Medicaid is a health insurance program for low-income individuals that is operated by the states according to guidelines established by the federal government. The federal government requires the states to offer Medicaid coverage to some groups of people and allows the states to cover certain additional groups. One group required to be covered by Medicaid is disabled individuals with low incomes. But states are allowed to have different eligibility requirements than the SSI disability program. Whether SSI recipients are automatically eligible for and enrolled in Medicaid depends on the state that the recipient lives in.
Where Medicaid Eligibility Is Automatic
Most states automatically grant Medicaid when you get approved for SSI based on disability. In fact, most states let the Social Security Administration handle Medicaid enrollment for SSI recipients when they are approved for SSI. Individuals in those states will receive information about their Medicaid enrollment along with their SSI award letter when they are approved for SSI.
Administered by Social Security
The District of Columbia and the following thirty-two states let Social Security determine Medicaid eligibility using SSI criteria and they allow Social Security to enroll SSI recipients: Alabama, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Montana, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.
Administered by the State
A few states make their own Medicaid eligibility decisions using the same income, resource, and disability criteria that Social Security uses for the SSI program. Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, Utah, and the Northern Mariana Islands all make their own Medicaid eligibility decisions using SSI criteria. That means that everyone who receives SSI in those jurisdictions should qualify for Medicaid. These states, however, require you to file a separate Medicaid application.
Where Medicaid Enrollment Is Not Automatic
Eleven states have elected to use eligibility criteria for Medicaid that are more restrictive than SSI's. In most of those states, SSI recipients will find that the rules about income and resources or the definition of disability are more restrictive for Medicaid than they are for SSI. Still, the federal government has imposed rules to limit how restrictive the states can be when screening SSI recipients for Medicaid eligibility.
The States With Their Own Medicaid Eligibility Criteria
The eleven states are Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia. Social Security calls these eleven states the “209(b) states” because it was section 209(b) of the Social Security Amendments of 1972 that gave states the option of using their own criteria for Medicaid.
209(b) Income Limits
The exact income, resource, and disability criteria for Medicaid eligibility differs from state to state among the 209(b) states. Except for Hawaii, however, the 209(b) income standards for the state are fairly close to the federal SSI income limit. Some of the 209(b) states also have different rules than Social Security for what is considered countable income. Contact your state's health and human services department to find out your state's Medicaid income limit.
209(b) Asset Limits
About half of the 209(b) states use the federal SSI resource limit as the asset limit for Medicaid, and half use a lower limit (and two actually use a higher limit).
All 209(b) states must allow Medicaid applicants to deduct medical expenses from their income when determining their eligibility for Medicaid. This "spend-down" ability is an important protection and allows many SSI recipients to meet the more restrictive income limits of some 209(b) states. For example, if an applicant's countable income is $200 more than the state's maximum allowable income for Medicaid eligibility, the applicant would still qualify if she had to pay for at least $200 in medical expenses during the month.