The Basics
Benefits programs give you resources that help make your life better. For most young people with disabilities, the benefits that help you the most provide you with health coverage and money.
This article discusses why benefits matter, what the most common benefits are, and how you can get them. It also explains how, if you get a job and save some money, you can still get good health coverage and may be able to keep getting cash benefits.
There's extra attention on how the rules change depending on your age, and how that can affect the benefits you get. These rules are explained clearly, so that you can know your options, no matter what your age.
Note: DB101 keeps track of changes to health coverage and related laws. DB101 articles and tools have recently been updated to include MO HealthNet's expansion of coverage for adults 18-64 years old (Medicaid Expansion). Get more information about applying for this coverage.
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Why Benefits Matter
A lot of young people don’t know much about cash and health care benefits. Sometimes parents take care of applying for benefits and managing money. Some people are embarrassed they get benefits. Others think that benefits are just too confusing to understand. Some don’t get benefits because they don’t know they qualify.
It is very important that you understand benefits, even if your parents do most of your benefits paperwork. You need to know how benefits can help you live independently and pursue your dreams, which can include going to college and getting a job.
Benefits Lead to Independent Living
As a person with a disability, you have more opportunities than you might think. People with disabilities are living in their own homes, graduating from college, working at good jobs, getting married, and having children. Getting jobs, studying, living on your own, making friends, and all of the other activities in life are all part of independent living!
One major reason that people with disabilities can live independently is the support that benefits offer. Benefits are keys that will give you the support you need as you decide what to do in life and get started with adulthood.
The most important disability benefits you will get are money and health care. The money will help you pay your rent, let you have a social life, make affording college possible, and help you buy food and other necessities. The health care benefits will keep you as healthy as possible and prevent health care expenses from putting you into debt. These benefits mean that you can think about your future and explore life, instead of constantly worrying about paying bills.
Benefits Help You Get a Job or Go to School
Benefits are designed to help you get an education and a job. You may be worried that getting a job will cause you to lose your cash benefits, but the reality is that when you get a job, your income will almost always go up.
Depending on the benefits you get, your cash benefits may go down as your work income goes up, though your job income will more than make up for the smaller amount in benefits.
With other benefits programs, and thanks to some work incentives discussed later, you may be able to keep getting the same amount of cash benefits after you get a job! Some of the best work incentives are actually ways for you to save money for an education or make money while you’re in school.
Benefits Give You Access to Health Care
Did you know that the average cost of an emergency room visit is more than $1,000 and that medical expenses are the number one cause of personal bankruptcy in the U.S.? Make sure you have health care benefits!
When you get a job and your income goes up, you will still be able to get health care coverage. In many cases you will continue getting the exact same coverage as you have now.
Are You Eligible for Benefits?
To get the benefits designed to help people with disabilities, your disability has to “qualify.” This means that it has to meet certain standards. Depending on your age, who offers the benefits, and what the benefits are, these standards vary and your disability may or may not qualify you for benefits.
Even if your disability qualifies, just having a disability doesn’t automatically mean you will get cash benefits or health care coverage. In addition to having a disability, you must also either have low income or have paid into an insurance program. How programs decide if your disability qualifies and whether you have a low enough income or will get insurance coverage are explained on the Eligibility pages of this article.
Income-Based Benefits
Income-based benefits help you if your family doesn’t earn a lot of money. Depending on your age and the benefits program, there may also be a limit on your resources.
For most young people with disabilities, the income-based benefits programs that help the most are Supplemental Security Income (SSI), which gives cash income support, and MO HealthNet, which offers health care coverage.
For more information on both programs, click here.
Insurance
Insurance programs are programs you pay into regularly. If something comes up and you need help, it becomes available.
For example, if you have private health insurance, you, your employer, or your parent pays money each month, and when you need to go to the doctor, the insurance pays most of the expenses.
Private health care coverage is described in greater detail in the sections about Key Programs and Private Health Care Coverage for Young People.
When you work, a small part of the money you make is automatically paid into a federal program called Social Security Disability Insurance (SSDI). If your disability gets worse and you can’t work anymore, SSDI will supply you with income support.
Most young people don’t qualify for SSDI because they haven’t worked long enough. However, Social Security also has a program called Child’s Benefits that helps the children of people with disabilities and children with deceased parents. Another program called Childhood Disability Benefits (CDB) offers benefits for people with disabilities over the age of 18 if their parents are retired, disabled, or deceased.
Why You Should Take Charge of Your Benefits
It is important that you understand and manage your benefits, because your money and your health care will be your responsibilities during adulthood.
Managing Your Benefits Gives You More Options
What role does money play in your life? You might think of money as something that you need to buy the things you want, but money is also used to pay bills, buy groceries, and take care of everyday concerns. We need money to carry out our day-to-day lives.
However, money can be more than that. It can also pay for your education, for your own apartment, or for a car that you can drive to work. It can be the key that opens the door to a brighter future — a future in which you feel in control and enjoy your life because of the path you have chosen.
Learning to take control of your money will help you realize your dreams and achieve your goals. Part of this involves learning how to deal with benefits. Cash benefits are a portion of your income that will help you during your transition to adulthood. Health care benefits will save you money that you can use for other purposes and at the same time, they will keep you healthy!
Managing your benefits will let you be the person who decides what you want to do with your life and help you fulfill your goals and dreams.
