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!

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 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.

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?

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 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?

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!

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 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!