r/Medicaid

So first backstory:
I struggled a lot in high school. I went on to community college, where I continued to struggle and barely graduated. After I moved out of my childhood home and tried to join the workforce like a functioning adult, but the complete lack of any sort of response from 99% of employers (and rejections from the remaining 1%) would send me into depression spirals and I'd just shut down. After a few years of this and some physical health problems, I ended up moving back home. I've been there ever since (15 years+).

I got medicated for my depression and anxiety. I help take care of my aging parents (they're in their late 70s now) and they help take care of me. I found a partner who understands me and loves me even with all my issues (we live apart so I only see them in person on weekends). Sure, I wasn't a "productive" member of society, but I was more or less happy.

And now the US government is pushing an 80 hour work requirement on anyone with Medicaid. I don't know what to do.

I'm not physically disabled and, so I feel like a disability exemption is completely out. Mentally, the thought of going back into the job search market feels overwhelming, much less the thought of trying to maintain a 3-4 hour work day every day for...forever (or at least until there's someone who isnt terrible in power). The knowledge that I have to maintain a requied number of hours or lose the ability to see a doctor or get my multiple medications without paying a small fortune makes me want to curl into a ball and cry. I'd completely lose my ability to have a longer weekend with my parrner or have a few days to just shut down if I need it.

Help.

I’m in NYC if that’s helpful to know and have been on Healthfirst Medicaid for the past year. My coverage ends on September 30th and have been getting emails regarding renewing and actually set up a phone call to renew with a rep on September 1st. Yesterday I got an email from NY state of health (the portal where I initially searched for and signed up for Healthfirst) saying I’ve been dis-enrolled from Medicaid and now enrolled in the Healthfirst essential plan 1.

I understand that all this insurance stuff is dependent on my income, but my income has not changed at all so I’m confused on how they’re doing all of this without me providing updated income or pay stubs. If possible I would like to stay on my current Medicaid plan because I feel I’m still eligible. I find it strange that Healthfirst is still emailing me about renewing when it says I’ve already been enrolled and this feels like a lot of mixed messages.
If anyone can help or provide some insight I’d appreciate it!

My friend is on Medicare with Medicaid/Tenncare as his supplement. He lives in Tennessee. He is covered under Specified Low Income Medicare Beneficiary. He has UHC. He was in the hospital for 19 days in 2025 with heart problems/defilibrator put in his heart. He has been receiving random bills with one being $6000. We have called so many times. The hospital says they didn't have his Tenncare number. We give it to them. Still get bill...rinse and repeat. His EOB shows all was paid and his part is $0 but they keep billing. It is now in collection. His letters from Tenncare say the hospital has agreed to accept the contracted amount. However, the hospital says no. What if anything can be done? No other Dr's or clinics bill for any amount.

I am still trying to find a job and have very limited self employment in the meantime. I do have barely enough interest income to squeak me by though IF it counts toward getting MaineCare. Can anyone help me to understand this please?

I've read recently on here that it's based on MAGI rather than hours worked, but I've gotten some info to the contrary from MaineCare and DHS recently. I would be very appreciative of any help. I volunteer working for a small startup who is not eligible for non-profit.

I got a reply from DHS in Maine a few months ago saying this:

"Name, bank interest is not earned income. Only earned income counts towards work requirements. Self employment income hours are based on amount of money earned."

Today I got a scary letter from MaineCare today that only mentioned work. Not income.

"MaineCare Expansion Adult members are 19 to 64 years old who get MaineCare based on their income. They do not meet the Social Security disability guidelines or do not have Medicare.

Why is MaineCare eligibility changing?

Congress passed a federal law that changes who can get Medicaid in every state. In Maine, Medicaid is called MaineCare. These changes will start in January 2027 for new MaineCare applicants. Current members are not impacted until they are due for their renewal in 2027.

What are the new MaineCare Work Requirements?

