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Understanding Medicaid and Disability: Do You Automatically Qualify in NYC?

As of 2022, 6.7% of the working-age population of New York was disabled (and as of 2019, 36% of American senior citizens report having at least one disability). If you have a disability that affects your capacity to make ends meet, you’re not alone. 

Below is a breakdown of everything you need to know to apply for Medicaid or disability benefits in New York in 2023, from eligibility requirements to the documents you’ll need.

Key Takeaways

  • Social Security defines “disabled” as being unable to perform work you used to perform, unable to adjust to different work, and being expected to be disabled for at least one year (or resulting in death).
  • To qualify for Medicaid coverage, you must meet certain low income requirements with some exceptions (i.e., if you are a child in foster care or are already receiving SSI (Supplemental Security Income), you automatically qualify).
  • You can apply for Medicaid or Social Security Disability Insurance (SSDI) online, over the phone, or in person (see below for details).

What Qualifies as a Disability in NYC

The term “disability” may seem vague and subjective, but federal and state laws outline what is considered a disability in terms of your capacity to work. Under Social Security, being disabled  means that you can’t perform work that you used to be able to perform, your medical condition leaves you unable to adjust to different work, and your disability has lasted (or is expected to last) at least one year or will result in death. 

This definition encompasses a variety of types of disabilities, including musculoskeletal disorders, mental and/or neurological disorders, special senses and speech, cancer, immune system disorders, endocrine disorders, skin disorders, hematological disorders, genitourinary disorders, respiratory disorders, and disorders of the cardiovascular system, digestive system, immune system, or multiple systems. Lists of examples and eligibility criteria for each type of disorder are available online.

Do You Automatically Qualify for Medicaid If You Have a Disability?

In order to be eligible for the Medicaid health insurance program, your income must currently sit below the Federal Poverty Level. As of 2023, this means you must make $14,580 or less annually as a single adult. Households of two people must make $19,720 or less annually combined, whereas households of three must make $24,860 or less. 

Families of four must take home $30,000 or less annually, and families of eight must take home $50,560 or less annually (for families of nine or more, add $5,140 for each additional person).

Groups with Medicaid eligibility include single adults at this income level, as well as families, children, pregnant people, and individuals certified blind or certified disabled by the previously mentioned criteria.

While you’ll usually still need to formally apply, certain groups, such as recipients of SSI or children in the foster care system, automatically qualify for Medicaid.

The Medicaid Disability Manual defines “disability” as “the inability of an individual to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months.” 

You will be subject to a Disability Review Team unless you are already eligible for an Old Age, Survivors, and Disability Insurance Benefit under Title II, already receiving Supplemental Security Income (SSI) benefits,  or are already eligible for Railroad Retirement benefits due to disability.

How Do I Determine If I Qualify for Medicaid?

In order to qualify for Medicaid health coverage, your income must fall below the Federal Poverty Level as defined on January 1st of each year. There are certain exceptions: For instance, if you are already an SSI recipient or are a child in the foster care system, you automatically qualify for Medicaid.

Additionally, extremely high medical bills may mean you qualify for Medicaid despite your higher income (once your medical bills are equal to your excess income for six months, if you are also under 21, over 65, certified blind, certified disabled, pregnant, or a parent of a child under 21, you qualify for the Medicaid Excess Income Program).

How to Apply for Medicaid and Disability in NYC

Applying for Disability

People with disabilities can apply for federal disability benefits online, by phone at (800) 772-1213 (7am-7pm Monday through Friday), or in person at your local Social Security Office. Once you apply, a disability analyst from the NYS Division of Disability Determinations will review your case, and you should hear back within three to five months. Once approved, you’ll receive your first payment in your sixth full month of disability (after another five months). 

Before you apply, make sure to have the following information: 

  • Your birth and citizenship information (or permanent resident card number)
  • Any marriage and divorce information (including your spouse’s birthday and SSN)
  • The names and birthdays of your children
  • Any U.S. Military Service information
  • Employment details for the current year and the prior two years
  • Bank information for direct deposit
  • Names and contact information for someone who can help you with your claim as well as your doctors, hospitals, and clinics 
  • Information on where additional records can be obtained, such as details on rehabilitation or worker’s comp
  • Your education and training information
  • Information on your job history
  • The date when your disability started affecting your work
  • Any additional jobs you’ve had before or since

Applying for Medicaid

You can apply for Medicaid online, through your Local Department of Social Services Office, by calling the Medicaid Helpline at (800) 541-2831, or through a Managed Care Organization (MCO) (a “middle man” healthcare company that provides you with an integrated group of doctors, hospitals, and other providers in order to ensure quality and reduce costs). Once you submit your Medicaid application, you should receive a letter notifying you of its status within 45 days (30 days if you are pregnant or applying on behalf of children, 90 days if you have a disability that needs to be evaluated).  

To apply, you’ll need proof of U.S. citizenship (i.e., a birth certificate) or your immigration status (i.e., a “green card”), a government ID (i.e., a driver’s license), proof of address (i.e., your lease or a postmarked piece of  mail), and proof of income (i.e., paycheck stubs, social security award letter). 

You’ll also need proof of current health insurance (or an insurance termination letter), proof that you pay for care for your child or parents while you work (if applicable), and proof of pregnancy (if applicable) (i.e., statement from a medical professional with expected delivery date). 

If you have incurred medical bills in the past three months, you’ll need those bills as well as proof of address and proof of income for those three months.

Once you have been accepted into the Medicaid program, you will then be able to access benefits such as exams, doctor and clinic visits, lab tests, prescriptions, and home health care services.  

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