CARD T257
Medicaid
A federal-state program that helps pay health-care costs for eligible people, including many with low incomes. Each state runs its program under federal rules, so eligibility and benefits vary.
How it works
Medicaid is jointly funded by federal and state governments and run by states. Eligibility can depend on income, household, age, disability, pregnancy, and other conditions. Some eligibility categories also count resources, meaning assets such as savings; not every applicant faces an asset test. Medicaid may cover qualifying long-term personal care that Medicare generally does not. A person can qualify for both Medicare and Medicaid—called dual eligibility—with rules determining how the programs share payment. [1]
A low-income older adult may have Medicare and also qualify for Medicaid help under the state’s program.
Medicaid is not simply Medicare for people under 65.
CARD T258
Children’s Health Insurance Program (CHIP)
A federal-state program providing low-cost health coverage for eligible children, often in families earning too much to qualify for Medicaid. States set eligibility within federal rules; some also cover pregnant people.
How it works
CHIP helps provide coverage for eligible children through state programs supported by federal funding. It often serves children whose family income exceeds Medicaid limits but who lack affordable coverage. States can operate a separate CHIP program, a Medicaid expansion, or both. Income thresholds, cost sharing, and coverage for pregnant people vary. Applications can generally be made year-round rather than only during Marketplace open enrollment. [8]
A family above the state’s child Medicaid income threshold checks CHIP eligibility instead of assuming no public coverage is available.
CHIP and Medicare are not the same program.
Practice Children’s Health Insurance Program (CHIP) · 3 questions
CARD T260
Supplemental Security Income (SSI)
A federal program providing payments to qualifying aged, blind, or disabled people with limited income and resources. It differs from SSDI.
How it works
SSI provides cash assistance to eligible people who are aged 65 or older, blind, or disabled and have limited income and resources. It is funded from general revenues rather than the Social Security trust funds used for insured benefits. Work credits are not required, although citizenship or eligible noncitizen status and other rules apply. Some people receive both SSI and Social Security benefits. Medicaid connections differ by state. [11]
A disabled person with little work history and limited resources may qualify for SSI even without insured status for SSDI.
SSI is needs-based assistance; SSDI is work-based insurance.
APPLY THE TERMS
Practice questions
Select an answer, then check it to see why each option is right or wrong.
T257 · Medicaid
0 of 3 answered
T258 · Children’s Health Insurance Program (CHIP)
0 of 3 answered
T259 · Social Security Disability Insurance (SSDI)
0 of 3 answered
T260 · Supplemental Security Income (SSI)
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Sources & further reading
Original explanations and practice scenarios informed by the following regulatory, legal, and product resources. State examples are not presented as nationwide deadlines or requirements.
CARD T259
Social Security Disability Insurance (SSDI)
A federal disability benefit based on qualifying work history and disability requirements. A private disability claim does not automatically establish SSDI eligibility.
How it works
Social Security Disability Insurance (SSDI) pays cash benefits to people with enough qualifying work history who meet Social Security’s disability rules. Work credits are earned through covered work; the number and recency required depend partly on age. The disability generally must prevent substantial paid work and be expected to last at least 12 months or result in death. This is more restrictive than merely being unable to return to one particular job. A five-full-month cash-benefit waiting period generally applies, with exceptions such as ALS. Medicare commonly begins after 24 months of disability benefit entitlement, subject to exceptions. [9] [10]
A surgeon unable to operate may qualify under a private own-occupation contract but must separately satisfy Social Security’s disability rules.
A private insurer’s approval does not automatically establish SSDI eligibility.
Practice Social Security Disability Insurance (SSDI) · 3 questions