SOCIAL INSURANCE · 6 MIN READ

Medicaid, SSI, and Federal Worker Programs

Medicaid is the joint federal-state, need-based health program — the payer of last resort for low-income people and the main funder of long-term services and supports. Long-term-care eligibility is income- and asset-tested, and transfers of assets are policed through a 60-month (5-year) look-back period; gifts within the window trigger penalty periods of ineligibility. Certain lawfully present immigrants face a 5-year waiting period, states can reshape their programs through Section 1115 waivers, and CHIP extends coverage to uninsured children from birth through age 18 in families above Medicaid limits. Within Medicaid live the four Medicare Savings Programs: QMB (income at or below 100% of the federal poverty level) pays Part B premiums plus all Medicare deductibles, coinsurance, and copays — and QMB enrollees cannot be balance-billed; SLMB (100-120% FPL) and QI (120-135% FPL) pay only the Part B premium; QDWI pays Part A premiums for certain disabled workers who lost premium-free Part A by returning to work. SSI — Supplemental Security Income, Title XVI — is the need-based cash companion to SSDI. It requires no work history; instead it applies strict tests: countable resources of no more than $2,000 for an individual or $3,000 for a couple, income counting rules that treat earned and unearned income differently, and deeming of a spouse's or parent's income. Assets held in a qualifying special needs trust are excluded, which is why such trusts matter in disability planning. SSI eligibility typically brings Medicaid; many low-income Medicare beneficiaries are dual eligibles served by D-SNP plans and Part D Low-Income Subsidy auto-enrollment. Finally, a patchwork of federal statutes replaces state workers' compensation for specific workforces. FECA covers federal civilian employees — no-fault benefits at 66 2/3% of pay (75% with dependents), administered by the Department of Labor's OWCP. LHWCA covers maritime workers on navigable waters and adjoining piers, and reaches fixed structures on the Outer Continental Shelf through OCSLA. The Defense Base Act extends LHWCA to overseas government-contractor employees. FELA is different in kind: a fault-based negligence remedy for interstate railroad workers, not no-fault comp. The Black Lung Benefits Act compensates coal miners totally disabled by pneumoconiosis. Railroad workers also have their own retirement system: Tier I mirrors the Social Security benefit formula, while Tier II is a pension-like benefit based purely on railroad service. Veterans' disability compensation runs on its own federal rating schedule.