How to Keep Medicaid Coverage When SSI Benefits Stop: A Guide for Families and Professionals

Understanding Special Provisions to Protect Healthcare Access for Individuals with Disabilities

Parents often tell me they fear letting their children work because they don’t want to lose benefits. I get it. However, I don’t think they’re as worried about losing the $943/mth (2024 number, if getting Federal max and no state supplement) from SSI, as much as they’re concerned about losing health insurance and possibly, Waiver support. It’s important to remember that “public benefits” can cover many programs, each with its own rules and regulations. SSI is a Federal program, while Medicaid is administered by individual States.

34 states and DC will automatically enroll you in Medicaid when you qualify for SSI. In 8 other states, you’ll be approved, but you still need to submit a separate application. This means in over 3/4 of the country you can get Medicaid when you get SSI. Here’s a link if you’d like to learn more. This is great, but what happens if you lose your SSI? Do you lose your Medicaid as well? It depends.

There are special provisions to help certain former SSI recipients keep their Medicaid coverage, even if they’re no longer eligible for SSI. These provisions, set by Congress, protect people from losing their healthcare coverage after a change in their income or benefits. In this article, I’m talking specifically about Social Security’s POMS SI 01715.015 - Special Groups of Former SSI Recipients.

I’ll tell you about Medicaid expansion and how it may allow you to earn more money while keeping benefits if you aren’t on SSI in a future article. Let’s break down the key groups that benefit from this POMS. It’s important to stay informed about your options. This is good information for individuals and professionals.