Individuals with Disabilities
Medicaid provides health coverage to over 8.8 million non-elderly individuals with disabilities, including those who are working or who want to work. Federal statute provides for both mandatory and optional coverage for individuals with disabilities.
Many individuals who qualify for Medicaid based on disability also receive cash assistance under the Supplemental Security Income (SSI) program. In almost all states, SSI eligibility automatically qualifies an individual for Medicaid coverage. However, some states use more restrictive eligibility criteria than those used by the SSI program. This means that in those states (commonly referred to as 209(b) states) receipt of SSI does not guarantee eligibility for Medicaid. Individuals not receiving SSI but seeking coverage based on disability must demonstrate that they have an impairment that prevents them from performing “substantial gainful activity” for at least one year. Once a disability determination is made, the individual must then undergo an asset test and meet specific income requirements in order to be considered for Medicaid eligibility.
Individuals with disabilities who are eligible for Medicaid are entitled to all services that are deemed medically necessary. Many require and receive long term services and supports. These services can be provided through a variety of delivery systems.