The MaineCare Work Requirements will be for MaineCare Expansion Adults to complete work activities like:

· Working

· Volunteering

· Going to school or an apprenticeship

Taking part in a job training or work program

To meet the Work Requirements, you must spend 80 hours in at least one month doing one of these activities or attending school or an apprenticeship at least half time. You can also combine hours in more than one of the activities to reach a total of 80 hours in at least one month.

If you are working or plan to work, you can meet the Work Requirements if you earn at least $580 in one month, or if you have seasonal work, you earned an average of $580 over the last six months.

IMPORTANT: OFI will use information already in your case and information we can check through electronic data sources whenever possible to determine if you are meeting the Work Requirements.

Who must meet the Work Requirements?

You need to meet the Work Requirements if you:

· Are age 19 to 64; and

· Qualify for MaineCare based only on income; and

· Do not fall into one of the groups below that do not have to meet the Work Requirements (see next section)."

Thanks for any help! Links are greatly appreciated!!

Florida.

I have just been given DPOA for my brother who is in rehab on SSI and in the process of transferring to LTC which will then place him on Medicaid. I’ve submitted all of the Medicaid documents and application with the facility and just got access to his bank account.

He has one account with $4000+ in it that I need to bring down to $2000. We already set up a $2500 “burial expenses account” with his bank. I would prefer to not have to waste the extra $2000+ on unnecessary spend.

I’ve read about moving money to an “irrevocable funeral trust” and was pretty sure I read that a bank can initiate the trust which would allow some flexibility as opposed to a funeral home and prepurchasing services with a specific business.

A lawyer setting up the trust seems like the fees would end up taking most of the amount needed to put in.

Has anyone set up an IFT at a bank? Did I misunderstand that capability, as the bank we use told me I would need a lawyer to set up the IFT.

If you’ve set up an IFT, what did you do?

I’m a 30-year-old low-income, disabled woman in South Carolina. I applied for Medicaid, but was denied.

When I reached out, they told me that to qualify under the disability path, I must already be receiving disability checks (SSI or SSDI). Because I’ve been denied Social Security disability twice and am currently in the process of applying a third time, I don't meet their requirement. 

Because SC hasn't expanded Medicaid, there seems to be no coverage pathway for low-income adults without dependent children unless you're already receiving federal disability. It feels like a total catch-22—I need medical care to manage my condition, but I can't get state healthcare without federal approval.

I may be uninformed, but I had no idea that this was even a thing I thought if you were low income and needed health insurance and you fit the income bracket you could just apply.

Has anyone else ever been in this situation and what did you do?

I’m in North Carolina and I’m seriously so done with UnitedHealthcare Community Plan.

I used to have Aetna, which I paid for monthly, but the program I was part of was discontinued in my state. I was then moved onto North Carolina Medicaid through UnitedHealthcare Community Plan.

I’m generally healthy and don’t have a ton of medical expenses. The only thing I’ve been dealing with recently is fibroids and extremely low iron, which required some scans, lab work and follow-up appointments. Otherwise, I pretty much just go to my yearly checkups.

Before seeing anyone, I contacted all of my providers to make sure they accepted my new insurance. Most of them did. I also contacted UHC directly to confirm that the providers were authorized/in-network under my plan.

Fast forward to an ultrasound, a doctor’s appointment, two follow-ups, three different sets of lab work and countless phone calls to UHC.

They have denied every single claim.

The reason they keep giving me is that I supposedly have Blue Cross Blue Shield as my primary insurance. I have not had BCBS since 2021.

I have told UHC this repeatedly. They asked for the termination date, which I gave them. They still kept saying BCBS was showing as my primary insurance, so I contacted BCBS myself. My account was so old that I had to be transferred through several departments just to find someone who could pull up my information and resend my termination letter proving that my coverage ended years ago.

Today I called UHC again, and now the representative told me their system shows that I’ve had BCBS since 2025 which is impossible because I had Aetna during that time.

