If you have fibromyalgia in Pennsylvania, you may qualify for federal disability benefits (SSI/SSDI), state Medicaid, or the Medical Assistance for Workers with Disabilities (MAWD) program. This guide explains eligibility, how to apply, income limits, work incentives, and where to get help—all tailored for Pennsylvanians with chronic pain and fatigue conditions like fibromyalgia.
To qualify for Social Security Disability Insurance (SSDI), you must have a significant work history and paid Social Security taxes. You also need a medical condition (like fibromyalgia) expected to last at least 12 months or result in death, preventing "substantial gainful activity." Supplemental Security Income (SSI) is for people with limited income and resources, regardless of work history. Both programs require your disability to severely limit your ability to work[2][6].
Pennsylvania residents with fibromyalgia may also qualify for state Medicaid or the Medical Assistance for Workers with Disabilities (MAWD) program. MAWD is for employed individuals ages 16–64 with a disability that meets Social Security standards, income under 250% of the federal poverty level, and resources under $10,000 (not counting your home or one car). There is a 5% monthly premium based on your income[3][4]. Medicaid (Medical Assistance) is automatically available to SSI recipients in Pennsylvania, providing immediate health coverage without the 24-month Medicare wait required for SSDI[1]. If your SSDI benefit is low, you might get "concurrent benefits" (both SSDI and SSI)[1].
Start your application as soon as your fibromyalgia limits your ability to work. Gather medical records, work history, proof of income, and contact information for your doctors. You can apply for SSI and SSDI online at SSA.gov, by phone at 1-800-772-1213, or at a local Social Security office[2]. For Pennsylvania Medicaid or MAWD, apply online at COMPASS, by phone, by mail, or in person at your County Assistance Office[4].
For SSI/SSDI:
For Pennsylvania Medicaid or MAWD:
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are the main federal disability programs for Pennsylvanians with fibromyalgia. SSDI is based on work history and taxes paid; SSI is needs-based with strict income and asset limits. Both require that your fibromyalgia severely limits your ability to work. In 2025, the average SSDI benefit is about $1,537/month, and the maximum SSI benefit is $943/month for an individual[1]. SSDI has a 24-month waiting period for Medicare; SSI recipients get Medicaid immediately in Pennsylvania[1]. You may qualify for both if your SSDI payment is low (called "concurrent benefits")[1].
Medical Assistance (Medicaid): In Pennsylvania, SSI recipients automatically qualify for Medicaid, which covers doctor visits, prescriptions, hospital stays, and more[1]. There are also Medicaid waiver programs (Home and Community-Based Services) for people who need long-term care at home.
Medical Assistance for Workers with Disabilities (MAWD): This unique Pennsylvania program helps people with fibromyalgia and other disabilities stay employed without losing health coverage. To qualify, you must be age 16–64, working, have a qualifying disability, income under 250% of the federal poverty level, and resources under $10,000 (excluding your home and one car). You’ll pay a 5% monthly premium based on your income[3][4]. MAWD covers a wide range of medical services, including mental health and rehabilitation[3].
ABLE Accounts: Pennsylvania residents can open ABLE accounts to save for disability-related expenses without affecting SSI or Medicaid eligibility[5].
Pennsylvania ABLE accounts allow you to save and invest money without losing eligibility for SSI, Medicaid, or other benefits, as long as the account balance stays under $100,000 (for SSI). Withdrawals for qualified disability expenses—like housing, education, transportation, and health care—are tax-free. You must have a disability that began before age 26 (expanding to age 46 in 2026)[5].
SSI: In 2025, the income limit is $943/month for an individual and $1,415/month for a couple. Countable resources must stay under $2,000 (individual) or $3,000 (couple)[1]. Medicaid (MAWD): Income must be under 250% of the federal poverty level (about $3,032/month for a single person in 2025), and resources under $10,000 (not including your home or one car)[3][4]. SSDI: No income or asset limits, but you cannot engage in "substantial gainful activity" (earning more than $1,550/month in 2025 during a trial work period)[1].
You must report any changes in income, work status, or living situation to the Social Security Administration and/or your County Assistance Office. Failing to report changes can lead to overpayments, which you may have to pay back. Keep records of all communications. If you receive too much in benefits, contact the agency immediately to arrange repayment. See our guide on avoiding overpayments for more details.
Fibromyalgia can be hard to prove for disability benefits. Gather all medical records, treatment plans, and statements from your doctors about how your condition limits your daily life and ability to work before you apply.
Pennsylvania’s MAWD program is unique—you can work, earn more, and still keep your Medicaid coverage by paying a small premium based on your income[3][4]. This is especially helpful if you can work part-time but still need health insurance.
Yes, both SSDI and SSI have work incentives. SSDI allows a "trial work period" (up to $1,550/month in 2025) without losing benefits. SSI reduces benefits as your earnings increase. The MAWD program lets you work and keep full Medicaid coverage if you meet income and disability rules[1][3].
You need detailed medical records showing diagnosis, symptoms, treatment history, and how fibromyalgia limits your daily activities and ability to work. Doctor’s notes, test results, and a history of treatments (like physical therapy or medications) are critical evidence.
SSDI is based on your work history and taxes paid; there are no income or asset limits. SSI is needs-based with strict income and asset limits. Some people with low SSDI payments may also qualify for SSI[1]. See our SSI vs SSDI guide for more details.
If you’re on SSI, your Medicaid continues as long as you meet SSI rules. With MAWD, you can earn up to 250% of the federal poverty level and keep Medicaid by paying a monthly premium. Always report income changes to avoid losing coverage[3][4].
Yes, with an ABLE account. You can save up to $100,000 without affecting SSI eligibility. Funds can be used for disability-related expenses, and growth is tax-free. The age of disability onset must be before 26 (expanding to 46 in 2026)[5].
This guide is for informational purposes only and is not legal or financial advice. Always consult with a qualified professional for personalized guidance.
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Many fibromyalgia claims are initially denied. You have the right to appeal, and providing more detailed medical evidence can help. Consider contacting an advocate or attorney for assistance.
Apply online at COMPASS, by phone at (866) 550-4355, by mail, or in person at your County Assistance Office. You’ll need proof of work, income, and disability[4].
Pennsylvania Medicaid covers doctor visits, prescriptions, mental health services, hospital stays, rehabilitation, and more. MAWD offers similar coverage for working people with disabilities[3].
SSI and Medicaid require periodic reviews. MAWD requires annual renewal and reporting of any changes in income, work, or living situation.
Contact your local Social Security office, County Assistance Office, or advocacy groups like Disability Rights Pennsylvania for free help[2][7].
