Do I need to apply for Social Security or other benefits to be eligible for Medicaid?

By David R. Okrent, CPA, Esq.

New York State requires people receiving or applying for Medicaid, known as “Applicants/Recipients” (hereafter referred to as A/R’s), who are eligible for, or reasonably appear to meet the eligibility criteria for an entitlement benefit which would reduce or eliminate the need for assistance and care, are required to apply for and fully utilize such benefits as a condition of Medicaid eligibility.

Entitlement benefits include Unemployment Insurance Benefits (UIB), Social Security Retirement, and Survivors and Disability Insurance (RSDI). For example, if someone has zero income ($0.00) but also discloses that s/he has a work history and recently lost a job, requiring the A/R to apply for UIB would be appropriate. If an A/R indicates zero income and s/he is disabled and unable to work and has a work history, applying for Social Security Disability benefits would be an appropriate referral.

With the increase in the retirement age for full Social Security retirement benefits, many individuals are delaying retirement and continue to work full time. When an A/R is still working full time, they are not required to apply for Social Security Retirement benefits as a condition of eligibility. However, if an A/R is not working full-time, they are required to apply when they become eligible at age 62. A/R’s can attest whether s/he works part-time or full-time. This policy is applicable to all Medicaid programs.

This is a long-standing policy of the Medicaid program. Medicaid is known as the “Payer of Last Resort” so if we keep that in mind any benefit we may be entitled to must be explored as a condition of Medicaid Eligibility. This also frequently comes up with Veterans; making sure they have applied or received documentation that they are not entitled to Veteran’s benefits. It is important Veterans have a formal letter from the Veterans Administration.

Mr. Okrent, Esq. has been handling elder law, estate administration, estate planning & special needs matters for over 30 years. He recently was working on policy matters as part of the Executive Committee of the NYSBA\Elder Law Section. His former experience with the IRS gives him a unique perspective in creating estate plans. Call 631-427-4600.