Hello. I am my mother's POA. She has been in a nursing home (Alzheimer's/Vascular Dementia) for almost a year. It is time to recertify her Medicaid. I, myself, am on SSDI. I recently had an unexpected, financial hardship & had to use "her" money (in a separate bank/account than mine, although I am on her account.) I replaced it as soon as my money came in. I didn't realize this was a huge NO-NO until talking with a nursing home representative today. I am worried how this could affect us both. I've read that it could cause her to lose Medicaid coverage & I also read I could be in major legal trouble. There is no way I can care for her in my home again as I was her only caregiver & her safety couldn't be guaranteed as I eventually had to sleep. The "commingling" (or whatever it's considered) was for 1 month. The other months - the accounting is impeccable. Has anyone dealt with this or know someone that has? While I'm most concerned about her well-being & continued level of care, I have never been in any kind of legal trouble & really hope to avoid it if at all possible. Should I tell the business office manager at the nursing home prior to turning in her bank statements which will obviously show all transactions? I'm scared & way out of my element here. Any and all advice is appreciated.

I recently qualified for Virginia Medicaid. I am totally new to this (still waiting for my card and information) so I appreciate your help with these questions:

1) Is choosing an MCO mandatory in Virginia? If optional, what are the pros and cons of having one?

2) Which is the best MCO to choose in Northern Virginia in terms of coverage, doctor network and prescription prior approvals?

3) Does Medicaid cover brand name medications or just generic? Where can I find a formulary of Medicaid covered prescriptions?

4) Will my current prescription refills be covered by Medicaid if they were not written by Medicaid covered PCP?

5) Do you have any recommendations for a good PCP that accepts new Medicaid patients? I prefer Springfield/Alexandria/Fairfax/Arlington but really do not mind traveling anywhere in NoVA to see a good one.

6) Do you have any recommendations for a good endocrinologist that accepts new Medicaid patients? I am on a complex thyroid treatment that involves several medications so I need a solid endo that actually listens to patients' and focuses on their symptoms.

7) Does Medicaid cover lab testing done at Quest Diagnostics and LabCorp?

8) I have a mammogram scheduled at Fairfax Radiology with an imaging order from my gyn (who does not accept Medicaid). Do I need a new mammogram order? Does Medicaid cover mammograms done at Fairfax Radiology?

Thank you for any guidance you can provide!

I just got this link texted to me. I've heard that other states have a list of illnesses that will give you an exemption to this 80 hours per month. Does Michigan have anything like this?

https://www.medicaid.gov/renew-info/MI

I live on contract work and am a full time grad student. Currently I’ve only made $6,600 this year and don’t have a set income for the remaining part of the year (adjunct). However, I fall off my parents insurance at the end of the month. I’m worried I’m not going to get Medicaid and I’ll miss the enrollment period for any alternatives that I can scrape by and potentially not have any insurance. Currently my application is sitting with an eligiblity determination status (since the beginning of the month) saying I’m missing documents, but the page says it’s all complete and won’t let me upload. I also currently have SNAP. is there any hope or anyway I can possibly get it expedited?

Few months ago I got Medicare added along to my Medicaid that I had for a while due to the disabled child benefit.

I got a shocked that my current dual plan didn't cover my migraine Botox completely. Medicaid used to cover it, but all of a sudden with Medicare, I have to pay $403

I didn't have to pay for my scripts either, but now I do.

The Botox one really surprised me.

I'm gonna contact the Medicaid department tomorrow. What should I ask?

I'm confused and brain-fried.

I have the Uhc Dual Medicare & Medicaid plan.

i recently got a job. i live in a city where minimum wage is higher ($19/hr in my city vs $16 statewide) and my rent is $960/mo. as far as i am aware, i cannot make more than $1,800/mo, but i will with my current hours. however, it'll leave me with very little for food and work expenses since i don't have my driver's license. (i am working on it)

some other info: i'm 22, i rent an apartment, i am on SNAP and medicaid, and my medicaid was just renewed.

i'm pretty sure i'm classified as disabled in CO Medicaid's system since i'm an ambulatory wheelchair user and am disabled under ADA, plus i likely have some hearing loss which may cause some issues with quality of care if i don't qualify for medicaid.

my job does offer health insurance but i'm going to school full time and won't be working enough to qualify for health insurance come August. is there any information i can get on how much i can make, what i can do if i make too much but rely on medicaid for my specialists, and if the buy in program is available for me or if i have to go through SSI? i'm so confused and i just cannot get a straight answer.

I’m a New York resident and currently have New York Medicaid, but I’ll be attending college in Missouri. I know NY Medicaid generally won’t cover routine medical care in Missouri, so I’ll need to get my school’s student health insurance.

My question is: can I keep my NY Medicaid and just use it when I’m back in NY during winter and summer breaks? Or would attending college out of state and getting student health insurance affect my eligibility?

