What Conditions Qualify As A Disability
No matter whether you have SSI, SSDI, Medicaid, ABD Medicaid or Medicare, the medical requirements are the same. First, you must meet the non-medical disability requirements. These are based mainly on your work history and social security taxes youve paid. Then, monthly disability benefits are paid if a medical condition is expected to last at least 1 year or result in death.
Different types of medical conditions that qualify as a disability for adults over age 18 are listed in the chart below. Note that the chart shows a general list. It doesnt include every condition that may qualify adults for social security disability. For a full list of qualifying conditions visit the Social Security Administration website Theres also a separate childhood listing that shows impairments for children with disabilities.
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How Benefit Payments Could Be Delayed
If the U.S. were to default on its debt, it would be unprecedented.
The big question is whether the Treasury Department would be able to prioritize what does and does not get paid if that occurs.
Unlike a government shutdown, where Social Security and Medicare benefits continue to flow, that may not be the case with a default, according to Adcock.
“There’s a good chance that benefits for retirees and people with disabilities and survivors would be disrupted,” he said.
Even a short delay could interfere with beneficiaries’ ability to pay for health care, food, rent, utilities or other necessary expenses, the National Committee to Preserve Social Security and Medicare said in a statement on Thursday.
The Treasury Department may be able to prioritize some payments, and that would include Social Security, said Jason Fichtner, chief economist at the Bipartisan Policy Center who previously served in several senior roles at the Social Security Administration.
However, the Social Security Administration may delay payments to ensure it has enough cash on hand, he said.
Meanwhile, Medicare payments may fluctuate, while other areas like federal employee salaries and food benefits through SNAP may stop. The process may be politically “messy,” Fichtner said.
“Social Security I’m sure will get paid, interest on the debt will get paid,” he said. “After that, flip a coin, who gets paid?”
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If You Get Ssdi Benefits And Are In A 24
- You may be able to get Medicaid coverage while you wait. You can apply 2 ways:
- Create an account or log in to complete an application. Answer âyesâ when asked if you have a disability. Weâll forward your application to your state Medicaid agency.
- Apply directly to your state Medicaid agency. Select your state from the menu on this Medicaid page for contact information.
What Are The Ssdi Income Limits For Medicaid
When it comes to counting income, Medicaid uses the same standards as the Affordable Care Act for what counts as income: modified adjusted gross income . MAGI includes all Social Security disability benefits, even though not all Social Security disability benefits are taxed by the IRS.
Many states limit SSDI income for Medicaid applicants to about $1,500 per month . Applicants should be aware, however, that states can have special rules that impact how Medicaid determines eligibility.
Fortunately, there are a few programs that can offer a way for some disabled adults who are over-income for Medicaid to qualify while they wait for Medicare coverage.
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Medicaid For Children & Adults With Disabilities
Medicaid can provide free or low-cost health care and long-term services and supports to low-income children and adults with disabilities.
Children and adults with disabilities who get Medicaid usually are in one or more of the following groups:
- They have little or no money.
- They get Supplemental Security Income. In Texas, people on SSI can automatically get Medicaid.
- They “buy-in” to Medicaid through the Medicaid Buy-In for Adults or Medicaid Buy-In for Children programs.
- They could be or have been placed in a nursing facility or care facility for people with intellectual disabilities.
- They already get home and community-based services through a waiver program like Home and Community-based Services or Texas Home Living .
To get Medicaid, you must be a Texas resident and a U.S. citizen or qualified non-citizen. When you apply, we’ll ask about your income, your age, and your disability status to see if you qualify.
Can I Be Covered By Both Medicare And Medicaid
It is possible to be eligible and covered by both Medicare and Medicaid. Within health care, it is known as being dual eligible. Typically, these individuals will be enrolled in Original Medicare but receive subsidized Medicaid benefits through Medicare Savings Programs such as the:
- Qualified Medicare Beneficiary Program
- Specified Low-Income Medicare Beneficiary Program
- Qualified Disabled and Working Individual Program
All of these programs would provide extra help for covering premiums, deductibles and coinsurance for Medicare.
If you dont qualify for Medicaid when you are enrolled in Medicare, there are still options to help provide financial aid for Part A, B and D deductibles. This would include enrolling in a supplemental Medigap policy such as Medicare Part F, which is offered by private health insurance companies.
