How many people used Medicaid expansion while waiting for Medicare after SSDI?

Using 2023 linked Medicare and Medicaid data, KFF counted 415,300 SSDI beneficiaries ages 19–64 newly enrolling in Medicare that year; 240,300 (58%) had any prior Medicaid, including 120,300 through the ACA expansion pathway.

Do SSDI beneficiaries waiting for Medicare qualify as medically frail?

KFF says people already determined disabled by SSA for SSDI should qualify for the medical frailty exclusion, but states may still require documentation of the SSDI decision if systems do not flag them automatically.

KFF: 120,300 SSDI enrollees used Medicaid expansion

KFF finds 120,300 SSDI beneficiaries newly entering Medicare in 2023 had prior ACA Medicaid expansion coverage, and says new work rules may threaten that bridge before Medicare starts.

medicaid · work-requirements · ssdi · medicare · disability

Diliff, Wikimedia Commons, CC BY 2.5

Direct Support News desk · October 14, 2026 · Updated October 16, 2026 · 1 min read

About 120,300 people who newly enrolled in Medicare through Social Security Disability Insurance in 2023 had been on ACA Medicaid expansion coverage beforehand—more than one in four of the 415,300 SSDI beneficiaries ages 19–64 entering Medicare that year—KFF reported Oct. 14, 2026.

Overall, 240,300 (58%) had some prior Medicaid. KFF linked 2023 Medicare and Medicaid administrative files to measure that bridge. The brief is a companion to KFF’s same-day analysis of SSI applicants and medical frailty under the 2025 reconciliation law’s work rules, which take effect Jan. 1, 2027, in 44 states unless a state starts earlier.

Why the wait matters

SSDI generally requires a five-month wait for cash benefits and then a 24-month Medicare waiting period after entitlement. Applications themselves often take months; SSA data cited by KFF put average initial disability processing at 186 days as of July 2026, with 885,000 people waiting on initial determinations (SSDI and SSI combined).

People applying for SSDI usually cannot meet an 80-hour monthly work or community-service test because they must stay under substantial gainful activity ($1,690 a month in 2026). KFF says they will often need the medical frailty exclusion instead, using the June 2026 interim final rule’s two-part test and CMS’s optional tiered claims-data framework.

SSDI beneficiaries already found disabled by SSA should qualify as medically frail, KFF writes, but may still lose coverage if states do not auto-identify them and demand paperwork.

Why this matters for providers and DSPs

Agency supports coordinators and QIDPs often help people with developmental disabilities or acquired disabilities through SSDI applications while Medicaid pays for HCBS or primary care. Coverage gaps in the Medicare wait raise ER use and unpaid caregiver load. Providers should ask state Medicaid agencies how SSDI status will feed medical-frailty flags before 2027 renewals, and keep SSA determination letters ready when self-attestation tightens in 2028.

Common questions

How many people used Medicaid expansion while waiting for Medicare after SSDI?: Using 2023 linked Medicare and Medicaid data, KFF counted 415,300 SSDI beneficiaries ages 19–64 newly enrolling in Medicare that year; 240,300 (58%) had any prior Medicaid, including 120,300 through the ACA expansion pathway.
Do SSDI beneficiaries waiting for Medicare qualify as medically frail?: KFF says people already determined disabled by SSA for SSDI should qualify for the medical frailty exclusion, but states may still require documentation of the SSDI decision if systems do not flag them automatically.