Originally published: October 2025 | Reviewed by Perry Morrison
Working while you’re getting SSDI in North Carolina can put your Medicaid benefits at risk if you don’t understand the rules.
Lots of folks worry that earning any income will automatically kick them off their healthcare coverage, but North Carolina has programs to help disabled workers keep Medicaid.
You can protect your Medicaid while working on SSDI by using North Carolina’s Health Coverage for Workers with Disabilities program and knowing the state’s work incentives.
The Health Coverage for Workers with Disabilities program allows workers with disabilities aged 16 through 64 to maintain full Medicaid coverage, provided their unearned income remains below 150% of the federal poverty guidelines.
Learning how to comply with county DSS requirements, reporting income accurately, and maximizing available work incentives can mean the difference between retaining your healthcare and losing it.
SSDI provides cash benefits and eventually Medicare, while Medicaid gives immediate health insurance based on income limits.
The problem pops up when work income affects Medicaid eligibility, sometimes leaving gaps in health coverage during the transition.
Social Security Disability Insurance pays monthly cash benefits to workers who become disabled. It’s essentially designed to replace lost wages for individuals who have paid into Social Security through their employment.
SSDI recipients must wait 24 months after their benefit start date before Medicare coverage becomes effective. That waiting period leaves a lot of people with a gap in health insurance.
The monthly SSDI payment depends on your work history and past earnings. If you earned more over your lifetime, your monthly check is usually bigger.
Key SSDI Features:
Unlike some other disability programs, SSDI doesn’t have income limits. You can get benefits even if your spouse works or you have family assets.
North Carolina offers several Medicaid programs for individuals with disabilities. Disability-based NC Medicaid covers extra services through waiver programs for those who qualify.
NC Medicaid Programs for Disabled Adults:
Traditional Medicaid requires income below set limits. These limits change every year and depend on your household size.
HCWD gives full Medicaid coverage to workers with disabilities ages 16 through 64. This program sets higher income limits for working people with disabilities.
Medicaid also looks at your assets and resources. Most programs limit countable assets to $2,000 for individuals.
SSDI recipients have a 24-month waiting period before Medicare coverage begins. The clock starts from your SSDI benefit start date, not your application date.
Many people rely on Medicaid for health coverage during this waiting period. SSI beneficiaries usually receive Medicaid automatically, while SSDI recipients typically get Medicare after a waiting period.
Timeline Example:
Some people end up with both Medicare and Medicaid. That dual coverage helps pay for things Medicare doesn’t cover.
The transition period often creates coverage gaps if you earn too much for Medicaid but don’t have Medicare yet.
If you work while receiving SSDI, your income may exceed Medicaid limits. Every dollar you earn counts toward your monthly income for Medicaid eligibility.
Most Medicaid programs use your gross monthly income to decide if you qualify. This includes wages, self-employment income, and any other earnings before taxes.
Income Counting Rules:
Reporting requirements make things even trickier. You must report income changes within specific timeframes to avoid penalties.
If your earned income goes up, you might qualify for Health Coverage for Workers with Disabilities if you meet the requirements.
Asset limits matter too. Saving up from work or benefits can push your resources over Medicaid limits. Bank accounts, vehicles, and other assets all count.
North Carolina has programs that allow SSDI recipients to maintain health coverage while earning employment income.
These include special Medicaid categories for workers with disabilities and income calculation rules that help protect your coverage.
The Health Coverage for Workers with Disabilities (HCWD) program offers full Medicaid coverage for North Carolina workers with disabilities ages 16 through 64. It’s designed for people who work but still need health insurance.
Eligibility Requirements:
The program sets higher income limits than regular Medicaid. You can earn employment income and keep your coverage if you stay within the program guidelines.
Apply through the standard NC Medicaid system. You’ll need to provide proof of your disability status and your employment information.
The HCWD program helps people with disabilities who want to work or increase their hours without losing health coverage.
North Carolina utilizes income disregards to assist individuals with disabilities in maintaining Medicaid while working. These rules let you exclude certain income types when applying for Medicaid.
Work Incentive Disregards:
Certain income sources don’t count toward Medicaid limits. That includes some disability payments and work supports.
NC Medicaid uses specific formulas to figure out countable income. These often work in favor of disabled people who are working.