You Are Approaching or Have Already Arrived at Adulthood
You are an adult or soon will be an adult. You need to know how to manage your benefits, your health, and your money. Your parents or other family members have probably helped you with benefits in the past, and up to this point in your life, they have made many choices about the direction of your life. As a young adult, it is important for you to set goals for yourself so that you can live an independent life. Your parents and family will still be able to help you, but as an adult, it will be your responsibility to lead your life and make the final decisions on how to live it.
You might feel anxious or scared about taking more control of your life and that’s okay. It’s a lot of work, and handling your benefits is hard, but there is also a lot of information available and many people who can help you make informed decisions. Begin with reading about Key Programs to get a brief introduction to the most important programs that can help you.
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Key Programs
There are many different disability benefits programs. This section explains some of the most important ones, focusing on:
- Supplemental Security Income (SSI)
- MO HealthNet programs for young people and people with disabilities
- MO HealthNet programs for people with disabilities who work
Make sure you understand why these are important by reading the introductions to them. Private health care coverage is also discussed, because it is an important health coverage alternative.
Supplemental Security Income (SSI)
SSI benefits are the most important income support for young people with disabilities. Even if you have never had a job, you may be able to get SSI benefits. Even if you are under 18 and live with your parents, you may be able to get SSI benefits.
Who It Helps
People who are disabled or blind may not be able to work or afford to live on their own. If you have a disability, don’t have enough money for your basic needs, don’t have much income, and have limited resources, you may be able to get SSI benefits. If you have a disability, are under the age of 18, and your parents have low income and limited resources, you may also be eligible for SSI benefits.
What You Get
If you qualify for SSI benefits, you get a monthly check. This money helps you pay for your expenses, like food and rent. Most people who get SSI also qualify for MO HealthNet.
Learn more in SSI Eligibility for Young People.
Watch this short video to learn more about SSI's basic rules.
SSDI benefits are another major income support for people with disabilities. When you work, taxes are taken out of your paycheck. Some of those taxes are automatically paid into the SSDI program. If you have paid enough money into SSDI, you will get SSDI benefits if your disability prevents you from working.
SSDI isn’t a very important program for most young people, because they haven’t worked long enough to get benefits from it. While you probably don’t qualify for SSDI now, if you get a job, you will qualify later; and the more you work, the bigger your SSDI benefits amount will be if you need it!
MO HealthNet Programs for Young People and People with Disabilities
MO HealthNet is the most important public health benefit for young people and people with disabilities.
Who It Helps
MO HealthNet is for people who cannot afford medical expenses, including people who have disabilities, are young, or are pregnant. Generally, to get it, you or your family must have low income. Most people who get SSI benefits also qualify for MO HealthNet.
What You Get
If you qualify, MO HealthNet pays for your medical expenses, including visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services.
To learn more, read the section on MO HealthNet Eligibility for Young People.
MO HealthNet if You Have a Disability and Work
There are some great programs that let you get a job, save up some money, and keep your MO HealthNet coverage.
Who They Help
MO HealthNet has three programs designed to help people with disabilities who have jobs. The three programs are called the spend down, SSI 1619(b), and the Ticket to Work Health Assurance (TWHA) program. Depending on your situation, you may qualify to get coverage through one of these programs.
What You Get
Under these rules, MO HealthNet will continue to cover the same services that standard MO HealthNet covers, including visits to the doctor, hospital stays, medical equipment, and other medical services. You may have to pay some of your medical expenses in the form of a spend down or a premium.
To learn more, read the section on MO HealthNet Eligibility for Young People Who Work.
Private Health Coverage
Private health insurance is the most common way for people to get health coverage.
Who It Helps
People get private health coverage in different ways. Some get it through their jobs, others get it from their parents’ employers, and some sign up for it on their own at HealthCare.gov. If you get an individual health plan, the government may help pay your monthly premium through tax subsidies. Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
What You Get
Private health care coverage pays for some of your medical costs when you see a doctor or other health care provider, or when you get prescription medicine at a pharmacy. Depending on your private health care coverage plan, the plan may pay for almost the entire cost of your medical expenses, or it may pay only a portion of those expenses.
To learn more, read the section on Private Health Care Coverage for Young People.
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Eligibility for Key Programs
Now that you’ve read some basic information about Supplemental Security Income (SSI), MO HealthNet, MO HealthNet’s rules for people who work, and private health care coverage, we can begin to look at the factors that will impact your eligibility for these key programs.
The rules for eligibility can seem very complicated. They are different for different programs and they can also be different depending on your age. In addition, you may be going through a period in your life during which you’re moving out of your parents’ home, going to college, or getting a job. Each of these changes can impact your benefits too!
The good news is that the DB101 website explains a lot. If you have more questions about these programs, talk to a Benefits Specialist.
When you get a job, or go to school, or get older, your eligibility and benefits amounts can change. DB101 includes Estimators that can help you figure out how your benefits might change. For young people, the School and Work Estimator is especially helpful. After reading about benefits, try it out!
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SSI Eligibility for Young People
Supplemental Security Income (SSI) pays a monthly benefits amount to people who have low income and low resources and are disabled or blind. To get SSI benefits, you have to meet certain rules. Some rules are the same, regardless of your age. For example:
- You must be a U.S. citizen or an eligible immigrant
However, other rules change a lot depending on your age. The biggest changes involve:
- How SSI decides whether you have a disability
- Whose income and resources are counted when SSI decides if your income and resources are low enough for you to get benefits
How to Apply for SSI
You can apply for SSI at your local Social Security office or by calling 1-800-772-1213 or 1-800-325-0778 (TTY). Talk to a Benefits Specialist to learn more about how to apply.
Many people who qualify for SSI benefits also qualify for MO HealthNet and SNAP (formerly Food Stamps), but you have to apply for those programs separately.
