2179.Medicaid While Working

2179.1Are you eligible for Medicaid even if you work?

Many States provide Medicaid eligibility (see http://www.benefits.gov) based on SSI eligibility regardless of whether you meet the State's own definition of medical need. Even if you lose your cash benefits because countable income is more than the FBR plus the State supplement, if any, you may be eligible for continued Medicaid coverage. Medicaid coverage continues for most working disabled or blind people when earnings (alone or combined with other income) become high enough to cause SSI cash benefits to stop.

NOTE: Performance of SGA is not an issue. One dollar in countable earned income is enough to qualify if all other requirements are met.

2179.2How do you qualify for Medicaid while working?

To qualify for Medicaid while working, you must:

  1. Have a disabling condition;

  2. Need Medicaid in order to work;

  3. Not be able to afford equivalent medical coverage and publicly funded personal or attendant care that you would lose without assistance;

  4. Meet all non-disability requirements for SSI payment (other than earnings); and

  5. Have been eligible to receive a regular SSI cash payment in a previous month within your current period of eligibility.

Note: In some states, you must have qualified for Medicaid the month before these rules apply.

2179.3Can you get SSI cash benefits again if your benefits ended because of your earned income?

If your benefits ended because you worked and had earnings, you can request to have your benefits started again without having to complete a new application, within 5 years from the month your benefits ended. We call this process “expedited reinstatement” or EXR. It was effective January 1, 2001.

You can be reinstated via EXR if:

  • Your previous SSI disability/blindness eligibility was terminated because of excess earned income or a combination of earned and unearned income;

  • You are unable to perform substantial gainful activity because of your medical condition;

  • You are not performing SGA in the month you request EXR;

  • Your current disabling impairment(s) is the same as or related to the impairment(s) that was the bases for the previous disability entitlement;

  • You request EXR within the consecutive 60-month period beginning with the month we terminated your eligibility for SSI payments or you have good cause for filing your request late;

  • We determine that you are under a disability; and

  • You meet all non-medical requirements for eligibility to SSI.

While we determine whether you can get benefits again, we can give you provisional (temporary) benefits for up to 6 months. These provisional benefits may include a cash payment and Medicaid coverage. If we deny your request, we usually will not ask you to repay the provisional benefits. If we approve your EXR request, your benefits will begin the month after your request. Your spouse may also be eligible for reinstatement of his/her SSI benefits.

Last Revised: Oct. 06, 2009