The state recognizes that people with disabilities may incur higher medical or work-related expenses. Income disregards help balance those extra expenses.
You can move between different Medicaid categories as your work situation changes. This flexibility helps you keep coverage when your employment changes.
Common Category Changes:
Category changes usually occur when your income changes due to a change in work. The state tries to keep you covered during these times.
You have to report income changes on time. The state reviews your information and determines which Medicaid category best fits you.
North Carolina aims to prevent gaps in coverage during these switches. Benefits often continue while your new application is processed.
Federal 1619(b) rules in other states guide North Carolina residents who receive both SSI and SSDI. These rules outline how work can impact various benefit programs.
This federal program allows SSI recipients to continue receiving Medicaid even when their earnings are too high for cash payments. Rules change by state.
North Carolina has its own rules, but the 1619(b) concept helps people understand how work affects benefits. The principles are useful for planning.
Planning Strategies:
Every state sets its own income limits for Medicaid eligibility. North Carolina’s limits might not match 1619(b) levels in other states.
Morrison Law Firm helps North Carolina families protect vital Medicaid benefits while receiving SSDI. Learn how our disability services safeguard your health coverage—contact us today to schedule.
If you’re ready to get started, call us now!
SSDI recipients in North Carolina can utilize certain work incentives and income calculation methods to maintain Medicaid eligibility while working.
These strategies include documenting work expenses, knowing benefit phases, and carefully managing income increases.
IRWEs reduce countable income for Medicaid when you have disability-related work costs.
The Social Security Administration lets you deduct these expenses so you can work without immediately losing benefits.
Qualifying expenses include:
Documentation requirements are strict. You need to keep receipts, invoices, and medical statements for every expense.
A doctor’s letter explaining how each cost connects to your disability really helps your case. It’s worth the extra effort to get one.
Income calculation is pretty straightforward. You subtract your verified IRWE amounts from your gross earnings.
For example, if you earn $1,200 a month and have $300 in documented IRWEs, Medicaid only counts $900 as your income.
Send your IRWE documentation to your local Social Security office as soon as possible. Waiting can slow down adjustments and mess with your benefits.
Trial Work Period (TWP) lets SSDI recipients work for nine months without losing benefits. In 2025, any month you earn more than $1,110 counts as a trial work month.
These months don’t have to be in a row. You can spread them out if your work is on and off.
During the TWP, you retain your full SSDI payments regardless of your earnings. It’s a chance to see if working is possible for you without risking your checks right away.
The Extended Period of Eligibility (EPE) comes after TWP and lasts for 36 straight months. You’ll only get SSDI payments for months when your earnings are below the substantial gainful activity level, which is $1,550 for non-blind folks in 2025.
Medicare continuation stretches for 93 months after TWP ends. That’s a huge help in keeping your healthcare while you try to work.
The work incentive programs give you a safety net as you try to increase your work hours. You can pause and restart benefits during the EPE if your work attempt doesn’t pan out.
Income disregards vary by state, but most states exclude certain amounts when determining Medicaid eligibility. North Carolina mostly sticks to federal rules for these exclusions.
Common exclusions include:
Asset limits usually stay at $2,000 for individuals. Some assets are excluded, such as your primary residence, one vehicle, and burial funds up to $1,500.
Medicaid Buy-In programs allow working individuals with disabilities to qualify even with higher incomes. The Ticket to Work program supports these Medicaid options focused on employment.
Keep in mind, different programs count income in different ways. What matters for SSDI might not matter for Medicaid, or vice versa.
Gradual income increases can help you keep benefits longer than if you suddenly make a lot more. Plan your work hours and schedule to stay within limits during your transition.
Strategic timing means knowing when to report changes and how Medicaid counts your income. Most Medicaid programs look at your monthly income, not your yearly average.
Part-time work is often the best way to start. You can gradually add hours and see how it affects your benefits before making any significant changes.
Seasonal work patterns may help things out. If you have some low-earning months, you could stay eligible even if you go over the limit in other months.
Employment goals should include specific income targets. Think about when your job’s insurance could take over for Medicaid.
Immediate reporting is essential when your income increases. Let Social Security and Medicaid know within 10 days of any increase.
Documentation preparation matters a lot. Gather pay stubs, work schedules, and any IRWE receipts to ensure your benefits are calculated accurately.
