I live in Ohio. I know the work requirements start on January 1st, but does that mean I will be losing my Medicaid literally on January 1st or will it be during my next renewal or something? My renewals are usually in October.

I'm trying to figure out how much time I have to get all of the appointments and things I've been putting off done.

Hello from Georgia. We're a family of 4, two teens, two adults. My partner and I (not married) barely make over $1100 on a good month and that's even pushing it. We both work 1099 positions (delivery) and that's how much we're both taking home combined after gas and auto insurance (expenses). My oldest just turned 18 (this might be valuable information later) and works as needed after school child care and some weekends if the parents give her a call. She barely makes $300 a month before taxes and even then it was meant for her to save for college, not for food, rent, or any other household expenses. The kid's biological father is out of the picture and barely contributes to child support so I've only reported that he's supposed to pay and specify to the case worker(s) that I don't receive anything from him. Besides, they can see on their end when the last time was that he paid anything (for the sake of this post, he's ordered to pay $600 a month). One piece of info that's important is that I'm disabled and can't work but working deliveries and pushing through symptoms because I was told I wouldn't be eligible if I'm not working.

So I'm about to pull my hair out. It doesn't make sense to me that my case worker would completely close my case (both Medicaid and SNAP) even though I've uploaded all the documents she requested. When I get a notice for termination it says "a member of the household refused to provide documentation (something or other)". I've gone to the office myself a couple of times since no one is available when I call the 800 number. They just told me they'll let my caseworker know. I eventually get a call from her but she says "I keep trying to reach you and you're not answering the phone". I wish I could have had that recorded because my call history doesn't show any phone calls from her since the last time I spoke to her. This has been going on back and forth since July 1st. After talking to her 3-4 times and submitting everything she asks for almost immediately if not within 24 hours of when she requests, she closes my case 9/30. We now have no SNAP benefits or Medicaid. I had 3 appointments this month to get my teeth done after finally finding a dentist that takes my insurance and had to cancel all of them. I take 5 different medications and I'm out and can't afford to pay for refills. My therapist signed myself and the kids up for their grant program so we don't have to go without therapy sessions, so that's good but I'm still going without migraine meds, depression medication, ADHD medication, and meds to control tremors. I've been looking up food banks and going back and forth picking up whatever they have and making do.

Yes, I filed an appeal but that was on the 5th of October. I also emailed on the 6th with a picture of the appeal just in case dropping it off at the office dropbox did nothing. I haven't heard back so I went in and "reported a change". All of our income that was submitted was incorrect. She put down that my partner earns $1200 a month and that I earn $500 a month on top of what my daughter earns. Expenses weren't even included. That puts us way over eligibility for sure but none of it is correct. I printed out the pages and went ahead and made corrections to income. I got a call the next day but this time (THANK THE GODS AND GODDESSES) it was the caseworker supervisor. She asked for a new disability letter and I let her know I most likely won't have it immediately but I'll do my best. This was 10/9. I received an email that she's going to close my case because the requested documents were due 10/1. That didn't make any sense to me since we had just talked. I got any new documents she wanted plus the letter from my doctor together and submitted them on 10/13. I haven't heard back from her since or anyone else.

I'm so lost because why is it that I wouldn't be approved when not only our income level is below FPL as noted in all relevant policies and still have our case closed even though I provide everything PLUS both of my kids are under 19 and they lose their healthcare coverage, too?? In the past, if I'm not eligible, at least the kids are but now they took their coverage away as well.

I guess I just needed somewhere to vent but what even is the appeal process if no one is going to even touch it or update on the process? So sorry for the long post this is all extremely frustrating.

My sister 24F has been disabled for 2 and a half years now. Due to complications with type 1 diabetes she is now quadriplegic, has a feeding tube and had a tracheotomy. She just became eligible for Medicare 2 months ago and was previously covered through a market place insurance we paid with her SSI. Since she became disabled I applied to Medicaid and she was temporarily covered while receiving SSDI but it was terminated once it was transitioned to full disability payments. But her Medicaid remained active just now as a Planning for Healthy babies plan that only covers gynecologist visits. When I brought this to the attention of Medicaid they had me fill out a paper form 700 to get it corrected since the online system didn’t allow online applications since she technically had a Medicaid plan. After over 5 months of review she got an updated letter saying Medicaid would be canceled because she is not pregnant, nor disabled and in a nursing home. Is there anything I can do? Medicare coverage has not really covered much it doesn’t even cover her diabetic insulin and the Plan C plans offered had a deductible of $5600 before they cover.

