A lesser-known piece of legislation passed five decades ago may be the difference between losing and retaining eligibility for Medicaid, the health-insurance program that offers medical coverage to tens of millions of people in the United States.
Dubbed the “Pickle Amendment”, the 1977 federal law protects Medicaid coverage for Americans who previously received both Social Security benefits and Supplement Security Income (SSI), but lost their SSI eligibility because of a cost-of-living adjustment (COLA) to their Social Security payments.
How the COLA can impact SSI and Medicaid coverage
A needs-based scheme for individuals who are over 65 or have a disability, SSI typically comes with automatic eligibility for Medicaid. A state-run program funded at both state and federal level, Medicaid provides healthcare to some 67 million low-income people in the U.S., according to the scheme’s latest enrollment figures.
This includes several million SSI recipients: per the latest stats published by the Social Security Administration (SSA), around 7.3 million people claim the benefit, which is worth a monthly maximum of $994 per individual in 2026.
Of the just over seven million SSI beneficiaries nationwide, around 2.5 million also receive retirement, disability or survivor pay as part of the Social Security program, an entitlement scheme which pays out monthly benefits based on a recipient’s employment history.
However, when the SSA applies its annual COLA to Social Security benefits – a measure designed to ensure monthly payments keep pace with inflation – this can nudge a Social Security recipient’s income over the limit for SSI eligibility. Social Security beneficiaries who have a further non-SSI source of income, such as a private pension, appear to be particularly vulnerable to this scenario.
If a beneficiary loses their SSI, this, in turn, can also mean they lose their Medicaid coverage.
“The Pickle Amendment says, ‘That’s not right,’” explains Dr. Ed Weir, a former Social Security manager who now offers advice on welfare programs on his popular YouTube channel. “The Pickle Amendment says, ‘You know what? For Medicaid, we’re just going to ignore [the COLA].’”
How does the “Pickle Amendment” work?
Under the legislation backed by James Pickle, then a House congressman for Texas’s 10th district, COLAs are excluded from the calculation of a Social Security recipient’s income – from the point at which the individual last qualified for SSI. Although this provision is not used to restore eligibility for SSI itself, it helps people to stay under the the benefit’s income cap in the eyes of Medicaid administrators, allowing them to keep their healthcare coverage.
For a more detailed analysis of the Pickle Amendment, including a case study on how the legislation is pressed into action, take a look at this explainer by the National Health Law Program.
If you have lost your Medicaid eligibility or may be at risk of losing it, but believe your coverage should be safeguarded by the Pickle Amendment, you should contact your state government. “This is administered by the states – you don’t go to the Social Security Administration and ask them about the Pickle thing,” Dr. Weir says. “That is a Medicaid determination, a state determination.” You will find each state’s Medicaid website at the end of this article.
When is the next COLA announced? How much will it be?
A measure typically applied to the SSA’s benefit amounts each December, the COLA is normally confirmed around two months beforehand. In late 2025, the SSA announced a 2.8% increase in Social Security and SSI payments, having implemented a 2.4% rise in benefits the previous year.
In fall 2026, the Senior Citizens League is currently predicting that the SSA will reveal its largest COLA in four years, with a 3.8% increase projected.
How to get in touch with your state’s Medicaid administration – every website:
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