Does Medicare or Medicaid Come With Social Security or SSI Disability Benefits?

Most people who are approved for disability benefits through the Social Security Administration get Medicare or Medicaid – eventually.

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Generally, if you are approved for Social Security disability insurance (SSDI) benefits, you will receive Medicare, and if you are approved for Supplemental Security Income (SSI), you will receive Medicaid. However, this isn’t true in all states. Medicaid is operated by the states, and the states are allowed to set eligibility criteria that are different than SSI’s criteria. As a result, whether getting approved for SSI gets you Medicaid depends on your state, as we’ll discuss below.

When Does Medicare or Medicaid Start?

SSDI recipients aren't eligible to receive Medicare benefits until two years after their date of entitlement to SSDI (this is the date their disability began, up to a year before their application date). Because it often takes a year or two to be approved for disability benefits, however, SSDI recipients often become eligible for Medicare soon after they get their award letter from Social Security.

In the states where Medicaid eligibility is automatic for SSI recipients, there is no waiting period for SSI recipients to receive Medicaid. In other states, you need to apply separately for Medicaid, but there is no waiting period.

In Which States Is Medicaid Enrollment Automatic?

The Social Security Administration handles Medicaid enrollment for the many states in which Medicaid eligibility is automatic for SSI recipients. Your state will contact you with information after you receive your SSI award letter from Social Security. These states are:

Alabama

Louisiana

Pennsylvania

Arizona

Maine

Rhode Island

Arkansas

Maryland

South Carolina

California

Massachusetts

South Dakota

Colorado

Michigan

Tennessee

Delaware

Mississippi

Texas

D.C.

Montana

Vermont

Florida

New Jersey

Washington

Georgia

New Mexico

West Virginia

Iowa

New York

Wisconsin

Kentucky

North Carolina

Wyoming

Note that SSI recipients in Indiana will be automatically enrolled in Medicaid starting on June 1, 2014. At that point, Indiana switches from being a 209(b) state (see below) to an automatic enrollment state.

Which States Make Medicaid Decisions Based on SSI Standards?

Some states use the same eligibility standards as the federal SSI program but insist on making their own Medicaid decisions. In these states, enrollment in Medicaid isn’t automatic when you are approved for SSI, and you must file a separate application with the state Medicaid agency to get enrolled in the Medicaid program.

These states, called “SSI criteria states,” are:

Alaska

Idaho

Kansas

Nebraska

Nevada

Oregon

Utah

 

 

Which States Use Their Own Criteria for Granting Medicaid?

The remaining states do not automatically grant Medicaid to persons with disabilities who qualify for SSI because they use their own criteria for determining whether someone is eligible for Medicaid. These states may have income limits that are higher or lower than SSI’s, different asset limits, or different requirements for what makes someone disabled.

In most of these states, however, the income limits for Medicaid aren’t too different from the income limit for SSI (though they may count income differently than the SSI program). And many of them use the same resource (asset) limit as SSI program, although several have a lower asset limit than SSI (preventing some people who qualify for SSI from qualifying for Medicaid), and a couple states have a higher asset limit (allowing more people to qualify for Medicaid than for SSI).

These states are called “209(b) states,” named after a section of the legislation that created the SSI program in 1972. This legislation prohibited states from making their Medicaid eligibility criteria stricter than the criteria the states were using in 1972. In these states, you must apply for Medicaid with your state’s Medicaid agency or health and human services department.

The 209(b) states are:

Connecticut

Hawaii

Illinois

Minnesota

Missouri

New Hampshire

North Dakota

Ohio

Oklahoma

Virginia

 

 

Note that Indiana ceased being a 209(b) state in 2014.

Even though some 209(b) states have lower income limits than the SSI program, these states have to let Medicaid applicants deduct their medical expenses from their income when their eligibility for Medicaid is being determined. This is called "spending-down." This means that SSI recipients with high medical bills will qualify for Medicaid in these states.

Note that SSI recipients in 209(b) states are allowed to spend down even if the state doesn't have a "medically needy" program, a separate type of Medicaid eligibility program that allows some individuals to spend down their medical expenses. In the 209(b) states that do have a medically needy program, SSI recipients have to spend down only to the 209(b) income standard, not the medically needy income limit (MNIL). (In most 209(b) states, the 209(b) income limits for Medicaid are higher than the income limits for Medicaid’s medically needy program.) 

What If I Was Approved for SSI But Denied Medicaid?

If you receive SSI but were denied Medicaid benefits in a 209(b) state – or any state for that matter, you should appeal the decision to your state’s Medicaid agency. Your state has to follow certain federal Medicaid rules in notifying you of the denial and holding a hearing. To learn more, read Nolo's article on appealing a Medicaid denial.

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