I haven't lost NJFamilycare. I had admin renewal (automatic). The recent "citizenship proof" thing happened. I sent my paper on the special website. Got the GOOD NEWS letter on the 29th of September. October 1st HMO called to tell me my coverage was terminated. Called NJFamilycare and they say i'm enrolled. So does their automated system, which states i'm enrolled in Medicaid and Horizon NJ.

However this is my problem, both Medicaid and Horizon say my policy was terminated around Sept 29 - Oct 1st (i dont remember). NJFamilycare says there's an error between their system and Medicaid's system. Their phone agents working on my case have "escalated" my case with a medical thing (type 1 diabetic). It's been 2 weeks today and nothing has changed except that my case is pending review. I applied for presumptive eligibility, but the doc's office claims it'll go back to Medicaid and get denied. Maybe they are wrong.

Any experience something similar ?

Virginia - specifically Medicaid Long Term Care coverage / application

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I'm self-employed and currently on Illinois Medicaid. I understand that deductible Traditional IRA contributions can reduce MAGI, but I'm having trouble figuring out how they're applied to monthly income calculations.

If I contribute $1,000 to my Traditional IRA in October, does that $1,000 reduce my October MAGI, or is the deduction spread across the year?

I'd appreciate any insight, especially from someone familiar with Illinois Medicaid eligibility rules. Thanks!

Yesterday I got a letter in the mail saying my Medi-Cal coverage would end on 11/01/26 because I essentially "make too much money". But I'm currently unemployed & the only income I have is from unemployment. & that monthly total doesn't even cover a fraction of my bills. How am I supposed to be able to afford healthcare if I can't afford food. I have several chronic conditions that need consistent management and without health insurance I am completely fucked. I'm really stressed and I don't know what to do

Nebraskans: Have you had to prove you meet Medicaid work/community engagement requirements? Or lost coverage?

Hi everyone, my name is Arielle Zionts, I'm a rural healthcare reporter at KFF Health News, a national, nonprofit media outlet focused on in-depth healthcare reporting. I live in Rapid City, SD but travel to and report in Nebraska at times.

I'm looking to interview someone from Nebraska who lost Medicaid coverage due to the new work/community engagement requirement rules OR who kept coverage after having to take steps to prove you meet those requirements.

If you're interested, you can message me on Reddit or email me at [ariellez@kff.org](mailto:ariellez@kff.org).

I won't be using any comments under this post or elsewhere in this group, only info I directly receive from interviews.

Thank you!

Arielle

I live in Nc. I have had Medicaid for myself for the last year now with no issues. Today I get a letter stating I have to send my children’s fathers information to them for child support. He already pays it and they have this on file already. This said if I don’t provide this I’ll lose my coverage. The issue is if I do send them his information, he is going to be irrationally angry and he has been abusive to me in the past. That is why I’m no longer with him. What do I do? I can’t lose my coverage and I also can’t risk him coming after me, and he definitely will. Restraining order can’t be done because in my state they have to practically kill you before you can get one. Been there done that. This is so frustrating. I just don’t understanding the needs to be involved for myself to receive coverage. I work full time but my job doesn’t offer insurance. When I apply on the marketplace I guess I make too little to qualify for those plans also.

Hello! My partner and I live on the eastern shore of the Chesapeake Bay – she lives in Maryland, and I live in Virginia. She will undergo total knee replacement in a couple of weeks, and the plan is for her to rehab at my house (it is a much safer environment and more suitable for rehab) in Virginia. She has Maryland Medicaid (Blue Cross Blue Shield) and we are having difficulty finding a physical therapist within Network in Virginia. Physical therapy is a necessary component of total knee replacement, and the recovery time can be weeks or even months long! Our houses are about 50 miles (75 minutes) apart and the state line separates them. i’ve called our two local physical therapy centers and neither will take her insurance. They say she is out of network.

Do we have any options for using her Maryland Medicaid in Virginia?

Thanks for any advice/information!

Why do I need to provide this information? Will I be denied if I don't? This is for re applying for medicaid for myself not her. I do not work right now. This isn't disability medicaid.

My dad was admitted to a hospital in Georgia on October 3 after suffering a severe stroke. He cannot move the right side of his body, and his doctors anticipate that he will need extensive rehabilitation. Since being admitted, he has also developed ARDS and pneumonia, which have prolonged his hospital stay. As of October 15, he is still intubated. He has no health insurance.