If you are blind and age 18 or older, you may be able to get additional cash benefits through Missouri’s Supplemental Aid to the Blind program or Blind Pension program. You do not have to get SSI to qualify for these benefits. If you think you might qualify for one of them, contact your local Family Support Division (FSD) office.
Eligibility Details
Our description of SSI eligibility is divided into four parts:
- SSI if you are younger than 18
- If you get SSI and are turning 18 soon
- SSI if you are already 18 or older
- Incentives that help you go to school, work, and save money
SSI if You Are Younger than 18
If you are under 18, SSI says you are a child and have a disability if:
- You have a physical or mental impairment or combination of impairments
- Your impairments cause severe limitations in your daily life, and
- Your condition has lasted or is expected to last for at least 12 months.
Not everybody with a disability automatically gets benefits. You must also have no other way to pay for basic expenses like food, rent, and utilities. If you are under 18, SSI decides whether you need help by looking at the money you and your parents earn and the resources you and your parents have, including bank accounts, stocks, real estate, and insurance policies.
Note: You can open an ABLE account where over time you can save up to $100,000 in resources and not have them counted by SSI. Learn more about ABLE accounts.
SSI counts both your income and resources and your parents’ income and resources when you are under 18 because they expect your parents to pay for your living expenses. This is called parent-to-child deeming.
For example, SSI could look at your parents’ income and decide to lower your benefits by $200 due to parent-to-child deeming. Instead of giving you a check for $943, they would give you a check for $743.
If you or your parents make too much money or have too many resources, you will not get SSI benefits. The exact limits depend on the size of your family. A complete table of income limits for families with a disabled child is listed near the bottom of Social Security’s SSI for Children webpage.
Almost all children under 18 have benefits sent to a parent or guardian. This person is called a representative payee. Occasionally, persons who are 16 or older can be their own payees, but they must meet strict criteria and prove that they are capable of managing their own finances.
If you live with one parent, and get child support from your other parent, SSI counts two-thirds of the child support as income.
Your parent gets $300 each month from child support. SSI counts two-thirds of that and lowers your monthly SSI benefits amount by $200.
Sometimes child support comes in the form of shelter, instead of a check. In that case, SSI will figure out how much money that support is worth and count two-thirds of it as income. In the case of shelter, your benefits check could be lowered by a maximum of $314.33.
If You Get SSI and Are Turning 18
If you get SSI and then you turn 18, the biggest change in SSI eligibility rules is that you are considered an adult, not a child. When SSI decides whether you have a disability, SSI will not use their definition of disability for children. Instead, as an adult, SSI looks at your ability to work, not just your physical or mental limitations. That means that some people stop getting SSI benefits after they turn 18.
During the first year after you turn 18, SSI will automatically check to see if they still consider you disabled. This is called the SSI Age-18 Redetermination. They will say you have a disability if:
- You have a physical or mental impairment or combination of impairments
- Your impairments limit your ability to work, and
- Your condition has lasted or is expected to last for at least 12 months.
SSI may also look at your work and school record to see if you are able to work and may even talk to your teachers, counselors, or employers.
If you are going through the SSI Age-18 redetermination, Social Security may consider you to have a disability, even if you are working and earn less than $1,550 per month.
If you were not getting SSI before you turned 18 and you apply for SSI as an adult, Social Security may consider you to have a disability if you are working, but only if you make less than $1,550 per month, if you aren't blind. If you are blind, you could earn much more.
If SSI decides that you are not disabled because you don’t meet the adult definition of disability, you will no longer be able to get SSI benefits. They will keep sending you SSI checks for two months, but then your benefits will end. In this situation, if you still want to get SSI benefits, you have two options:
- You can appeal. When SSI sends you the letter telling you that your benefits are ending, you have 10 days to request an appeal. During the appeal process, you can ask that SSI continue your benefits until they make a decision. For more information on the appeals process, click here.
- If you are participating in an employment support program, like Vocational Rehabilitation (VR), an Individualized Education Program (IEP), a Plan to Achieve Self-Support (PASS), or any other program approved by SSI that will help you get a good job in the future, you can apply to continue benefits through a special rule called Section 301.
If SSI says that you meet the adult definition of disability and that you will continue to get benefits after turning 18, these are the things that could impact the monthly amount you get:
- Parent-to-child deeming ends. This means that SSI will no longer count your parents’ income and resources when considering your eligibility for benefits. This may help you get higher benefits than before you were 18.
- If you or your family gets child support for your living expenses, SSI will now count the full amount as income. This may cause your benefits to go down.
- Your living situation: If you live alone or pay your fair share of expenses as a roommate with others, your benefits amount may be higher than if you live with others who help pay for your shelter.
- In-kind support and maintenance: If someone else helps to pay your rent, your benefits amount may be lowered by up to one-third ($314.33). This is called a Value Third Reduction (VTR).
If you have any questions about this, talk to a Benefits Specialist.
SSI if You Are Already 18 or Older
If you are 18 or older and did not get SSI before turning 18, SSI says you are an adult and have a disability if:
- You have a physical or mental impairment or combination of impairments
- Your impairments limit your ability to work, preventing you from earning Substantial Gainful Activity ($1,550 per month if you’re not blind), and
- Your condition has lasted or is expected to last for at least 12 months
Note: If you are blind, you could be able to earn more than $1,550 per month.
Some people who get SSI benefits before they are 18 lose their benefits when they turn 18 because they don’t meet the adult definition of disability. Other people who couldn’t get SSI benefits before they were 18, due to parent-to-child deeming, may now be able to get benefits.
