Getting benefits through the Social Security Disability Insurance (SSDI) program is a great relief to a person under age 65 who is unable to earn a living because of a disability. Its monthly payments guarantee some degree of financial security.
An added benefit to SSDI is health insurance coverage through Medicare. But there is a precarious two-year gap between receiving approval for disability benefits and becoming eligible for Medicare’s insurance coverage. The practical impact of this waiting period is that numerous SSDI beneficiaries are temporarily both unemployed because of their disabilities and without health insurance.
Lower-income SSDI applicants may qualify for Medicaid, especially if they live in one of the 39 states that have expanded Medicaid to include anyone whose income is below 138 percent of the Federal Poverty Level, no disability required. But this still leaves a large number with higher incomes who can face the life-threatening consequences of going without health insurance during the two-year waiting period. If this is the case for you, what are your options?
First of all, it might be possible to at least narrow the two-year gap by harnessing any delays in getting your case heard by the Social Security Administration (SSA). If, for example, you were on a waiting list for six months before a hearing with an ALJ (administrative law judge, the SSA official who adjudicates SSDI cases), that period might be counted toward the two-year delay in receiving Medicare coverage. In this instance, that would leave an 18-month period to cover.
Another possibility is individual insurance purchased on the exchanges made possible by the Affordable Care Act. Although coverage can be expensive depending on where you live, be sure to research your options. You may be eligible for government subsidies to help you pay the premiums for an individual health plan if your modified adjusted gross income (MAGI) ranges from 100 to 400 percent of the previous year’s federal poverty guidelines.
The subsidies are tax credits that are available to help middle-income and low-income people afford health insurance when they don’t have access to affordable employer-sponsored coverage or government-sponsored coverage (Medicaid or Medicare). Most eligible enrollees take those tax credits in advance, paid directly to their health insurance carrier each month to offset the amount that has to be paid in premiums.
It goes without saying that no one, least of all someone with disabilities, should be without health insurance coverage. With careful planning and research, you may manage to navigate this insurance gap at little or no cost. Be sure to consult with a special needs planner, who can advise you on your qualifications and the laws in your home state.
In its first three weeks in office, President Biden’s administration reversed a range of high-profile Trump Administration regulations that affected people with disabilities -- rules covering Medicaid, disability reviews, immigration and housing discrimination.
Medicaid work rules: Since 2018, the Trump Administration had been pushing states to enact work requirements for certain Medicaid recipients to maintain benefits. In Arkansas, the only state that enacted these requirements, the program resulted in 18,000 people losing Medicaid coverage in three months before a court put the program on hold. This included many people with disabilities, despite being ostensibly exempt from the rules.
According to sources, the Biden Administration will withdraw the Trump Administration’s permissions to states to enact work requirements or invitations for states to apply for waivers to enact such requirements. It will also rescind existing waivers for Arkansas, Kentucky, and New Hampshire. Courts have uniformly ruled that the Medicaid Act prohibits these work mandates, although the question is now in front of the Supreme Court.
Disability reviews: On January 28, 2021, the Social Security Administration (SSA) withdrew proposed regulations that would have subjected certain Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) recipients to more frequent reviews to ensure people receiving benefits still have qualifying disabilities. The SSA currently requires these reviews on a seven-year, three-year, or six- to 18-month basis, depending on if the person is classified as “Medical Improvement Not Expected,” “Medical Improvement Possible,” or “Medical Improvement Expected.”
The proposed regulations would have created a new category, covering an estimated 4.4 million people, called “Medical Improvement Likely.” These recipients would have been subjected to reviews every two years, and the every-seven-year requirement for people in the “Medical Improvement Not Expected” category would have been shortened to six years. Disability advocates, who had characterized the proposed rules as a way to harass SSDI and SSI recipients, applauded the SSA’s withdrawal of the proposed changes.
Public Charge Rule: President Biden signed an executive order February 2 ordering a review of regulations finalized by the Trump Administration that would permit the federal government to deny people citizenship on the grounds that they may be a “public charge,” meaning they are likely to need government benefits. While existing laws already permit the government to deny people citizenship on this basis if they are likely to need SSI, the Trump Administration’s regulations expanded the “public charge” definition to encompass people who have received or may need SNAP (food stamps), Medicaid and other benefits that many people with disabilities rely on for help.
For many advocates, the rules harkened to a time when immigration laws systematically excluded people with disabilities. The rule was also credited with sparking a significant drop-off in non-citizens seeking medical care out of deportation fears.
Housing discrimination: On January 26, President Biden issued an executive order rescinding proposed Department of Housing and Urban Development (HUD) regulations that would have made it significantly harder to prove discrimination under the Fair Housing Act (FHA). The proposed regulations targeted claims where discrimination is proven not by showing the intent of a policy but by demonstrating the policy’s discriminatory effects, such as through statistical analysis and other evidence. The Trump Administration would have created a higher, “robust” standard for plaintiffs to make FHA claims, thus making it significantly harder to prove housing discrimination based on disability.
Disability discrimination claims have long been the most frequent type of claim brought under the FHA. They have traditionally been used to successfully challenging everything from bank lending practices, to landlords discriminating against people with housing subsidies, and zoning ordinances that limit the placement of group homes.