Re-evaluation requests can fix mistakes or add deductions you missed. If you have new information, ask for a fresh review of your case.
The 1619(b) Medicaid While Working provision can keep your Medicaid going even if your SSI stops because you’re earning more. This helps you bridge the gap until you get job-based insurance.
The appeals process gives you a way to fight back if your benefits are cut off unfairly. You typically have 60 days to request a hearing after an unfavorable decision.
Legal assistance sometimes makes a difference, especially if you’re juggling several programs. Disability lawyers know how these work incentives play with Medicaid rules.
Don’t just assume you’ve lost benefits for good. Many work incentive policies allow you to keep coverage if you apply and document things correctly.
Staying in touch with your county DSS and holding onto good records goes a long way in protecting your Medicaid while you’re working on SSDI.
Knowing the reporting timelines, maintaining the correct paperwork, and understanding your appeal rights can help you avoid sudden benefit interruptions.
You need to report income changes to your county DSS within 10 days of your first paycheck or SSDI payment. This covers new jobs, changes in your work hours, or any adjustments to your SSDI benefits.
Start by calling your county DSS, then send a written follow-up. Many counties now accept reports online or by email. Always obtain confirmation that they have received your report.
When you report, be specific:
If your SSDI amount changes because of a cost-of-living increase or another SSA change, report that too. It’s important to report both increases and decreases in your benefits.
If you stop working, please notify DSS immediately. Your Medicaid eligibility might actually improve when your job ends.
Write down every time you talk to DSS. Note the date, time, and who you spoke with—it’s just good practice.
Good documentation protects you during reviews and appeals. Keep all documents for at least three years after your case is closed.
Here’s what you should save:
Keep IRWE receipts somewhere safe. These cover assistive tech, special transportation, attendant care, and changes to your car or workspace.
Hang onto all letters and emails with DSS and SSA. That means applications, renewal forms, and any written decisions about your benefits.
Write down your work history—dates, job duties, and why you left each job. It might come in handy during a review.
Set up a simple filing system. Use separate folders for each type of document, and create backup copies whenever possible.
Request important information in writing so you have a written record. DSS and SSA both have to give you certain documents if you request them.
From DSS, ask for:
County departments must provide access to confidential client records if you ask the right way.
From SSA, ask for:
Send written requests by certified mail or use secure online portals. Always keep a copy of your requests and any responses you get.
Request documents before you actually need them. Sometimes it takes weeks to get a response, especially when offices are busy.
If DSS or SSA says no, ask for the denial in writing with their reasons. You may be able to appeal if they refuse to provide what you need.
You can appeal any decision made by the DSS regarding your Medicaid. However, you must follow the deadlines closely.
Appeal timeline:
File your appeal in writing with your county DSS. Include your case number and explain why you think the decision was wrong.
Ask them to keep your benefits going while you appeal. If you file within 10 days of the notice, Medicaid should continue during the process.
Collect your supporting documents before the hearing—pay stubs, medical records, IRWE receipts, and any letters from DSS.
You can represent yourself or bring someone with you. Legal aid groups often assist with Medicaid appeals at no cost.
DSS employees who handle confidential information must adhere to strict training and policy guidelines. If your case was mishandled, that could matter for your appeal.
If you lose, you can ask for a second review or even go to state court. Sometimes, it’s worth consulting a Medicaid attorney if you reach that point.
Working while on SSDI? Morrison Law Firm guides clients through Social Security Disability appeals and Medicaid eligibility, ensuring no benefits are lost. Call now to schedule a free consultation.
If you’re ready to get started, call us now!
SSDI recipients in North Carolina face significant risks when attempting to maintain Medicaid, including overpayment demands or asset recovery.
Being aware of these issues helps you avoid costly mistakes and protects your benefits in the long run.
DSS might demand repayment if they believe you got Medicaid benefits you weren’t actually entitled to. This typically occurs when you fail to report income or asset changes promptly.
Common triggers include:
The repayment demand shows up as an official notice. You have 30 days to request a hearing and dispute the amount they claim you owe.
DSS determines overpayments by counting the months they believe you were ineligible. They multiply the monthly premium cost by the number of those months.
Protection strategies:
Sometimes, DSS makes mistakes or falls behind on paperwork, which can result in overpayments. Always double-check their math and collect anything that proves you were actually eligible during those months.
