What Happens to Medicaid Benefits When a Disabled Child Shifts from SSI to SSDI Income?

Elder Law | Dec 19, 2023 | Jennifer S. Rossettini

Navigating the intricate landscape of government assistance programs can be daunting, particularly when it concerns the welfare of a disabled child. For many families, Medicaid plays a crucial role in ensuring their child receives essential medical care and support. However, when a disabled child’s income transitions from Supplemental Security Income (SSI) to Social Security Disability Insurance (SSDI), it may trigger alterations in their Medicaid coverage.

Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) are federal programs providing financial assistance to individuals with disabilities. SSI is a needs-based program available to disabled children, adults, and elderly individuals with limited income and resources. In contrast, SSDI is an insurance program offering benefits to disabled individuals who have accumulated sufficient work credits. While SSI automatically qualifies individuals for Medicaid benefits in most states, SSDI eligibility for Medicaid is contingent on factors such as income and resources.

SSDI is tailored for those who become disabled after an extended period of work. To receive SSDI benefits, a beneficiary must have contributed to the Social Security system for at least ten years before their disability onset. However, for adults disabled since childhood, meeting this criterion can be challenging. Some disabled adults may qualify for SSDI based on their parent’s work record through the Disabled Adult Child Program (DAC).

To qualify for DAC, the adult child must:
(1) have a qualifying disability,
(2) be single and not legally married,
(3) have a disability that manifested before turning 22,
(4) have a parent with sufficient work credits for retirement benefits, and
(5) have a parent who is deceased, permanently disabled, or receiving retirement benefits. If the parent retires or becomes disabled, the disabled child receives 50% of the parent’s benefit, and in the event of the parent’s death, the child receives 75%.

Now, what transpires regarding Medicaid eligibility when a disabled adult child transitions from SSI to SSDI benefits? To safeguard Medicaid coverage for specific groups losing SSI payments, Congress established special Medicaid continuation provisions. These provisions mandate state Medicaid agencies to regard certain former SSI beneficiaries as still qualifying for Medicaid, under sections 1634(c) and 1935(a)(2)(D) of the Social Security Act. Those eligible for the DAC program can thus maintain their Medicaid coverage, ensuring continuity as long as they meet the specified criteria.

Jennifer S. Rossettini

Attorney, Shareholder, CFP®
757-399-7506 | 252-722-2890
[email protected]

Jennifer Rossettini is a Shareholder of Hook Law where she focuses her practice in the areas of elder law, estate planning, estate and trust administration, and financial planning. Her practice includes complex estate planning for clients with a net worth over $5 million as well as simple plans for individuals with very limited assets. Ms. Rossettini rejoined the firm in 2018 after spending ten years as a CERTIFIED FINANCIAL PLANNER™ professional with the wealth management divisions of two regional financial institutions. She is a member of the Financial Planning Association, serving as Secretary for the Hampton Roads chapter and serves on the Board of Directors of the non-profit organization, PrimePlus Senior Centers. Jennifer lives in Virginia Beach with her husband and two daughters. She is active in the Girl Scout organization, serving as both a troop leader and as the treasurer for the local Service Unit.

Practice Areas

  • Elder Law
  • Estate & Trust Administration
  • Estate Planning
  • Financial Planning
Make a Plan
Let's make a plan.
We help individuals and their families navigate the legal maze and implement plans to secure their futures. By working together, we're able to offer comprehensive planning, life care services and legal representation, giving you peace of mind for what ever life brings.