Healthcare is one of the biggest concerns for people with disabilities. Medical appointments, prescriptions, therapies, and equipment can add up quickly—and most people on SSI are living on very limited income. The good news is that SSI and Medicaid are closely connected in most states, providing a healthcare safety net alongside your monthly cash benefit. Understanding exactly how this connection works can help you make the most of your coverage.
In this article, we'll cover:
- How SSI eligibility connects to Medicaid in most states
- States that handle the SSI-Medicaid connection differently
- What Medicaid typically covers for people with disabilities
- How losing or gaining SSI affects your Medicaid
- The difference between SSI/Medicaid and SSDI/Medicare
- Protecting your Medicaid coverage when your situation changes
The SSI-Medicaid Connection
In most states, qualifying for SSI automatically qualifies you for Medicaid. This is called the 1634 states arrangement (named after the relevant section of the Social Security Act).
How it works:
- SSI approval automatically satisfies Medicaid's income and resource requirements
- Your SSI approval letter essentially serves as your Medicaid enrollment
- No separate application or eligibility determination needed
- May still need to contact state Medicaid agency to get your card and choose a health plan
For people struggling with a disability and navigating the complex SSI application process, this automatic link is a significant benefit.
States That Do Things Differently
Not every state uses the automatic SSI-Medicaid connection.
209(b) States:
- Have their own Medicaid eligibility criteria
- May be more restrictive than SSI's standards
- As of 2025: Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia
In 209(b) states:
- You might qualify for SSI but need to apply separately for Medicaid
- You might not automatically qualify
- However, they must allow "spend down" of excess income through medical expenses
Other states (California, Nevada):
- State administers its own Medicaid eligibility process for SSI recipients
- May need additional paperwork with state Medicaid agency
- Eligibility still based on SSI status
What Medicaid Covers
Medicaid coverage varies by state, but generally provides comprehensive benefits.
Mandatory services (required by federal law):
- Inpatient and outpatient hospital care
- Physician services
- Laboratory and X-ray services
- Nursing facility services for adults
Common additional coverage:
- Prescription drugs
- Mental health services
- Physical and occupational therapy
- Medical equipment and supplies
- Vision and dental care
- Home and community-based services
Disability-specific programs:
- Personal care attendants
- Supported employment services
- Home modifications
For people with disabilities, Medicaid often covers services that private insurance wouldn't—or would cover only with significant copays and limitations.
What Happens If You Lose SSI
If you lose SSI eligibility, you might worry about losing Medicaid too. Several protections exist:
Section 1619(b): If you lose SSI because your earnings from work are too high, you can often continue receiving Medicaid as long as:
- You still meet the disability criteria
- Your earnings aren't high enough to replace SSI and Medicaid combined
- You have medical expenses that prevent you from affording private insurance
This provision encourages SSI recipients to work without fearing loss of vital healthcare.
Other options if you don't qualify for 1619(b):
- Medicaid buy-in programs for working people with disabilities
- Regular Medicaid based on income alone
- Check with your state Medicaid agency about all available options
SSI/Medicaid vs. SSDI/Medicare
SSI links to Medicaid:
- Typically automatic in most states
- Comprehensive coverage
- Free or very low-cost
- Often covers long-term care and home-based supports
SSDI links to Medicare:
- Coverage starts 24 months after SSDI benefits begin
- Two-year waiting period can leave people without affordable coverage
- Has premiums, deductibles, and copays
- Less comprehensive than Medicaid for many services
Dual eligibility:
- If you receive both SSI and SSDI (concurrent benefits), you may eventually have both Medicaid and Medicare
- Provides very comprehensive coverage
Protecting Your Healthcare Coverage
Because Medicaid is so valuable, plan carefully to maintain coverage:
If you're considering working:
- Explore 1619(b) and Medicaid buy-in programs first
- Don't assume you'll lose coverage
Stay current with paperwork:
- Keep contact information current with your state Medicaid agency
- Respond to renewal notices promptly
- Many states do annual renewals
If you do lose Medicaid:
- Act quickly
- Limited window to appeal or apply through different pathway
- Don't wait until you need medical care to figure out your coverage
How Purple Helps
Understanding how your benefits work together helps you make smarter financial decisions. Purple helps SSI recipients:
- Track resources and income
- Stay compliant with program rules
- Protect the benefits you depend on—including Medicaid coverage
- Get benefits up to 4 days early
- Manage finances with confidence