Are SSI Recipients Automatically Eligible for Medicaid?

The Supplemental Security Income (SSI) program provides monthly payments to adults and children with a disability or blindness who have limited income and resources. Most SSI recipients are often also eligible to receive Medicaid, which is another program that provides benefits for low-income individuals.

However, whether an SSI recipient is automatically eligible for and enrolled in Medicaid depends on his or her state of residency. In some states, an SSI application is also an application for Medicaid. However, other states require two separate applications for each program and may have different eligibility criteria.

We explain Medicaid eligibility as an SSI recipient in greater detail below. If you have been approved for SSI but denied Medicaid, our legal team is ready to fight for the benefits you need. You can call us to set up your free initial consultation with no obligation to retain our services after this meeting.

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Instances When Medicaid is Automatically Granted

SSI is determined using standard national criteria whereas Medicaid is administered by the states. The majority of states will automatically grant Medicaid after being approved for SSI due to a disability.

These states allow the Social Security Administration (SSA) to manage Medicaid enrollment when an SSI recipient is granted disability benefits. People residing in these states are informed about their Medicaid enrollment at the same time they receive their disability award letter when approved for SSI.

The District of Columbia and states with automatic Medicaid enrollment for SSI recipients include:

For instance, in Arizona, the Arizona Health Care Cost Containment System (AHCCCS) is the state’s Medicaid agency. To qualify for AHCCCS, you must be deemed disabled by the SSA and meet certain income requirements. If you are already receiving SSI, you will automatically qualify for AHCCCS and do not need to apply separately to enroll in the state’s Medicaid program.

There are some states that do not leave it up to the SSA to handle Medicaid enrollment. These states do, however, use the same SSI criteria to make their own eligibility decisions when it comes to Medicaid.

An SSI recipient must file a separate Medicaid application in the following states:

Anyone approved for SSI that resides in one of the above states will likely be eligible for Medicaid.

When Medicaid is Not Automatic for SSI Recipients

Other states have decided to use more restrictive eligibility criteria for Medicaid than the SSI program. The income, resources and disability requirements often make it harder to be eligible for Medicaid than it is to qualify for SSI. These states also require SSI recipients to file a separate Medicaid application.

Having to file a separate application may limit Medicaid enrollment for SSI recipients for many reasons:

• It requires even more time and effort
• It increases the risk of processing delays
• It causes a longer period of uncertainty

As a result, some people may be approved for SSI, but denied Medicaid.

What If I Am Denied Medicaid Benefits?

If you have applied for Medicaid but the Medicaid agency in your state has denied you benefits, you have the right to appeal that decision. A Phoenix-based Social Security Disability lawyer at our firm is prepared to answer any questions you may have and guide you at every step of the appeals process.

Your state agency is required to provide a written denial notice within 90 days from the date you applied for Medicaid due to a disability. The notice must inform you of the following:

• Your right to a hearing to appeal the denial
• How to go about requesting a hearing
• Reasons your application was denied
• The specific state rules used to deny benefits

Certain states may ask that you make your request to appeal in writing. Once an appeal hearing date has been set, you must appear at the hearing or jeopardize losing your appeal. It is in your best interest to retain the services of a lawyer who has experience representing clients at these hearings.

He or she can advise you on how to best prepare for an appeal hearing, help you practice answering questions the judge or hearing officer may ask of you, as well as gather and submit additional evidence in support of your claim. For instance, If your application was denied because the state Medicare agency thought you were not disabled, you may be asked to take to another medical exam.

Should you win your appeal, you may be owed retroactive pay from the date you became eligible for Medicaid. In most cases, this is the date that you filed for Medicaid benefits.

Request a Free Consultation to Get Started

If you need help applying for benefits, Dayes Law Firm is here to help. We are ready to review your claim and discuss your eligibility during a free consultation.

Find out what our clients have to say about our services. Our firm is available to take your call anytime, day or night. There are no upfront fees involved.

Call 1-800-503-2000 to talk to a lawyer.