At this point I even contacted BCBS again because I started wondering if someone had somehow opened a policy using my information. As far as I can tell, there is no other policy.

Every time I give UHC the information they ask for, I’m told it will take about two weeks for the “update” to process and that I need to wait before calling back. So I wait two weeks, call again, explain the entire situation again, and somehow I’m right back where I started.

Meanwhile, my providers are contacting me about bills because UHC keeps denying the claims.

I asked to speak with a supervisor again today and was told I’ll receive a callback, which I doubt. At this point, I’m expecting another round of the same thing.

I genuinely don’t know what else I’m supposed to do.

Has anyone else dealt with this, especially with NC Medicaid/UHC Community Plan? Is there someone at the state level I can contact to get this corrected? Do I need to file a formal grievance or appeal? At this point I’m looking for anything that will get this fixed because calling UHC every two weeks and starting from square one clearly isn’t working.

Additional information:

1. My plan with Aetna was canceled June 2025 and I was immediately enrolled into Medicaid.

2. My first doctor's appointment was October 2025 then December 2025, and February 2026.

3. I started calling UHC in February after finding out the claims were denied and they originally said it was a taxonomy problem.

Hello! I am a realtor and I am trying to help a client and I'd love any advice you all have!

I have a client who is selling her mom’s manufactured home in a park. She bought it for 120k in 2022. Everything is like new. She cannot move into the nursing home until it sells and then she can use the money to pay for the nursing home until it runs out, then medicaid kicks in. As you all probably know, with medicaid, they cannot price the home too low or it will get flagged. I suggested getting the home appraised so we would have some evidence for how much the home is actually worth. But that didn't work out because it appraised for way too high! I’ve found that pricing manufactured homes as low as possible is the only real way to sell them quickly, otherwise, it seems like they tend to sit, sometimes for months and months. In this case, we can’t price it crazy low because we don’t want medicaid to get flagged. I listed the home for $79,900, tax records show its value at $62k, the appraisal came in at $98k. It’s been on the market for a week, and we have had zero showings.

Is there a process in which I can reduce the price if there is no interest at all? Can my seller use the evidence of no showings to fight against medicaid if they flag it for us selling too low?

I have sold medicaid manufactured homes before with medicaid in mind but they were 20+ years old, so the low price was justified. With a 2022 home, it is much harder to sell at a reduced price. Any information is welcome!! Thank you!

i'm currently on pregnancy medicaid , me and my fiance have one child together and we were thinking about getting married! my fiance currently doesn't get medicaid , he qualifies as "medically needy" if we get married , will i lose my benefits since he doesn't qualify ? we're in florida

is it legal in California for therapy programs to charge medi-cal patients with no income cancelation/no show fees? I just started a new therapy program and I had to go sick because I got sick one day before my session. Their policy is you get charged $100 if you cancel less than 48 hours in advance or no show. They do NOT waive this fee for medi-cal patients like most programs do. They do not even discount it. It's $100 out of pocket for everyone. There are no exceptions except true emergencies like being hospitalized or if the therapist is the one who cancels.

I previously believed it was illegal in California for anywhere to charge medi-cal patients out of pocket even if they're willing to pay. I've gotten turned away from a few urgent cares who didn't accept my medi-cal plan despite offering to self pay and there being 0 urgent cares in my city that accept it. They told me they turned me away because it'd be illegal to allow me to self pay as they can't legally charge me. They literally said it was illegal in the state of California.

I assumed this applied to all healthcare. But since have had several people argue with me that ONLY places like urgent care have this rule, refraining it as like a policy tsome places have rather than an actual state law, and that I should be able to self pay at other types of places if ever able to. (though I'm not able to regardless since I have no money and no income so)

So I asked a few state social workers, and got conflicting answers. Some told me yes it's completely illegal here. Others told me it's technically legal but falls in a legal grey area.

Even with the state workers I cannot seem to get the true answer?

