When you apply for supplemental security income (SSI), one of the main benefits in addition to disability coverage is Medicaid for medical coverage. Medicaid is a federal health program offered to low income Americans. When you qualify for SSI, the state you live in allocates those payments, and Medicaid is a part of the SSI payments in most states. Indeed, Medicaid is one of the most important parts of the entire SSI program because it provides medical coverage for the aged, blind and disabled.
The federal agency that administers Medicaid is the Centers for Medicare & Medicaid Services (CMS). Each state submits their Medicaid plan to CMS for approval. Each state’s plan is different, but all states provide Medicaid for at least some of their SSI beneficiaries. CMS receives state plans from the 50 states as well as the District of Columbia, and a plan from the Commonwealth of the Northern Mariana Islands (NMI).
Medicaid is the federal government’s medical assistance program. It is part of the Social Security Act (Title XIX). In most states, the program is called and known as Medicaid. It is called Medi-Cal in California and AHCCS in Arizona, for the Arizona Health Care Cost Containment System.
The Title XIX statute requires that Medicaid coverage be provided to certain mandatory groups in any state that has a Medicaid program, while states have the option to provide Medicaid coverage for other groups. This is the reason why the plans vary so much from state to state.
It can also get confusing because Title XIX also allows for states to provide medical assistance to individuals not eligible for SSI. Although these programs are medical, they are not under the Medicaid umbrella of coverage.
Medicaid is paid according to a cost-sharing between the federal government and states. The federal government pays about half of the administrative costs for each state.
Regarding eligibility, a person must first be in a category that is addressed by a cash assistance program (the mandatory needy disabled with low incomes, optional needy, and those individuals that qualify as medically needy under a Medicaid waiver). You can also be a family member in a family with dependent children that qualify for the Aid to Families with Dependent Children (AFDC) program. If you are not in one of these categories, you cannot get Medicaid.
In most states, your SSI application also serves as your Medicaid application. This allows faster processing of benefits if you do qualify for Medicaid. Upon qualifying, there is retroactive coverage of covered medical expenses that occurred up to three months before you submitted your SSI/Medicaid application if the individual would have been eligible at that time. There are also stipulations for benefits payout should the person die while the application is being processed.
When you’re approved for SSI, Medicaid is automatically granted in most states. A few states use the same SSI criteria, but make their own decisions about Medicaid eligibility:
SSI uses income, resource, and disability criteria to qualify you for both SSI and Medicaid. A few states make their own Medicaid eligibility decisions using the same federal SSI criteria: Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, and Utah. This means that everyone receiving SSI should also qualify for Medicaid, but approval is not automatic and you have to fill out a separate Medicaid form. Finally, several other states have Medicaid criteria that are much stricter than the federal SSI criteria. The federal government does have rules for how restrictive states can be.
Regarding qualifying criteria, you must have proof of your disability and it must meet SSI criteria as outlined in the Blue Book which lists qualifying disabilities.
There is also an income requirement for Medicaid, and you must not exceed the Medicaid monthly income limits. There are rules for what counts as income, and there are also asset limits you must meet.