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SSI & Medicaid Eligibility

Supplemental Security Income (SSI) is a federally funded program that offers monthly cash payments to help support the basic needs of disabled people who have minimal or no income. Eligibility for SSI can include access to health insurance coverage through Medicaid. Beneficiaries of SSI who are able to work and whose earnings exceed the limits for cash assistance may maintain Medicaid coverage if several criteria are met.

  1. SSI Eligibility

    • SSI eligibility is dependent on several qualifying factors. Recipients of SSI must prove disabled status and have earnings below the designated income limits. Following acceptance of a Supplemental Income application, the applicant becomes eligible for Medicaid benefits. Beneficiaries whose earnings exceed the stated limits of SSI may continue Medicaid coverage providing that at least one month of cash assistance was received through Supplemental Security Income.

    Disabled Status

    • The Social Security Administration (SSA) defines disabled as a medically identified physical or mental impairment that impedes substantial or gainful action that would result in both profit and productivity. SSI and the corresponding Medicaid coverage require that the disability has lasted or is expected to last at least 12 months or may result in death. In order to receive continued Medicaid coverage the disability status requirement must be met.

    Income Requirements

    • A disabled person whose income exceeds the maximum allowed for SSI cash assistance (approximately $1000 per month) may continue Medicaid coverage if the reported income is not enough to support replacement of the monthly cash payment or Medicaid benefits. In that case, the beneficiary's income must not exceed threshold amounts as specified by Red Book, a publication provided by the Social Security Administration as a guide for the disabled who are employed. Both earned and unearned income is taken into consideration for the threshold test, as well as deemed income which refers to the income of a spouse or parents in the same household.

    Resources

    • Certain assets will be counted as resources and, combined with reported income, will be used to determine eligibility for Medicaid. Resources include cash on hand, accounts, stocks, bonds and property. Certain resources are allowable and are not considered in the determination for benefits such as the land and house in which the beneficiary resides, one vehicle per household or life insurance with a value of less than $1,500.

    Medicaid by State

    • Medicaid is a state administered program and qualifications vary from state to state. In 32 states, Medicaid eligibility is automatically granted upon acceptance of an SSI application. Several states, including Utah, Oregon, Nebraska, Kansas, Idaho and Alaska, adhere to the same standards of eligibility as stated by the Social Security Administration, but require a separate Medicaid application to be submitted. Other states utilize their own eligibility criterion which differs from that of the SSA. These states include Virginia, Oklahoma, Ohio, North Dakota, New Hampshire, Missouri, Minnesota, Indiana, Illinois, Hawaii and Connecticut.

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