Arthritis Benefits in Virginia: 2025 Guide

To qualify for federal disability benefits (SSI or SSDI) with arthritis, your condition must be severe enough to prevent you from doing substantial work for at least 12 months. The Social Security Administration (SSA) uses a five-step process to decide eligibility:

• Step 1: Current Work Activity – If you earn more than the Substantial Gainful Activity (SGA) limit ($1,620/month in 2025 for non-blind individuals), you generally won’t qualify unless you qualify for work incentives.
• Step 2: Severity of Condition – Arthritis must significantly limit your ability to do basic work activities.
• Step 3: Medical Listings Match – If your arthritis meets or equals the criteria in SSA’s Listing of Impairments, you may be approved automatically.
• Step 4: Past Relevant Work – The SSA checks if you can do work you’ve done in the past 15 years.
• Step 5: Other Work Capacity – If you can’t do past work, the SSA decides if you can adjust to other work based on your age, education, and skills.

You must also meet non-medical requirements, such as income and resource limits for SSI, or work credits for SSDI [1][3][4][5][7].

Virginia does not add a state supplement to federal SSI payments, so SSI recipients receive only the federal amount: $943/month for individuals and $1,415/month for couples in 2025 [1]. For SSDI, payment amounts depend on your work history and earnings, not your state of residence.

Virginia offers Medicaid waivers for people with disabilities, including those with arthritis who need home and community-based services. The main waivers are the Community Living (CL) Waiver, Building Independence Waiver, and Family & Individual Support Waiver. These programs help with supports like personal care, home modifications, and respite care, but there is a waiting list and slots are assigned based on urgency of need [2].

To qualify for a Medicaid waiver, you must meet both federal disability criteria and Virginia’s eligibility requirements, which include functional limitations and financial need. Contact your local Community Services Board (CSB) to start the application process [2].

• Gather medical records showing your arthritis diagnosis and how it limits your daily activities.
• Apply for SSI or SSDI online at SSA.gov, by phone, or at a local Social Security office.
• If you need Medicaid waiver services, contact your local Community Services Board (CSB) to start the process.
• Report any changes in income or health to avoid overpayments [1][2][5].

• Step 1: Collect Medical Evidence – Get records from your doctors, including diagnosis, treatment history, and how arthritis affects your ability to work and do daily activities.
• Step 2: Apply for SSI/SSDI – Go to SSA.gov and fill out the online application, or call Social Security at 1-800-772-1213. You’ll need to provide personal, medical, and work history information.
• Step 3: Wait for a Decision – The Disability Determination Services (DDS) in Virginia will review your application using the five-step process. This can take several months.
• Step 4: Apply for Medicaid Waivers – If you need home and community-based services, contact your local CSB. They will help you apply for a waiver and determine your eligibility based on need and urgency.
• Step 5: Report Changes – If your income, health, or living situation changes, report it to Social Security and Medicaid to avoid overpayments or loss of benefits [1][2][5].

• SSI (Supplemental Security Income) – Provides monthly cash payments to people with limited income and resources who have a disability, including arthritis.
• SSDI (Social Security Disability Insurance) – Provides monthly payments to people who have worked and paid Social Security taxes but can no longer work due to a disability like arthritis.
• Medicare – Available to most SSDI recipients after a 24-month waiting period.
• Medicaid – Available to some SSI recipients and those with low income and resources, including those with arthritis.
• Work Incentives – Programs that help people with disabilities, including arthritis, test returning to work without losing all benefits [1][3][4][5][7].

• Community Living (CL) Waiver – Provides home and community-based services for people with disabilities, including arthritis, who need ongoing support.
• Building Independence Waiver – For adults 18+ who can live mostly independently but need some support.
• Family & Individual Support Waiver – For children and adults who may live with family or in their own homes and need functional, behavioral, or medical supports.
• Virginia Medicaid – Covers medical care and some home and community-based services for eligible people with disabilities, including arthritis.
• ABLE Accounts – Tax-advantaged savings accounts for people with disabilities, including arthritis, to save for disability-related expenses without losing benefits [2].

Virginia residents with arthritis may qualify for an ABLE account if their disability began before age 26. ABLE accounts let you save money for disability-related expenses without affecting SSI, Medicaid, or other benefits. Withdrawals for qualified expenses are tax-free. Learn more about Virginia ABLE accounts and how to open one [internal_link_ABLE_Accounts].

• SSI Income Limits (2025): $943/month for individuals, $1,415/month for couples (federal only, no state supplement in Virginia).
• SSDI Substantial Gainful Activity (SGA) Limit (2025): $1,620/month for non-blind individuals, $2,700/month for blind individuals.
• Medicaid Income Limits: Vary by program and household size; generally, SSI recipients automatically qualify for Medicaid in Virginia.
• ABLE Account Limits: $17,000/year in contributions, $100,000 in account balance before SSI is affected.

If your income, health, or living situation changes, you must report it to Social Security and Medicaid. Failing to report changes can lead to overpayments, which you may have to repay. Use the SSA’s online portal or call your local office to report changes. For Medicaid, report changes to your local Community Services Board [internal_link_Avoiding_Overpayments_Reporting_Changes].

• Social Security Administration
  Phone: 1-800-772-1213

  TTY: 1-800-325-0778

  Hours: 8:30am–5:00pm ET

  Website

  For SSI/SSDI questions and applications.
• Virginia Department of Medical Assistance Services
  Phone: (804) 786-3921

  TTY: (804) 371-8977

  Email: [email protected]

  Hours: 8:30am–5:00pm ET

  Website

  For Medicaid waiver questions.

• Can arthritis qualify me for disability benefits in Virginia?

  Yes, if your arthritis is severe enough to prevent you from doing substantial work for at least 12 months, you may qualify for SSI or SSDI. You must provide medical evidence showing how arthritis limits your daily activities and ability to work [1][5].

• How much does SSI pay for arthritis in Virginia?

  In Virginia, SSI pays $943/month for individuals and $1,415/month for couples in 2025. Virginia does not add a state supplement to the federal SSI amount [1].

• What is the SSDI income limit for arthritis in Virginia?

  The SSDI Substantial Gainful Activity (SGA) limit is $1,620/month for non-blind individuals in 2025. If you earn more than this, you generally won’t qualify for SSDI unless you qualify for work incentives [3][4][7].

• Can I get Medicaid if I have arthritis in Virginia?

  Yes, if you qualify for SSI or meet Medicaid’s income and disability requirements, you can get Medicaid in Virginia. Medicaid covers medical care and some home and community-based services for people with arthritis [2].

• What Medicaid waivers are available for arthritis in Virginia?

  Virginia offers the Community Living, Building Independence, and Family & Individual Support waivers. These provide home and community-based services for people with disabilities, including arthritis, who need ongoing support [2].

• How do I apply for Medicaid waivers for arthritis in Virginia?

  Contact your local Community Services Board (CSB) to apply for Medicaid waivers. They will help you start the process and determine your eligibility based on need and urgency [2].