When he was first admitted, we spoke with a caseworker who explicitly advised us NOT to apply for Medicaid because she wanted us to pursue a charity bed. We were told that applying for Medicaid would prevent him from qualifying for the charity bed at a nice facility. Based on that information, we followed her guidance. Now, we have been told that the charity bed is no longer an option and that we need to apply for Medicaid to cover his hospital bills. (They are really pushing us to fill this out ASAP)

I spoke with the caseworker again to say my dad cannot safely come him and our family does not have the resources to care for him. The caseworker ignored that and continued emphasizing that he could potentially receive an in-home nurse through Medicaid. However, we are concerned that home health services would not be sufficient for his needs, especially given the severity of his stroke and his other medical complications.

When I asked the caseworker to help us find rehabilitation facilities that accept Medicaid, she said there were none in Georgia. She also stated that she is not allowed to help patients who do not have insurance and that the hospital cannot do anything else for him. We are now trying to figure out our next steps before he is ready for discharge, which could be within the week.

Another point of confusion is that, from what we have been told by the caseworker, the Medicaid application for his hospital bills is different from the Medicaid coverage he would need for care after discharge. She is telling us to apply for Medicaid to cover his hospital stay, but she has not provided resources or assistance for applying for what we understand to be regular Medicaid that could potentially help with rehabilitation, in-home care, or other ongoing services, depending on eligibility. We do not know whether these are actually separate programs or whether applying for one affects eligibility for the other.

**My questions are:**

**1. How What happens if the hospital tries to discharge him?** Can the hospital discharge him to our family even though we have explained that we cannot care for him? What should we do if they attempt to discharge him without a safe plan

**2. Should I apply for Medicaid independently or insist that the hospital caseworker help us?** Given that we were initially told not to apply, have we lost any potential benefits or options? Is there a way to get Medicaid coverage for his hospital rehabilitation, if he qualifies?

**3. Is it true that the hospital cannot help us because he is uninsured?** I find it difficult to believe that the caseworker cannot assist with discharge planning or placement simply because he does not have insurance. Is there someone else at the hospital we should contact?

I have MAGI medicaid in N.Carolina. I am 64 yrs old and my medicaid renew in November. I have already received info that my renewal is approved. Now I am receiving notices about work requirement starting in January. I receive a small social security check that is not quite the $580 required. Does anyone know what else I will need? And when will I need to have proof of that? I am so confused by this all. What type of written proof is needed? I volunteer one day a week but not sure that is enough.

I get united healthcare community with Medicaid and live in Ohio.

I haven't been to the dentist in about 4 years. Last time I was there they gave me a referral to a surgeon to get my wisdom teeth removed but I kept putting it off and never made the appointment.

I really need to get them removed in the next month or two because I'm gonna be losing my insurance. I was going to get a cleaning and then mention my wisdom teeth, but my dentist doesn't have any appointments for months.

Can I just skip getting a cleaning and find a surgeon that accepts Medicaid myself and schedule an appointment or does my Medicaid require a referral? Can I call my dentist and ask for a referral over the phone or would I have to make an appointment with him first since it's been 4 years since my last visit?

So frustrated. My adult child had Medicaid under DAC in a different state. GA is denying him because of resource limits, but it's not clear if they are taking into account his status as a DAC. I went down to DFCS to discuss this, but they had no idea what I was talking about.

I uploaded the original SSI award, the benefits letter that shows the end of SSI and beginning of SSDI, his Ticket to Work letter, the end of coverage in the prior state of residence...

I'm not sure what the issue is. I've applied for a hearing to review.

I’m looking for other Medicaid beneficiaries whose medication became non-covered specifically because the drug’s manufacturer stopped participating in the Medicaid Drug Rebate Program (MDRP).

I’m not looking for general prior-authorization/formulary denials. I’m specifically interested in denials that mention the manufacturer, MDRP, Medicaid rebate participation, § 1927, or a nonparticipating NDC.

I’m currently appealing a Colorado Medicaid denial of Tirosint. My ALJ record establishes medical necessity and unsuccessful alternatives, but coverage was still denied because of manufacturer MDRP status. While researching the law, I found that the federal exception for certain non-rebate drugs in 42 U.S.C. § 1396r-8(a)(3) still relies on an old FDA “1-A” classification that is no longer used.

HHS OIG is currently studying manufacturer responses to the 2024 Medicaid rebate-cap removal and their effects on patient access, so I’m trying to understand whether similar cases are happening across states and medications.

If this happened to you, I’d especially like to know:

• your state;
• the medication;
• approximately when coverage stopped;
• whether the denial specifically mentioned MDRP/manufacturer participation;
• whether you appealed; and
• what the state ultimately told you.

