Haris Ashley
Medicaid is a federal-state health insurance program for low-income individuals, including those with disabilities. It is jointly funded by the federal government and states, covering children, the elderly, blind, and/or disabled individuals eligible for federally assisted income maintenance payments. Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are federal programs that provide disability benefits, impacting Medicaid eligibility. While SSDI recipients may face higher incomes that disqualify them from Medicaid, SSI beneficiaries often rely on Medicaid for healthcare coverage. States have varying eligibility rules, and some offer Medicaid to SSI recipients, ensuring continued eligibility even with higher earnings. The interplay between SSDI, SSI, and Medicaid affects healthcare access for millions with disabilities, with policy changes potentially impacting coverage and costs.
| Characteristics | Values |
|---|---|
| What is Medicaid? | A jointly funded, Federal-State health insurance program for low-income and needy people. |
| Who is covered by Medicaid? | Children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments. |
| How is eligibility for Medicaid decided? | Thirty-five states and the District of Columbia provide Medicaid eligibility to people eligible for Supplemental Security Income (SSI) benefits. The remaining states use their own eligibility criteria. |
| Can you receive Medicaid if you are receiving Social Security disability insurance (SSDI) benefits? | Yes, but your income could be too high to qualify for Medicaid. |
| Can you receive Medicaid if you are working? | Yes, but you need to check how working affects your disability benefits. |
| How many people with disabilities have Medicaid coverage? | More than 1 in 3 people with disabilities (15 million) have Medicaid coverage. |
| What are the implications of policy changes on Medicaid spending? | Options under consideration in Congress to reduce Medicaid spending by up to $2.3 trillion over ten years could have major implications for people with disabilities. |
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What You'll Learn
Medicaid eligibility for SSI recipients who work
In most states, Supplemental Security Income (SSI) recipients are automatically eligible for Medicaid; however, in some states, a separate application for Medicaid must be filed. In these states, the SSI application is not considered an application for Medicaid, and the applicant must establish their eligibility for Medicaid with another agency. The following states use their own eligibility rules for Medicaid, which are different from the Social Security Administration's (SSA) SSI rules: Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Oklahoma, and Virginia.
If an SSI recipient's state provides Medicaid to people on SSI, the recipient will continue to be eligible for Medicaid, even if their earnings become too high for an SSI cash payment. This is because Medicaid coverage can continue even if a recipient's income becomes too high for SSI.
The disability determination process may create a sharp discontinuity in Medicaid coverage rates. Individuals awaiting an initial disability determination or appealing a rejected initial determination may ultimately be eligible for Medicaid, but costs, information gaps, and barriers to access reduce the likelihood that they will apply.
Under all three policy regimes, individuals can apply for Medicaid regardless of their SSI application status. However, in some states, SSI eligibility confers Medicaid eligibility, but SSI awardees must file a separate Medicaid application. Ten other states also require a separate Medicaid application and employ more restrictive Medicaid income or asset limits, resulting in some SSI recipients not qualifying for Medicaid coverage in those states.
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Medicaid eligibility for SSDI recipients
Medicaid is a federal-state health insurance program for people with low incomes. It covers children, the elderly, blind people, and/or disabled people, as well as those eligible for federally assisted income maintenance payments. As a federal program administered by the states, Medicaid's eligibility rules vary from state to state. Thirty-five states and the District of Columbia provide Medicaid eligibility to people eligible for Supplemental Security Income (SSI) benefits, where the SSI application is also the Medicaid application.
Social Security Disability Insurance (SSDI) beneficiaries often qualify for Medicare after receiving disability benefits for at least two years. However, if you receive SSDI and have high medical expenses, you may be able to qualify for Medicaid if your state has a Medicaid spend-down or "medically needy" program. In this case, you can reduce your monthly income to the Medicaid eligibility level by paying your medical expenses or those of your spouse or child.
In most states, SSI beneficiaries automatically qualify for and receive Medicaid coverage. In 2021, 6.5 million people were eligible for Medicaid through the SSI disability program. SSI is available to people regardless of their work history, and eligibility is redetermined every 1 to 6 years or when a change affecting eligibility or payment is reported.
If you are eligible for Medicaid, your coverage may continue even after you enroll in Medicare. However, if you are turned down for Medicaid, you may be able to enroll in a private health plan through the Marketplace while waiting for your Medicare coverage to start.
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Medicaid eligibility for those with intellectual and developmental disorders
Medicaid is a federal-state health insurance program for people with low incomes. It covers children, the elderly, blind, disabled, and other people eligible for federally assisted income maintenance payments. In 2021, 6.5 million people were eligible for Medicaid through the SSI disability program, and 1.6 million beneficiaries received both SSI and SSDI.
