SSDI counts as income for MassHealth, but it may not disqualify you

Yes, Social Security Disability Insurance (SSDI) is counted as income when MassHealth reviews your process or renewal. However, receiving SSDI does not automatically mean you lose coverage or fail to meet MassHealth's income limits. MassHealth has different income thresholds depending on which program you're in, and some programs are more generous than others. The key is understanding which MassHealth program you're in and what that program's actual income limit is.

MassHealth uses your total monthly income—including SSDI, wages, pensions, and other sources—to decide if you stay within the limit for your program. If your SSDI payment pushes you over the limit for one program, you may still may have access to for a different one. Many people receiving SSDI remain on MassHealth because their SSDI payment alone does not exceed the income threshold, or because they may have access to for a program with a higher limit.

Key Takeaways

  • SSDI payments count as income on your MassHealth process, but income limits vary by program and household size.
  • If your SSDI payment exceeds one program's limit, you may still may have access to for MassHealth Standard or another program with a higher threshold.
  • MassHealth counts only the SSDI you actually receive each month, not the full benefit amount if some goes to a representative payee or is withheld.
  • You must report any change in your SSDI amount to MassHealth within 30 days to keep your coverage accurate.
  • If you lose MassHealth due to SSDI income, you may regain it if your SSDI payment decreases or if you become a parent or caregiver.

Which MassHealth programs have income limits that matter for SSDI recipients

MassHealth has several programs, and each has its own income limit. The programs most relevant to SSDI recipients are MassHealth Standard, MassHealth Limited, and MassHealth CommonHealth. MassHealth Standard is the broadest program and has higher income limits than Limited. CommonHealth is designed for people with disabilities and has its own income threshold.

As of 2024, MassHealth Standard allows income up to roughly 138% of the federal poverty level for most household sizes, though this varies. For a single person, that is approximately $1,550 per month; for a couple, roughly $2,100. These numbers change yearly. If your SSDI payment is below these limits, you will likely stay on MassHealth Standard. If it exceeds the Standard limit, MassHealth will check whether you may have access to for Limited or another program.

MassHealth Limited covers emergency services only and has a lower income limit—around 100% of the federal poverty level. CommonHealth, which serves people with disabilities, has a higher income limit and may be an option if you have a disability-related condition. The program you are currently in matters because MassHealth will not automatically move you to a different program when your income changes; you may need to report the change and ask about other options.

How MassHealth counts SSDI when you have other household members

MassHealth looks at your entire household income, not just your own. If you live with a spouse, children, or other relatives, their income counts too. However, SSDI received by one household member is counted only for that person's coverage decision—it does not automatically disqualify everyone in the home.

For example, if you receive SSDI and your spouse works, MassHealth adds both incomes together. If the total exceeds the limit for MassHealth Standard, you might lose coverage while your spouse remains on it if their income alone is below the limit. Household size also affects the income limit: a family of three has a higher threshold than a single person, so adding a child to your household can raise the income limit and help you stay on MassHealth even with SSDI income.

What happens if your SSDI payment changes

SSDI payments can change for several reasons: a cost-of-living adjustment (COLA) each January, a change in your work activity, or a medical review that affects your benefit amount. When your SSDI payment changes, you must report it to MassHealth within 30 days. Failing to report a change can result in overpayment of benefits or loss of coverage without warning.

If your SSDI payment increases and pushes you over the income limit for your current program, MassHealth will send you a notice. You then have the chance to ask about other programs or provide additional information. If your SSDI payment decreases, you should report that too, because it may restore your coverage or move you to a program with better benefits.

You can report a change in SSDI income by calling MassHealth at 1-800-505-5000, by mail, or through your MassHealth account online. Keep a copy of your Social Security statement or the letter from Social Security that shows the new amount, because MassHealth will ask for proof.