North Carolina tries to recover Medicaid costs from your estate after you die. The state looks at assets that go through probate.
Assets subject to recovery:
The state can’t touch assets with joint owners or named beneficiaries. They also can’t go after your estate if you leave behind a spouse or disabled child.
Asset protection methods:
Don’t transfer assets within five years of needing long-term care Medicaid. Doing that can trigger penalty periods and affect your eligibility.
The state can’t recover more than what Medicaid actually paid for your care. If they claim too much or value assets incorrectly, families can push back.
North Carolina uses a five-year look-back when you apply for long-term care Medicaid. DSS checks every asset transfer within that window to determine if you should be penalized.
Countable resources include:
DSS divides the amount you transferred by the average monthly cost of nursing home care in North Carolina (about $6,500). That gives them the penalty period in months.
So, if you transfer $26,000, you face a four-month penalty period with no Medicaid coverage.
Exempt transfers that don’t create penalties:
If you receive SSDI, consult with an attorney before making significant financial transactions. The wrong move can result in lengthy penalty periods when you need care the most.
Income spikes can cause SSDI recipients to lose Medicaid coverage, at least temporarily. Knowing how to get reinstated can save you a lot of stress.
Common causes of eligibility lapses:
If you lose eligibility, DSS sends a termination notice with an end date. You have 90 days to resolve the issue and potentially have coverage restored retroactively.
Reinstatement process:
If you can’t get Medicaid back, you might qualify for marketplace insurance with subsidies. However, you would lose out on Medicaid’s broad coverage and low costs.
Prevention strategies:
Some individuals quickly regain Medicaid coverage once their income drops again. Others have to spend down extra income on medical bills before they qualify.
North Carolina’s 100 counties all have their own DSS offices. Some move fast, others drag their feet, and a lot depends on where you live.
Processing time variations:
Some counties are efficient, thanks to better staffing or tech. Others get bogged down, and your coverage can suffer.
Discretionary differences include:
If you move to a new county, you have to start the application process over. Your old county’s decision doesn’t follow you.
Strategies for county-specific challenges:
Wake and Mecklenburg counties usually process things quickly than rural areas. However, even city offices can become overwhelmed when everyone applies at once.
Keep a record of every call or email with DSS. If you ever need to appeal or fix a mistake, those notes can make a huge difference.
SSDI recipients in North Carolina really need solid documentation and tracking to keep Medicaid while working.
These actionable planning tools help you get organized for income reporting, track work incentives, and maintain clear communication with the state.
Contact DSS First
Verify Work Incentive Programs
Gather Required Documentation
□ Most recent Social Security award letter
□ Current Medicaid card and eligibility notice
□ Medical records showing your disability is ongoing
□ List of your current meds and treatments
Employment Details To Confirm
□ Exact start date and your work schedule
□ Hourly wage or salary
□ If the job comes with health insurance
□ What you’ll actually do and any physical requirements
□ HR contact info
Try to finish this checklist at least two weeks before you start work. Getting ready early keeps you from falling through the cracks.
Income Tracking Section
IRWE Deduction Categories
□ Prescription meds insurance doesn’t cover
□ Medical equipment or devices
□ Transportation for medical appointments
□ Attendant care during work hours
□ Specialized work equipment or modifications
| Category | Amount | IRWE Eligible |
| Medications | $_____ | Yes |
| Medical Transport | $_____ | Yes |
| Work Equipment | $_____ | Yes |
| Regular Living Expenses | $_____ | No |
Countable Income Formula
This worksheet format makes it easier to track changes month to month. Update it every pay period and keep all your IRWE receipts.
Required Reporting Timeline
Income Reporting Triggers
□ First paycheck from a new job
□ Any raise or pay cut
□ Switching from part-time to full-time
□ Getting overtime or a bonus
□ Cutting your hours for medical reasons
Documentation Deadlines
If you lose your job due to disability, report it to DSS right away. Also, let them know if you get an insurance settlement or legal payout.
Set reminders for these deadlines—it really helps. Missing a reporting date can lead to reviews or even a temporary benefits freeze.
Sometimes, you really need professional help with SSDI and Medicaid. These programs can get complicated fast, especially when your benefits are at risk.
In certain situations, immediate legal intervention is necessary to protect your finances and healthcare.
Overpayment notices need quick action from a disability attorney. Social Security sometimes says you got too much money and wants it back.