Medicaid eligibility rules vary from state to state, and your income must be below your state's limit to qualify. Thirty-five states and the District of Columbia provide Medicaid eligibility to people eligible for SSI benefits, and eight states use their own eligibility criteria. If you are receiving Social Security Disability Insurance (SSDI) benefits, your income may be too high to qualify for Medicaid. However, if you have high medical expenses, you may be able to qualify through a Medicaid spend-down program, which allows you to spend down your income on medical expenses to reach the Medicaid eligibility level.
Intellectual and developmental disabilities (IDD) are permanent conditions that affect a person's ability to learn and function in daily life, up to the age of 22. Examples of IDD include cerebral palsy, autism, Down syndrome, and schizophrenia. In 2022, intellectual and developmental disorders were the most common disabling conditions among SSI beneficiaries (33%), and the second most common among SSDI beneficiaries (14%).
If you have an intellectual or developmental disability, you may be eligible for Medicaid through the SSI program or, if you are under 65, through the SSDI program. You can check with your state's Medicaid agency to see if you qualify for any medical assistance programs, as some states have expanded Medicaid coverage. Additionally, states are developing resources to support adults with IDD living with aging caregivers, who may require additional support to meet their own needs and those of the person they are caring for.
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Medicaid eligibility for those with high medical expenses
Medicaid is a jointly funded, federal-state health insurance program for people with low incomes and resources, including those with high medical expenses. It covers children, the aged, blind, and/or disabled people, as well as other people who are eligible to receive federally assisted income maintenance payments.
While Medicaid is a federal program, it is administered by the states, so eligibility rules vary. In general, to qualify for Medicaid, one must meet their state's rules for income and resources, as well as other rules like being a resident of the state. Thirty-five states and the District of Columbia provide Medicaid eligibility to people who are eligible for Supplemental Security Income (SSI) benefits, and in these states, the SSI application is also the Medicaid application.
Some states have expanded Medicaid coverage, allowing individuals to qualify based on their income alone. In these states, if an individual's household income is below 133% of the federal poverty level, they qualify for Medicaid. However, a few states use a different income limit.
For those with high medical expenses, some states have a Medicaid spend-down program, sometimes called the "medically needy" program. If an individual's income is above the state's Medicaid limit, they can "spend down" the amount above the limit by paying non-covered medical expenses until their income is lowered to a level that qualifies them for Medicaid. It is important to note that not all states have these spend-down programs, and each state sets its own income limits.
Additionally, Social Security disability insurance benefits count as income for Medicaid purposes. While Medicaid uses the same standards as the Affordable Care Act for determining income, known as "modified adjusted gross income" (MAGI), there are certain types of income that are not included in MAGI for Medicaid eligibility.
It is recommended to check with your state's Medicaid agency to determine if you qualify for any medical assistance programs, as the rules and eligibility criteria can vary from state to state.
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Medicaid eligibility for those with disabilities
Medicaid is a jointly funded, federal-state health insurance program for low-income individuals and families. It covers children, the elderly, blind, and/or disabled people and other eligible recipients of federally assisted income maintenance payments. The program is the single largest source of health coverage in the United States, with over 77.9 million Americans covered.
To be eligible for Medicaid, your income must be below your state's limit. This is determined using the Modified Adjusted Gross Income (MAGI) methodology, which includes all Social Security disability benefits, even those not taxed by the IRS. However, each state sets its own income limits, and these vary, so you should check with your state's Medicaid agency to see if you qualify. Thirty-five states and the District of Columbia provide Medicaid eligibility to people eligible for Supplemental Security Income (SSI) benefits, and in these states, the SSI application is also the Medicaid application.
If you are receiving Social Security Disability Insurance (SSDI) benefits, your income could be too high to qualify for Medicaid. However, if you have high medical expenses, you may be able to qualify through a Medicaid spend-down program, also known as the "medically needy" program. In this case, you can spend down your income by incurring medical expenses until your income reaches the eligibility level for Medicaid.
Medicaid beneficiaries enrolled through disability pathways include those with physical conditions (such as quadriplegia or traumatic brain injuries); intellectual or developmental disabilities (for example, cerebral palsy, autism, Down syndrome); and serious behavioral disorders or mental illnesses (such as schizophrenia or bipolar disorder). Over 10 million people qualify for Medicaid based on a disability, and of these, 6.2 million do not have Medicare coverage.
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Frequently asked questions
Medicaid is a federal-state health insurance program for people with low incomes. It covers children, the elderly, blind people, and/or disabled people, as well as those eligible to receive federally assisted income maintenance payments.
Social Security disability insurance benefits count as income for Medicaid purposes. If your income is too high, you may not qualify for Medicaid. However, if you have high medical expenses, you might be able to qualify for Medicaid if your state has a Medicaid spend-down program.
To qualify for Medicaid, your income must be below your state's limit. Each state sets its own income limits, so be sure to check with your state's Medicaid agency to see if you qualify for any medical assistance programs.
