Health & Benefits

Yes. Some people with a disability A substantial impairment that functionally limits a person in carrying out major life activities, such as walking, lifting, seeing, or learning. or disabilities may be able to receive Medicaid. A person must be considered disabled under the Social Security Administration (SSA) definition. The SSA defines “disabled” as someone who can’t participate in “substantial gainful activity” because of:

• A medically determinable physical or a mental impairment,
• That has lasted or is expected to last for at least 12 months or is expected to result in death.

Some workers with disabilities can receive Medicaid if they have something called “1619(b) status.” There are also other programs for disabled workers, including a spend-down program or Health Benefits for Workers with Disabilities (HBWD). 

1619(b) status is a phrase used to describe Supplemental Security Income (SSI) beneficiaries listed under Section 1619(b) of the Social Security Act. SSI recipients who have 1619(b) status may still receive Medicaid. To qualify for continuing Medicaid coverage as an SSI recipient that returns to work, a person must: 

• Have been eligible for an SSI cash payment for at least one month;,
• Meet the disability A substantial impairment that functionally limits a person in carrying out major life activities, such as walking, lifting, seeing, or learning. requirement while working,
• Must meet all other non-disability SSI requirements,
• Need Medicaid benefits to continue to work, and
• Not earn enough from work to replace SSI, Medicaid, and publicly funded attendant care services. 

The SSA uses a “threshold amount” to decide whether a person has 1619(b) status. They post the threshold amounts on the SSA website each year. In 2026, the threshold amount in IIllinois is $47,756. This means that if a person makes that amount or more, they may not have 1619(b) status. 

If a person makes more than the threshold amount, they may still be able to have 1619(b) status if they can reduce the threshold amount to below that number. Certain people are eligible to have their threshold amount adjusted on an individual basis:

• People with impairment-related work expenses, like a wheelchair, certain transportation costs, and specialized work-related equipment,
• People who are blind,
• People with a Plan to Achieve Self-Support (PASS),
• People who have a personal attendant whose fees are publicly funded, or
• People with medical expenses above the state average amount.

There are two ways a person who is working may still be able to receive Medicaid. First, they could enroll in a Medicaid spend-down program. In this type of program, a person pays for the cost of their medical care up to a set amount every month. The amount paid is based on their income and assets. Anything a person owns that has financial value The cost of their spend-down can vary depending on if they need assistance at home and work or if they pay for residential care. Learn more about the Medicaid spend-down program.

Illinois also has the Health Benefits for Workers with Disabilities (HBWD) program. It is a special Medicaid program for people with disabilities that are currently working. HBWD program participants must pay a monthly premium to receive Medicaid.

To qualify for HBWD, a person must:

• Be between the ages of 16-64 and working,
• Be a resident of Illinois,
• Be a US citizen or an immigrant with Lawful Permanent Resident status (LPR or green card) for at least five years,
• Have a disability, A substantial impairment that functionally limits a person in carrying out major life activities, such as walking, lifting, seeing, or learning. as defined by the SSA, and
• Must be employed or self-employed, and pay Federal Insurance Contributions Act (FICA) taxes or contribute to the Illinois Municipal Retirement Fund (IMRF) through payroll.

If a person isn’t employed, they must provide proof they will be employed within 60 days. When applying, people must also have a Social Security number, A number that the federal government gives to each U.S. citizen. It keeps track of their earnings and retirement benefits. have income equal to or less than 350% of the Federal Poverty Guidelines for their family size, and have no more than $25,000 in assets, Anything a person owns that has financial value regardless of their family size.

A person’s wages, The amount of money that a person is paid for work they do SSI or other Social security income, and their spouse’s income is considered countable income for HBWD. To show they meet the income requirements, people must report their income for themselves and their spouse if applicable.

Countable income does not include SSI payments or earned income deductions and expenses, which include:

• Taxes,
• Transportation,
• Day care expenses,
• Union dues,
• Life insurance or retirement plan withholding, When an employer keeps some of a person's paycheck to cover their taxes
• Special work expenses, and
• The small lunch allowance.

An applicant must provide proof they receive the above to not count them toward their income.

Countable assets can include: 

• Bank accounts,
• Savings accounts,
• Property that is not the home the applicant lives in,
• Stocks, and
• Bonds.

Certain assets are exempt under the HBWD program, such as the value of the disabled person’s home and one motor vehicle. Under HBWD, the disabled person and their spouse may have unlimited retirement accounts as long as they can’t be accessed without penalty before age 59 ½, and certain medical savings accounts like an Archer Medical Savings Accounts.

Benefits begin after the first premium is paid. If the premium is paid before the 20th of the month, benefits start the 1st of the next month. For example, if someone pays on January 15th, their benefits start on February 1st.

If the premium is paid after the 20th of the month, they would not start until the month after next. For example, if someone pays on January 30th, their benefits will start on March 1st.

A person can also get three months of HBWD benefits retroactively before their first month by paying their premium plus the premiums Money that must be paid every month, such as for health insurance for three more months. If a person’s premium payment is $100 per month, and their first premium payment is due January 15th, they can pay $400 during the first payment. This is $100 for the first payment, plus $300 for the previous three months. Then they are covered for the past December, January and February, and their first premium payment started in March.

Benefits may end if a person:

• Doesn’t pay their premium,
• Fails to provide proof of employment,
• Stops employment for medical reasons for more than 90 days, or
• Stops work for any other reason for more than 30 days. 

They can apply online at abe.illinois.gov, or submit an application by mail. Learn more about applying for HBWD benefits.