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Q Can I Have Both Medicaid And Medicare At The Same Time
A. It depends. If you receive Supplemental Security Income from the Social Security Administration, you are automatically eligible for Medicaid and often receive Medicare as well. If you receive both Medicaid and Medicare, Medicaid will pay your Medicare premium, co-payments and deductibles. If you have both Medicare and Medicaid, you should show both cards to your medical care provider each time you receive services. Resources for Those Who Have Medicare and Full-Benefit Medicaid
What Will Happen To Health Care Providers If A Majority Of Their Patients/residents No Longer Have A Payer Source
We expect this will have an impact on any provider who serves Medicaid patients. This is a major concern for the Department not only for now but for the future, as there is a possibility that some providers may go out of business and not be able to reopen if they lose Medicaid patients for as little as a month.
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Health Coverage For People With Disabilities
If you have a disability, you have three options for health coverage through the government.
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Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply.
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Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease . Learn about eligibility, how to apply and coverage.
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Affordable Care Act Marketplace offers options to people who have a disability, dont qualify for disability benefits, and need health coverage. Learn about the .
Medicaid Or Va Benefits: Which Is Better
The type of care a person requires is usually the major deciding factor between choosing Medicaid or a VA pension.
Generally, for those needing home care or assisted living, VA benefits are better. For those who need nursing-home care, Medicaid is usually better. That is because Medicaid will usually cover the full cost of a nursing home, while VA benefits will only cover a portion. In 2020, the median monthly nursing home cost was $7,756.
Depending on the situation, the VA may also pay all or part of the cost of a private nursing home. However, in most cases, the VA will only pay a portion of the cost, with the veteran making up the difference through personal funds or insurance.
Medicaid payments are sent directly to the health-care provider, while VA benefits are usually paid directly to the eligible beneficiaries.
While Medicaid will cover the full cost of residential long-term care, in many states most long-term care facilities only accept a limited number of Medicaid patients. This means that even if someone is approved for Medicaid benefits, they may wait a very long time for an opening.
VA provides in-home health care if it is medically required, as well as services like adult day care and hospice care for all veterans eligible for VA medical benefits. Veterans with certain disabilities may also be eligible for nursing home care from the VA or state.
See: VA Long Term Care Payment Options
See: Nursing Home Care From the VA
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Medicaid As Secondary Insurance
Can you use Medicaid as a secondary insurance? If you take your employers insurance or you have private coverage, you might still have trouble paying deductibles and co-pays. But qualified low-income families and individuals might be able to cover co-pays, deductibles, and insurance premiums by using Medicaid as a secondary insurance.
Just keep in mind that Medicaid is always the last resort payer if you have coverage through another agency. Secondary payers usually cover the smaller amount, like coinsurance or co-pay, while primary insurance covers the bigger costs.
How Do I Apply For Ssi
SSI is not a state program. There are three ways you can apply for SSI through the Social Security Administration with the federal government:
- In person: To find the closest Social Security office, call or go online.
- Online:
The easiest way to get direct information on applying for SSI is to go in person to an SSA office. Sometimes call wait times can be long and we recommend you go in person if possible.
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What The Arc Is Doing
Medicaid is critical for people with I/DD and their families providing benefits, supports, and civil rights protections that help make community living possible and it is a top priority for The Arc.
Our Policy GoalsThe Arcs Public Policy Goals include many recommendations on how to protect, strengthen, and expand Medicaid to better meet the needs of people with I/DD. We believe in maintaining individual entitlement to a full range of Medicaid health and long term supports and services for all eligible children and adults with disabilities regardless of employment status, time limits, or other caps. We oppose Medicaid deconstruction or any moves to provide states with flexibility that eliminates basic protections for eligible individuals. We also oppose the imposition of entitlement caps, Medicaid block grants, per capita caps, allocations, allotments, limiting provider taxes, and other proposals that shift costs to states or other mechanisms that cause reductions in eligibility, services, or protections.
Our Coalition WorkThe CCD LTSS Task Force, which The Arc co-chairs, works with Congress and the Department of Health and Human Services to support expansion of LTSS and oppose efforts to repeal, weaken, or block implementation of relevant LTSS provisions.
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Ssdi And Supplemental Security Income
Like Medicaid and Medicare, SSDI and SSI are two separate, government-run programs with their own qualifications. While both provide benefits to disabled individuals, eligibility for the programs differs:
- SSDI SSDI recipients qualify based on work credits earned through Social Security income taxes. In general, beneficiaries must have a minimum of 20 credits, or about five years of work, to qualify.
- SSI SSI beneficiaries do not need work credits. Instead, eligibility is needs-based and open to individuals with minimal income and resources. In many states, SSI recipients automatically qualify for Medicaid.
