Losing SSI does not automatically end your Medicaid, and understanding what happens to Medicaid when you lose Supplemental Security Income starts with that fact. Federal rules require your state Medicaid agency to check whether you qualify under any other eligibility category before closing your case, and several specific protections exist to keep coverage in place even after the SSI check stops. Which one applies depends on why your SSI ended, whether you’re working, and where you live.
Your State Has to Check Other Categories First
Before a state Medicaid agency can terminate your coverage, it must determine whether you qualify under any other basis of eligibility. If Medicaid truly doesn’t fit any category, the agency also has to check whether you qualify for subsidized Marketplace coverage.1eCFR. 42 CFR Part 435 Subpart J – Redeterminations of Medicaid Eligibility This is called an ex parte redetermination.
In practice, the quality of these reviews varies. Some states do them thoroughly; others do not. If a termination notice arrives, don’t assume the agency checked every category properly. Read the notice, figure out which of the pathways below might apply to you, and be ready to apply or push back on your own.
If You Lost SSI Because You Went to Work: Section 1619(b)
If your SSI cash payment dropped to zero because of earnings from work, Section 1619(b) of the Social Security Act is built for this exact situation. It lets you keep full Medicaid even though you no longer get an SSI check.2Social Security Administration. Continued Medicaid Eligibility (Section 1619(B))
To qualify, you need to meet all of the following:
- You received at least one SSI cash payment.
- You still meet SSA’s disability or blindness standard.
- Your resources stay within SSI limits, and you meet citizenship and residency requirements.
- You rely on Medicaid-covered services to maintain employment.
- Your gross earnings are below your state’s annual threshold.
State thresholds for 2026 range from roughly $40,000 in states like Alabama and Arkansas to over $84,000 in Minnesota, with most falling between $45,000 and $65,000.3Social Security Administration. POMS SI 02302.200 – Charted Threshold Amounts Even if your earnings exceed the standard threshold, SSA can calculate an individual threshold based on your actual medical costs, impairment-related work expenses, or publicly funded attendant care.2Social Security Administration. Continued Medicaid Eligibility (Section 1619(B))
Under 1619(b), SSA still considers you an SSI recipient for Medicaid purposes, and your state must cover you as part of a mandatory eligibility group. It is not optional or discretionary.4Medicaid.gov. Implementation Guide – Working Individuals Under 1619(b) Contact your local Social Security office to start this determination.
If You Lost SSI Because of Another Benefit
Federal law protects several groups by treating them as continuing SSI recipients for Medicaid purposes, even after their SSI payments stop. These protections are mandatory in every state, and they share a common thread: the person didn’t lose SSI because their financial life improved. They lost it because of a technicality tied to a different benefit.
Disabled Adult Children
If you’re 18 or older, receive SSI based on a disability that began before age 22, and then become entitled to Social Security child’s insurance benefits (or get an increase in those benefits) that push you off SSI, you are still treated as an SSI recipient for Medicaid. The protection lasts as long as you would otherwise still qualify for SSI without those child’s benefits in the picture.5Social Security Administration. Social Security Act 1634 – Determinations of Medicaid Eligibility
The Pickle Amendment: Lost SSI Because of Social Security COLAs
Named after a former member of Congress, the Pickle Amendment protects people who once received Social Security and SSI at the same time, but lost SSI because Social Security cost-of-living increases gradually pushed their income above SSI limits. If you would still qualify for SSI when those COLA increases are stripped out of the calculation, your state must provide you Medicaid. The rule is at 42 CFR 435.135.6eCFR. 42 CFR 435.135 – Individuals Who Become Ineligible for Cash Assistance as a Result of OASDI Cost-of-Living Increases
Certain Disabled Widows and Widowers
Disabled widows and widowers aged 60 through 64 who lost SSI because they were required to apply for Social Security widow’s or widower’s disability benefits must be treated as SSI recipients for Medicaid. This applies when the Social Security benefits they were forced to take made them ineligible for SSI.7eCFR. 42 CFR 435.138 – Disabled Widows and Widowers Aged 60 Through 64
For any of these three categories, start at your local Social Security office with documentation showing why your SSI ended.
