How SSI can lead to Medicaid
SSI stands for Supplemental Security Income. In most states, Social Security also makes the Medicaid decision for people who get SSI.
These are called 1634 states, after a section of the Social Security Act. In these states, if you qualify, the SSI award letter says you will hear from your state about Medicaid soon. The District of Columbia and 34 states work this way.
Medicaid is health coverage run through your state. If you get Medicaid, it may help with rides to medical care. The section on ride coverage below explains more.
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States that make their own Medicaid decision
In some places, the state makes its own Medicaid decision for people who get SSI. If you live in one of these places, you may need to contact your state Medicaid agency. Social Security may refer you there.
Social Security’s policy manual lists these states, and the list can change. Ask Social Security or your state Medicaid agency which rules apply to you.
- States that use SSI rules but make their own decision: Alaska, Idaho, Kansas, Nebraska, Nevada, Oklahoma, Oregon and Utah, plus the Northern Mariana Islands.
- States that may use at least one stricter rule than SSI (called 209(b) states): Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota and Virginia.
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How SSDI can lead to Medicare
SSDI stands for Social Security Disability Insurance. Social Security’s rules call these disability insurance benefits, and they can lead to Medicare.
If you get Social Security disability benefits, you’ll get Medicare automatically after getting disability benefits for 24 months. In most cases, Medicare starts on the first day of your 25th month of entitlement to disability benefits.
Medicare Part B is medical insurance. It covers some ambulance trips, as explained below.
Exceptions for ALS and kidney failure
If you have ALS (also called Lou Gehrig’s disease), there is no 24-month wait. You get Medicare automatically as soon as you start getting disability benefits.
If you have End-Stage Renal Disease (ESRD), which is permanent kidney failure that needs regular dialysis or a kidney transplant, you may get Medicare at any age. If you’re on dialysis, Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments. You can sign up through Social Security.
While you wait for Medicare
The 24-month wait can be hard if you need rides to treatment. During this time, you may still qualify for Medicaid under your state’s rules.
Social Security’s own policy manual tells its offices that people who get Social Security disability benefits, not just SSI, may be eligible for Medicaid in all states. Its offices should refer people to the state Medicaid agency when that fits. You can ask your state Medicaid agency whether you qualify.
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What Medicaid and Medicare may cover for rides
Federal rules say each state Medicaid agency must ensure necessary transportation for its members to and from medical providers. Each state decides how it does this, so call your Medicaid plan or state agency to learn how to book a ride.
Medicare Part B covers ground ambulance transportation when traveling in any other vehicle could endanger your health. In some cases, Medicare may pay for a non-emergency ambulance if your doctor writes an order saying it is medically necessary.
See the Medicaid rides guide and the Medicare guide on this site for more detail.
Travel to Social Security exams and hearings
Social Security or your state disability agency may pay you back for some travel while you pursue a claim. This covers medical exams they ask you to attend to decide your disability claim. These are called consultative exams. It also covers certain hearings on your claim.
For a hearing, they pay travel only if the trip from your home or office to the hearing site is more than 75 miles.
The agency that asks you to travel is usually the one that pays. It should tell you about travel repayment when it tells you about the exam or hearing.
Payment is usually made after your trip. You can ask for an advance, which may be approved if you show the amount is reasonable and necessary. Keep your receipts, because you must send an itemized list of what you spent with receipts.
Special costs, like an ambulance, an attendant, meals, lodging or taxis, may be paid. These usually must be approved in writing before you travel, unless they were unexpected or unavoidable.