I'm looking for adventure game recommendations where the game makes you feel like you are actually there living the story. Some come to mind that made me feel this way, probably because the passage of days and going back "home" to sleep and such: The Last Crown (maybe the sequels will come out before I die), Call of Cthulhu: Dark Corners of the Earth, Rise of the Dragon (Sega CD), Dreamfall, Gabriel Knight Sins of the Fathers, Blade Runner - to name a few.

Hi all,

I'm in North Carolina and currently on Medicaid Expansion. I'm trying to understand the upcoming community engagement/work requirements that are scheduled to begin in 2027 and also a letter I recently received from Medicaid.

A little background:

• Age: in my 40's
• Medicaid Expansion recipient
• No current income, living off savings
• Worked for about 20 years before being laid off a few years ago
• Diagnosed OCD/anxiety disorder and ADHD
• Under treatment and taking medication
• Actively trying to return to work
• Currently spending most of my time studying, getting certifications, building a portfolio, and working on projects related to my profession

My goal is to get back to work. I'm not looking for disability as a long-term solution. However, I am trying to understand my options in case I'm still not working by the time the new requirements take effect. I'm not ready just yet to return to work, but hope to be soon (my Doctor would attest to this).

Questions about the 2027 community engagement requirement:

1. Has anyone seen details on how "medical frailty" will be determined? Everything I've found so far says medically frail individuals will be exempt, but that the criteria are still being developed.
2. Are there expected self-attestation periods for medical frailty? For example, would someone be able to self-attest temporarily while documentation is being obtained from a doctor, or will documentation be required up front?
3. If someone has a long-standing diagnosed mental health condition (OCD/anxiety disorder in my case), is there any indication how that might be evaluated under a medical frailty exemption?
4. Does anyone know whether states are expected to require periodic re-certification of medical frailty exemptions?

Questions about qualifying activities:

Most of my time is currently spent:

• Studying for certifications
• Taking training courses
• Building software projects for my portfolio
• Maintaining a professional LinkedIn presence
• Working on career development and return-to-work efforts

This is largely self-directed and not part of a formal program.

Has anyone seen guidance on whether self-directed training, certification study, portfolio projects, or similar career-development activities can count toward community engagement requirements, or does it generally need to be a formal education/training program?

Confusing letter from Medicaid

I also received a letter that has me confused. It says my Medicaid is up for renewal the end of November (which I already knew, this is 12 months from last renewal).

The relevant section says:

>IF ANYONE IN YOUR FAMILY IS DISABLED, YOU MUST DO ONE OF THE FOLLOWING WITHIN 30 DAYS OF THE DATE OF THIS LETTER. OTHERWISE WE WILL NOT CONTINUE YOUR MEDICAID UNTIL WE DECIDE IF YOU (OR A FAMILY MEMBER) IS DISABLED.

The letter goes on to say:

>When we review your Medicaid eligibility, we are required to consider whether anyone in your family is disabled under Social Security rules.

The second page is basically a form where you can list family members who are "disabled from working."

What is confusing me is the wording:

>OTHERWISE WE WILL NOT CONTINUE YOUR MEDICAID UNTIL WE DECIDE IF YOU (OR A FAMILY MEMBER) IS DISABLED.

That sounds like Medicaid will stop in 30 days if I don't respond, but the rest of the letter reads more like a disability screening notice.

Has anyone received a similar letter?

Is this:

• A routine disability-screening notice?
• A request to apply for disability-based Medicaid?
• Something that actually requires a response even if nobody is claiming disability?

Thanks for any insight.

Has anyone had anxiety/emotional swings during the onboarding period with Vyvanse?

I have OCD/anxiety disorder and currently take 200 mg sertraline and 400 mg nefazodone. I’ve been on one SSRI or another for 15+ years.

My experience with Vyvanse has been a little complicated.

Last summer, I tried 20 mg for about 3 weeks, but stopped because I didn’t like how I seemed to lose interest in my hobbies after it wore off around supper. I also wasn’t taking my SSRI at the time, and shortly after that I had to spend some months getting back on it and getting through a rough period.

More recently, I started Vyvanse again at 30 mg for a week, then moved up to 40 mg for about 2 weeks. I stopped because I started dealing with breakthrough anxiety, though I’m honestly not sure whether that was related to the Vyvanse or more due to life circumstances. After a couple weeks off, things smoothed out and I wanted to try again, this time staying at 30 mg instead of increasing.

The first week back on 30 mg felt like fairly normal onboarding: I felt good when it kicked in, which I actually find distracting, but that faded after about a week (which is good).

Then I came down with a cold/sinus infection that knocked me down for about 4 days. I couldn’t really be productive, exercise, or keep my normal routine. I also took a lot of phenylephrine/Sudafed PE (otc), both day and night. During that time, I actually felt okay in terms of the Vyvanse.

But around day 4 or 5, when I was starting to feel better from the cold, I started having anxiety in the morning before taking Vyvanse, and then anxiety for a good portion of the day afterward. I’ve also been getting emotional/weepy, which tends to happen when anxiety wears me down. This has been going on for about 4 days now. It usually tapers off by early afternoon.

Yesterday marked 2 weeks back on Vyvanse 30 mg. I’d really like to make it to 4 weeks before deciding whether it’s right for me, but I’m having trouble telling whether this is still part of the onboarding/adjustment phase, or whether I’m just dealing with breakthrough anxiety symptoms because of being sick, disrupted routine, life circumstances, etc. It's interesting to note that the anxiety seems to start only after a couple weeks taking it.

Has anyone experienced something similar during the first few weeks of Vyvanse? Did it smooth out after an adjustment period, or was it a sign that the medication/dose just wasn’t a good fit for you?

I’m looking for some anecdotal input from others who have been in a similar situation.

I tried Vyvanse last summer for about 3 weeks at 20mg and ended up putting it on hold. About a month ago I started again at 30mg. 30mg felt better than 20mg, it seemed to last longer and I didn’t get the same evening crash where I just wasn’t interested in anything. That said, I still didn’t feel like my focus improved enough.

For context, I also take 200mg Zoloft and 400mg nefazodone for OCD/anxiety. I’ll likely come off nefazodone at some point, but I’ll always need to be on an SSRI/SNRI. The issue is higher SSRI doses give me pretty significant brain fog, which seems to make the ADHD worse. I was only diagnosed with ADHD last summer (I’m in my 40s), so I’m still figuring this out.

After about a week on 30mg Vyvanse, I increased to 40mg and have been on that for 2–3 weeks. Since going up, I’ve noticed pretty bad brain fog (maybe worse than at 30mg), and it’s been harder to start tasks, I feel like I’m procrastinating more. Interestingly, it does help my anxiety at any dose, but that also seems to feed into the procrastination.

I’ve been considering trying 50mg to see if it changes anything, but I’m unsure if that’s the right direction given what I’m experiencing. I'm trying to get my brain sharp, I need to get back to work.

Other notes:

• I take it in the morning with breakfast
• I usually need coffee about an hour later to feel like my brain “turns on” (very caffeine dependent)
• I often still need more coffee after lunch

Curious if anyone has had:

• Worse brain fog or motivation issues at higher Vyvanse doses
• Different experiences when combining stimulants with SSRIs
• Better results going up vs going back down in dose
• Any patterns with caffeine + Vyvanse

Not looking for medical advice, just trying to hear how this has played out for others.