SSDI earnings violations can result in these notices if your work income exceeds the allowed limit.
Asset disputes pop up when Medicaid questions your resources. This might happen during a review or if you inherit money or property.
An attorney can help you figure out asset protection strategies that fit your situation.
Appeals processes benefit from legal expertise at several steps:
Threats of benefits termination require an immediate response. When Social Security or Medicaid threatens to stop payments, there’s not much time to act.
Missed deadlines can result in losing your benefits permanently.
Complex work situations also call for professional advice. If you’re starting a business, receiving stock options, or have an unpredictable income, things can get complicated.
Experience matters most when you’re picking someone to help. It’s best to look for attorneys who specialize in disability law rather than general practice.
North Carolina disability attorneys should have real experience with SSDI and Medicaid cases.
Fee structures aren’t all the same:
Professional credentials can reveal a great deal. Certified Disability Representatives undergo additional training, and board-certified disability attorneys have passed rigorous tests and stay up-to-date with new laws.
Local knowledge is invaluable with North Carolina’s Medicaid rules. State regulations can be surprisingly specific, and out-of-state lawyers may not be familiar with the details.
Local attorneys also know how your regional Social Security office operates.
Client references are worth checking. Ask for recent clients who’ve dealt with similar problems. It’s wise to research state bar records before deciding who to hire.
Financial records form the backbone of any case. Attorneys require full banking statements, tax returns, and investment account records for the past two years.
This means every checking, savings, and retirement account counts. If you think, “Oh, that old account doesn’t matter,” it probably does.
Medical documentation backs up disability status and ongoing treatment needs:
SSDI and Medicaid correspondence tell your current story. Bring all letters from the Social Security Administration and North Carolina Medicaid.
This covers award letters, overpayment notices, and eligibility determinations. If it came from them, toss it in the stack.
Work history information shows earning patterns and capacity. You’ll need employment records, pay stubs, and anything that shows attempts at work since you started getting benefits.
Asset documentation refers to items such as property deeds, vehicle titles, and insurance policies. Attorneys want the whole picture to figure out how to protect what you have.
Choosing the right attorney can make the difference between losing vital benefits and protecting your future.
At Morrison Law Firm, clients consistently praise our dedication, compassion, and results:
These real stories reflect what sets our firm apart:
Call Morrison Law Firm today for a free consultation and let us help you protect your Medicaid and SSDI benefits while securing your future.
Can I keep Medicaid if I start working while on SSDI in North Carolina?
Yes. Many SSDI recipients can maintain Medicaid by applying for Health Coverage for Workers with Disabilities (HCWD), reporting their income promptly, and staying within the resource limits set by NC Medicaid.
What is HCWD in North Carolina?
HCWD, or Health Coverage for Workers with Disabilities, is a Medicaid program that allows people with disabilities under 65 to work and still qualify for coverage, even with higher income and resource thresholds.
How much can I earn and still keep Medicaid on SSDI in NC?
Income limits depend on the Medicaid category. With HCWD, earned income can be significantly higher, and resource limits rise to about $25,728 (2025). Deductions, such as impairment-related work expenses, reduce countable income.
Does Medicare replace Medicaid after 24 months on SSDI?
Not necessarily. After 24 months, you qualify for Medicare, but you may keep dual coverage if you still meet Medicaid rules. Many North Carolina residents keep both, using Medicaid to cover costs Medicare doesn’t pay.
What expenses can reduce my countable income for Medicaid?
Impairment-Related Work Expenses (IRWEs) — such as special equipment, medical devices, or transportation related to your disability — can be deducted from income when DSS calculates Medicaid eligibility.
What happens if I don’t report my earnings to DSS while on Medicaid?
Failure to report income changes can lead to Medicaid termination, overpayment notices, or repayment demands. Always report new earnings to your county DSS within 10 days.
Can part-time work affect my Medicaid if I’m on SSDI?
Yes. Even part-time income must be reported, but in many cases, part-time work falls within Medicaid limits or qualifies under HCWD. Careful tracking ensures you don’t unintentionally exceed thresholds.
When should I consult an attorney about Medicaid and SSDI?
You should seek legal help if your Medicaid is denied or terminated, if you face an overpayment notice, or if you’re unsure how your work income will affect your SSDI and health coverage.
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