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Disability-Based Medicaid

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    Disability-Based Medicaid

    Frequently Asked Questions

    If you need more help in understanding Medicaid, you can:

    There are different ways to apply for Medicaid:

    If you get Supplemental Security Income (SSI) or used to and now are on SSI 1619(b), you automatically get Medicaid coverage and do not need to apply for it separately. If you need to sign up for SSI, you can apply with Social Security.

    It depends on how you qualified for Medicaid. The Iowa Health and Wellness Plan (IHAWP), Medicaid for pregnant women, and Healthy and Well Kids in Iowa (Hawki) have no resource limit. However, some people with disabilities and seniors may qualify through disability-based Medicaid programs, which do have resource limits:

    Note: If your disability began before you turned 46, you can open an ABLE account where you can save up to $20,000 each year and not have it counted by Medicaid. Learn more about ABLE accounts.

    In most cases, it does not matter how you qualify for Medicaid, because the actual medical coverage you get from Medicaid will be the same. Generally speaking, the big difference is that people with disabilities may get extra ways to qualify and if you have a disability and start working, you can earn more while still getting Medicaid coverage.

    DB101 has information about different ways to get Medicaid:

    No, countable income is not the same as how much you make. When public programs look at your income to figure out if you should qualify, they don’t always count all of your income. What they do count is called “countable income.” This benefits you, because it means that you might have more income than the income limit for a program, but still qualify.

    When Social Security or Medicaid reviews your income to see if you qualify for Supplemental Security Income (SSI) or some other disability-based Medicaid programs, only about half of your earned income (money you get from work you do) is counted. For example, if you make $2,000 per month at a job and have no other income, that’s only $957.50 in countable monthly income.

    Note: This countable income calculation is only used for some ways of getting disability-based Medicaid, including through SSI. If you apply for Medicaid through the Iowa Health and Wellness Plan (IHAWP), almost all of your income is counted. Learn more about the Iowa Health and Wellness Plan.

    Try this tool to get an idea of how much countable income you have:

    Your Countable Income:

    Yes, if you're getting Supplemental Security Income (SSI), you automatically get Medicaid as well. You do not need to file an additional application. Note: State Supplementary Assistance is a similar program to SSI that you you may qualify for if you get SSI, but also may qualify even if you don't get SSI. You must apply for it separately. People who get State Supplementary Assistance also automatically get Medicaid coverage.

    If you’re on SSI and Medicaid and your monthly SSI benefits drop to zero because your earned income goes up, Social Security’s 1619(b) provision lets you keep your Medicaid coverage. If you are on 1619(b), you can have up to $53,732 in total income per year ($54,260 if blind), as long as your resources don’t go above the SSI resource limit ($2,000 for an individual, $3,000 for a couple).

    Yes, even if you don't qualify for Supplemental Security Income (SSI) benefits, you may still qualify for Medicaid.

    If you have a disability and work, you may qualify for Medicaid for Employed People with Disabilities (MEPD), a Medicaid program that lets you earn more income than the SSI income limit, save up to $12,000 in resources ($13,000 if you're married), and keep your same Medicaid coverage. Depending on your income, you may need to pay a monthly premium. Learn more about MEPD.

    If you have a disability and need extra care to keep living in your home or apartment in the community instead of moving into a facility, you may qualify for a Medicaid waiver program. With a waiver, you get regular Medicaid coverage plus additional services you need to continue living at home. Waiver programs have a higher income limit than SSI, so you may qualify even if you don't qualify for SSI.

    You may also qualify for Medicaid through the Iowa Health and Wellness Plan (IHAWP), which does not require you to have a disability and has no resource limit. Learn more about the Iowa Health and Wellness Plan.

    There are different health coverage options as your income goes up.

    If you have a disability and are working, you may be able to get Medicaid coverage through Medicaid for Employed People with Disabilities (MEPD), which has a higher income limit than regular Medicaid. With MEPD, you and your family can have a combined countable income of up to 250% of the Federal Poverty Guidelines (FPG) (that's $3,260 or less per month if you're single; for a family of four, that's $6,698 or less per month of countable family income). You can also have up to $12,000 in resources, which is a higher resource limit than regular Medicaid. You may have to pay a monthly premium, depending on your income.

    If you have been getting Medicaid through Supplemental Security Income (SSI) benefits, you may be able to keep your Medicaid coverage if you go back to work through SSI's 1619(b) provision. If you're on 1619(b), you can have up to $53,732 in total income each year ($54,260 if blind) and still keep your Medicaid coverage.

    You may be able to get government help to pay for individual insurance plans on HealthCare.gov. To get this help, your family’s income has to be between 138% and 400% of the Federal Poverty Guidelines ($62,600 for an individual; $128,600 for a family of four).

    The bottom line: There should be a health coverage option for everyone. If you have questions about the impact work will have on your health care, talk to a benefits planner or get an idea of your options with DB101’s Benefits and Work Estimator.

    Medicaid is a public health coverage program. There are different ways to qualify for Medicaid, depending on things like your age, income, resources, and whether you have a disability.

    Regular Medicaid: You may qualify for regular Medicaid coverage through the Iowa Health and Wellness Plan, which looks only at your income, or through disability rules, if you have low income, low resources, and a disability. You automatically qualify for Medicaid if you get Supplemental Security Income (SSI) or qualify for SSI’s 1619(b) provision.

    Medicaid for Employed People with Disabilities (MEPD): MEPD is a way for people with disabilities who work to get Medicaid coverage even if they make more money than the regular Medicaid income limit. With MEPD, you and your family can have a combined countable income of up to 250% of the Federal Poverty Guidelines (FPG) (that's $3,260 or less per month if you're single; for a family of four, that's $6,698 or less per month of countable family income). Depending on your income, you may have to pay a monthly premium.

    Read about the different ways of qualifying for Medicaid on DB101.

    Yes, if your family’s income is low enough for you to qualify for Medicaid, you may do so even if your job offers insurance.

    If you get Medicaid and also want to enroll in your employer's health plan, you may qualify for Iowa's Health Insurance Premium Payment (HIPP) program. If you have HIPP, Medicaid pays your plan's premium and the other costs of getting medical care, like the copayments and the deductible. You are not enrolled in a Medicaid managed care plan; instead, your employer's health plan is your main health coverage.

    You must apply separately for HIPP after you are approved for Medicaid. Note: If you also have Medicare, you can't qualify for HIPP.

    Learn more about HIPP and how to apply.

    Yes, if you qualify for Medicare and Medicaid, it is helpful to have both at the same time. Medicaid covers many more services than Medicare, so by having both you’ll have better health care coverage. Also, Medicaid will usually pay your Part A and Part B premiums and it may also pay your Medicare deductibles, co-insurance, and copayments. With Medicare Part D, you’ll likely have cheaper prescription drug costs by enrolling in both programs.

    You must be a U.S. citizen or meet specific noncitizen requirements to be eligible for Medicaid:

    Learn more

    Supplemental Security Income (SSI)

    SSI helps people with disabilities and seniors who have low income and resources.

    Medicare

    Medicare is public health coverage for people with disabilities and seniors.

    Medicaid for Employed People with Disabilities (MEPD)

    MEPD is Medicaid for people with disabilities who work.