Do You Automatically Qualify for Medicaid With a Disability? What You Need to Know

Do you have a disability and need healthcare coverage? You aren’t alone. About 14 percent of people enrolled in Medicaid have a disability.

Many people ask, “Do you automatically qualify for Medicaid with a disability?” Each state administers its own Medicaid program. Most states grant automatic Medicaid eligibility to Social Security Disability recipients.

In other states, individuals must apply and prove eligibility to get Medicaid. Thus, it’s important to speak with your local office to learn about your state’s rules.

Qualifying for Medicaid with a disability involves several factors and options. Keep reading to find answers to your questions.

What Qualifies as a Disability?

Disability beneficiaries include a varied group of people. Those under the age of 65 may qualify if they’ve had a disabling condition since birth. It also includes people with an injury or illness causing decreased functional ability.

The term disability refers to physical, developmental, mental, or behavioral problems. Is it difficult for you to perform normal activities of daily living without help? If so, you may qualify for disability and Medicaid assistance.

Understanding SSA Benefits

If you or a family member has a disability, you may get help from the Social Security Administration (SSA). There are two types of benefit plans.

Supplemental Security Income (SSI)

SSI helps older adults and persons with disabilities of any age. Its purpose is to provide minimal basic financial help. These individuals must have minimal resources and income.

Social Security Disability Insurance (SSDI)

To qualify for SSA benefits, you must earn the minimum work credits required by SSA. Work credits come from the “Social Security Withholding” from your paycheck.

This SSA qualification may result from your own employment or a family member’s employment. If you become disabled, then you may receive SSDI support.

What Is the Difference Between Medicare and Medicaid?

It’s important to know the difference between Medicaid and Medicare. Each state oversees its Medicaid program. It’s designed to help Americans of any age who have low income.

The government-run federal health care entitlement program is Medicare. It serves Americans aged 65 and over who paid into the fund while working. Today, about 36.5 percent of Americans get Medicaid or Medicare benefits.

An In-Depth Look at Medicaid

Medicaid isn’t concerned with the person’s age, only their income. The federal government provides regulatory oversight. Yet, state and local governments run the program.

The Health and Human Service’s current federal poverty income for a single person is $12,880. In a household, each extra member increases this level by $4,540.

Each state sets a threshold for the individual or family’s income to qualify. Most states have expanded Medicaid coverage. This qualifies single adults for Medicaid if their income is at or below $17,744 a year.

Medicaid doesn’t charge monthly premiums or have annual deductibles. You may need to pay a small co-payment for some medical services.

Most medical services qualify for Medicaid coverage. Examples include hospitalizations, lab work, X-rays, family planning, clinical care, and midwives. It also covers nursing home and home health care.

Some states also offer coverage for dental and vision care as well as prescriptions.

Do You Automatically Qualify for Medicaid With a Disability?

Once you qualify for SSDI, most states grant automatic Medicaid services. In these states, you don’t have to submit forms or apply for Medicaid.

In other states, individuals must submit some form of an enrollment request. There are also states where SSI recipients don’t automatically qualify for Medicaid.

Do You Automatically Get Medicare and Medicaid With Disability?

If you have enough work credits and limited income and resources, you can get SSI and SSDI. Most states link Medicaid qualification to SSI benefits. Medicare, on the other hand, relates to Social Security benefits.

Thus, individuals can receive both Medicaid and Medicare. In fact, the state may pay your Medicare premiums.

SSDI recipients get free Medicare Part A which covers hospital expenses. Yet, you will need to pay monthly premiums for Part B to cover provider visits. The same is true for Part D, which pays for prescription drugs.

If you have trouble paying for Part B, D, or co-pays, there’s help available. The “Extra Help with Medicare Prescription Coverage” program assists low-income/resource individuals. 

This applies if you’re an SSI beneficiary and eligible for Medicaid. This pays Medicare premiums, deductibles, and co-payments, as well as prescription drug costs.