Not everybody who meets the adult definition of disability automatically gets benefits. You must also have no other way to pay for basic expenses like food, rent, and utilities. If you are over 18, SSI decides whether you need help by looking at your income and how many resources you have, including bank accounts, stocks, real estate, and insurance policies.
There are certain cases where SSI will not lower your benefits amount because you have a job or are saving money. Read about these in the section on Incentives that Help You Go to School, Work, and Save.
Learn more about SSI for adults in DB101's SSI article.
If you work, you may have to spend money on things, like transportation, medical expenses, or accommodations, to do your job. If you have a disability, SSI may consider some of your expenses to be Impairment Related Work Expenses (IRWEs) and may not count the money you spend on them as income. If you are blind, the rules are a bit different and the expenses are called Blind Work Expenses (BWEs). Be sure to keep all receipts for expenses you think qualify as IRWEs or BWEs.
The bottom line: If you have IRWEs or BWEs, you may qualify for SSI even if you think your income is too high to get it. Or, you might get higher SSI benefits than you otherwise would.
Incentives That Help You Go to School, Work, and Save
SSI and many other government benefits programs have strict limits on how much income and savings you can have. If you go over the limits, you will no longer get benefits. The problem is that sometimes they end up preventing people from working and saving.
When the government realized that these limits were actually stopping people from getting jobs, saving money, and living better, they created work incentives like the Student Earned Income Exclusion (SEIE), Plans to Achieve Self-Support (PASS), Individual Development Accounts (IDAs), and ABLE Accounts that help you earn and save money without losing your benefits.
Student Earned Income Exclusion (SEIE)
Usually, if you make too much money, your SSI benefits will either go down or stop altogether. There are some exceptions to this rule, however, which SSI calls exclusions.
One of those exclusions is the Student Earned Income Exclusion (SEIE). This exclusion lets students earn up to $2,290 per month, and up to $9,230 per year, without having those wages count as part of their countable income.
In order to qualify for the SEIE, you have to be under 22, working, and regularly attending school. That usually means you have to go to school more than:
- 8 hours a week for college students
- 12 hours a week for grades 7 – 12
- 12 – 15 hours a week for employment training
You make $1,050 per month at a summer job. During the school year, you also make $350 each month at a work-study job. Since the money you make doesn’t go over the monthly and annual limits for the SEIE, your SSI benefits won’t go down at all.
If you drop out of school, you will no longer get the SEIE, and you will get smaller benefits than you would have gotten if you had stayed in school. Stay in school! You’ll get more money thanks to the SEIE, and when you graduate, you’ll get a higher paying job thanks to your degree!
Plans to Achieve Self-Support (PASS)
Usually, if you have too many resources or too much income, you stop qualifying for SSI benefits. Setting up a PASS is one way for people getting SSI benefits to save money without having it count against their benefits eligibility.
To set up a PASS, you must qualify for SSI benefits, have a specific work goal, and have expenses that you need to pay to reach your goal. You must also show that you’ll have enough income to pay for your basic living expenses after you’ve set up your PASS.
There are a couple of big advantages to having a PASS:
- You can use unearned income to save money, which means that you can start saving even if you don’t have a job yet.
- SSI does not count the money that you place in a PASS account as income or resources. So you can earn and save more with a PASS without having your SSI benefits go down.
The limitation is that the money you save with a PASS must be used for an employment-related expense. However, those expenses can include things like money for school, transportation, books, and services.
For more information, read the DB101 article on Building Assets and Wealth or contact a PASS Cadre.
Learn more about SSI young people who work by watching the short video below.
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MO HealthNet Eligibility for Young People
MO HealthNet helps people with low income pay for their visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services. Most people who get Supplemental Security Income (SSI) also qualify for MO HealthNet.
To get MO HealthNet, you have to meet certain rules. First we present the rules for young people under the age of 19, and then we present them for anybody 19 or older. Read the section that is appropriate for you.
If you work and have some earned income, you should also make sure to read about MO HealthNet Eligibility for Young People who Work.
Note: DB101 keeps track of changes to health coverage and related laws. DB101 articles and tools have recently been updated to include MO HealthNet's expansion of coverage for adults 18-64 years old (Medicaid Expansion). Get more information about applying for this coverage.
The MO HealthNet website has instructions on how to apply for health coverage online, by phone, or by mail. If you need help completing your application, talk to a Benefits Specialist.
Note: To get benefits, some rules apply to all people, no matter what your age. You must:
- Have or apply for a Social Security number
- Live in Missouri and intend to remain
- Be a United States citizen or an eligible noncitizen
MO HealthNet if You Are Younger than 19
If you are under age 19, there are ways you can qualify for MO HealthNet if your family has low to moderate income, regardless of whether or not you have a disability. Here are the three ways to qualify for MO HealthNet if you’re under 19:
- MO HealthNet for Kids Non-SCHIP is for children with and without disabilities whose families have the lowest income. For example, if you are 16 years old and there are four people in your family, the income limit for your family is $3,848 per month. There is no resource limit.
- MO HealthNet for Kids SCHIP is for uninsured children with and without disabilities whose families have more income. For example, if you are 16 years old and there are four people in your family, the income limit for your family is $7,800 per month.There is no resource limit. To get MO HealthNet for Kids SCHIP, your family will have to also pay a monthly premium if your family income is more than 150% of the Federal Poverty Guidelines ($3,900 per month for a family of four).
