The Social Security Disability Insurance (SSDI) program provides monthly benefits to individuals with long-term disabilities, but beneficiaries often face a significant hurdle: a 24-month waiting period before they become eligible for Medicare. During this time, many rely on Medicaid to avoid being uninsured, as the SSDI application process can take months or even years.
In 2023, Medicaid covered over 120,300 SSDI applicants and beneficiaries waiting for Medicare eligibility, representing about 29% of the 415,300 new Medicare enrollees from SSDI that year. The Affordable Care Act (ACA) Medicaid expansion has been crucial in providing coverage for these individuals, but new work requirements set to take effect in January 2027 could disrupt this safety net.
Starting in 2027, 44 states will require Medicaid enrollees in the ACA expansion group to meet work requirements, such as engaging in qualifying activities for 80 hours per month or qualifying for an exemption. However, the criteria for medical frailty exclusions, as outlined in a June 2026 interim final rule, may make it difficult for some SSDI applicants and beneficiaries to maintain their Medicaid coverage before becoming eligible for Medicare.
SSDI applicants, who are generally unable to work, may struggle to prove they meet the requirements or qualify for exemptions. This could leave many individuals with disabilities at risk of losing health insurance during a critical period, potentially exacerbating their financial and health challenges.