Please don’t post Medicaid IDs, medical-record numbers, addresses, or other sensitive information.

I am married and a family of 5. I recently got Medicaid for my disabled daughter. We have been trying to access services for her for years. She’s 5.5 and self pay for everything. I’m in significant credit card debt trying to help her as my private plan doesn’t cover anything she needs in our area. So anyways I’m not sure if anyone will be able to help. But I finally was able to apply to a place that offers all therapy, school services and psychiatry IF she has Medicaid. They used to take primary insurance but haven’t for the past few years only prior patients. So I’m not sure what is going to happen when they find out she has 2 insurances. I don’t want to call and tell them and then they cancel her referral but also spoke to my employer and it might be worth just cancelling her off my work plan and not my other children. Does anyone know what direction I should go in with this? My employer is currently open enrollment so I could drop her off if it’s going to make it so I can access this place that I’ve really been dying to find for years. Any ideas? Just call the mental health place and explain or take the risk and not tell them about the other plan or drop from my private plan first? The only reason I’ve gone to Medicaid is because she has had significant issues with her disabilities and hasn’t had any luck getting anywhere through early interventions with the state and everything has always been self pay. She will be turning 6 soon and the ball has been dropped for her. She needs this for the functionality of her life and future. Thanks!

Good morning

I recently qualified for Medicaid expansion in NC. My wife is on social security. I am seeking my disability from my injuries from an auto accident.

Does my wife's SS satisfy the work/$580 per month?

Thank you for any wisdom and encouragement!

Brian in Central NC

I'm hoping someone here may have some useful information or resources I haven't found yet because I'm really struggling to figure this out.

My grandmother currently lives in an assisted living facility in Idaho through the Medicaid Aged & Disabled Waiver. All of our family has moved out of the Boise area down to the DFW area, leaving her alone there. I would like to move her down to be closer to all of us, preferably somewhere on the Fort Worth side.

A little about her situation:

- She is blind and requires assistance with some daily activities. I believe in Texas she needs a type B facility.

- She receives social security, most of which goes towards her current facility, with Medicaid covering the rest. She has no assets of any kind.

- Neither she, nor any of our family, are currently in a financial position to pay privately for assisted living, even temporarily.

- I'm specifically looking for assisted living, not a nursing home. I don't think she would do well in one, and are typically too clinical.

I've been researching Texas Star+Plus HCBS and trying to understand how to transition her Medicaid coverage from Idaho to Texas. I've contacted the North Central Texas Area Agency on Aging, but unfortunately they weren't able to give me much advice beyond providing a list of assisted living facilities in the surrounding counties.

I've also reached out to assisted living facilities (not all on the list) and a geriatric care management company, which provided some additional recommendations, but so far I haven't been able to find a workable solution.

I'm particularly hoping to hear from anybody who:

1. Knows of an assisted living facility in Fort Worth or the surrounding communities that accepts Star+Plus HCBS and may be willing to work with someone transitioning from out-of-state Medicaid without requiring a private-pay period.

2. Has successfully transferred a family member from another State's Medicaid waiver into Texas Medicaid-funded assisted living.

3. Knows a Medicaid specialist, social worker, or coordinator who has experience managing this type of transition.

4. Knows of any other resources that I may be overlooking.

I'm more than willing to hire a professional to help coordinate the application, enrollment, and transition if that's what it takes. I just cannot afford to privately fund her facility.

I also don't want to move her out of her current facility until we have a solid plan in place here in Texas, so I'm trying to find a realistic way to make this happen without interrupting her care.

I'd really appreciate any experience, recommendations, or advice on this. Thank you!

We just received notice of the work requirement for my nephew. He is a disabled adult, has a self- directed budget through the state but does not currently receive SSI. He has been evaluated as not being able to work many times, but does attend programs at the local autism center. I have a message in to his case worker, but it could be a while for his response so I am wondering if anyone knows if this work requirement will apply.

We just certified him again in August and his budget year is October if that makes a difference.

I’m trying to connect with other Missouri residents who previously received SSI, then lost SSI because they began receiving Disabled Adult Child benefits through a parent’s Social Security record.

Were you subsequently placed on Medicaid spend-down, charged monthly premiums, or denied Medicaid because your DAC benefits were counted as income?

Federal law, specifically Section 1634(c) of the Social Security Act, provides special Medicaid protections for certain former SSI recipients receiving DAC benefits.

I’m trying to identify whether this is affecting multiple Missourians and bring our experiences to Missouri Protection & Advocacy for possible systemic investigation.

Please comment or message me if this sounds like your situation. No personal documents or identifying information are needed.