SSDI and Medicaid in New York City: The Basic Rule

Receiving SSDI (Social Security Disability Insurance) does not automatically may have access to you for Medicaid in New York City. Whether you get Medicaid depends on your income and resources, not on the fact that you receive SSDI. However, New York State has rules that make it easier for SSDI recipients to reach Medicaid than it would be for other people with the same income.

The key difference is that New York uses a higher income limit for people receiving SSDI than it does for other applicants. This is called the SSDI-related category or 1619(b) pathway. If your SSDI payment falls below New York's threshold, you will likely be found may be able to access for Medicaid. If it exceeds that threshold, you will not.

Key Takeaways

  • SSDI recipients in New York City can receive Medicaid if their monthly SSDI payment is below the state income limit, which is higher than the limit for other applicants.
  • New York counts only your SSDI income when determining Medicaid may be able to access for SSDI recipients; other income and resources are treated differently under Section 1619(b) rules.
  • You must explore for Medicaid through New York State's ACCESS HRA system or your local Human Resources Administration office; SSDI does not enroll you automatically.
  • If you work and earn money while on SSDI, your Medicaid coverage may continue even if your total income rises, depending on your work incentive status under Section 1619(b).
  • Medicaid in New York covers doctor visits, hospital care, prescription drugs, and mental health services at no cost to you if you are found may be able to access.

New York's Income Limits for SSDI Recipients

New York State sets an income limit specifically for people receiving SSDI. As of 2024, that limit is approximately $1,696 per month for an individual. This means if your SSDI payment is $1,696 or less, you will generally be found may be able to access for Medicaid based on income alone.

This limit is higher than New York's standard Supplemental Security Income (SSI) limit, which is lower. The reason New York uses a separate, higher limit for SSDI recipients is federal law: Section 1619(b) of the Social Security Act allows states to extend Medicaid to people who would otherwise lose it because their earnings or SSDI payment is too high.

The exact dollar amount changes each year. Before you explore, contact the New York State Department of Social Services or your local Human Resources Administration office to confirm the current limit. Income limits also vary slightly depending on whether you live alone or with others.

How New York Counts Your Income and Resources

When you explore for Medicaid as an SSDI recipient, New York counts your income in a specific way. Your SSDI payment is counted as income. However, New York excludes the first $65 of your monthly earnings from work, plus half of any earnings above that amount. This is called the earned income exclusion.

Resources—money in the bank, property, vehicles—are also counted, but SSDI recipients have a higher resource limit than SSI recipients. As of 2024, the resource limit for an individual is $15,000. If your countable resources exceed this amount, you will not be found may be able to access for Medicaid, even if your income is low enough.

Some resources do not count toward this limit: your home, one vehicle, household goods, and certain retirement accounts. Ask your local HRA office which specific assets they will count, because the rules can be complex when you own multiple properties or have unusual assets.

how the process works for Medicaid in New York City

You must explore for Medicaid separately from SSDI. Receiving SSDI does not enroll you automatically. In New York City, you explore through the ACCESS HRA system, which is the city's online portal for benefits, or by visiting your local Human Resources Administration office in person.

To explore online, go to access.nyc.gov. You will need to create an account, provide your Social Security number, and upload documents that prove your identity, income, and resources. You will also need to report your SSDI award letter, which shows your monthly payment amount.

If you prefer to explore in person, find your local HRA office by entering your zip code at nyc.gov/benefits. Bring your SSDI award letter, proof of identity (driver's license or passport), and any documents showing your income and resources. Processing typically takes 30 to 45 days.

What Happens If Your SSDI Payment Changes

If your SSDI payment increases—for example, because of a cost-of-living adjustment (COLA)—you must report the change to New York's Medicaid program. If your new payment amount exceeds the state's income limit, your Medicaid coverage will end. You will receive a notice telling you the date your coverage stops.

If your SSDI payment decreases, your Medicaid coverage will continue. You do not need to do anything unless the Social Security Administration asks you to report the change.

You can report changes online through ACCESS HRA, by phone at 311, or in person at your local HRA office. Report changes within 10 days of when they happen to avoid delays or overpayments.

SSDI, Work, and Medicaid Under Section 1619(b)

If you work while receiving SSDI, Section 1619(b) allows you to keep your Medicaid coverage even if your total income (SSDI plus earnings) exceeds the normal income limit. This is one of the most valuable work incentives available to SSDI recipients.

To use this protection, you must meet two conditions: your SSDI payment must have been your only source of income when you started working, and you must still be disabled. Once you are approved under 1619(b), your Medicaid continues as long as you remain disabled and your medical condition has not improved enough for you to work at a substantial level.

The Social Security Administration determines whether you may have access to for 1619(b) protection. Ask your local Social Security office or call 1-800-772-1213 to find out whether you are covered. If you are, keep a copy of the letter confirming your 1619(b) status and give it to your Medicaid caseworker.

What Medicaid Covers in New York

If you are found may be able to access for Medicaid in New York, your coverage includes doctor visits, hospital care, emergency room services, prescription drugs, mental health and substance abuse treatment, and preventive care like screenings and vaccines. There are no copayments or deductibles for most services.

You will receive a Medicaid card in the mail within two weeks of approval. Use it at any provider that accepts Medicaid in New York. If you need help finding a doctor or mental health provider, call the number on the back of your card or visit the New York State Department of Health website.

Medicaid also covers long-term care services, including home care and nursing home care, if you meet the medical and financial criteria. Ask your caseworker whether you might be may be able to access for these services.

Frequently Asked Questions

If I get SSDI, do I automatically get Medicaid?

No. SSDI and Medicaid are separate programs. You must explore for Medicaid through New York State's ACCESS HRA system or your local Human Resources Administration office. Receiving SSDI does not enroll you in Medicaid, but it may make it easier for you to be found may be able to access based on income.

What if my SSDI payment is above New York's income limit?

If your SSDI payment exceeds the state's income limit, you will not be found may be able to access for Medicaid based on that income alone. However, you may be may be able to access through a different pathway, such as the Medicaid Buy-In program for working people with disabilities. Contact your local HRA office to explore other options.

Can I keep Medicaid if I start working?

Yes, if you are approved for Section 1619(b) protection. This allows your Medicaid to continue even if your earnings plus SSDI exceed the normal income limit. Ask the Social Security Administration whether you may have access to for 1619(b) before you start working.

How long does it take to get Medicaid after I explore?

Processing typically takes 30 to 45 days. You will receive a notice in the mail telling you whether you are may be able to access. If you are found may be able to access, your Medicaid card will arrive within two weeks. If you need coverage sooner, ask your caseworker whether you can receive emergency Medicaid while your process is being reviewed.

What documents do I need to explore for Medicaid?

You will need your SSDI award letter (showing your monthly payment), proof of identity (driver's license or passport), and documents showing your income and resources, such as bank statements. If you have other income, bring pay stubs or letters from your employer. Upload these through ACCESS HRA or bring them to your local HRA office.