- If you do not qualify for MO HealthNet for Kids and you have a disability, you may qualify for MO HealthNet based on disability.The rules are the same as for persons age 19 or over (explained below), except that if you are under age 18, your parents’ resources are counted along with a portion of their income.
The key here is that you and your family must not be over the income limit for your family situation. Depending on the number of people in your family and your age, the income limit varies. To see the exact income limits for your family, click here. MO HealthNet may not count all of your income, so you should apply even if you think you won’t qualify. It may turn out that you do qualify. Depending on your family situation, your parents may also qualify.
If you have any questions, talk to a Benefits Specialist.
| Your family size: | |
 | |
Income limits for your family: | |
| Income-based MO HealthNet, adults (138% FPG) | |
| MO HealthNet for Kids, free (150% FPG) | |
| MO HealthNet for Kids, premium (300% FPG) | |
| Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
| |
MO HealthNet if You Are 19 or Older
If you are 19 or older, you may qualify for MO HealthNet if:
- Your family has low income, regardless of whether you have a disability (on DB101, this is called "income-based MO HealthNet" and you may hear it called the "Medicaid expansion"), or
- You have a disability and low resources and your family has low income (this way of qualifying is called "disability-based MO HealthNet").
If you have a disability, work, and earn too much for MO HealthNet, you may qualify for Ticket to Work Health Assurance instead.
Income-Based MO HealthNet
If you are 19 or older and your household's Modified Adjusted Gross Income (MAGI) is 138% of FPG or less ($20,783 per year or less if you are single), you may qualify for income-based MO HealthNet (also called "Medicaid expansion"). It doesn't matter how much your family has in resources.
Check whether your income is low enough for you to get income-based MO HealthNet:
| Your family size: | |
| |
Income limits for your family: | |
| Income-based MO HealthNet, adults (138% FPG) | |
| MO HealthNet for Kids, free (150% FPG) | |
| MO HealthNet for Kids, premium (300% FPG) | |
| Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
| |
Learn more about income-based MO HealthNet for adults in DB101's How Health Benefits Work article.
Disability-Based MO HealthNet (and other groups)
If you are 19 or older, you can also qualify for MO HealthNet if you have low income, have low resources, and you meet at least one of the following conditions:
- You have a disability
- You are blind
- You are pregnant
- You have a child who gets MO HealthNet
- You are over age 65
- You are a woman being treated for breast or cervical cancer
Your income will be counted, but your parents’ income will not be counted. The exact income limit will depend on your situation, such as whether you are single or married, whether or not you have a disability, and whether or not you are blind. To get more information about eligibility and the income limits for the basic MO HealthNet program for people with disabilities, click here.
If you are blind or disabled, your resources must be below MO HealthNet’s resource limit. If you are disabled, the resource limit is $5,909.25 if you are single and $11,818.45 for couples. If you are blind, the resource limit is $5,909 if you are single and $11,818 for couples. There is no resource limit for pregnant women or low-income parents.
Note: You can open an ABLE account where over time you can save money and not have it counted as resources by MO HealthNet. Learn more about ABLE accounts.
Get a detailed summary of the different MO HealthNet programs for people with disabilities and more information about their income limits.
MO HealthNet if You Work
If you have a disability, work, and have earned income, there’s a pretty good chance that you still qualify for MO HealthNet coverage, even if you think your income is higher than the income limit. There are three different MO HealthNet programs that can help you qualify. They are called the spend down, SSI 1619(b), and the Ticket to Work Health Assurance (TWHA) program. To read more about them, click here.
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MO HealthNet Eligibility for Young People who Work
A lot of people are afraid that if they get a job, they’ll lose their MO HealthNet benefits, but often that’s not true. If you have a disability, you can usually keep your health coverage benefits, which are so important to your health and well-being, even after you get a job. In addition, your job may supply you with private health benefits that can also help you get the health care you need.
Here we’ll talk about different ways you can keep getting MO HealthNet after you get a job. Elsewhere in this article, we’ll talk about getting private health coverage.
If you have a disability, there are three main ways you can continue to get MO HealthNet even if you make more money at work than MO HealthNet’s income limit seems to allow:
- You can get MO HealthNet with a spend down
- You can get MO HealthNet through the Supplemental Security Income (SSI) 1619(b) rule
- You can get MO HealthNet through a program called the Ticket to Work Health Assurance (TWHA) program
To qualify through these you must:
- Have or apply for a Social Security number
- Live in Missouri and intend to remain in the state
- Be a U.S. citizen or an eligible noncitizen
-
You must have low resources:
- Less than $5,909.25 ($11,818.45 for couples) to qualify for the spend down or TWHA
- Less than $2,000 for MO HealthNet based on the 1619(b) rule ($3,000 for couples)
Note: You can open an ABLE account where over time you can save up any amount of resources and not have them counted by MO HealthNet. Learn more about ABLE accounts.
However, the amount of money you can make and whether you have to pay a monthly premium or spend money of your own for care depends on your income. Here we’ll explain the differences between these three rules.
The MO HealthNet website has instructions on how to apply for health coverage online, by phone, or by mail. You don’t have to tell FSD that you want to apply for the spend down or for the Ticket to Work Health Assurance program. They’ll look at your application and figure out which is the best MO HealthNet program for you.
If you were getting SSI benefits and now qualify for MO HealthNet through 1619(b) status, you need to report this to your FSD office (how to report this is explained later in this article).
If you need help completing your application, talk to a Benefits Specialist.
MO HealthNet with a Spend Down Eligibility
If you make more than MO HealthNet’s income limit for people with disabilities, you may qualify for MO HealthNet with a spend down. A spend down is like an insurance deductible or an insurance premium. With a spend down, you are responsible for part of your medical expenses each month before MO HealthNet coverage will start.
