Yes in the 34 states and the District of Columbia that SSA calls 1634 states, where SSA makes the Medicaid eligibility decision for SSI recipients. Eight SSI criteria states make that decision themselves, and eight 209(b) states apply at least one rule stricter than SSI. The three state categories are listed below.
Does SSI automatically come with Medicaid?
It depends on which of three arrangements your state chose, and SSA's operations manual sorts every state into one of them. The manual section is POMS SI 01715.010, Medicaid and the Supplemental Security Income (SSI) Program, in the version effective September 30, 2026.
SSI and Social Security Disability Insurance (SSDI) are separate programs, and SSDI connects to Medicare rather than Medicaid. It is easy to treat the two as one benefit with one set of health coverage rules. They are not. If you are not sure which program you applied for, our guide to the difference between SSDI and SSI sets them side by side.
For SSI, the three arrangements in the POMS are:
- 1634 states, where SSA makes the Medicaid eligibility decision for people receiving SSI.
- SSI criteria states, which use the SSI eligibility rules for Medicaid but make their own determinations.
- 209(b) states, which use at least one eligibility rule more restrictive than SSI.
The category tells you who decides your Medicaid and which rules apply to it. We represent adults on SSI claims nationwide, and our SSI claims page explains how we handle them.
1634 states, SSI criteria states and 209(b) states compared
SSA's current POMS places 35 jurisdictions in the 1634 group, eight states plus the Northern Mariana Islands in the SSI criteria group, and eight states in the 209(b) group.
| Category | Who decides Medicaid for SSI recipients | Jurisdictions listed in POMS SI 01715.010 |
|---|---|---|
| 1634 states | SSA makes the Medicaid eligibility decision | The District of Columbia and the 34 states not listed in the other two groups |
| SSI criteria states | The state makes its own determination using SSI rules, or may ask SSA to do it | Alaska, Idaho, Kansas, Nebraska, Nevada, Oklahoma, Oregon, Utah, and the Commonwealth of the Northern Mariana Islands |
| 209(b) states | The state, using at least one rule stricter than SSI | Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Virginia |
1634 states. SSA makes Medicaid eligibility decisions for people receiving SSI. SSA does not decide Medicaid ineligibility. The state makes that decision and issues any Medicaid denial notice.
SSI criteria states. The state applies the SSI eligibility rules but makes its own Medicaid determination for SSI recipients. In practice that means the state Medicaid agency, not the SSI award, is where your Medicaid answer comes from.
209(b) states. These states use at least one eligibility criterion more restrictive than SSI, so meeting the SSI rules alone may not be enough for Medicaid. The POMS states that 209(b) states must let aged, blind and disabled applicants deduct incurred medical expenses from income to qualify, a process called spend-down. It works the way a deductible works on a household insurance policy: the medical bills you have already run up count toward the line you need to reach.
Medicare, not Medicaid, is the health coverage tied to SSDI
SSDI brings Medicare, after a qualifying period. SSA's page for approved disability beneficiaries says SSA automatically enrolls you in Original Medicare, Parts A and B, after you get disability benefits for two years. If your disability results from amyotrophic lateral sclerosis (ALS), Medicare coverage begins sooner.
That two-year gap is the part people do not expect. An SSDI approval starts the cash benefit, but the health coverage that comes with it sits behind a waiting period, much like a new insurance policy with a waiting period before coverage starts. SSA's work incentives page describes the same rule: everyone eligible for SSDI is also eligible for Medicare after a 24-month qualifying period. Our guide to the SSDI waiting period covers the separate wait before the first check.
Medicare also follows SSDI beneficiaries into work. SSA's Medicare work incentives page says a beneficiary may receive at least 93 months of hospital and medical insurance after the trial work period, as long as the disabling impairment continues. The trial work period itself is explained in our trial work period guide.
Medicaid and SSDI are not strangers, though. The approval page notes that states may pay Medicare premiums for beneficiaries with low income and points you to your state or local welfare office or Medicaid agency.
How 1619(b) keeps Medicaid for SSI recipients who go to work
Section 1619(b) of the Social Security Act lets an SSI recipient keep Medicaid after earnings rise too high for an SSI cash payment. SSA's 1619(b) page lists the requirements. You must:
- have been eligible for an SSI cash payment for at least one month;
- still meet the disability requirement;
- still meet all the other non-disability SSI requirements;
- need Medicaid benefits to continue to work; and
- have gross earnings that are insufficient to replace SSI, Medicaid and publicly funded attendant care services.
The last requirement is measured against a threshold amount. SSA builds each state's threshold from two figures: the amount of earnings that would cause SSI cash payments to stop in that state, and average Medicaid expenses in that state. Because both inputs are state-specific, the threshold differs from state to state, and SSA publishes the threshold amounts for 2026 for each state on the same page. Those amounts stay in effect until the next year's figures replace them.
The practical point is that the check and the coverage are separate. Losing the SSI cash payment to earnings does not by itself end Medicaid if you meet these requirements. That is worth knowing before you turn down hours out of fear of losing coverage, and it is one of the reasons we talk through working while on disability with clients before they take a job.
Who to contact about SSI and Medicaid in your state
Start by finding your state's category, then go to the state for anything about Medicaid. In a 1634 state, SSA makes the Medicaid eligibility decision. In an SSI criteria state or a 209(b) state, the state makes the decision itself.
Either way, a Medicaid denial comes from the state, not from SSA. Under the POMS, SSA does not determine Medicaid ineligibility, and the state issues Medicaid denial notices. A question about why Medicaid was denied, or how to appeal that denial, belongs with your state Medicaid agency.
Keep the two tracks straight in your own records. The SSI decision, its appeal deadlines and its payment amount are SSA's. The Medicaid decision, its notices and its appeal rights are the state's. When we work on an SSI claim, we keep the SSA side moving and point you to the state agency for the Medicaid side, because a call to the wrong agency costs time neither office can give back.
Questions People Ask About This
How will I hear about Medicaid after an SSI award in a 1634 state?
Through your SSI award notice first. POMS SI 01715.010 says that in 1634 states, SSA tells people eligible for both SSI and Medicaid in the SSI award notice that they will hear from the state. SSA's Medicaid decision covers SSI recipients who meet the citizenship and immigration requirements. Watch your mail for the state contact, and call the state Medicaid agency if it does not arrive.
Can I get 1619(b) Medicaid if I earn more than my state's threshold amount?
Possibly. SSA's 1619(b) page says SSA can set an individual threshold for some people instead of the state figure, for example when a person has impairment-related work expenses. That means the published state amount is not always the figure that applies to you. If your work costs are high, ask SSA whether an individual threshold should be calculated in your case.
Can Medicaid help pay my Medicare premiums while I receive SSDI?
It can, depending on your income. SSA's page for approved disability beneficiaries says states may pay Medicare premiums for people with low income. SSA directs people to their state or local welfare office or Medicaid agency to find out whether they qualify, so the request goes to the state, not to SSA.