How to Keep Medicaid When You Receive SSDI

Medicaid and SSDI are separate programs, but they're often tied together

When you start receiving Social Security Disability Insurance (SSDI), your Medicaid coverage does not automatically stop. However, the rules that keep you on Medicaid change once you're receiving SSDI, and if you don't understand those rules, you can lose coverage without realizing it's happening.

The key difference: before you receive SSDI, Medicaid is based on your income and assets. Once you're on SSDI, most states use a different rule called Medicaid Continuation (or "Section 1619(b) Medicaid" in the federal system). This rule lets you keep Medicaid even if your SSDI payment pushes your income above the normal Medicaid limit—but only if you meet specific conditions and report changes to your state Medicaid office.

The most common way people lose Medicaid while on SSDI is by not reporting a change in their situation—usually earning too much money from work, or failing to report that they're no longer disabled. This guide explains what you need to do to keep coverage.

Key Takeaways

Medicaid Continuation lets you stay on Medicaid even though your SSDI income is above the normal limit, but you must report any changes in your work, income, or living situation to your state Medicaid office.
If you earn more than the Substantial Gainful Activity (SGA) threshold—currently $1,550 per month for non-blind individuals—your SSDI will stop, and you will lose Medicaid Continuation unless you may have access to for a different Medicaid program.
You have a Trial Work Period of nine months where you can earn any amount without losing SSDI, but you must still report your work to Social Security.
Your state Medicaid office, not Social Security, controls whether you keep Medicaid, so you must contact them directly to report changes and confirm you still may have access to.
Some states offer additional Medicaid programs for people with disabilities who earn too much for Medicaid Continuation, so ask your state Medicaid office what other options exist.

Understanding Medicaid Continuation and the income limit

When you're on SSDI, your state Medicaid office can keep you on Medicaid under a rule called Medicaid Continuation even if your SSDI payment alone would make you ineligible. The rule exists because Medicaid is meant to cover people with disabilities, and the rule recognizes that losing health coverage when you start receiving disability benefits would be harmful.

To stay on Medicaid Continuation, you must meet two conditions: you must still be disabled (in Social Security's view), and your income must not exceed your state's Medicaid limit. The income limit varies by state—some states set it at 100% of the federal poverty level, others at 200% or higher. Your state Medicaid office can tell you what your state's limit is.

Your income for Medicaid purposes includes your SSDI payment, any wages from work, and certain other sources. However, Social Security excludes the first $65 of your monthly earnings plus half of the rest when calculating your SSDI payment—this is called the Earned Income Exclusion. Some states use the same exclusion for Medicaid, but others do not, so you must check with your state office about how they count your income.

How work affects your SSDI and Medicaid at the same time

If you work while on SSDI, you have a Trial Work Period of nine months during which you can earn any amount without losing your SSDI payment. During this time, you must report your work to Social Security each month, but your payment will not change. You must also report your work to your state Medicaid office, because Medicaid Continuation depends on your income.

After your nine-month Trial Work Period ends, Social Security looks at whether your earnings are above the Substantial Gainful Activity (SGA) threshold. For 2024, SGA is $1,550 per month for non-blind individuals and $2,590 for blind individuals. These amounts change each year. If your earnings stay below SGA, your SSDI continues and you keep Medicaid Continuation (as long as your total income is below your state's limit). If your earnings go above SGA, your SSDI stops.

When your SSDI stops because of work, you lose Medicaid Continuation automatically. However, you may still be able to get Medicaid through a different program—some states have Medicaid Buy-In programs or Section 1619(a) Medicaid that cover working people with disabilities who earn too much for regular Medicaid. Ask your state Medicaid office whether you may have access to for these programs before your SSDI stops.

What changes you must report to keep Medicaid

Your state Medicaid office needs to know about changes in your situation because those changes affect whether you still meet the rules for Medicaid Continuation. The most important changes to report are:

You start working or your earnings change.
Your living situation changes (for example, you move in with someone else, or someone moves in with you).
Your household income changes for any reason.
You receive a notice from Social Security saying your SSDI has stopped or changed.
Your address or contact information changes.

You must report these changes to your state Medicaid office, not to Social Security. The two agencies do not automatically share information, so if you only tell Social Security about a change, your Medicaid office may not know. Contact your state Medicaid office directly—usually by phone, mail, or an online portal—and ask how to report changes. Keep a record of when you reported each change and who you spoke with.

