Automatic Medicaid Eligibility for Supplemental Security Income (SSI) Recipients
Recipients of Supplemental Security Income (SSI) are often eligible or even automatically qualify for Medicaid, making it much easier to receive Medicaid Long Term Care benefits like nursing home coverage and Home and Community Based Services waivers. This is known as an eligibility pathway to Medicaid, or the SSI pathway to Medicaid benefits.
How SSI and Medicaid are Linked
Supplemental Security Income (SSI) is a cash benefit provided through the federal government’s Social Security Administration to recipients who meet these criteria:
– SSI recipients are low-income, meaning they earn less than a certain amount every month and have assets whose total value falls under a specified limit
– SSI recipients are aged, blind, or disabled
In this way, SSI is quite similar to Medicaid, which also has income and asset limits. And for older individuals who need Medicaid Long Term Care benefits, like nursing home coverage or care services in their own home or assisted living community, there is a functional requirement as well, meaning that someone must demonstrate that they need the Medicaid Long Term Care benefits when they apply.
Because the criteria are so close, in fact, someone who is eligible for one program is often eligible for another. In most states, SSI recipients are automatically accepted into Medicaid, and in some of those states they don’t even need to apply for Medicaid because the application is the same.
There are additional steps to receive nursing home (institutional) Medicaid or HCBS waivers, described below, but the application process should move faster.
Eligibility Requirements for Medicaid and SSI
Supplemental Security Income has the same eligibility requirements for all Americans, whereas Medicaid eligibility rules are different depending on the state in which one resides. Despite the state variances, the criteria for acceptance often overlap.
For an applicant who is single to be eligible for SSI, their income in 2022 must be less than $841 per month. Married couples must have a combined income of less than $1,261 per month.
Medicaid eligibility criteria is very similar to SSI, but the important thing to know is that it can vary widely depending which state one lives in. Usually, Medicaid is for people who make less than $2,523 per month, but that figure might be different in your state.
Obviously, someone who earns $841 or less and qualifies for SSI would also be financially eligible for Medicaid.
While the income limits are usually three times higher for Medicaid than SSI, the asset limits are often the same: $2,000 for a single individual and $3,000 for a couple.
Countable assets for eligibility purposes often do not include one’s home or vehicle, but will include money in bank accounts. For more on which assets are countable and which are not, click here.
Physical / Functional Criteria
For Medicaid Long Term Care benefits—nursing home/institutional Medicaid and Home and Community Based Services (HCBS waivers)—there are physical or functional criteria as well. Because every state is different and there can be several variations of these programs in just one state, it’s very difficult to summarize exactly what those criteria are, but very generally one is evaluated for physical need before Medicaid will provide LTC benefits. For nursing home Medicaid, for example, an applicant needs to show that they require full-time nursing care and cannot live at home.
There are also some physical or functional requirements for SSI. Recipients must meet one of these requirements:
– Be 65 or older
– Be partially or fully blind
– Have a medical condition that impairs the ability to work
While someone who receives SSI is automatically financially eligible for state Medicaid benefits, the functional criteria element means there will be additional steps in order to receive Long Term Care (nursing home coverage and HCBS waivers). If you are accepted for SSI, in other words, state Medicaid offices will still evaluate for physical need before granting LTC benefits, because they are needs-based and therefore different from standard Medicaid coverage.
In Which States Do SSI Recipients Automatically Qualify for Medicaid?
Does receiving Supplemental Security Income automatically qualify one for Medicaid? Does automatic qualification mean that someone who receives SSI does not need to apply for Medicaid? It depends on the state. In order to receive Medicaid long term care benefits in a nursing home or through a Home and Community Based Services waiver, one will still need to be evaluated for functional need.
States where SSI recipients automatically qualify for Medicaid and don’t need to fill out a Medicaid application:
Alabama, Arizona, Arkansas, California, Colorado, Delaware, D.C., Florida, Georgia, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Montana, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.
In these states, people who are approved for SSI are enrolled in Medicaid by the Social Security Administration. When someone who resides in these states is accepted for SSI benefits, they’ll receive information with their SSI award letter that says they’ve also been enrolled in Medicaid.
To receive nursing home Medicaid or HCBS waivers, the additional step of being evaluated for functional need is necessary. For HCBS waivers, because they are not an entitlement, eligibility does not guarantee one can enroll in the program. More information on nursing home evaluations, and more for HCBS waivers.
States where SSI recipients qualify but still need to apply for Medicaid:
Alaska, Nebraska, Utah, Idaho, Nevada, Kansas, and Oregon.
In these states, after receiving a notification that SSI has been awarded, you can go through the process of applying for Medicaid knowing you’ll be accepted. Upon acceptance for SSI benefits, the Social Security Administration will provide information on how to apply for Medicaid and the process should move fairly quickly.
If you need to know how to apply for Medicaid, including how to apply for long term care benefits, click to find your nearest Medicaid office.
States where SSI does not guarantee Medicaid eligibility:
Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia.
In these states, income limits might be slightly different. Asset limits and the criteria for disability might also be different from SSI. Often, the Medicaid asset limit in these states is lower than the SSI asset limit. These states are sometimes called “209(b) states”.
Residents in these states should apply for Medicaid through the nearest office. Click here for contacts and guidance.