Understanding Medi-Cal and Social Security Disability
When you live with a serious health condition or disability, both Medi-Cal and Social Security Disability can serve as critical safety nets. Medi-Cal provides access to affordable or no-cost healthcare coverage for Californians with limited income, while Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) provide financial assistance for individuals who cannot work due to a disabling condition.
Because both programs are need-based in some way, many California residents wonder what happens when they start receiving Social Security Disability benefits — will they lose Medi-Cal coverage? The answer depends on which type of disability benefits you receive, your household income, and how those benefits interact with California’s Medicaid program.
At Roeschke Law, LLC, our team of disability attorneys in San Diego helps clients understand how to protect their healthcare and income benefits while navigating the complexities of federal and state disability programs.
How Medi-Cal Works in California
Medi-Cal is California’s version of the federal Medicaid program. It provides free or low-cost healthcare to people with limited income and resources. Eligibility is based on your income level compared to the Federal Poverty Level (FPL)and can vary depending on your household size and other factors.
There are two primary categories of Medi-Cal eligibility:
- Income-Based Medi-Cal: Determined through the Modified Adjusted Gross Income (MAGI) standard. This type typically covers low-income adults, children, pregnant individuals, and certain families.
- Disability-Based Medi-Cal: Available to individuals who meet the Social Security Administration’s (SSA) definition of disability but have income or assets above the MAGI limits.
If you currently qualify for Medi-Cal due to low income and then start receiving disability benefits, your eligibility may change depending on the amount of your monthly benefit and which Social Security program you are approved for.
The Difference Between SSDI and SSI in Relation to Medi-Cal
The type of Social Security benefit you receive plays a major role in whether you keep your Medi-Cal coverage.
- Social Security Disability Insurance (SSDI): This benefit is based on your work history and the payroll taxes you’ve paid into the system. SSDI is not a needs-based program, meaning your income or assets don’t affect your eligibility. However, once you are approved for SSDI, you will eventually become eligible for Medicare — usually two years after your first SSDI payment.
- Supplemental Security Income (SSI): This benefit is needs-based and intended for individuals with very low income and limited assets. In California, receiving SSI automatically qualifies you for Medi-Cal coverage.
If you’re approved for SSI, you do not lose Medi-Cal — your healthcare coverage continues seamlessly. However, if you’re approved for SSDI, your situation may be different once your Medicare coverage begins.
What Happens to Medi-Cal When You Start Receiving SSDI?
When you begin receiving SSDI, your income will likely increase because SSDI benefits are often higher than SSI payments. This can affect your Medi-Cal eligibility if your total income exceeds the program’s threshold.
However, California offers several ways to keep Medi-Cal coverage even after your income rises:
- Medi-Cal with a Share of Cost (SOC): You may still qualify but will have to pay a portion of your medical expenses each month before Medi-Cal pays the rest.
- Aged and Disabled Federal Poverty Level (A&D FPL) Program: If your income is below a certain threshold and you are aged, blind, or disabled, you can continue receiving full-scope Medi-Cal benefits.
- Pickle Amendment Protections: Some individuals who lose SSI eligibility due to cost-of-living adjustments in Social Security benefits may still qualify for Medi-Cal under special “Pickle” protections.
- Working Disabled Program (WDP): If you return to part-time work while still disabled, this program allows you to keep Medi-Cal coverage by paying a small monthly premium.
Each of these programs helps ensure that individuals who rely on Medi-Cal for healthcare do not suddenly lose access simply because their disability benefits changed.
How Medicare and Medi-Cal Can Work Together
When you receive SSDI benefits for two years, you automatically become eligible for Medicare. Many Californians in this situation qualify for what’s called “dual eligibility,” meaning they receive both Medicare and Medi-Cal.
Dual eligibility provides valuable coverage:
- Medicare becomes your primary insurance.
- Medi-Cal serves as your secondary coverage, paying for costs that Medicare doesn’t fully cover — such as copayments, coinsurance, or certain medications.
In many cases, this combination provides stronger healthcare protection than either program alone. You can also qualify for Medicare Savings Programs (MSPs) that help pay Medicare premiums and out-of-pocket expenses.
Maintaining both benefits requires that you continue to meet income and asset guidelines for Medi-Cal. If your SSDI benefits increase significantly, you may need to reapply under a different Medi-Cal category to remain eligible.
Will My Assets or Income Cause Me to Lose Medi-Cal?
While SSDI does not consider assets for eligibility, Medi-Cal does. California has made significant progress toward eliminating asset limits for many categories of Medi-Cal, but certain programs still impose restrictions.
If your financial situation changes after SSDI approval — for example, through retroactive back payments — you should promptly report the change to your local county Medi-Cal office. Failing to do so can cause interruptions or overpayment issues later.
Fortunately, many recipients can retain Medi-Cal coverage by spending down excess assets on allowable expenses (such as medical care, home modifications, or debt repayment) or by moving to a program with higher income limits.
Our attorneys often help clients review their options before changes occur, ensuring continued access to medical care and minimizing financial stress.
What Steps Should You Take After Being Approved for Disability Benefits?
If you are approved for Social Security Disability benefits in California and are concerned about losing Medi-Cal coverage, you can take several steps to protect your benefits:
- Confirm which disability program you were approved for — SSDI or SSI.
- Notify Medi-Cal about your new benefits immediately.
- Request a redetermination if your income has changed to see which Medi-Cal category you now qualify for.
- Ask about dual eligibility if your Medicare coverage is starting.
- Consult an experienced disability attorney if you receive a notice of termination or reduction in benefits.
In most cases, you will not lose healthcare coverage entirely — it may simply shift to a different category or require some adjustments.
How Roeschke Law, LLC Helps Protect Disability and Healthcare Benefits
Navigating the overlap between federal and state programs can be confusing, especially when both Social Security and Medi-Cal have strict and changing rules. At Roeschke Law, LLC, we help clients across San Diego and throughout California protect the benefits they’ve worked hard to earn.
Our attorneys assist with disability applications, appeals, and benefit transitions to ensure clients don’t experience unexpected coverage gaps. We understand how crucial consistent medical care is for managing serious conditions, and we take pride in guiding clients through every step of the process.
If you have been approved for disability benefits and are worried about losing Medi-Cal, we can help you understand your rights and explore all available coverage options.
Contact Roeschke Law, LLC Today
Receiving Social Security Disability benefits should make life easier, not harder. If you’re concerned about how your new benefits might affect your Medi-Cal eligibility, contact Roeschke Law, LLC at 800-975-1866.
Our team serves clients across San Diego and throughout California, helping individuals navigate the intersection of disability law and healthcare coverage. We’re here to help you protect the support you need for your health, stability, and peace of mind.
