Do You Automatically Get Medicare or Medicaid With Social Security Disability or SSI?

Most people approved for disability benefits through the Social Security Administration will get Medicaid or Medicare—eventually.

By , Attorney · UC Law San Francisco

Generally, if you're approved for Social Security disability insurance (SSDI) benefits, you'll receive Medicare. And if you‘re approved for Supplemental Security Income (SSI), you'll get Medicaid—but not in all states.

Medicaid is a federally funded program that's operated by the states. And the states are allowed to set eligibility criteria that differ from SSI's criteria. As a result, whether being approved for SSI is enough to qualify for Medicaid benefits depends on where you live.

When Does Medicare or Medicaid Start?

If you're getting SSDI, eventually, you'll be eligible for Medicare benefits—but not until two years after your "date of entitlement." That's the date Social Security says you're eligible to start collecting benefits. Your date of entitlement could be up to a year before you applied for SSDI.

Because it can take a year or two to be approved for disability benefits, 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's no waiting period—you'll get Medicaid as soon as you're approved for SSI. In other states, you need to apply separately for Medicaid, but there's no waiting period. If you're approved for SSI, your Medicaid benefits will start immediately.

Can You Automatically Get Medicaid With SSI Where You Live?

If you live in one of the many states where Medicaid eligibility is automatic for SSI recipients, the Social Security Administration (SSA) will handle your enrollment in the healthcare program. After you receive your SSI award letter from Social Security, your state Medicaid office will contact you with information.

The states that automatically offer Medicaid benefits to SSI recipients are:






Rhode Island



South Carolina



South Dakota











New Jersey



New Mexico

West Virginia


New York



North Carolina




Which States Use SSI Standards, but Require a Separate Medicaid Application?

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're approved for SSI. To be enrolled in the Medicaid program, you must file a separate application with the state Medicaid agency.

These states, called "SSI criteria states," include:








Which States Use Their Own Criteria for Granting Medicaid?

The remaining states don't automatically grant Medicaid to people with disabilities just because they qualify for SSI. Instead, these states use their own criteria to decide who's eligible for Medicaid. The state requirements for Medicaid can differ from Social Security's in any of the following ways:

  • income limits that are higher or lower than SSI income limits
  • asset limits that differ from SSI's, or
  • different requirements for what qualifies someone as disabled.

In most of these states, the income limits for Medicaid aren't too different from the income limit for SSI—but some count income differently than the SSI program does.

Some use the same resource (asset) limit as SSI—although several have lower asset limits, preventing some people who qualify for SSI from qualifying for Medicaid. And a couple of states have a higher asset limit, which allows 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. This legislation prevents states from making their Medicaid eligibility criteria stricter than the criteria that 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 following are the 209(b) states:






New Hampshire

North Dakota



No matter what the state's Medicaid income limit is, these 209(b) states must let you deduct your medical expenses from your income before determining if your income is low enough to qualify for Medicaid (called "spending down"). Under the "spend down" programs in these states, SSI recipients with high medical bills will qualify for Medicaid.

Note that some states also have a separate Medicaid program for the "medically needy" that also allows participants to spend down to meet income limits. In most 209(b) states, the 209(b) income limits for Medicaid are higher than the income limits for these medically needy programs.

If you're an SSI recipient in a 209(b) state, you're allowed to spend down even if your state doesn't have a "medically needy" program. And if your state does have one and you're getting SSI, you only have to spend down to the 209(b) income standard—not the generally lower medically needy income limit (MNIL).

If You Get Disability, Can You Get Both Medicare and Medicaid?

Since Medicaid is a need-based program, whether or not you can get it will always depend on how much income and assets you have. Some Social Security disability recipients do qualify for Medicaid, while others don't.

If you're getting both SSDI and SSI benefits (called concurrent benefits), you'll generally also be able to get Medicaid for the first two years. After that, you'll become eligible for Medicare coverage, and you should qualify for one of the Medicare savings programs to cover all or part of your premiums and co-pays.

If you're only getting SSI disability benefits, you'll generally only qualify for Medicaid. But once you turn 65 (or if you have end-stage renal disease), you'll be eligible for Medicare. If your income and assets remain low enough, you might keep Medicaid as secondary insurance (to cover the out-of-pocket health care costs not covered by Medicare).

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 other state—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.

Learn more about how to appeal if your Medicaid application was denied.

Updated January 30, 2023

Talk to a Disability Lawyer

Need a lawyer? Start here.

How it Works

  1. Briefly tell us about your case
  2. Provide your contact information
  3. Choose attorneys to contact you
Boost Your Chance of Being Approved

Get the Compensation You Deserve

Our experts have helped thousands like you get cash benefits.

How It Works

  1. Briefly tell us about your case
  2. Provide your contact information
  3. Choose attorneys to contact you