman by the name
              of John who is starting to work with an annual salary
              of $31,000.
                 This annual salary is greater than or higher than
              his state threshold amount.
                 John relies on attendant care services that are paid
              for through a state program, and in addition, he uses
              his Medicaid to cover his medical expenses.
                 He also has a number of impairment-related work
              expenses.
                 So when calculating John's individualized threshold
              amount, we're going to start with step one, the base
              SSI rate for his state of residence.
                 In this example, it's Texas, and that's $14,100.
                 In step two, we're going to compare the Texas
              average per capita Medicaid expense, which is $7,946,
              with John's own Medicaid expenses during the last 12
              months, which were $18,000.
                 Clearly, John's expenses were the higher of the two,
              so we're going to add in the 18,000-dollar figure into
              the formula.
                 In step three, we're going to add John's
              impairment-related work expenses of $6,000.
                 In step four, we're going to skip that because John
              doesn't have a plan for achieving self-support, so it's
              not applicable.
                 And finally, in step five, we're going to add the
              value of John's publicly- funded attendant care
              services which are $36,000.
                 Now, the total of all of these figures added
              together is $74,000.
                 I'm sorry, it looks like 74,100 on the monitor
              there.
                 And that represents John's individualized threshold
              amount.
                 Clearly, John's annual earnings of $31,000 are less
              than his individualized threshold, so he does meet the
              threshold determination to be eligible for 1619(b).
                 Okay.
                 Now what I'd like to do is in the last couple
              minutes talk about some important 619(b) facts that
              everybody should be aware of.
                 The first of these have to do with reinstatement of
              benefits.
                 1619(b) is arguably one of the most powerful SSI
              work incentives.
                 It's available to individuals.
                 Not only does it provide extended Medicaid coverage,
              but in addition, it enables the person to keep a --
              stay active on the SSI case rolls, so they have an
              active case status.
                 What this means is that at any point in time that a
              person is 1619(b), and experiences a reduction in
              earnings below the break-even point, then they are
              eligible right away to be reinstated for an SSI cash
              benefit without having to reapply.
                 So you have that automatic reinstatement of
              benefits.
                 It provides something of a safety net there.
                 Now, the second point that has to do with 1619(b) is
              for eligible couples.
                 Well, 1619(b) is clearly an effective tool for
              individuals, it doesn't always work to the best
              advantage of eligible couples.
                 Now, if both members of an eligible couple are
              working and have some level of earnings, then both
              members of the couple will be eligible or have access
              to 1619(b) when earnings exceed the break-even point.
                 But here's the glitch:  If only one member of the
              eligible couple is working and has earnings, when
              earnings exceed the break-even point, then only the
              working spouse will have access to 1619(b).
                 The spouse who is not working will lose their
              Medicaid eligibility unless they're found eligible
              under another category in their state.
                 Now, that's something that's very important for
              individuals to be aware of when they're making choices.
                 There has been a legislative proposal submitted by
              SSA to change the manner in which eligible couples are
              treated but at the present time, the rules that I just
              described are the rules that apply.
                 Now, the next point that I want to talk about has to
              do with 1619(b) and individuals who live in 209(b)
              states.
                 And your first question is probably, what in the
              world is a 209(b) state and do I live in one.
                 Well, there are only 11 209(b) states in the
              country, and these are states that have their own
              eligibility criteria for Medicaid.
                 In many cases, these criteria are more restrictive
              than the SSI standards.
                 Now, if a person lives in one of these 209(b) states
              and is determined eligible for 1619(a) or 1619(b)
              status, they will keep their Medicaid eligibility as
              long as they were eligible for Medicaid in the month
              prior to entering 1619(b) status.
                 So in other words, even if the person does not meet
              their state's more restrictive criteria for Medicaid,
              their Medicaid agency must continue their Medicaid
              eligibility if they were determined -- or if they had
              Medicaid in the month prior to moving into 1619(b)
              status.