Unlike Medicaid, Medicare has a waiting period for people with disabilities. In most states, you must be qualified as an SSDI beneficiary for 24 months. After that time, you automatically qualify for Medicare.

The two-year count begins on the day you’re accepted for SSDI. Thus, even if circumstances cause a delay in payments, the clock has already started.

For some people, their medical condition gives them immediate access to Medicare. This includes people with permanent kidney failure. The person must need regular dialysis or a transplant.

Amyotrophic lateral sclerosis (ALS) is another automatic qualifying illness. This is often called Lou Gehrig’s disease.

Dental Coverage With Medicaid

Most low-income people find themselves focused on trying to get by each day. Seeing a dentist often isn’t a high priority. Without dental coverage, going to the dentist will only add to the pile of bills.

Importance of Dental Care

Visiting a dentist on a regular basis is vital to maintain oral and general health. Lack of dental care increases your risk of mouth infections and cardiovascular disease.

Poor oral hygiene can also impact your professional and personal interactions. Mouth infections cause halitosis (bad breath) which interferes with communication. Dental-related illnesses can result in lost time at work and reduced income.

It’s best to start routine dental cleanings and preventative services at a young age. Yet, statistics show that low-income families often lack access to dental care. Thus, they’re more prone to develop long-term dental problems.

Adult Eligibility

The good news is that Medicaid offers coverage for adult dental care. The specific benefits vary by state. Yet, thousands of low-income families receive free or low-cost benefits across the country.

Benefits may include teeth cleaning, dental X-rays, or even emergency surgery. If you live in a state that doesn’t offer the benefits you need, keep checking. These programs change from year to year based on funding.

Eligibility for Children

If a child is a Medicaid beneficiary, they’re able to receive dental coverage as well. Common minimal services include treating pain and infections and tooth restoration. They can also see a dentist for routine preventative oral health care.

Most Medicaid plans require a physician’s referral for the child to see a dentist. It’s important to find out about your state’s rules and eligibility requirements. Visit or your local Medicaid office.

Will Medicaid for People With Disabilities Stop if They Start Working?

If you receive SSDI and Medicaid and wish to return to work, you may wonder if you’ll lose benefits. The“Spotlight on Continued Medicaid Eligibility for People Who Work: Section 1619(b)” has this answer.

Disability Consideration

Are you disabled or blind and have Medicaid before starting work? If so, your coverage will continue most of the time.

There aren’t any age restrictions for this coverage. Yet, you must still have the disabling condition while working.

What if My Income Is Too High for SSI?

Some people worry that their income will disqualify them for SSI and Medicaid. Usually, you will continue to qualify for Medicaid if the following remains true:

  • You’re blind or disabled; and
  • Except for your income, you meet SSI eligibility rules; and
  • You qualify for at least one month of SSI payment before meeting SSA’s Section 1619; and
  • You met Medicaid eligibility in the month before qualifying for Section 1619; and
  • To be able to work, you need Medicaid

The last rule is that your work income can’t replace the value of your assistance. This includes Medicaid or SSI cash benefits. Your earning can’t cause the loss of publicly funded personal care related to your income.

Even if your earnings exceed the threshold, you may still qualify for help. For example, you may get Medicaid for special work or medical expenses.

Always notify the funding authorities if you accept a job or become self-employed. They’ll want to know when your job starts and stops and how many hours you plan to work.

Based on this information and your disability, they’ll grant you a trial work period for up to nine months. Be sure to tell them if you have expenses related to your disability, such as medications or a wheelchair. Make sure you tell them if these charges change as well.

Do You Have a Disability and Need Medical Coverage?

Many Americans today are struggling to make financial ends meet. The hardships have increased due to the pandemic. This article answered the question, “Do you automatically qualify for Medicaid with a disability?”

Federal, state, and local governments offer help to those with low income/resources. Individuals can get benefits from the SSA, Medicaid, and Medicare. Many businesses now offer programs to help those in need as well.