Should you or a family member be awarded Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), you will probably receive Medicare or Medicaid, respectively. It can take time, however, and in a handful of states, the approval of Medicaid programs requires filing a separate application.
In 1972, the US Federal government decided to move all “welfare” programs to state control. SSI is considered to be a welfare program since recipients (even though they must pass through an arduous application process) aren’t earning benefits based on job history. As a result of that decision nearly a half-century ago, getting Medicaid isn’t quick or automatic. In fact, SSI disability benefits do not guarantee Medicaid coverage in several states.
We wrote this article to help you make sense of the medical coverage you can receive, and the differences between human service agencies in the various states. Medicaid is state-run, so every state processes applications somewhat differently.
Table of Contents
- 1 Can You Be Eligible For Medicaid or Medicare and Social Security Disability Benefits?
- 2 When will Medicare or Medicaid Begin With Your Disability Benefits?
- 3 Which States DO NOT Provide Automatic Medicaid Enrollment?
- 4 What Are My Options If I’m Approved For SSI But Denied Medicaid?
- 5 Can A Social Security Disability Lawyer Help?
Can You Be Eligible For Medicaid or Medicare and Social Security Disability Benefits?
If you are approved for disability, it is crucial that you know whether you qualified under Title 2 (SSDI) or Title 16 (SSI). Do not make assumptions about which title qualifies you; if you have a disability attorney, ask. Just because you haven’t “worked much” doesn’t mean you don’t qualify under Title 2. By the same token, if you believe you have “plenty of assets” you may still qualify under Title 16.
If you qualify under Title 2/SSDI, Medicare coverage becomes your new health insurance policy. As long as you receive SSDI, you have medical coverage.
If you qualify under Title 16/SSI, you are likely to receive Medicaid at the same time as your disability benefits are approved; your letter of approval will specify this. In other words, in most states, there is no waiting period or additional application for the SSI program to begin and you can begin paying medical bills and medical expenses from that date.
Some individuals qualify under both Title 2 and Title 16. For this to occur, the general rule is that you must have some work history (defined as a history of “substantial gainful employment”) and currently meet the SSA definition of “asset limits.” In other words, you have to have very little income, property, or means of support.
SSI and Medicaid
Qualifying for SSI and Medicaid coverage is somewhat more straightforward, assuming you do not live in one of the states where a separate Medicaid application is necessary. The Social Security Administration set parameters for Medicaid eligibility in 43 states, but be sure to check on how your state operates.
Your Medicaid coverage will begin immediately, which means you can get use your SSI benefits to purchase prescription drugs. You will have medical insurance and can use health care services anywhere Medicaid is accepted. There is no monthly premium required.
SSI and Medicare
If you are a low-income individual and qualify only under Title 16/SSI, you are likely to receive Medicaid. The Medicare benefits will only apply if you reach the age of 65, at which point you will become eligible for Medicare (with retirement Social Security benefits). SSI recipients can only receive health coverage through Medicaid, however.
The Medicaid system provides emergency care, wellness visits, and substantially reduced prescription drugs.
SSDI and Medicaid
If you receive SSDI, an entitlement program, you are not going to have Medicaid benefits. Keep in mind, however, that many people who qualify for disability benefits do fall under both Title 2 and Title 16. If you are one of those individuals, you can choose Medicaid rather than Medicare (which requires a monthly premium for Part B, or health insurance).
SSDI and Medicare
Medicare is a helpful benefit, although it does require paying for Part B, or the health insurance if you receive a monthly check from SSA. In fact, SSA deducts the monthly Part B premium. We recommend reading this brief from SSA to understand how Medicare operates in more detail.
In summary, Medicare Part A (hospital insurance) is covered, but Part B (medical insurance) is deducted from any disability payments.
There is also a Medicare Part D that covers prescription benefits.
The advantage of eligibility for Medicare is that you can get insurance coverage at a reasonable rate. For people with pre-existing medical conditions, getting affordable health insurance in the United States continues to be a challenge.
The caveat for SSDI and Medicare has to do with timing. You will not be considered eligible for Medicare until two years after your disability “onset date” or the date that is designated as the first day you became disabled.
When will Medicare or Medicaid Begin With Your Disability Benefits?
Medicare begins two years after you established (not alleged) date of onset. Medicaid begins the day you are approved for SSI. If you are uncertain about these dates, or receive a letter from SSA, check in with your disability attorney.
Which States DO NOT Provide Automatic Medicaid Enrollment?
The following seven states process separate applications for Medicaid but use exactly the same criteria as SSA (which means you are nearly 100% guaranteed to get approval):
If you live in one of the states above, there will be a delay in getting Medicaid. It is NOT automatic and requires that you (or your attorney) file a Medicaid application.
Which States Have Their Own Medicaid Standards?
The following states have somewhat different criteria, having to do with income, for determining Medicaid eligibility.
- New Hampshire
- North Dakota
We highly recommend reading more on this topic to gain a better understanding of how these standards work. Make a list of questions to discuss with your disability attorney.
The “Easy” States That Follow SSA Rules
The remaining states use the same criteria as SSA and do not have a separate application process. These include:
- Rhode Island
- South Carolina
- South Dakota
- New Jersey
- New Mexico
- West Virginia
- New York
- North Carolina
Indiana has recently joined the list above.
What Are My Options If I’m Approved For SSI But Denied Medicaid?
You may file an appeal with your state Medicaid agency. You can do this on your own but due to the bureaucratic complexity, most individuals choose to hire a disability attorney.
Can A Social Security Disability Lawyer Help?
If you live in a state with its own Medicaid eligibility rules, a disability lawyer is a much-needed (and much-used) asset. The Medicaid (and Medicare) rules are difficult to follow for the lay person, and an experience disability law firm can be a great support and help.
A phone call is all that is required to get started with a free evaluation from a law firm. Or, you can go online and leave a phone number or contact information and a representative will be in touch. When it comes to sorting out the world of Medicaid and Medicare, professional help is highly recommended.