Getting Medicare or Medicaid if Approved for Disability

Persons with disabilities (according to Social Security's definition) should be able to get free health care.

If Social Security grants you disability benefits, you will become eligible (at some point) for health care through Medicare or Medicaid. Which program you will be eligible for, and when you’ll be enrolled in the health care program, depends on whether you are approved for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) benefits.

Medicare and SSDI

Disability applicants who are approved for Social Security disability (SSDI) are eligible for Medicare, but only after a two-year waiting period. The two years is counted from the date that the applicant was entitled to be paid disability benefits -- even if he or she didn’t receive the payments until months later because the claim was not yet decided. This date can be no earlier than five months after the applicant’s onset date of disability.

For most SSDI recipients, Part A Medicare (hospital coverage) will be free, but there will be a monthly premium for Part B (doctor’s visits) and Part D (prescription drug coverage). There are programs, however, to help those with low income with these premiums as well as co-pays.

Medicaid and SSI

Most states automatically grant Medicaid eligibility to those who are approved for SSI disability benefits. If you are approved for SSI in these states, you’ll be eligible for Medicaid the month after you apply for SSI (as long as Social Security finds you were disabled at that point).

However, the federal government does allow states’ Medicaid eligibility requirements to be more restrictive (within limits) than that of the SSI disability program, and some states do not automatically approve SSI recipients for Medicaid.

The states with different eligibility criteria for Medicaid are Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia.

In all of these states, at least one of the eligibility criteria is different than for SSI. About half of these states use the federal SSI resource limit as the asset limit for Medicaid, but half of these states use a lower limit, meaning you have to have less money to qualify for Medicaid than for SSI.

As to income limits, most of these states’ limits are close to the SSI income limits, though Hawaii’s is actually higher because of Hawaii’s high cost of living. Some of these states have different rues than the SSI program as to what income is counted toward to eligibility income limit.

All of these states, however, allow Medicaid applicants to deduct their medical expenses from their income when the state Medicaid agency is determining their eligibility for Medicaid. This is called "spend-down." For example, if the income limit in Illinois is $700 per month, and a Medicaid applicant has $800 per month in income but pays $170 in medical expenses, the applicant would be eligible for Medicaid because of the spend-down.

If you live in one of the above states with different eligibility criteria, call your state's health and human services department about your state's Medicaid eligibility rules.

Being Denied Medicaid

If you have been approved for disability benefits through the SSI program but your state has denied you Medicaid benefits, read Nolo's article on appealing a Medicaid denial and consider contacting a disability lawyer.

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