The Health Insurance Coverage Benefits Associated with a Favorable Social Security Disability Claim

An application for Social Security disability insurance benefits (SSDI) and Supplemental Security Income (SSI) can assist with obtaining health insurance benefits in a number of different ways.   Whether it’s obtaining Medicaid Insurance (which is a Federal program administered by the states, and which is called Medicaid in New Hampshire, Mainecare in Maine and Mass Health in Massachusetts) or, ultimately Medicare (the Federal health insurance program that provides benefits not only to those who have hit retirement age, but also to certain qualified individuals who have been approved for SSDI Benefits, the potential additional benefit associated with an application for SSDI and SSI cannot be ignored.  

When looking at whether one qualifies for a health insurance benefits under the welfare Medicaid program, the rules for approval differ from one state to another.  What remains consistent, however, is that an approval for SSI (and a finding of disability under this Federal program) triggers automatic entitlement to health insurance under the Medicaid program.  And so, it is quite common to see that when one is hospitalized in a Boston, Massachusetts area hospital, and without insurance or a mechanism for payment of their medical bills, that the hospital’s financial aid assistance office will have an individual associated with their office who will seek to have the patient apply for SSI benefits.  In this way, if SSI is ultimately approved, the individual would have automatic Medicaid approval which would help defray the hospital’s costs of treatment.  Likewise, the patient is many times referred to their local Massachusetts Department of Transitional Assistance (DTA) office so as to pursue an application for such benefits as Emergency Aid to the Elderly, Disabled and Children, Food Stamps and Mass Health (the state name for the Federal Medicaid program).   In fact, an application for Mass Health typically requires that the individual show that they are likewise applying for SSI/SSDI as, ultimately, an approval for SSI/SSDI will ultimately ensure entitlement to Medicaid (Mass Health) insurance.   Moreover,  approval for SSDI ultimately carries with it entitlement to Medicare insurance eligibility, much like a senior citizen receives: such benefits are available to Social Security disability recipients once they have been deemed qualified to receive an SSDI benefit for 24 months.  That is to say, there is a 24 month waiting period from the time initiation of a disability check takes place until the time one becomes eligible to pay a premium for the Federal Medicare health insurance benefit.

It is important to note that some states are more difficult than others in terms of providing a state Medicaid benefit. Typically, the state of Maine will deny an individual for Medicaid assistance (assuming they qualify financially for the welfare program) if they are denied on their Social Security application: while an appeal can be made through the Department of Human Services (DHS), such appeals prove difficult to win.  Many times, an individual only gets approved for Mainecare once they have actually been approved their Social Security disability claim: at the point in time one is found disabled under Social Security’s rules, there would be automatic approval under the Mainecare program, which approval would allow for benefits to be paid to one’s health care providers retroactive to the date of one’s SSI approval.

In New Hampshire, the standard typically applied for a Medicaid claim is the same as that called for under their cash assistance program for the long term disabled called APTD (Aid to the Permanently and Totally Disabled): that is, one needs to show they meet the Social Security regulations in terms of being found “disabled” under Social Security’s rules, but for what would be expected to be a period of 48 months or longer (versus Social Security’s standard of a year or longer).  Obviously, this becomes a much more difficult standard to meet.   In fact, of the three states (Maine, Massachusetts and New Hampshire), only the State of Massachusetts makes its own, independent determination whether one meets one of Social Security’s guidelines for establishing disability and, assuming so, then provides for Mass Health.  That is to say, Massachusetts will look to see if a claimant meets either one of Social Security’s listed impairments or they are likely to remain disabled from all forms of gainful employment under Social Security’s rules for a year or longer.

Once again, it’s important to understand that upon an approval for SSI and SSDI, one will automatically be deemed to meet the disability standard for any of the states’ Medicaid programs listed above: this approval will go back to the date one is found disabled under the Social Security program.  Likewise, it is important to understand that upon approval for a benefit under the Federal Medicare program one can request that the individual state cover the cost of their Medicare premium: assuming they remain entitled from a financial standpoint to the state Medicaid program, the state will then typically pick up the cost of the monthly Medicare premium.  The reason for this is quite simple. Medicare becomes one’s primary insurer, and Medicaid is secondary.   That is, the Federal government will pay health insurance costs first under the Medicare program and this will serve to save the state money in terms of what they would need to pay under the Medicaid program.

The need to apply for and obtain SSI and SSDI benefits is not simply related to the cash benefit one will receive: it is equally important to whether one will obtain health insurance through the state and/or Federal government. This is another important reason why you should be seeking the assistance of a skilled and zealous lawyer to assist with your Social Security disability claim or appeal.  If you, a family member or friend requires such assistance, contact the Law Offices of Russell J. Goldsmith at  1-800-773-8622 to discuss your circumstances.   There is no cost to speak with us, and should we end up assisting you with your claim, attorney’s fees are contingent upon obtaining benefits.