Section 1619(b) Nevada: Keep Medicaid While Working on SSI

The biggest fear parents have when their disabled adult child starts working is losing Medicaid. Section 1619(b) of the Social Security Act exists specifically to prevent that. It lets your child keep full Nevada Medicaid coverage even after their earned income pushes their SSI cash payment to zero.

How 1619(b) Works

Under normal SSI rules, earned income above $85/month reduces the SSI payment by $1 for every $2 earned (after the $20 general exclusion and $65 earned income exclusion). At a certain earnings level, the SSI cash payment hits zero. Without 1619(b), that would also end Medicaid in most states.

Section 1619(b) prevents this. As long as your child:

1. Was eligible for SSI cash payments for at least one month
2. Still meets the disability criteria
3. Still meets all non-disability SSI requirements (resource limit, residency)
4. Needs Medicaid to continue working
5. Has gross earnings below the state threshold

...their Medicaid continues as if they were still receiving SSI.

Nevada's 1619(b) Earnings Threshold

Each state has its own annual threshold, calculated based on per-capita Medicaid spending for SSI recipients. For Nevada:

• 2025: $47,006
• 2026: $49,629

If your child earns less than $49,629 annually in 2026 and meets the other 1619(b) requirements, they can qualify for continued Medicaid under 1619(b). If they earn more, the SSA can still establish an individualized threshold based on your child's actual medical and personal care costs — so even high earners may qualify if their disability-related expenses are substantial.

What This Means Practically

A young adult with a disability working part-time at $15/hour for 25 hours/week earns roughly $19,500/year. That's well below the Nevada threshold. Their SSI cash payment would be reduced (the income formula would leave about $224/month in SSI at that wage), and Medicaid would continue without interruption.

If the same person gets promoted and starts earning $22/hour for 35 hours/week ($40,040/year), their SSI cash payment drops to zero. But they're still under the $49,629 threshold, so Medicaid stays active under 1619(b).

The Resource Limit Still Applies

Section 1619(b) protects Medicaid — it does not waive the $2,000 SSI resource limit. If your child saves their earnings in a regular bank account and the balance exceeds $2,000, they lose SSI eligibility and 1619(b) protection simultaneously.

This is where the ABLE account becomes essential. The first $100,000 in a Nevada ABLE account is excluded from the SSI resource count. Your child can earn, save in the ABLE account, and maintain both SSI eligibility (if they still receive a cash payment) and 1619(b) Medicaid protection.

Impairment-Related Work Expenses also help. Costs your child pays specifically because of their disability in order to work — transportation, medications, job coaching, assistive devices — are deducted from gross earnings before the SSI income formula applies. This keeps the SSI cash payment higher and delays the point where 1619(b) becomes necessary.

Reporting Requirements

Your child must continue reporting wages to the SSA monthly, even after the cash payment reaches zero. The SSA needs ongoing wage data to confirm that earnings stay below the 1619(b) threshold. If reporting stops, the SSA may assume your child is no longer working and terminate the 1619(b) Medicaid.

Report wages by the sixth day of the month after you get paid. Use the SSA mobile wage reporting app, call 1-866-772-0953, or report at the Las Vegas or Reno SSA field office.

Nevada-Specific Complication

Because Nevada is an SSI Criteria State, Medicaid is administered separately from SSI. If your child's SSI cash payment drops to zero and 1619(b) activates, the SSA notifies the state — but it's worth confirming with DWSS (through Access Nevada) that the Medicaid case reflects the 1619(b) status. Automated systems occasionally fail to process the notification, and a manual verification prevents an erroneous termination of coverage.

Our Nevada SSI at 18 & Adult Disability Benefits Guide includes the full SSI earned income calculation worksheet, 1619(b) threshold tracker, and ABLE account contribution calculator so your child can maximize earnings while protecting every benefit they depend on.

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