1. Understanding the Difference Between Medicaid and Medicare

In Texas, Medicaid is a state and federal program designed for individuals and families with low income and limited resources. It covers a wide range of medical services, including doctor visits, hospital stays, prescriptions, and long-term care.

SSDI, on the other hand, is a federal disability program based on your work history and the Social Security taxes you’ve paid. Once approved for SSDI, you will eventually qualify for Medicare — but not immediately. There is generally a two-year waiting period from the date your SSDI benefits begin before Medicare starts.

2. Keeping Medicaid After SSDI Approval

Whether you can keep Medicaid after being approved for SSDI in Texas depends primarily on your income and resources after your SSDI payments begin. Because SSDI counts as income, an increase in your monthly benefit amount could push you over Medicaid’s income limits.

However, Texas has special programs that allow some individuals to keep Medicaid even if their income increases. These include:

• Medically Needy Program — Allows you to spend down excess income on medical expenses to qualify.
• Medicaid Buy-In Program for Working Adults with Disabilities — Lets you pay a monthly premium to keep Medicaid if you work part-time or have income above the standard limit.
• Dual Eligibility — If you qualify for both Medicaid and Medicare (once your Medicare coverage starts), you may receive extra help paying for premiums and medical costs.

3. Potential Coverage Gap Before Medicare

A common concern is the period between SSDI approval and the start of Medicare coverage. Since Medicare begins 24 months after SSDI eligibility, some people lose Medicaid and have no affordable coverage during this waiting period. This is why it’s important to review your situation as soon as you’re approved for SSDI, so you can plan for continuous healthcare coverage.

4. Steps to Protect Your Coverage

If you receive a notice about changes to your Medicaid after SSDI approval, take these steps immediately:

• Contact Texas Health and Human Services to review your eligibility.
• Explore special Medicaid programs for people with disabilities.
• Keep records of your medical expenses to help with a “spend down” if your income is too high.
• Seek legal or advocacy help if you believe your coverage was ended in error.