Paths to Medicaid for People with Disabilities in Washington State

Why do I need Medicaid?

Medicaid pays for basic medical services, including medical care and prescriptions. Medicaid also provides Home and Community Based Services for people with disabilities, which includes things like skilled nursing care, in-home caregiving, respite care, employment support, and other services.

How do I get Medicaid?

There are many different groups of people who qualify for Medicaid, and the groups are different in each state. Everyone who gets Medicaid gets basic medical coverage, but getting additional coverage, like community and home based services, depends on what group you are in.

Non-Disability Groups

Child MAGI and Adult MAGI

What is it?

These groups are both income-based. MAGI stands for Modified Adjusted Gross Income.

How can I access it?

These groups are income based. You can qualify based on your income and on not having access to other healthcare. Income limits change every year. There are no resource limits for MAGI Medicaid in Washington State. Learn more and apply at https://www.wahealthplanfinder.org/.

Disability Groups

SSI

What is it?

This group is for people receiving Supplemental Security Income (SSI). SSI is a Social Security disability benefit for people with disabilities who have little or no income.

How can I access it?

SSI recipients are automatically enrolled in Medicaid in Washington State. This group has an income limit that changes every year and a $2,000 resource limit. Learn more about SSI applications here: https://www.ssa.gov/apply/ssi

1619b

What is it?

This group is for people who used to get SSI, but now earn too much money to keep the cash benefit.

How can I access it?

If you’re on SSI and you begin earning too much to keep your cash payments, keep reporting your wages to Social Security. Social Security determines 1619b eligibility. This group has an income limit that changes every year and a $2,000 resource limit. Learn more about 1619b here: https://www.ssa.gov/disabilityresearch/wi/1619b.htm

DAC

What is it?

This group is for former SSI recipients who transition to the DAC benefit. The Disabled Adult Child benefit (DAC), or Childhood Disability Benefit (CDB), is a Social Security disability benefit for people whose disabilities started before the age of 22 and who have a parent who is retired, disabled, or deceased. If a person used to have SSI, but moves to the DAC benefit when a parent retires, becomes disabled, or passes away, the DAC beneficiary can keep their Medicaid.

How can I access it?

If you used to have SSI, but now have DAC, your Medicaid should continue without interruption. This group has an income limit that changes every year and has a $2,000 resource limit.

HWD

What is it?

This group is for people with disabilities who are working. Healthcare for Workers with Disabilities is Medicaid Buy-In, meaning that you pay a premium to access Medicaid. The premium is between 0-7.5% of your income.

How can I access it?

You may qualify for HWD if you have a qualifying disability and you have any amount of taxable income. There is no minimum amount of work required. This group has no income limit and no resource limit. Learn more and apply here: https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/apple-health-workers-disabilities-hwd

Medically Needy Spenddown

What is it?

This group is for people with high medical expenses who have income above the SSI rate. The SSI rate changes every year. The difference between the person’s income and the SSI rate must be spent on approved medical costs within a given time frame before Medicaid coverage kicks in.

How can I access it?

You may qualify for the Medically Needy Spenddown program if you have high medical costs. There is no income limit, but the difference between your income and the SSI rate must be spent on approved medical expenses. There is a $2,000 resource limit. You can start your application here: https://www.washingtonconnection.org/home/ or call your local DSHS office.

300% Group or Special Income Level

What is it?

This group is for people who are eligible for Home and Community Based Services based on their need for care and who have income of less than 300% of the SSI rate.

How can I access it?

You may be eligible if you have a qualifying health condition and high care needs, and have income less than 300% of the SSI rate; the SSI rate changes every year. This group has a $2,000 resource limit. You can start your application here: https://www.washingtonconnection.org/home/ or call your local DSHS office.