The amount of SSDI the youth now receives may be low enough to allow for a smaller SSI payment to continue. In 41 states, the District of Columbia, and the Northern Mariana Islands an SSI recipient is automatically eligible for Medicaid. In most of those states, there is no need for a separate Medicaid application. In eight states (Alaska, Idaho, Kansas, Nebraska, Nevada, Oklahoma, Oregon, and Utah) and the Northern Mariana Islands a separate Medicaid application is required and then SSI payment status is enough to establish Medicaid eligibility.
Medicaid in the Section 209(b) States: Medicaid is not automatic for SSI recipients in these nine states. It is determined using state-specific eligibility criteria. These states include: Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Oklahoma, and Virginia. VR counselors should become familiar with state specific eligibility criteria for youth if they are in one of these states.
- Other Potential Medicaid Options
If the youth does not retain SSI after SSDI payments begin, retains SSI but lives in a 209(b) state, or initially retains SSI but then loses it due to work and budgeted wages, the youth may qualify for Medicaid through another pathway to eligibility.
The optional “medically needy” spend-down or share-of-cost program exists in two thirds of the states. It is for individuals with high medical costs and too much income to qualify for Medicaid through SSI status or through another pathway available in their state. In 209(b) states, this program is mandatory and individuals who are blind or disabled must be given the opportunity to spend down to the medically needy level. States set their own income and resource eligibility thresholds. At state option, the state can use a period of one to six months for determining an individual’s spend-down.
Example: KP gets monthly SSDI of $920 which is too much to qualify for SSI. After excluding $20 of KP’s income under state rules, she is still $100 above her state’s medically needy eligibility threshold and she will face a $100 per month spend down. KP can establish Medicaid eligibility after paying for or incurring at least $100 in qualified medical bills. Some states may also allow her to pay $100 each month to the Medicaid agency to meet her spend down.
The 1619(b) work incentive is available in every state and allows former SSI recipients to retain Medicaid if: they lost SSI through countable earned income; they have annual earnings below their state’s unique eligibility threshold; and other eligibility criteria are met. See our Print and Go Tip Sheet, The Section 1619(b) Work Incentive: Keeping Medicaid after SSI Payments End through Work and Wages.
The optional Medicaid Buy-In for working individuals. More than 40 states have established a Medicaid Buy-In program. It will be known by different names in different states. See our Print and Go Tip Sheet, The Optional Medicaid Buy-In (MBI) for Working Individuals Program.
Social Security Childhood Disability Benefit (CDB) recipient, who lose SSI upon eligibility for CDB or when their CDB payment increases, may be eligible for continued Medicaid if he or she would still be eligible for SSI if the CDB payment or the recent increase is excluded from countable income. This provision, section 1634(c) of the Social Security Act, always applies to exclude the CDB or the CDB increase in the 41 states where Medicaid is automatic for SSI recipients. In the nine 209(b) states (see above), the state may or may not follow SSI rules, including this rule, to determine countable income. VR counselors who reside in a 209(b) state should check with their Medicaid agency to determine if this special rule applies in their state.
Medicaid Waivers: Every state has one or more of the optional Home and Community Based Services (HCBS) waivers which have been approved by the federal Centers for Medicare and Medicaid Services. HCBS waivers often target a particular disability group, such as individuals with traumatic brain injuries or those with intellectual disabilities. Often an HCBS waiver program will waive financial eligibility rules, e.g., establishing is higher income eligibility threshold than that used in the regular Medicaid program; or ignoring parental income and resources for a minor child even though regular Medicaid rules would count that income and resources. When eligible for a waiver, a youth may get a range of services not available through the regular State Medicaid program, potentially including things like job coaching services, home modifications, or vehicle modifications. VR counselors can check with their State Medicaid Program to see what HCBS waivers (or other waivers) the state offers.