Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Federal Provisions


Since 1982, certain SSI disability beneficiaries who are able to work and earn more than the SGA amount ($1,000 per month for 2010) have been permitted to keep their SSI and Medicaid benefits, provided their countable income is within SSI qualifying limits. Under this provision, individuals with earnings up to $1,433 per month in 2010 are typically able to continue receiving SSI cash benefits.29

Former SSI beneficiaries with even higher earnings may continue to qualify for Medicaid, as long as their earnings are below a state-specified level that is roughly equivalent to the value of the total SSI and Medicaid benefits they would receive if they did not work.30 The Medicaid component of this amount is the average amount spent by Medicaid for beneficiaries with disabilities in the relevant state. States must provide Medicaid to individuals with earnings above even this level, if they can show that their medical expenses are higher than the state average used to establish the cutoff. The Social Security Administration administers both provisions.

Little use was made of these protections at first because they were not widely understood. Thus, the number of working persons with disabilities whose earnings were protected in this manner in 1982, the first full year of implementation, was just under 6,000. By September 1999, however, the number had risen to nearly 100,000.31 In December 2008, there were 355,762 SSI disabled beneficiaries who were working--only 5.5 percent of the total SSI blind and disabled caseload--with average earnings of $605 a month; 23 percent earned $65 or less per month.32

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