Medicaid provides health care coverage for people with low incomes. It's a federal program that's administered by the states, so some of the rules—including eligibility rules—vary from state to state. But no matter where you live, your income must be below your state's limit to qualify for Medicaid.
If you're receiving Social Security disability insurance (SSDI) benefits, your income could be too high to qualify for Medicaid. And with only a few limited exceptions, once you qualify for SSDI benefits, you won't be eligible for Medicare for two years.
In too many cases, Medicaid's income limits mean that those on SSDI often won't qualify for this low-income health care coverage. So you might have to go without health insurance while you wait for Medicare coverage. (Learn more about how long it takes to get Medicare with a disability.)
Some states use the federal poverty level (FPL) as the cutoff amount for Medicaid eligibility. The FPL changes from year to year and depends on the size of your household. In 2023, the FPL breaks down this way:
In monthly income, that works out to:
In most states, but not all, SSI recipients automatically qualify for Medicaid.
Many more people became eligible for Medicaid because the federal Affordable Care Act (ACA) encouraged states to raise the income cutoff for Medicaid to 133% of the federal poverty level. In addition, the ACA overhauled the way states count income and assets for Medicaid eligibility. The changes allowed more low-income SSDI recipients to qualify for Medicaid during the 24-month Medicare waiting period.
But as of early 2023, eleven states haven't expanded Medicaid coverage, including:
The higher Medicaid income limits and other changes under the ACA only apply to residents of D.C. and the other 38 states—those that have expanded Medicaid coverage.
Yes, Social Security counts as income for Medicaid purposes. When it comes to counting income, Medicaid uses the same standards as the Affordable Care Act for what counts as income: "modified adjusted gross income" (MAGI). MAGI includes all Social Security disability benefits—even those not taxed by the IRS.
But for Medicaid eligibility, your MAGI doesn't include the following types of income:
Many states limit income (including SSDI) for Medicaid applicants to about $1,620 per month (or $2,200 for a couple). (This represents about 133% of the federal poverty level.) But you should be aware that your state might have special rules that impact how Medicaid determines your eligibility.
Fortunately, it's sometimes possible to qualify for Medicaid even if your SSDI benefits are over the income limit. If you're "over-income" for Medicaid, you might still qualify for Medicaid while you await Medicare eligibility, thanks to Medicaid "buy-in" and "spend-down" programs in some states.
Several states have programs known as "Medicaid buy-ins," which allow low-income individuals with disabilities to get Medicaid coverage for an affordable monthly premium.
To participate in many of these programs, you must:
But before you go back to work to qualify for a Medicaid buy-in, give careful thought to how working could affect your disability benefits.
If you receive SSDI and have high medical expenses, you might be able to qualify for Medicaid if your state has a Medicaid spend-down program (sometimes called the "medically needy" program).
If paying your medical expenses (or your spouse's or child's medical expenses) reduces your monthly income to the Medicaid eligibility level, and your state has a spend-down program, you should qualify. It doesn't usually matter whether the medical expenses are ongoing or past due bills.
Contact your state's Medicaid agency to find out whether you qualify for a spend-down program or any other medical assistance programs. You can find your state's Medicaid website using the interactive map at Medicaid.gov.
With each state setting its own income limits, just how much disability you can get and still qualify for Medicaid depends on where you live. And the medical assistance programs that might be available to you (as an SSDI recipient) during the 24-month Medicare waiting period also vary from state to state. But the bottom line is that your SSDI benefits will count as income for Medicaid eligibility no matter where you live.
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 applied for Medicaid and were denied coverage because of financial ineligibility, you have the right to appeal the Medicaid denial.
Updated February 3, 2023