How to Qualify for Medicaid and Keep Your Health Coverage

For many people with disabilities, Medicaid is essential for accessing affordable healthcare, covering doctor visits, prescriptions, and long-term care. However, eligibility rules can be complex, especially when receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). This guide will help you understand how to qualify for Medicaid, maintain coverage, and navigate changes in your income or disability status.

What is Medicaid?

Medicaid is a federal and state program that provides free or low-cost healthcare to low-income individuals, including people with disabilities. Coverage varies by state, but Medicaid typically includes:

• Doctor visits, hospital stays, and preventive care

• Prescription medications

• Durable medical equipment

• Home health services and long-term care

• Mental health and substance use treatment

How to Qualify for Medicaid

1. Qualifying for Medicaid Through SSI

If you receive SSI, you may automatically qualify for Medicaid in many states. This means you do not need to submit a separate application.

• Automatic Medicaid States: In most states, SSI recipients are automatically enrolled in Medicaid upon approval.

• Application Required States: In states like Connecticut, Minnesota, Ohio, and Hawaii, you must apply for Medicaid separately.

2. Qualifying for Medicaid Through Expanded Eligibility (Non-SSI Recipients)

If you do not receive SSI, you can still qualify for Medicaid if your income is below a certain limit, which varies by state.

• Medicaid Expansion (ACA States): Under the Affordable Care Act (ACA), many states expanded Medicaid to cover low-income adults earning up to 138% of the Federal Poverty Level (FPL).

• Medically Needy Programs: If your income is too high but you have significant medical expenses, some states allow you to “spend down” excess income to qualify.

3. Qualifying for Medicaid While on SSDI

Unlike SSI, SSDI does not automatically qualify you for Medicaid. Instead:

• You will qualify for Medicare after 24 months of SSDI benefits.

• If your income is low, you may still qualify for Medicaid as a dual-eligible beneficiary (meaning you receive both Medicare and Medicaid).

Keeping Medicaid Coverage While Working (1619(b))

If you receive SSI and start working, you may worry about losing Medicaid. Fortunately, Section 1619(b) allows individuals to keep Medicaid even if their earnings exceed SSI limits, as long as they remain below their state’s Medicaid threshold.

1619(b) Eligibility Requirements:

• You must have received SSI benefits in at least one prior month.

• You still meet SSI’s disability criteria.

• Your earned income remains below your state’s Medicaid threshold (varies by state, often over $50,000 per year in some cases).

• You continue to need Medicaid for healthcare services.

How to Maintain Medicaid When SSDI or Income Increases

If your income increases due to work or SSDI payments, here are some options to keep Medicaid:

• Medicaid Buy-In Programs – Some states allow people with disabilities to pay a premium to keep Medicaid even with higher income.

• Medically Needy (Spend-Down) Programs – If your income is above Medicaid limits but you have high medical bills, you may still qualify by spending down your income.

• Dual Eligibility (Medicare & Medicaid) – If you qualify for Medicare and Medicaid, Medicaid can help cover premiums, deductibles, and co-pays.

How to Apply for Medicaid

If you need to apply for Medicaid, follow these steps:

• Check your state’s Medicaid eligibility rules at Medicaid.gov.

• Apply online through the Health Insurance Marketplace at Healthcare.gov.

• Contact your state’s Medicaid office for a paper or in-person application.

• Provide required documents such as proof of income, disability status, and identity.

Stay Covered and Informed

Medicaid eligibility rules can change, and income adjustments may impact your coverage. Always report income changes promptly and explore available work incentives and state-specific programs to ensure uninterrupted healthcare.

How Purple Can Help

Navigating Medicaid eligibility alongside SSI and SSDI can be complicated. Purple helps you track your income, stay informed about benefit thresholds, and avoid coverage interruptions.

Get started with Purple today and take control of your healthcare and benefits!