Every month when you meet the spend down, you will get MO HealthNet coverage. When you don’t meet the spend down, you won’t get MO HealthNet coverage. If you do not have health care expenses every month, you may choose to pay the spend down some months and not pay it in other months.
There are three ways you can meet your spend down:
- You may send a payment to MO HealthNet. You will have coverage for the whole month that you pay for.
- You may have your payment taken directly out of your bank account on the 10th of each month by the MO HealthNet Division. To have your payment automatically taken out of your bank account, you must complete the Spend Down Automatic Withdrawal Form.
- You may use bills for medical services to reach the spend down amount. When the amount of the services you get reaches your spend down amount, you must give the bills to your eligibility specialist at your local Family Support Division (FSD) office. MO HealthNet coverage will start the day you reach your spend down amount. You are responsible for the spend down amount.
Thomas has a $400 monthly spend down. He doesn’t pay it every month, because he doesn’t always need medical treatment. Instead, he submits copies of his bills for the first $400 in medical expenses he has in a month to the Family Support Division (FSD) and then MO HealthNet pays the rest.
In April, he incurs $700 in medical expenses. Thomas submits bills for the first $400 to his FSD eligibility specialist who activates his MO HealthNet coverage. MO HealthNet will pay the remaining $300. In May, Thomas has only $50 in medical bills. Since he doesn’t have enough bills to meet the full $400 spend down amount for May, MO HealthNet will not pay for any medical expenses in May.
SSI 1619(b) Eligibility
If you’re on Supplemental Security Income (SSI), there is a special rule that allows you to keep your MO HealthNet coverage even when your earned income is too high to get any SSI cash benefits. This rule is called 1619(b). Thanks to 1619(b), you can have up to $44,287 in gross earnings per year without losing your MO HealthNet.
To get MO HealthNet based on 1619(b), FSD has to obtain documentation that you qualify from the Social Security Administration (SSA). SSA does not send this information to the local FSD office; the FSD office will request that you get the documentation from SSA. Once the FSD gets this documentation, FSD will approve you for MO MO HealthNet as long as you continue to qualify for 1619(b).
Learn more about 1619(b) in DB101's SSI article.
If You Qualify for the Ticket to Work Health Assurance (TWHA) Program
If you have a disability and are working, you may be able to continue getting MO HealthNet thanks to a program called Ticket to Work Health Assurance (TWHA) even if you are not eligible for 1619(b). If you were never on SSI benefits, but have a disability that meets Social Security’s definition of disability, you may also be able to get MO HealthNet coverage through TWHA.
With TWHA, you can make as much as $90,840 per year and continue to get MO HealthNet benefits. If you get MO HealthNet through TWHA, you may have to pay a monthly premium to be covered. The premium depends on your income and family situation, up to a maximum of $211.
You can learn more about Ticket to Work Health Assurance in DB101's How Health Benefits Work article.
All three of these ways of qualifying for MO HealthNet – the spend down, 1619(b), and the Ticket to Work Health Assurance (TWHA) program – are great options if you like your current MO HealthNet coverage and start working. You don’t have to be afraid you will lose your health coverage!
For more information about your health coverage options, see DB101's How Health Benefits Work article. You can also try DB101’s School and Work Estimator to get an idea of what type of MO HealthNet you qualify for.
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Private Health Care Coverage for Young People
To get private coverage, somebody — you, your employer, your parents, your parents’ employer — must pay for that coverage. In this section, we will introduce you to the basic ways you can get private health care coverage, as well as point out what sorts of health care expenses you may encounter.
Coverage Through Work
Many, but not all, jobs offer health care benefits. That’s why private health care coverage through work is the most common way that Americans get their health care coverage.
If you get your health coverage through your job, usually your employer pays most of the expenses. This means that the employer pays hundreds of dollars each month so that you have access to health care. Depending on your job, you will also have to pay a monthly amount in addition to what your employer spends. The total monthly expense paid for the private health care coverage is called the premium.
In addition to the premium you and your employer will be paying, you will have to pay various other expenses out of your own pocket. The most common health care expenses are called copayments. A copayment means that every time you have a doctor’s appointment, have a test done, or get a prescription filled, you will have to pay some money. With private coverage, copayments generally range from about $10 to $50.
Depending on your health care plan, you may not have to pay anything for certain types of services (testing and vaccinations, for example). But you may have to pay a lot for other types of services. Some plans, for example, may require you to pay for half of all your hospitalization expenses, which can add up to hundreds or even thousands of dollars each day. Other plans simply do not cover certain medical expenses, such as wheelchairs or other durable medical equipment.
All plans have an annual limit on the total amount you have to pay in addition to your monthly premium. This limit is called the out-of-pocket maximum. So, if you have a plan with a $2,000 out-of-pocket maximum, once you’ve paid a total of $2,000 in copayments and other medical expenses, you won’t have to pay any copayments or other expenses for the the rest of the year. Note: You will still have to pay your monthly premium.
Learn more about employer-sponsored coverage in DB101's How Health Benefits Work article.
You are allowed to get employer-sponsored private health coverage and public health coverage, such as MO HealthNet, at the same time. You don’t have to quit MO HealthNet just because you are now covered by employer-sponsored private coverage as well. That can be a help, because MO HealthNet may pay for some services that your private health coverage doesn’t cover.