The important date for reporting varies by state and by the type of change. Some states give you 10 days, others 30 days. If you miss the important date, your Medicaid may be terminated without warning. If this happens, you can ask for a hearing to explain why you missed the important date, but it's much easier to report changes on time.

What happens if you lose Medicaid while on SSDI

If your Medicaid is terminated, you will receive a notice in the mail explaining why and telling you how to request a hearing. Read this notice carefully, because it tells you the important date to ask for a hearing—usually 10 to 30 days depending on your state.

If you believe the termination was a mistake—for example, your income is actually below the limit, or you reported a change and the office lost the paperwork—you can request a hearing. At the hearing, you can present documents (pay stubs, letters from your employer, proof of your living situation) to show that you still meet the rules. If you win, your Medicaid will be restored, sometimes back to the date it was terminated.

While you wait for a hearing, you will not have Medicaid coverage. Some states offer emergency Medicaid for urgent medical needs, but this is limited. If you need prescriptions or ongoing care, ask your doctor's office whether they can help you find low-cost or free care while your case is being decided.

State Medicaid Buy-In programs for people who work

If your earnings go above the SGA threshold and you lose SSDI, you may still be able to get Medicaid through a Medicaid Buy-In program (also called a Work Incentive Program). These programs are run by individual states, so they vary widely in income limits, cost, and what they cover.

Some states have Buy-In programs that let you keep Medicaid even if you earn significantly more than the SGA threshold—sometimes up to 250% of the federal poverty level or higher. Some programs charge a small premium (usually $20 to $100 per month), while others are free. Some states have no Buy-In program at all.

To find out whether your state has a Buy-In program and whether you would may have access to, contact your state Medicaid office directly. Ask them to explain the income limit, any cost, what services are covered, and how the process works. If your state does not have a Buy-In program, ask whether there are other Medicaid programs for working people with disabilities.

How to contact your state Medicaid office about your coverage

Your state Medicaid office is the only place that can tell you whether you still may have access to for Medicaid Continuation or whether you may have access to for another Medicaid program. Social Security cannot answer these questions—they manage SSDI, not Medicaid.

To find your state Medicaid office, visit Medicaid.gov and select your state, or call 1-800-MEDICARE and ask for your state Medicaid office phone number. You can also search online for "[your state] Medicaid office" or "[your state] Medicaid contact".

When you call, have your Social Security number and Medicaid case number ready. Ask the following questions: (1) Do I still may have access to for Medicaid Continuation? (2) What is my state's income limit for Medicaid? (3) How does my state count my work income for Medicaid? (4) What changes do I need to report? (5) Does my state have a Medicaid Buy-In program? Write down the answers and the name of the person you spoke with, in case you need to follow up.

Frequently Asked Questions

Can I lose Medicaid if I'm still disabled and my income is below the limit?

No, as long as you report all changes to your state Medicaid office and your income stays below your state's limit, you should keep Medicaid. The most common reason people lose coverage is failing to report a change—usually starting work or earning more money. Report changes promptly to avoid termination.

What if I earn money during my Trial Work Period—will I lose Medicaid?

Not automatically. During your nine-month Trial Work Period, you can earn any amount without losing SSDI. However, you must report your earnings to both Social Security and your state Medicaid office. Your state Medicaid office will check whether your total income (including your SSDI payment and your earnings) is below the state's limit. If it is, you keep Medicaid.

If my SSDI stops because I earn too much, can I get Medicaid back?

Maybe. Once your SSDI stops, you lose Medicaid Continuation. However, you may may have access to for a different Medicaid program—such as a Medicaid Buy-In program, regular Medicaid based on income, or another work incentive program. Contact your state Medicaid office when ready to ask what programs you might may have access to for.

Do I need to tell Social Security about changes, or just my Medicaid office?

You should tell both, because they manage different programs. Tell Social Security about changes that affect your SSDI (like starting work or earning more). Tell your state Medicaid office about changes that affect your Medicaid (like income changes, living situation changes, or changes in your disability status). The two offices do not share information automatically.

What if I disagree with a decision to terminate my Medicaid?

You have the right to request a hearing. The termination notice will explain how to request one and the important date (usually 10 to 30 days). Submit your request in writing to your state Medicaid office. At the hearing, you can present documents and explain why you believe you still may have access to. If you win, your Medicaid will usually be restored back to the termination date.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.