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Return To Work: TWWIIA And Medicaid


Thanks to a federal law known as TWWIIA, if you have been receiving Medicaid and are not working because of your health, you can return to the workforce without losing your Medicaid coverage until you start to earn a basic income.

TWWIIA also permits states to authorize the purchase of Medicaid by people who are working but who have a health condition.

For an overview of the law, which applies to everyone who collects any Social Security benefit due to disability, including Social Security Disability Insurance (SSDI) and/orSupplemental Security Income (SSI), see TWWIIA

Can I keep Medicaid if I return to work?

  • If you receive Supplemental Security Income (SSI)As long as you receive even $1 from Supplemental Security Income (SSI), you are eligible for Medicaid. See SSI: Return to Work.
  • Once you have returned to work after being on disability, as long as your earnings are below a stated amount, you can continue to receive Medicaid but you may have to pay a sliding scale premium for it based your earnings. TWWIIA recently raised the maximum amount of earnings. The law gives states flexibility to set their own income and resource limits. Not all states have enacted a higher cap.The idea behind TWWIIA is not only to help people return to work, but to maintain health coverage once they do because appropriate health care will go a long way to helping you continue to work. It's worth keeping this in mind when determining whether you want to pay a premium for Medicaid. For information in your state, see below.
  • NOTE: If you are receiving both SSI and Medicaid, you should check out the provisions of Section 1619. Section 1619 is an underused provision which permits you to retain Medicaid even if you no longer receive SSI - provided you both receive SSI and have Medicaid before you return to work. To learn more, see: Section 1619.

Can I get Medicaid even if I work?

  • In addition to extending Medicaid eligibility for disabled people who return to work, TWWIIA also permits States to make Medicaid available to working people with low incomes who are not yet disabled.
  • By expanding access to early treatment, this feature is designed to help people postpone or avoid a medical condition that could otherwise become disabling. 
  • So long as you are employed and have an income below state-set levels, you are eligible if you have a health condition.  You do NOT need to be disabled or a member of any other "regular" Medicaid eligibility category to qualify.
  • The income levels are set by each state and may vary.  Most states are expected to use virtually the same income rules they use for Medicaid coverage of the working FULLY disabled under TWWIIA----about $43,000 yearly for one person. In addition to setting income limits of people who are working, states are also able to limit participants by number and disease type. Refer to the site below for the latest updates on your State's requirements.  

How Can I Find Out About The Rules Relating To Returning To Work and Medicaid In The State In Which I Live?

To find information in your state, see: offsite link

As you search for more information, keep in mind that historically Medicaid (and Medicare) have been administered by a federal agency called the Health Care Finance Administration (HCFA). The name of the agency was recently changed to  Centers for Medicare and Medicaid Services (CMS). You will find both terms used on their literature.


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