Hi all, my partner is pregnant with our child and is currently on Medicaid. I plan to join the military shortly after our son is born and we wanted to get married before I go to bootcamp. If we get married, would her Medicaid coverage be void or should she be fine since she got on it while not married. We just don’t want any hiccups with hospital bills during the birth. Edited to add we are in Florida

I’m in Missouri, and am looking for advice desperately. I’ve been unemployed since mid May and my partner has been taking care of things, but he recently lost his job and I had to find one. I am supposed to start full time on the 29th but because it’s a warehouse job it of course puts me over the income limit. Unfortunately before my partner lost his job I was scheduled for a hysterectomy on sept 14th, and I really really need it for pain. I’m wondering if I just work the first 2 weeks and take my medical leave that I could keep my Medicaid until I return back to work. If I work only the 2 weeks I’ll stay under the income threshold but I’m still worried they’re gonna see how much I worked before the surgery and assume that’s how much I’ll work every week and say that I won’t be eligible due to how much I’ll make when I return full time. Or that because I was hired full time I’m ineligible on day 1 of starting the job, that’s what I’m worried about the most. I’m allowed to take leave that early into starting but it’s unpaid, so I figured maybe that would help me stay eligible to at least cover the surgery until I can figure things out. But I’m really lost and I don’t want to push my surgery back, and go through the process of losing my Medicaid again because they were a pain about giving it back to me last time.

Medicaid will apparently not reimburse your prescriptions if a Medicaid doctor didn' t write them. This is ridiculous, I have never had a health insurance plan that wouldnt fill all prescriptions regardless of which doctor wrote them! This means my functional medicine doctor cant write my prescriptions anymore and Medicaid wont pay them. Ive been going to her for 8 years. Is there anything I can do? I pay out of pocket for the dr and dont need the reimbursement but I do need my prescriptions each month. Pissed at Medicaid on this.

My dad recently had a stroke and I'm looking into getting him eligible for Medicaid (in Florida) as he'll need home care. He doesn't have any assets other than his whole life plan insurance at 50k. What are best available options?

Also: my mom has assets (they're married) but I'm not sure if that affects his eligibility. Thanks for any advice!

Hi, so I guess I’ve been living under a rock cause I got a text today from NY state health market about the new work requirements.

I make roughly 13 thousand per semester, but my semesters are not guaranteed either. I finished grad school in May 2025 and have been adjuncting since while looking for full time work.

I’m also having surgery later this year, which is not covered under the essentials plan of NY of course.

Why did NY wait so long to inform people of all this. They still haven’t sent letters about what individuals are affected…

From reading here I understand I think it’s 580 dollars per month you have to earn to be eligible? Is that correct?

I just renewed it in June this year with NY, now all of a sudden they’re gonna cut people off?

Thanks, just confused and worried today about what’s going on. No one can seem to give straight answers.

My financial situation just changed temporarily, and for the next 4 months, I can probably qualify for Medicaid. I don't have any insurance right now (long story), but I will be able to apply for the marketplace for January 2027. At that time, my income will be such that I won't qualify for Medicaid.

My question is, is it worth it to get benefits for just the rest of this year (Sept - Dec)? It seems like a big hassle (I tried filling out the application, and there were just a lot of questions that were difficult for me to answer because my income isn't steady) to fill out the application and then cancel the Medicaid at the end of the year (which I would need to do in order for it not to mess up my chances of getting the marketplace benefits).

I'm in my 50s but am healthy and have no medical issues that require meds or anything like that. I go to the doctor only about once or twice a year for maybe a sinus infection or the flu, for antibiotics. I'm wondering if it's just worth it for me to take my chances and pay out of pocket if I need something like this for the next 4 months.

Since I've never been on Medicaid, I just don't know if it's worth it for that short a time span.

