Disability-based Medicaid

Is It Right for You?

Medicaid is government-funded health coverage for people in certain situations. You may qualify if you:

• Have low to moderate income, no matter how much you have in resources or whether you have a disability. Learn more about income-based Medicaid.
• Have low income and resources, and have a disability or are 65 or older. In general, you must qualify for Supplemental Security Income (SSI) or SSI's 1619(b) status to qualify for Medicaid this way, but some people get it without getting SSI or 1619(b). Disability-based Medicaid is explained on this page.
• Have a disability and work, even if your income is higher and your resources are higher than the regular Medicaid limits. Learn more about Health Insurance for Work Advancement (HIWA).

This page looks at the ways you may qualify for disability-based Medicaid. If you do, it's probably your best health coverage option because it doesn’t have a premium and Medicaid covers more services than most private plans. Also, if you qualify for Medicaid, you cannot get government help paying for an individual plan on Nevada Health Link.

Medicaid Rules for Immigrants

For Medicaid, you must be a U.S. citizen or meet specific noncitizen requirements:

• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements may qualify for Medicaid or other Nevada health programs.
• Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for some coverage if they need emergency medical services.

If You Get Supplemental Security Income (SSI)

If you get Supplemental Security Income (SSI) benefits, or if you meet the SSI requirements but don't get benefits yet, you qualify for Medicaid. However, you have to apply for Medicaid separately from SSI.

You don't already have to be approved for SSI to apply for Medicaid: You can apply while you are waiting for your benefits to start.

If you used to get SSI but your benefits go to zero because you go back to work, you may qualify for SSI's 1619(b) rule, which lets you keep your Medicaid coverage.

Read more about SSI and 1619(b) and see if you qualify in DB101's SSI article.

Tip: If your income or resources go over the SSI or 1619(b) limit because you work, you may qualify for Health Insurance for Work Advancement (HIWA). Learn more about HIWA.

If You Don't Get SSI

Some people who don't qualify for SSI or SSI's 1619(b) rule can still get disability-based Medicaid. You may qualify if you are in one of these situations:

• You have countable income below SSI's limit, but you don't get SSI for one of these reasons:
  • You have a trust that qualifies you for Medicaid but not for SSI
  • You have more than $100,000 in an ABLE account, or
  • You don't want to get SSI.
• You are elderly or have a disability and need the level of care normally provided by a nursing home, hospital, or other institution. In this case, you may qualify for a Medicaid waiver program, which pays for services that let you live in your own home instead of a facility, even if your income is too high for SSI. Medicaid waiver programs are explained 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

Medicaid waiver programs, also called Home and Community-Based Services (HCBS) waivers or 1915(c) waivers, are for people who need higher levels of care to live in their own home or apartment in the community instead of a facility. Nevada has a number of waivers that help people in different situations, including waivers for people who are age 65 or older, people with intellectual and developmental disabilities, and people with physical disabilities.

If you qualify for a waiver, you get regular Medicaid coverage, plus extra services you need to be able to live in your home or community.

The income limit for waivers is higher than the income limit for SSI, so you may qualify even if you don't qualify for SSI. To qualify for a waiver, you must:

• Need a level of care normally provided by a hospital, nursing home, or other care facility
• Have resources that are $2,000 or less if you are single ($3,000 or less for couples), and
• Have gross income at or below $2,982 or less a month.

Note: Waivers often having waiting lists, which means that even if you meet the qualifications for a program, you may not get access to its services right away.

Learn more about Medicaid waivers on the Nevada Medicaid website.

How to Sign Up

You can apply for Medicaid:

• Online with Access Nevada
• In person at your local Division of Social Services (DSS) office, or
• By downloading the Application for Health Insurance, completing it, and then faxing or bringing it in person to your local Division of Social Services (DSS) office, or mailing it to the address listed on the form, or
• By calling 1-755-684-7200 (if you live in Northern Nevada) or 1-702-486-1646 (if you live in Southern Nevada).

To apply for a waiver, contact your local Aging and Disability Services Division (ADSD) office, or contact your local ADSD Developmental Services office if you have an intellectual or developmental disability.

Staying on Medicaid

Usually, once approved for Medicaid, you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your Division of Social Services (DSS) office know as soon as possible. You can do this in person, by phone, or by email. Or, you can update your information online using Access Nevada. If you have disability-based Medicaid, you must report any change by the tenth day of the month after the change happened.

When you report your changes, the county or website tells you whether you continue to get Medicaid or if you have new health coverage options, like individual coverage with subsidies or Health Insurance for Work Advancement (HIWA).