Medicaid provides essential health coverage for millions on disability. Understanding how to qualify and keep coverage—especially when working—is crucial.
In this article, we'll cover:
- Medicaid eligibility basics
- SSI and automatic Medicaid
- Working and keeping Medicaid
- What to do if coverage is threatened
1. Medicaid Eligibility Basics
How to qualify:
- Income below state limits
- Meet categorical requirements
- Disability determination
- State residency
Who qualifies:
- SSI recipients (most states)
- Some SSDI recipients
- Low-income adults
- People with disabilities
What Medicaid covers:
- Doctor visits
- Hospital care
- Prescription drugs
- Long-term care
- Mental health services
Application:
- Apply through state Medicaid office
- Online options in many states
- Social services office
- Health insurance marketplace
Important: In most states, SSI recipients automatically qualify for Medicaid. But rules vary, so check your state.
2. SSI and Automatic Medicaid
Automatic coverage states:
- Most states give Medicaid with SSI
- No separate application needed
- Coverage starts with SSI
- Same eligibility rules
209(b) states:
- Some states have stricter rules
- May need separate application
- Different income/asset limits
- 11 states use this option
Check your state:
- Contact state Medicaid office
- Ask during SSI application
- Verify coverage status
- Understand your state's rules
SSDI and Medicare:
- SSDI leads to Medicare (after 24 months)
- Can have both Medicare and Medicaid
- Dual eligible status
- Coordination of benefits
3. Working and Keeping Medicaid
The 1619(b) provision:
- Continue Medicaid while working
- Even if SSI cash stops
- Must have been on SSI
- Need Medicaid to work
1619(b) requirements:
- Still meet disability definition
- Need Medicaid to work
- Meet state threshold amount
- Can't have enough to replace SSI/Medicaid
Medicaid Buy-In programs:
- Many states offer
- Working people with disabilities
- Pay small premium
- Keep coverage while earning
How it works:
- Report income to SSA
- SSA determines eligibility
- Medicaid continues
- Coverage protected
4. What to Do If Coverage Is Threatened
If you get termination notice:
- Read carefully for deadlines
- Understand the reason
- Appeal if appropriate
- Continue until resolved
Protecting coverage:
- Report changes on time
- Respond to all requests
- Keep documentation
- Know your rights
Appealing denials:
- File within deadline
- Request hearing
- Gather evidence
- Seek help from advocate
Emergency coverage:
- Ask about presumptive eligibility
- Community health centers
- Hospital financial assistance
- Prescription assistance programs
Special Situations
Losing SSI but keeping Medicaid:
- 1619(b) provision
- Medicaid Buy-In
- Continued eligibility possible
- Don't assume it ends
Moving to new state:
- Must reapply
- Different rules may apply
- Coverage may continue during transition
- Act quickly
Changes in income:
- Report promptly
- May affect eligibility
- Work incentives help
- Don't wait to report
How Purple Helps
Purple supports your benefit management:
- Track income easily
- Monitor resources
- Simple financial records
- Stay organized
- Understand your situation