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What If Iwas Approved For Ssi But Denied Medicaid
If you receive SSI but were denied Medicaid benefits in a 209state or any state for that matter, you should appeal the decision to yourstates Medicaid agency. Your state has to follow certain federal Medicaidrules in notifying you of the denial and holding a hearing. To learn more, readNolos article on appealinga Medicaid denial.
You could be eligible for up to $3,148 per month in SSDI benefits
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Did The Affordable Care Act Affect Medicaid Eligibility For Ssdi Recipients
Many more people became eligible for Medicaid because the federal Affordable Care Act encouraged states to raise the income cutoff for Medicaid to 133% of the federal poverty level. In addition, the ACA overhauled the way states count income and assets for Medicaid eligibility. The changes allowed more low-income SSDI recipients to qualify for Medicaid during the 24-month Medicare waiting period.
But as of 2022, twelve states haven’t expanded Medicaid coverage, including:
The higher Medicaid income limits and other changes under ACA only apply to residents of D.C. and the other 38 statesthose that have expanded Medicaid coverage.
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Special Home And Community
The Special Home and Community-Based Services Waiver Group eligibility pathway allows states to extend Medicaid eligibility to individuals receiving HCBS under a waiver program87 who require the level of care provided by a nursing facility or other medical institution.88 This eligibility pathway is sometimes referred to as the 217 Group in reference to the specific regulatory section for this group, 42 C.F.R. Section 435.217. States use the highest income and resource standard of a separate eligibility group covered by the state plan under which an individual would otherwise qualify if institutionalized. For example, states that offer the Special Income Level pathway described above can extend eligibility to waiver program participants with income up to 300% of the SSI FBR. States must use the income- and resource-counting methodologies used to determine eligibility for this same eligibility group. States may also apply Section 1902s more liberal income-counting rules to this group.
Find Out How Ssdi Affects Medicaid Eligibility In Your State
With each state setting its own income limits, just how much disability you can get and still qualify for Medicaid depends on where you live. And the medical assistance programs that might be available to you during the 24-month Medicare waiting period also vary from state to state. But the bottom line is that your SSDI benefits will count as income for Medicaid eligibility no matter where you live.
Check with your state’s Medicaid agency to see if you qualify for any medical assistance programs. You can find the website for your state’s agency by selecting your state from the map on the Medicaid website.
If you applied for Medicaid and were denied coverage because of financial ineligibility, you have the right to appeal the Medicaid denial.
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In Addition To Eligibility Arent There Going To Be Program Cuts Or Eliminations
Yes. Several Medicaid services also may end. These include:
- Pediatric Day Health Care program that serves medically fragile children from birth up to age 21 may be eliminated.
- Community Psychiatric Support and Treatment and Psychosocial Rehabilitation may be eliminated for people age 21 and older with serious mental illness.
- Outpatient drug and alcohol treatment services may be reduced for people with a Substance Use Disorder.
- Ambulatory, or same day surgery services may be eliminated.
What Disabilities Qualify For Medicare
In some cases, individuals under 65 may qualify for Medicare if they have certain disabilities. Depending on the disability, there may be a 24-month waiting period before individuals can enroll in Parts A and B.
You can qualify for Medicare if youre under 65 and you have:
- Amyotrophic lateral sclerosis
- Qualified for Social Security retirement benefits and received Social Security Disability Insurance for 24 months
- Qualified for certain disability benefits from the Railroad Retirement Board for 24 months
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Child Disability Starter Kit
What You Should Know Before You Apply for SSI Disability Benefits for a Child
Children from birth up to age 18 may get Supplemental Security Income benefits. They must be disabled and they must have little or no income and resources. Here are answers to some questions people ask about applying for SSI for children.
How does Social Security decide if a child is disabled?
Social Security has a strict definition of disability for children.
- The child must have a physical or mental condition that very seriously limits his or her activities and
- The condition must have lasted, or be expected to last, at least 1 year or result in death.
A state agency makes the disability decision. They review the information you give us. They will also ask for information from medical and school sources and other people who know about the child.
If the state agency needs more information, they will arrange an examination or test for the child, which we will pay for.
How does Social Security decide if a child can get SSI?
Children can get SSI if they meet Social Securitys definition of disability for children and if they have little or no income and resources. We also consider the familys household income, resources and other personal information.
How will I know what Social Security has decided?
We will send you a letter. It can take 3 to 5 months to decide a childs SSI disability claim. Let us know if your address or telephone number changes so that we can get in touch with you.
Medicaid