Another option is that you can have MO HealthNet pay your premium for your employer-sponsored private health insurance. For example, if you have employer-sponsored private coverage and pay a $200 per month premium for your insurance, MO HealthNet may be willing to pay the $200 per month. That’s called the Health Insurance Premium Payment (HIPP) program. HIPP may also pay your copayments or deductible. To learn more about HIPP, click here.
Coverage Through Parents
Federal law says that parents who get health coverage through their jobs are allowed to add any children under the age of 26 to their plans. Usually, a parent adding a child to their employer-based coverage will have to pay some or all of the child's monthly premium.
Buying Individual Coverage
Some people pay a health coverage company directly instead of getting it through their jobs or parents. This is called individual coverage. With individual coverage, you will have to pay a monthly premium, copayments, and perhaps a deductible, depending on your plan.
HealthCare.gov is the easiest place to apply for individual coverage. It used to be that health insurance companies could deny your application or charge you more if you had a disability, but that's no longer true. Now, anybody under the age of 65 can go to HealthCare.gov and sign up for a private insurance plan.
You should think about getting an individual plan through HealthCare.gov if you cannot get health coverage from:
- Your job
- Your spouse’s job
- Your parent’s job
- MO HealthNet, or
- Medicare
If you cannot get health coverage from any of the above options, the government may help you pay your monthly premium via a tax credit. If your family’s income is at or below 250% of the Federal Poverty Guidelines (FPG), ($37,650 for an individual or $78,000 for a family of four), the government also helps you get a silver plan that has lower copayments and other expenses.
Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
| Your family size: | |
| |
Income limits for your family: | |
| Income-based MO HealthNet, adults (138% FPG) | |
| MO HealthNet for Kids, free (150% FPG) | |
| MO HealthNet for Kids, premium (300% FPG) | |
| Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
| |
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Other Programs
There are many other benefits programs that you may qualify for. If you get Supplemental Security Income (SSI) and are over 18, you probably can also get SNAP (formerly Food Stamps). And if your income and resources are low enough and you have a child under age 19, you may also be able to get income support from the Temporary Assistance program.
Depending on your circumstances, two Social Security programs may give you benefits based on contributions your parents made during their careers: Child’s Benefits and Childhood Disability Benefits (CDB).
A third set of programs, including ABLE Accounts, Individual Development Accounts (IDAs), and the Earned Income Tax Credit (EITC), help you save up money or other resources without losing your other benefits.
SNAP (formerly Food Stamps)
The Supplemental Nutrition Assistance Program (SNAP) helps people with low income and low resources pay for food. You don’t get actual “stamps” anymore. Instead, you get a plastic card called an Electronic Benefits Transfer (EBT) card that looks and works like a debit card. Missouri puts money on the EBT card each month and you use the card to pay for food.
To get SNAP (formerly Food Stamps), download an application, fill it out, and submit it to your local Family Support Division (FSD) office in person or by mail or fax your application to 1-573-522-6220. You may also complete and submit the application online. For more details, see the Missouri Food Assistance website.
Temporary Assistance
Temporary Assistance gives money to families who don't have enough to pay for basic needs like food, clothing, and rent. Temporary Assistance defines a family as 1 or 2 parents living with their child or children under 18. The age limit is 19 for children who are in school full-time. A family could include biological children, stepchildren, adopted children, and children of relatives.
In order to get Temporary Assistance, you must apply at your local Family Support Division (FSD) office in person. For more details, see the Temporary Assistance website.
Child’s Benefits (only if you are under 19)
The most common way for adults to get Social Security benefits like SSDI or retirement benefits is to work and pay into Social Security’s trust fund.
For young people, however, a more common way to get Social Security benefits is to qualify for Child’s Benefits. You do not need to have a disability to qualify for Child’s Benefits. To get them, you must:
- Be under the age of 18 (or 19 if you’re attending high school or other secondary education)
- Not be married, and
- Have a parent who gets Social Security retirement benefits or SSDI. If your parent is deceased, you may also qualify.
Note: You'll get Child's Benefits in any month your parent gets a Social Security disability or retirement benefit. You will also get benefits if your parent is deceased and would have qualified for benefits based on his or her work record. That means that if your parent is in SSDI's Trial Work Period, you'll keep getting Child's Benefits, but during the Extended Period of Eligibility, you'll only get a Child's Benefit in any month your parent gets an SSDI benefit. Make sure to notify Social Security if your family is in this situation.
You can apply for Child’s Benefits at your local Social Security office, or by calling 1-800-772-1213 or 1-800-325-0778 (TTY).
To learn more about Child’s Benefits, click here or talk to a Benefits Specialist.
Childhood Disability Benefits (CDB) (only if you are 18 or older)
If you have a disability, you may be eligible to get money each month through the Childhood Disability Benefits (CDB) program.
CDB is based on your parent’s work record. You can only get CDB if you are 18 or older. To qualify for CDB, you must also:
- Have become disabled before you turned 22
- Not be married, unless your spouse also gets SSDI or CDB
- Meet the adult definition of disability, and
- Have a parent who gets Social Security retirement benefits or SSDI. If your parent is deceased, you may also qualify.
You don’t automatically get CDB when you turn 18. You can apply for it at your local Social Security office or by telephone at 1-800-772-1213 or 1-800-325-0778 (TTY).
If you get CDB, you can also get health coverage through Medicare after a 2-year waiting period.
To learn more about CDB, read about it on the Social Security website or talk to a Benefits Specialist.
Asset-Building Programs
Asset-building programs are a different type of benefit designed to help you save money you have earned. Instead of sending you a check or paying for your health care expenses, asset-building programs help you save money so that you can afford to pay for your own expenses, such as education, buying a car, or even retirement.
