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 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!

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?

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

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.

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.

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'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!

Just got a message that the new “work requirements” will take affect January 1st 2027. I had clavicle surgery and I’m gonna need my plate removed because I can’t work long due to irritation, the surgeon that did it moved out of state. If I can’t find a surgeon to do it before January am I fucked? This requirement needs to be shut down because it will do more harm than good.

I did my recertification in August and was approved starting sept 1st. On sept 29th, their "automated system" concluded that I was no longer eligible for financial aid. This is, of course, not true. My insurance was going to end oct 31st all of a sudden.

My insurance company and case worker were both baffled. It took a week of calling around before someone could even get information about *why* i was deemed ineligible, because the notice of my services ending had a big blank spot where the reason is supposed to go. When my insurance rep tried to resubmit my application with me, it was rejected automatically.

Eventually the right person at my insurance reached the right person at the dept of health, who told us I was determined to have too high an income. That person couldnt see anything in my ​​account that would reflect that though, so she had to open a ticket and circle back.

Today we (me + caseworker + insurance rep) called the medicaid line again and *finally* someone admits that this was an automated system error related to me being a non filer for taxes. The system "found" financial data that doesnt exist while trying to verify my lack of income, and determined me ineligible based on that info that it imagined. She had to file an IT ticket to have it fixed, because she can't just overturn the automated systems decision herself.

If youre also in NY and got a confusing disqualification notice, please please call your insurance and ask to speak to someone in retention. Have them help you contact the dept of health / medicaid to find out why you were disqualified/denied. I cant imagine im the only one getting an AI rejection like this, and it very well could have cost me my life if we hadnt fixed it in time.

My mother who is a 75 years old green card holder got a letter from NY state of health to apply for Medicare to continue keeping her Medicaid.

She has only been a green card holder for 2 years so she is not federally eligible for Medicare. ( you need to have 5 years).

We called NY State of health a week ago letting them know she is not eligible for Medicare. They created a ticket and are still processing it.

Should we just continue to wait? Deadline to respond is coming up in 2 weeks. Or should we upload a letter on her account stating again that she is not federally eligible for Medicare?

Has anyone come across this before or any advice?

Louisiana, Male, Single, No Kids, No Disability.

Hello! Here’s my situation: I currently make around $67,000 a year and in August I’ll be entering a program at school that lasts for 16 months. It’s full time and I cannot work during this time. I have been very good about budgeting and tracking expenses and am on track to save up about $35,000 which I will be able to live off of during this time. My issue is that medical insurance is required while I’m in this program and I would like to be on Medicaid since I technically won’t be earning income and, if adjusted as income, what I have saved is roughly $2,100 a month.

Any input is greatly appreciated!

I am a 19yr full-time college student right now. I work a part time job making at most 9k a year. I am filed independent on my taxes from my mother and she tells me i can get medicaid for basically nothing. I really need this for clinical onboarding and im really scared that things won't be okay. Is what she said true? and if so can i get it before November 1st?

EDIT: here’s the message I received:

Medi-Cal update: Starting Jan 1, you will not be in a Medi-Cal health plan anymore, but you will NOT lose Medi-Cal. Learn what to do: dhcs.ca.gov/f43

The link leads to the immigration status related transition from managed plans to FFS page.

Got a text which I thought was in error (I am a U.S. citizen) that certain immigrants will be switched from managed care to the fee for service MediCal in January.

First, does this message mean the county has my status wrong and think I am an immigrant? Or are they sending those messages to everyone? I haven’t received any official notices. Should I contact them to correct it?

Second, it seems like fee for service is the same as straight MediCal? Is it worse or better than being on a managed plan? I’ve read up on it and on the surface it seems more flexible which is better for me but maybe there are downsides?

I am a high school teacher and serious amateur poker player with a family of 4 (2 adults and 2 young children) living in Kentucky.  My teaching income is comfortably under the income limit for Medicaid and our family has been enjoying the benefits of Medicaid for the last several years with one brief interruption due to my gambling winnings.

I have no interest in suggestions to underreport my income - I am trying to navigate the system legally and honestly.

My current situation is that some gambling winnings have resulted in a notice that my family’s Medicaid coverage will be discontinued as of the end of 2026.  

My goal is to be covered for January 2027 specifically (because my primary medical insurance deductible resets at that time and my family has significant regular medical costs).  My previous interactions with system employees and my attempts at online research have left me with some confusion about what I need to do to ensure this result.  Is one of the following accurate or is there some 3rd truth that I am missing?

1. If I have no gambling income in January I will be able to re-apply for Medicaid based on my teaching income alone and should re-qualify (even if I earned several thousand dollars in December gambling); Medicaid will function retroactively to the beginning on the month in case I have any medical costs before my application is finalized.

OR

1. I ought to stop playing poker well before the end of 2026 so that I can re-apply for Medicaid and have no poker income within a specific look-back period.  If this is correct, what relevant time period do I need to consider?

Thank you for your help -- my poker activity is important to me personally and I am a profitable player -- but not profitable enough to be worth the likelihood of having to pay serious out-of-pocket medical costs.

If I make more than $1835 one month, will I get kicked off medicaid and have to reapply the next month? Or is it based on my yearly income divided by 12?

I'm reaching out here on Reddit because reddit's awesome and there's got to be somebody else in this little small little corner of Earth Delaware that also has Highmark Health Options and might be able to help me find a provider that will help me cover the $2,000 at least for an Autism evaluation in Delaware my psychiatrist from Delaware referred me to Neurology Associates PA in in Newark and I don't understand why and went halfway through the process only to find out that the data Network I'm like how does that even happen. I'm a 39-year-old alternate autistic Little Wizard over here and I have found some forms to submit a dispute and try and navigate stuff but I'm already navigating like LIHEAP unemployment in Delaware benefit s trying to secure them and I this autism evaluation really help me and my one of two autistic children with their evaluation give them some insight into their autism like hey it comes from Mom. But I don't know if anyone else here is autistic I have also have ADHD it's just like you go your whole life you know wondering why you're different and why you are the way you are and it's hard to understand the people why it's just important for you to have that missing piece of deposit of a diagnosis formally it's also important because I really don't think I can work I can't do it like I had to walk out of a training at a part-time job at a movie theater because I got over stimulated and it was too bright and loud anyway can anyone steer me towards what to do to find a provider that would cover neurological evaluation for autism in Delaware like do I need to obtain a prior authorization before I even try to find a provider or is that something I can get later I mean I'm already on a ball with it like I have talked to my psychiatrist about it but he hasn't called me back yet. If it helps I am in Wilmington Delaware.

Hi I am here to ask if volunteering makes me eligible if I am not working at times in 2027. I do work that is irregular. If volunteering is enough, how do you prove you did 80 hours a month?

Thank you

The email today said:

“You can satisfy the new work requirement by completing any of the following:
Working, volunteering, participating in a work training or education program for at least 80 hours a month;
Enrolling in an educational program at least half-time; or
Earning at least $580 in monthly income (or, for seasonal workers, an average of $580 over six months).”

15th of one month to 15th of the next?