Good afternoon,

I just noticed it came out my bank yesterday and the money is sitting in the brokerage company, but can't invest yet until it fully clears..I suppose. The previous rep(super nice) was telling me that while they don't count the money you deposit in to the IRA as COUNTABLE income for the month, they do count the "interest" it makes" I was scratching my head..like huh?lol I'm thinking she didn't understand how IRA"s work what she was talking about when it comes to that. All I do now is what counts for my countable income for the month is my Gross-minus business expenses as I'm self employed, any realized gains from my brokerage(taxed account). whatrbrt that number is would be my net income and is what medicaid sees as my countable income for the month, correct?

Now while chatting with her she said to call back when I got my first statement and then we would update your application on the website stating you now have an IRA. Do you think that would be the appropriate time to do so? THis month I think my countable income is like 2,000. I deposited $500. I would like to deposit more before the month is over. I'm shooting for another 500 to be deposited. I want them to be aware of this, so they know my countable income would be well under. That being said, I would have my statement to show what was deposited that month, so technically, I have proof, right? Any information you think I should be aware of with the countable income, ira's and letting them know anything would be appreciated.

Thanks.

I'm in California and currently have Medi-Cal through CalOptima.

I started a new job in April 2026 and my income increased. I recently realized that I was supposed to report the income/employment change within 10 days, but I didn't. It's now been about four months.

I also realized my Medi-Cal case was never updated when I got married in 2021. My husband has had no income and is currently unemployed/uninsured. He isn't currently listed on my Medi-Cal case.

My current Medi-Cal case shows a household of 3: myself and my two children (ages 19 and 21), both of whom I expect to claim as tax dependents. All three of us currently have active Medi-Cal.

My annual income from my new job is about $41,150 and my husband's income is $0.

I'm going to report both changes now and give Medi-Cal the correct dates and information. I'm interested in hearing from California Medi-Cal eligibility workers or anyone who has dealt with something similar.

My questions:

1. What typically happens when an income increase is reported about four months late? Could Medi-Cal seek repayment for those months if they determine I was over the income limit?
2. When I report my marriage and add my husband to the household, will Medi-Cal recalculate my household size? Since I expect to claim my two children as tax dependents and live with my husband, could my household be 4 even though my current BenefitsCal case shows 3?
3. Since my husband has $0 income and is uninsured, can Medi-Cal also evaluate him for his own eligibility when I report the change?
4. Has anyone dealt with reporting a marriage several years late when the spouse had no income? What documentation did the county request?

I'm not trying to avoid reporting anything — I want to correct the case now and understand what to expect before I submit the change.

Hey there, my name is Conner and I've been fighting my Medicaid insurance for almost 4 years at this point. I've seen several different doctors and I have seen zero progress from my insurance. I call and try to appeal things but they tell me they can't help me. I am 550 pounds with significant pain that limits my exercise severely. I have tried Noom and weight watchers, counting calories, and even intermittent fasting, but nothing has been helpful. I was wondering if anyone had any advice on getting zepbound covered by Medicaid. I have a new PCP and they have been trying to help me, as well as a medication assisted weight loss professional, but neither of them have been able to make any progress. I fear that this is my only opportunity to help me lose weight besides getting surgery, which I would like to avoid. I do have Obstructive sleep apnea as well, I should have mentioned.

As of July 16th of 2026, the NYRX PDL lists zepbound as something they will cover for those who have OSA and a bmi over 40, which I do, but every time I call and try to make my case, they read off their script that It isnt covered and they cant help me

Any advice on how to proceed would be amazing. I worry about my health. Every day I worry I'm going to have a heart attack, and every day, I'm getting weaker and in more pain. Any help would be greatly GREATLY appreciated, as im feeling hopeless about ever getting zepbound.

Hi, my parent just got accepted for nj medicaid. does have another insurance from healthcare marketplace which doesn't cover much. And some chronic health issues going on. Is it better to keep another insurance as a primary and medicaid as secondary or should we use medicaid as primary? And how does the billing work if we use another insurance as primary?? Thank you!