If None of Those Apply: Income-Based Medicaid
In the 41 states (including D.C.) that have expanded Medicaid under the Affordable Care Act, you may qualify based on income alone, with no disability determination required. The limit is roughly 138% of the federal poverty level, which in 2026 works out to about $22,025 a year for an individual.8Federal Register. Annual Update of the HHS Poverty Guidelines
This is often the pathway people overlook. Many people who lose SSI still have low income, and if yours stays below that threshold, expansion Medicaid can cover you regardless of why the SSI ended, whether you have a disability, or how much you have in resources. Expansion Medicaid generally has no asset test, which is a real advantage over SSI-linked Medicaid and its $2,000 resource cap.
The ten non-expansion states leave a gap. In those states, adults without dependent children who lose SSI and don’t qualify under a protected category may have no Medicaid pathway at all if their income is too high for traditional Medicaid but too low for Marketplace subsidies.
Other Pathways Worth Checking
Medically Needy Spend-Down Programs
About 33 states and D.C. offer medically needy programs for people whose income exceeds normal Medicaid limits but who face significant medical bills. Your medical expenses count against your income; once they bring your effective income down to the state’s medically needy threshold, you qualify for Medicaid for the rest of a set period, which runs from one to six months depending on the state. These programs work best when you have predictable, recurring medical costs.
Medicaid Buy-In for Workers with Disabilities
Separate from 1619(b), most states offer a Medicaid Buy-In for working people with disabilities, authorized under the Ticket to Work and Work Incentives Improvement Act. These programs let you earn substantially more than traditional Medicaid limits allow, typically in exchange for a monthly premium.9Medicaid.gov. Ticket to Work The median monthly income limit across participating states runs around $3,261 for an individual, and premiums are often $20 to $40 per month, though this varies by state.10U.S. Department of Labor. Medicaid Buy-In Q&A Unlike 1619(b), the Buy-In doesn’t require that you previously received SSI, and it’s optional for states rather than mandatory. If you’re working and disabled, check whether both options are available in your state.
Home and Community-Based Services Waivers
If you need long-term care services to live outside a nursing facility, HCBS waivers can provide both those services and Medicaid coverage.11Centers for Medicare & Medicaid Services. Home and Community-Based Services 1915(c) They can apply institutional income and resource rules, which are more generous than community Medicaid limits, and can shelter part of a spouse’s income and assets. If you’re already enrolled in a waiver when your SSI ends, the waiver typically preserves your Medicaid. Waivers often have long waiting lists, so getting on one after losing SSI takes planning.
A Note If You Live in a 209(b) State
Seven states — Connecticut, Hawaii, Illinois, Minnesota, New Hampshire, North Dakota, and Virginia — use what’s called the 209(b) option, meaning they apply their own Medicaid eligibility rules rather than automatically covering SSI recipients.12Social Security Administration. POMS SI 01715.020 – List of State Medicaid Programs for the Aged, Blind, and Disabled Their criteria can be more restrictive than SSI’s in some respects and more generous in others.13Medicaid.gov. Implementation Guide – More Restrictive Requirements – 209(b) States Because Medicaid was never automatically tied to SSI in these states, losing SSI doesn’t trigger the same automatic loss of coverage it might elsewhere. You will still need to check the state’s income and resource rules with the state Medicaid agency.
What to Do When You Get a Termination Notice
If a notice arrives saying your Medicaid is ending, open it the day it comes. You have up to 90 days from the date the notice is mailed to request a fair hearing.14eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries But timing inside that window matters. If you request the hearing before the effective date of the termination listed on your notice, the state must continue your Medicaid until a final hearing decision is issued. This is called aid paid pending. The window can be as short as 10 days, so don’t wait.
One caveat: if the hearing goes against you and you kept getting benefits during the appeal, the state may try to recover the cost of that coverage. Weigh that against the risk of a coverage gap.
Even with the state’s obligation to check other categories, contact the agency directly and confirm the review is happening. You can reach your state agency by phone, in person, or through its online benefits portal.15HealthCare.gov. Medicaid and CHIP Coverage Bring documentation for whichever pathway fits your situation: earnings records and proof of prior SSI receipt for 1619(b), documentation of the benefit change that ended SSI for the deemed categories, income proof for expansion Medicaid, medical bills for a spend-down, or proof of disability and employment for the Buy-In.
Move quickly. Providers may refuse appointments during a gap, prescriptions can go unfilled, and retroactive reinstatement isn’t guaranteed. If Medicaid is denied under a new category, the denial notice must explain the reason and your appeal rights, and the state must also check whether you qualify for subsidized coverage through the federal Marketplace.