SSDI and work incentives: how earnings affect your MassHealth coverage

If you receive SSDI and work, your earnings also count as income for MassHealth. Social Security has work incentive programs that allow you to earn money without losing your SSDI benefit when ready, but MassHealth counts all earned income toward its limit. This means you could keep your SSDI benefit under Social Security's rules but lose MassHealth coverage because your total income (SSDI plus wages) exceeds MassHealth's threshold.

Some work incentive programs, like Impairment Related Work Expenses (IRWE) or Plans to Achieve Self-Support (PASS), can reduce the income MassHealth counts. For example, if you spend money on equipment or services related to your disability to work, IRWE may allow you to deduct those costs from your income. PASS lets you set aside income and resources for a work goal without it counting against you. These programs require planning and documentation, so speak with a work incentive counselor at your local Social Security office or a disability work program before starting work.

If you lose MassHealth because of SSDI income

If your SSDI payment causes you to exceed MassHealth's income limit, you have options. First, check whether you may have access to for MassHealth Limited, which covers emergency services. Limited has a lower income limit but is better than no coverage. Second, explore whether you may have access to for a different program based on your household situation—for instance, if you become a parent or caregiver, you may may have access to for a program with a higher income threshold.

Third, look into whether you are may have access to to any work incentives that reduce countable income. Fourth, if your SSDI payment is expected to decrease (for example, because you will reach full retirement age and your benefit will change), report that to MassHealth and ask whether your coverage can be restored. Finally, if you lose coverage, you may regain it if your circumstances change—such as if you have a child, if your SSDI payment decreases, or if you become unemployed.

You can also ask MassHealth about a spend-down program. In some cases, if your income is slightly above the limit, you can set aside money for medical expenses, and MassHealth will count that toward bringing you below the threshold. This is not automatic, so you must ask about it when you receive a notice that you no longer meet the income limit.

How to report SSDI income to MassHealth and keep your coverage current

When you first explore for MassHealth, you will need to provide proof of your SSDI income. Acceptable proof includes a Social Security award letter, a benefit verification letter from Social Security, or a recent pay stub from Social Security. You can request these documents from Social Security online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office.

After you are on MassHealth, you must report any change in your SSDI amount within 30 days. You can do this online through your MassHealth account, by phone at 1-800-505-5000, by mail, or in person at a MassHealth office. When you report a change, have your new Social Security letter or pay stub ready. MassHealth will update your income and tell you whether your coverage changes.

MassHealth also sends renewal notices, usually once a year. When you renew, report your current SSDI amount. If you do not respond to a renewal notice, your coverage will end. Keep all letters from Social Security about your benefit amount, because MassHealth may ask for proof if there is a discrepancy.

Frequently Asked Questions

Can I stay on MassHealth if my SSDI payment is $1,600 a month?

It depends on your household size and which program you are in. For a single person in 2024, $1,600 likely exceeds MassHealth Standard's income limit but may fall within MassHealth Limited or CommonHealth. Contact MassHealth at 1-800-505-5000 to find out which program you may have access to for based on your exact household situation.

Does MassHealth count SSDI that goes to a representative payee?

Yes. MassHealth counts the full SSDI amount you are may have access to to receive, even if a representative payee (such as a family member or organization) manages the money on your behalf. The amount that actually reaches you is what matters for MassHealth's purposes.

What if I receive both SSDI and SSI?

Both payments count as income for MassHealth. However, if you receive SSI, you may already be on MassHealth automatically, because SSI recipients in Massachusetts are usually enrolled in MassHealth. Report both payments to MassHealth to may support your income is recorded correctly.

Will getting a COLA increase in January affect my MassHealth coverage?

It may. If your COLA increase pushes your total income over your program's limit, MassHealth will send you a notice. You should report the increase to MassHealth as soon as you receive your new Social Security letter so the change is processed quickly and you know whether your coverage changes.

Can I appeal if MassHealth says my SSDI income makes me ineligible?

Yes. You have the right to appeal any MassHealth decision. If you disagree with the decision, you can request a hearing. MassHealth will send you information about how to appeal in the notice that tells you that you no longer meet the income limit. You typically have 30 days to request an appeal.