ABLE Accounts
If your disability began before you turned 26, you can open an ABLE account and save resources in it. The first $100,000 in your account aren't counted by SSI and none of your ABLE account is counted as resourced by MO HealthNet. ABLE accounts mean that if you get a job, you can start saving some money without losing your benefits. Additionally, the money in an ABLE account gets tax advantages similar to the way retirement accounts work.
However, ABLE accounts have restrictions:
- They can only be opened through specific programs or institutions.
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You can only open one ABLE account.
- Missouri's ABLE account program is MO ABLE, which is only open to Missouri residents.
- You can choose to open an account in another state’s ABLE program.
- You and the other people making contributions on your behalf have a limit on how much you can deposit each year. Combined, you cannot deposit more than $18,000 in 2024.
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You can only use money in an ABLE account for specific things, such as:
- Education
- Housing
- Transportation
- Help getting and keeping work
- Health care
- Assistive technology, and
- Other approved expenses.
- A person can only have one ABLE account.
Learn more about ABLE accounts.
Individual Development Accounts (IDA)
An Individual Development Account (IDA) helps people save money for a specific goal, such as purchasing a home, starting a small business, or paying for education. The great thing about an IDA is that for every dollar you save, the bank or other financial institution where you have your account will match your money. For example, if you save $50 per month, the financial institution might contribute $100 per month. The amount they’ll contribute depends on the institution, but sometimes they will put more money into your account than you do!
Note: There aren't as many IDA programs as there used to be. Some are still active, but it can take a bit of effort to find one that is accepting applications.
To open an IDA:
- You must have low income, and
- The money you contribute must be money that you earned from work, not from a benefits check, your parents, or any other source.
If you are getting SSI, it is very important that you enroll in an IDA that is federally funded through Temporary Assistance for Needy Families (TANF) or the Assets for Independence Act (AFIA). (You do not need to be getting TANF benefits to do a federally funded IDA program.)
SSI does not count money deposited into federally funded IDAs, so the money you save will not cause your SSI benefits to be reduced or stopped.
If you enroll in a nonfederally funded IDA (for example, one funded by a nonprofit or private company), money deposited and matched in your IDA could affect your benefits.
IDAs are a great money-saving tool, but you need to be sure and enroll in the right type of IDA so that you don’t jeopardize your benefits. To learn more, read the DB101 article on Building Assets and Wealth.
Earned Income Tax Credit (EITC)
The Earned Income Tax Credit (EITC) gives money to low- to moderate-income workers and families. Even people who don’t make enough money to owe income taxes may be able to get a check from the IRS if they qualify for this tax credit.
To qualify, the only requirement is that you have income from employment, self-employment, or employer-paid disability benefits. If your income is too high, you will no longer qualify for the credit.
To get the EITC, you need to file your taxes, even if you owe nothing! Make sure to complete the “Schedule EIC” as well. This is free money, and lots of people don’t get it because they don’t know about it! And if you qualify for an EITC, you should also make sure to file your state taxes to get the Missouri Working Family Credit!
The amount of your EITC depends on your family size and income. The credit for tax year 2024 (filing by April 2025) ranges from $2 to $7,830. Make sure to file your taxes and apply!
Missouri also has a similar credit for state taxes. The Missouri Working Family Credit is 10% of the Federal EITC, or $0 to $783. For example, if your federal EITC is $4,000, your Working Family Credit is $400. To claim the Missouri Working Family Credit, you must qualify for the federal EITC on your federal tax return, and you must file a state tax return (Form MO-1040) with Form MO-WFTC and a copy of your federal taxes attached.
For more details, read DB101’s Tax Credit page.
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Next Steps
Apply for Benefits
You can apply for Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), Childhood Disability Benefits (CDB), and Child’s Benefits at your local Social Security office or by calling 1-800-772-1213 or 1-800-325-0778 (TTY).
HealthCare.gov is the easiest place to apply for a private individual health plan.
To get SNAP (formerly Food Stamps), download an application, fill it out, and submit it to your local Family Support Division (FSD) office in person or by mail or fax your application to 1-573-522-6220. You can also complete and submit the application online. For more details, see the Missouri Food Assistance website.
To apply for Temporary Assistance go to your local Family Support Division (FSD) office.
To apply for a Plan to Achieve Self-Support (PASS), contact your local PASS Cadre.
Learn About Asset Building
DB101’s Building Assets and Wealth article discusses programs that can help you build your savings without risking your disability benefits. It includes information about:
- ABLE Accounts, where over time you can save up some money and keep getting SSI and MO HealthNet.
- Plans to Achieve Self-Support (PASS), a program that helps you save money for a work-related goal while you get SSI benefits
- Individual Development Accounts (IDAs), savings accounts that help people with low incomes build resources
- The Earned Income Tax Credit (EITC) and Missouri Working Family Credit, federal and state tax programs that lower the amount of income taxes owed by low- to moderate-income workers and families
Ticket to Work
Social Security’s Ticket to Work Program helps people with disabilities who get Social Security benefits re-enter the workforce and become more independent. The Ticket to Work Program offers free access to employment-related services, such as training, transportation, and vocational rehabilitation.
Benefits Planning Services
If you're currently on SSI, SSDI, or CDB benefits, and you're looking for a job, a trained Benefits Specialist can help you avoid complications when you are working on a job plan for your future. For questions or guidance specific to your situation, you can speak to someone at the Ticket to Work Help Line at 1-866-968-7842 (1-866-833-2967 TTY/TDD) Monday through Friday from 8:00AM - 8:00PM EST.