Medicaid – Overview

July 29, 2017


As mentioned above, most SSI disabled recipients receive Medicaid coverage for their health expenses. Medicaid was established in 1965 as a joint federal/state program to provide medical coverage to the needy. States administer the program and, within federal guidelines, establish their own eligibility standards, types and levels of services, and rates of payment. Since the establishment of the SSI program in 1974, most SSI recipients have been eligible for Medicaid benefits, although in some states SSI is not a specific eligibility category. However, most SSI recipients in those states qualify for Medicaid under another eligibility category.

In some states, a Medicaid “buy-in” is available for certain categories of disabled individuals. The buy-in permits them to enroll in Medicaid even though they would not otherwise qualify because of income or resource considerations. The states may require the individual to share the cost of Medicaid by paying a premium or through some other cost-sharing arrangement, although these arrangements are generally assessed on a sliding scale based on income.

The federal government pays a percentage of total state Medicaid expenses. The federal percentage is determined by a formula based on state per capita income, with higher-income states receiving a smaller federal contribution rate. The federal contribution cannot be lower than 50 percent or higher than 83 percent. States may impose deductibles, copayments, or both for some services. And, as mentioned above, some categories of persons eligible for a Medicaid buy-in pay part or all of the cost of the coverage. For persons eligible for both Medicare and Medicaid, Medicare is the primary payer and Medicaid supplements payments.


Medicare Overview

July 29, 2017


Social Security beneficiaries receiving benefits based on their own disability are entitled to Medicare benefits beginning in the 25th month of entitlement. Medicare was implemented in 1966, providing medical benefits to complement the monetary benefits of Social Security retirees. In 1973, Medicare benefits were extended to disabled workers after a 24-month waiting period. Medicare is funded mainly through Hospital Insurance payroll contributions; additional sources of funding include general revenues, premiums, and a portion of the income taxes collected on Social Security benefits.

Until recently, Medicare had two parts: Part A (Hospital Insurance) and Part B (Supplementary Medical Insurance). In 1997, a third part, Part C, was added to Medicare, known as Medicare Advantage. Part C offers beneficiaries options for participating in private-sector health plans. In 2003, a fourth part, Part D, offering prescription drug coverage was added and Part B was modified. Part D was implemented in 2006. Modifications to Part B will take effect in 2007.

Part A, Hospital Insurance (HI), covers the cost of in-patient hospital care and is generally provided free to persons eligible for Medicare. It is paid out of the HI trust fund. There are deductibles and copayments under HI.
Part B, Supplementary Medical Insurance (SMI), covers doctors and other services. It requires a premium, which for most people is equivalent to 25 percent of the average expenditure for the aged for this coverage ($88.50 per month in 2006), to be paid by the beneficiary or on the beneficiary’s behalf. The balance comes from the Treasury as general revenue contributions. SMI also requires deductibles and coinsurance payments. Beginning in 2007, under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, beneficiaries with higher modified adjusted gross income ($80,000 or more for individuals, $160,000 or more for married couples) will pay a higher monthly premium based on a sliding scale that will be phased in over 3 years.
Part C, Medicare Advantage, expands beneficiaries’ options for participation in private-sector health care plans. Coverage and cost vary by plan. Part C receives funding from the HI and SMI trust funds and beneficiary premiums.
Part D, Prescription Coverage, became effective on January 1, 2006. Beneficiaries pay a premium that varies by income level and involves deductibles and copayments. The Part D subsidy benefit is also available to assist low-income beneficiaries who meet certain income and resource requirements.

Medicaid: 1634 states and Section 206(b) states

July 1, 2017

There are two primary governmental medical programs: (1) Federal medicare and (2) state medicaid. Beneficiaries receiving Supplemental Security Income (SSI) residing in “1634” states are categorical eligible and are automatically enrolled in medicaid. These individual do not need to apply for medicaid benefits separately.

The section 206(b) states have opted to use more restrictive criterias in determining medicaid eligibility. For beneficiary residing in “209(b)” states must separately apply for medicaid.


1634 209(b) SSI 1634 209(b) SSI
Alabama 1634 Montana 1634
Alaska SSI Nebraska SSI
Arizona 1634 Nevada SSI
Arkansas 1634 New Hampshire 209(b)
California 1634 New Jersey 1634
Colorado 1634 New Mexico 1634
Connecticut 209(b) New York 1634
Delaware 1634 North Carolina 1634
Dist of Columbia N Mariana Islands SSI
Florida 1634 North Dakota 209(b)
Georgia 1634 Ohio 1634
Hawaii 209(b) Oklahoma 209(b)
Idaho SSI Oregon SSI
Illinois 209(b) Pennsylvania 1634
Indiana 1634 Rhode Island 1634
Iowa 1634 South Carolina 1634
Kansas SSI South Dakota 1634
Kentucky 1634 Tennessee 1634
Louisiana 1634 Texas 1634
Maine 1634 Utah SSI
Maryland 1634 Vermont 1634
Massachusetts 1634 Virginia 209(b)
Michigan 1634 Washington 1634
Minnesota 209(b) West Virginia 1634
Mississippi 1634 Wisconsin 1634
Missouri 209(b) Wyoming 1634


1634:  States Automatically Grant Medicaid With SSI Disability.

209(b): The States with Their Own Medicaid Eligibility Criteria.