Will I Still Be Eligible for Medicaid if I Start Getting Social Security Disability?

Disability payments may give you too much income for Medicaid, but most states have buy-in and spend-down programs to help you qualify.

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People with disabilities can qualify for Medicaid, a federal program that is administered by the states, only if they are low-income. Eligibility rules vary from state to state, but many states use the federal poverty level (FPL) as the cutoff amount for Medicaid eligibility. In 2021, the FPL is $12,880 for a household with one person.

Many recipients of Social Security disability insurance (SSDI) have incomes that are too high to qualify for Medicaid under current law. And with only a few limited exceptions, people who qualify for SSDI benefits do not become eligible for Medicare until two years after the date they become entitled to receive benefits. (For help understanding how long it will take to get Medicare, see our article on how long it takes to get Medicare with a disability.) In too many cases, that means that individuals who get a high SSDI check will go without health insurance during their waiting period for Medicare coverage.

Fortunately, there are a few programs that can offer a way for some disabled adults who are "over-income" for Medicaid to qualify while they wait for Medicare coverage. (Note that in most states recipients of Supplemental Security Income, or SSI, automatically qualify for Medicaid.)

Medicaid Buy-In Programs

Several states have programs known as "Medicaid buy-ins," which allow low-income disabled individuals to obtain Medicaid coverage for an affordable premium. These programs are generally limited to low-income disabled individuals who are working, although the work requirement can be very limited, like an hour or two each month. Before you go back to work to qualify for a Medicaid buy-in, give careful thought to how your work will affect your SSDI benefits.

Medicaid Spend-Down Programs

If you receive SSDI and have high medical expenses that reduce your monthly income to the Medicaid eligibility level, you might be able to qualify for Medicaid if your state has a Medicaid spend-down program. These programs (usually called "medically needy" programs) allow disabled individuals to qualify for Medicaid when they (or their spouse or child) have high medical expenses (either ongoing or past due bills). Contact your state's Medicaid agency to find out whether you qualify for a spend-down program.

How Health Care Reform Affected Eligibility for SSDI Recipients

Many more people became eligible for Medicaid because the federal Affordable Care Act (ACA) encrouaged states to raise the income cutoff for Medicaid to 133% of FPL. (This is $17,130 in annual income for an individual in 2021). In addition, the ACA overhauled the way states count income and assets for Medicaid eligibility in ways that allowed more low-income SSDI recipients to qualify for SSI during the 24-month waiting period. However, a number of states declined to participate in this "Medicaid expansion," so these changes only apply to residents of some states.

Check With Your State Medicaid Agency

The bottom line is that there is variation among the states in the kinds of insurance programs that may be available to SSDI recipients during the 24-month waiting period. Check with your state's Medicaid agency to see if you qualify for any medical assistance programs. You can find the website for your state's agency by selecting your state from the map on the Medicaid website. If you are denied Medicaid because of financial ineligibility, you have the right to appeal the Medicaid denial.

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