How will going on Social Security effect Medicaid?

[EricW236758]

At this moment my wife and I are are surviving on my SSDI benefits alone, and we do not have any other sources of income.  Also, my wife is currently receiving chemo to combat her cancer, and she is unable to work.  The doctor says she will continue chemo until late December, and then she will start radiation therapy sometime in January of 2026.  Her radiation therapy is expected to last until Febraury of next year.  Additonally, my wife's medical coverage is through Medicaid, and we are living in the state of North Carolina.

Also, My wife has not worked since 2012, and it appears doubtful that she will ever be able to return to work.  We have been advised that my wife, who is now 61, should apply for SSDI.  However, since my wife is now receiving Medicaid, what will happen to medical coverage if she gets approved to receive SSDI?  Will she stay on Medicaid, or will her existing Medicaid be transformed into Medicare?  Additionally, I'm receiving $1,991 a month in SSDI, and we expect that my wife will  receive around $1,200 in SSDI.  Based upon our expected incomes, will the state Medicaid continue to pay for my Medicare, and also her possible Medicare?

Any info greatly apprpeciated.  

[GailL1]

@EricW236758 

Your wife can apply for her own SSDI benefit but it is a long process and is based on the factor that she cannot work (any job).  If her cancer is deemed terminal, she may get SSDI relatively fast based on the SSA Compassionate Allowance list.   Her oncologist and other providers are the best source of this determination of disability.

They need to be onboard with the decision that she is disabled because the determination for this is based on the medical reasoning of not being able to work (any job).  

Now what this might do to her Medicaid benefits - Medicaid benefits are based on income level and low to no asset or resource level. The more income there is, the less likelihood that there is a Medicaid benefit.  There are actually (2) different types of Medicaid -

(1) the ORIGINAL program where benefits are based on LOW INCOME and a category status of:

• elderly (over 65) - includes Long term care
• declared disabled - either under SSDI or SSI - includes long term care
• blind - includes long term care
• pregnant women
• Children under the CHIPS program 

(2)  EXPANDED Medicaid under the ACA program for LOW INCOME abled, bodied individuals less than 65 years old and only based on their yearly Modified Adjusted Income Level.   Assets and Resources are not counted in this category of MEDICAID.  

It seems based on what you have posted that she is getting MEDICAID based on #2 EXPANDED MEDICAID.  

If my assumption is correct based on what info you have given  and IF she files for and receives SSDI, then her MEDICAID status will pass from Medicaid #2 to Medicaid #1 and her income level, with her SSDI benefit, could DISQUALIFY her from receiving Medicaid #1 - at least for FULL Medicaid coverage.  

IF she gets SSDI, then after the wait period of 24months from her date of disability, she would have access to MEDICARE and some of her MEDICARE expense could be covered by the Medicare Savings Program which she may be eligible. 

However, if she is right now under the ACA EXPANDED Medicaid Program (#2) then beginning soon she will be exposed to the new work requirement of either working, volunteering or going to school for some 80 hours a month.,  This requirement would go away if she is successful in getting SSDI because, like I said, if she gets the SSDI approval she will pass from Expanded Medicaid #2 to Original Medicaid #1 IF her income is low enough for MEDICAID #1.  

A remedy to this might be, IF SHE CAN WAIT UNTIL SHE IS 62 YEARS OLD, is to file for both her early retirement at age 62 AND SSDI - that way she will begin to received her reduced (early filing) Retirement benefit and then IF her SSDI application is approved, the SSA will go back to the beginning date of benefits and adjust her benefit upwards to what she should have received under SSDI rather than retirement.

I assume that you know that SSDI is one’s full Social Security benefit as of the date of disability whereas an EARLY retirement Social Security benefit is reduced because of not meeting one’s full retirement age requirement. 

Any Medicaid benefit is gonna be based on 

(a)  income

(b) status based on which Medicaid program she is under at the time #1 or #2 

Have I thoroughly confused you???  The best way to determine what she should do is to determine if she is actually disabled and cannot work (any job).  Rely on her doctors to help in this decision.  Then firm up the numbers - her benefit amount if under SSDI and under early (age 62) retirement.  Then figure out the income limits and any status descriptions under each of the (2) Medicaid programs.  Original Medicaid and Expanded Medicaid.  

[EricW236758]

Hello GailL1, and yes I'm very confused as usual.

As I recall, when my wife turned sixty, the state of North Carolina took away her requirement to work, and they have not mentioned it to us since.  However, at this moment, she is only sixty one-years old.  So based upon this information, it sounds like she is most likely receiving Medicaid 2 right now?  How would I determine this?

[GailL1]

@EricW236758 

That is the way I see her - EXPANDED Medicaid (#2) because she does not fit anyplace else.  She stays on this and is prequalified by her tax return every year or a recertification,  She can stay on expanded Medicaid until she turns 65 and is eligible for Medicare.  

There is a new work requirement being installed at the federal level for those with abled bodied, MAGI, ACA expanded Medicaid participants.  (or Medicaid # 2 in my description)  Will become effective in 2026 - 2027 with a work requirement of 80 hours a month - work, school or volunteering - for those on EXPANDED Medicaid.  

NC Expanded Medicaid description

N.C. Expanded Medicaid 

She has NO eligibility conditions for Original Medicaid (#1 ) that you mentioned - that is being a low income person

• being elderly (over 65)
• being declared disabled - SSDI or SSI
• bing blind
• being a pregnant 
• being a child on the CHIPS program

The only other way would be to be on EXPANDED Medicaid (#2) - where the only thing they go by for eligibility is being low income and that is based on the MAGI - see the above link.  The hyperlinks will further explain the eligibility for Expanded Medicaid.  

[EricW236758]

Well, I'm not certain, but I think my wife might be considered a low-income person, as she does not have any income of her own, and we both rely upon my SSDI benefits for survival.  (My wife has not worked for many years due to undiagnosed depression, and she was also diagnosed with learning disabilites as a child.)

At any rate, it seems as though we should not rush into anything blindly,  and it is starting to seem that we should avoid having her apply for Social Security, because doing so might push our monthy income over the limit income limit set by North Carolina, and if that were to happen, we would then have to start paying out of pocket for part of her cancer treatment.  Does this sound right to you?

[GailL1 · Accepted solution]

@EricW236758 

Wife, age 61, low income Expanded Medicaid eligible, NC resident, currently undergoing cancer therapy.  

Remaining on what she is doing now seems the best for now.  Sometimes in the next couple of years there will be a Medicaid work requirement put into place by each state for those on Expanded Medicaid that are not working.  Presently, that work requirement could be work, volunteering or going to school for 80 hours a month.  Defined rules have not yet been written to date.

At that time she will be at least 63 so she will still have the same options of 

• continuing on as she is now with perhaps the requirement to do some work, school or volunteering beginning in 2027 or there about
• apply for her EARLY SS benefit and at the same time
• apply for SSDI depending on her health condition at that time

These same choices (all of them) apply when she turns 62 and continue - 

Just make sure that she reads any communications sent to her from the NC Medicaid office - NCHHS

Edited to add:  Work hours applicable to SSDI do expire - work hours applicable to SS Retirement do not expire.  So depending upon how long it has been since she work - she may or may not have an access to SSDI.  Her “date last insured” (DLI) should be shown on her online Social Security Account - Her DLI is a rolling five-year period after she stopped working, and you must be disabled before this date to receive SSDI. 

SSA.gov - Disability Benefits | How Does Someone Become Eligible? 

[EricW236758]

Thank you for the guidance, and I will advise her to wait a few more years.