Disability-Based Medicaid

Disability-Based Medicaid if you don't get SSI

Medicaid is government-funded health coverage for people in certain situations. Most people who qualify, get Medicaid coverage because they:

• Get Supplemental Security Income (SSI) benefits or qualify for SSI’s 1619(b) rule, which helps people who used to get SSI. In either case, you automatically get Medicaid coverage and don’t need to worry about the rules discussed here. Learn more in DB101’s SSI article.
• Have low income, no matter how much you have in resources or whether you have a disability. Learn more about income-based Medicaid.

However, some people who don't qualify for SSI, 1619(b), or income-based Medicaid may still qualify for disability-based Medicaid. You may still qualify if you are in one of these situations:

• You have countable income at or below $235 per month. Note: This is much lower than SSI's income limit and if your income is this low, you should apply for SSI. You might have disability-based Medicaid, but not SSI if you have certain types of trusts or simply don't want to get SSI.
• You are elderly or have a disability and need the level of care typically offered by a nursing home, hospital, or other institution. Medicaid Waiver programs may pay for services that let you live in your own home instead. Medicaid Waiver programs are introduced on this page.

Note: If you have Medicare coverage and don't qualify for Medicaid, you may qualify for a Medicare Savings Program (MSP), which would help pay for your Medicare expenses. Learn more about MSPs.

Medicaid Waiver Programs

If you are elderly or have a disability and you need the level of care typically provided in a nursing home, hospital, or other institution, Kentucky offers six Home and Community Based Medicaid Waiver programs that pay for the services you need in order to be able to stay in or return to your home or community. Each of the six progams helps people in certain situations, like those with brain injuries, intellectual or developmental disabilities, or who need a ventilator and high intensity nursing care. Learn more about Medicaid Waiver services. Note: Most of these Medicaid Waiver programs have long waiting lists.

The monthly gross income limit for most Medicaid Waiver programs is $2,829, which is much higher than for disability-based Medicaid or for SSI and SSI-linked Medicaid. The monthly gross income limit for the Supports for Community Living Waiver is $5,658.

Your resources must be $2,000 or less if you live alone; $4,000 or less for couples. Some resources are not counted by Medicaid Waiver programs and do not affect eligibility, including the home you live in and any money you have in an ABLE account.

Because of the higher income limit, some people with disabilities who wouldn't otherwise qualify for Medicaid may qualify. But if your countable income is higher than $2,829, Medicaid may charge you a monthly fee — called a patient liability — for your waiver services. The amount you have to pay can vary.

Many people don't have to pay a patient liability. That includes anybody who:

• Gets SSI benefits
• Qualifies for SSI’s 1619(b) rule
• Stopped getting SSI benefits because Childhood Disability Benefits (CDB) started or went up based on a parent's work record
• Got both SSI and Social Security Disability Insurance (SSDI) at the same time, and the SSI benefits ended because of a SSDI cost of living increase, or
• Stopped getting SSI benefits after starting to get SSDI because of the work record of a deceased spouse (known as Disabled Widow or Widower benefits).

If you are paying a patient liability fee and think you shouldn't have to, contact your Department for Community Based Services (DCBS) office. If you need help with this issue, contact Kentucky Protection & Advocacy.

If you do have to pay patient liability, the best way to improve your overall financial situation is to work, because earnings will cause your income to go up a lot more than your patient liability will.

How to Sign Up for Medicaid and Medicaid Waiver Services

You can apply for Medicaid and other benefits, such as SNAP (formerly Food Stamps), and Kentucky Transitional Assistance Program (K-TAP), at the same time:

• Online at kynect benefits
• At your Department for Community Based Services (DCBS) office by mail or in person, or
• By calling the DCBS Family Support Call Center at 1-855-306-8959.

Note: A quick online pre-screening process can let you see if you might qualify for Medicaid, Kentucky Children's Health Insurance Program (KCHIP), SNAP, or K-TAP.

For help with your application, visit or call your local Department for Community Based Services (DCBS) office or contact the Call Center at 1-855-306-8959.

Staying on Medicaid

Usually, once you are approved for Medicaid, you will continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your Department for Community Based Services (DCBS) office know. When you report your changes, the county will tell you whether you will continue getting Medicaid or if you have new health coverage options, like individual coverage with subsidies.