Supplemental Security Income for People with Disabilities: Implications for Medicaid | KFF

The federal Supplemental Security Income (SSI) program provides a cash payment to serve as a minimum level of income for people who have low incomes and limited assets and are elderly or meet the Social Security Administration's (SSA) strict rules that define disability. The maximum federal SSI benefit is less than the federal poverty level (FPL), $794 per month or about 74% FPL for an individual, in 2021. As a result of the SSA's strict disability determination rules, not all people with disabilities qualify for SSI. States generally must provide Medicaid to people who receive SSI. This issue brief describes key characteristics of SSI enrollees, explains the SSI eligibility criteria and eligibility determination process, and considers the implications of changes in the SSI program for Medicaid, including the effects of the COVID-19 pandemic and resulting economic downturn and proposals supported by President Biden that Congress might consider. Key findings include the following: Working people with disabilities experience disproportionate job loss during economic downturns compared to workers without disabilities, and SSI applications generally increase when the unemployment rate increases. The COVID-19 pandemic has presented additional challenges not present during other economic downturns, such as the closure of SSA offices due to social distancing measures. People in households where someone experienced a job or income loss were more than three times as likely to have applied or attempted to apply for SSI during the pandemic, or plan to apply in the next 12 months, compared to those in households without job or income loss. Because SSI eligibility generally is a pathway for Medicaid eligibility, changes that affect the ability of people with disabilities to obtain or retain SSI also can affect the ability of people with disabilities to access Medicaid. SSA expects disability claims (including SSI and SSDI) to increase by nearly 300,000 in the second half of FY 2021, and over 700,000 in FY 2022, compared to FY 2020. SSA received fewer applications than expected in FY 2020, due to office closures and other disruptions due to the pandemic. Additionally, the Affordable Care Act's (ACA) Medicaid expansion was not available during prior economic downturns, so the extent to which people might forgo an SSI application (as a means to access Medicaid) because they are eligible for Medicaid through the ACA expansion (in states that have chosen to expand) remains to be seen. Finally, the extent of chronic disabling illness experienced by people with “long COVID” is not yet fully understood but could result in a new population seeking SSI due to their inability to work.