Just saw the news about the freeze on funding, my whole family relies on Medicaid. Does anyone know when this will go into effect?

https://www.mprnews.org/story/2026/07/21/fraud-cited-as-trump-administration-puts-another-freeze-on-medicaid-funds-to-minnesota

I apologize for how long this is, I just feel I need to thoroughly explain this situation and why I need help.

I have been trying for weeks to find an attorney or someone similar to help me fill out the paperwork for the Med Connect program in CT. They all keep telling me they don't specialize in that despite them having Medicaid paperwork or Social Services help on their websites!

I'm at my wits end! I'm 23, have two chronic illnesses, and can work (just not a ton). But even when I'm not struggling too much with my health, I can't afford to work more or I'll be kicked off of Husky D for making too much money! I'm allowed to make 22k a year, or I'm kicked off. I have Type 1 Diabetes which is extremely expensive to have due to the price of all my equipment and medications. I also have gastroparesis, and need medications for that. Plus I had two ER visits this month due to it (which is rare but it happens). This is why I need benefits still. I applied for disability 2 years ago when I was really suffering and was denied. I have improved since then, and realized I don't want to be restricted by being on disability. But I am still disabled, Type 1 Diabetes is a 24/7 job, and it's exhausting and painful at times. Gastroparesis also makes life hell often, but I can still work. That's also a disability.

However, I cannot have a life on less than 22k a year. I can barely get savings together because all I can afford are part time jobs that have to give me less then 20 hours a week to avoid going over 1,800 a month. I also have to buy specialty groceries because I'm on a strict diet due to my gastroparesis (no gluten or dairy, and very few raw/fresh veggies and fruits, which is like a 50% increase over normal groceries). I can't save for big car repairs or replacements like tires, and my car payment every month is expensive because it was the cheapest any company would give me (newer driver, no accidents ever, but being new raises my payment). I also can't look into career opportunities since they're all full time. I'm locked into poverty and want to get out.

Med Connect seems like the perfect program. As far as I'm concerned, my understanding of the program is that I would continue to get Husky D benefits, but make up to 85k a year instead of 22k. A house and car do not count as assets (since they're used for living and travel to medical appointments). The only downside is I can't have that much in savings. Not sure where investment accounts fall, but certain programs like 401ks don't count against savings. It would allow me to pursue a career for myself, and work more.

The reason I need help is because I was already denied for disability, I don't want to be denied this program too. I think if I had legal help filling it out, I would have a higher chance of being approved (especially because I have a very poor understanding of legal terms, and may have thought I filled out the disability paperwork correctly and actually did a bad job).

I don't want to be a burden to myself or my loved ones, I want to have a full time job, a career, a house of my own someday! I can't pay for that right now, I can barely buy groceries, gas, and my car payment every month. The rest goes into a sad savings account.

What should I do? Is there anyone in CT that even helps with this sort of thing?? Is there another option if this isn't possible?? I'm so stuck :(

Hello, has anyone received a semiannual review only for Medicaid in Pennsylvania for a family of 4 with children included?

HHS Secretary RFK Jr. says CMS is withholding $867M from California and $200M+ from Minnesota, citing suspected fraud and noncompliance. It's a payment deferral, not a permanent cut — both states can submit documentation to get funds released.

• California: review focused on in-home care programs, after CMS flagged spending growth well above national trends
• Minnesota: review covered 14 high-risk service areas, including providers previously flagged in program integrity reviews

Newsom and Walz both call it politically motivated retaliation. Curious what people closer to the program side are seeing. Is this consistent with known fraud patterns in these programs, or does it look more like a political target list?

https://www.reuters.com/world/us-health-secretary-kennedy-says-cms-is-pausing-medicaid-payments-california-2026-07-21/

(Reuters is paywalled for some — CBS News has an open mirror of the story: https://www.cbsnews.com/news/medicaid-payments-california-minnesota-fraud-hhs/)

I work almost exactly 20 hours per week. I am an independent contractor. I don’t make an hourly wage. I don’t get paid the same for every client. I get a percentage of insurance reimbursement rates once they are paid to the org I work under and they are perpetually delayed by 3-8 weeks. I make about 12k per year gross.
What is going to happen if I get sick? Which I do, often, with bladder infections. (Menopause) when they flare I’m out for 2
weeks sometimes.
Will I get kicked off my insurance? Becuase they are making us go back 3 months of work to prove we worked. What about vacation? What about when our orgs are closed for the holidays? Does anyone have any idea what is going to happen? I’m so scared. I have a specialist for my urology issues and I take medication daily to prevent bladder infections but they still flare 3-4 times a year. If I flare and can’t make my hours I don’t know what I’m going to do. I won’t be able to afford a doctor visit and my medication.

Hey, I have a question: I have a small ABA practice. Maryland Medicaid now wants us to put referring doctors NPI in the claims to be able to bill after July 1st.

I just figured out that the last preauthorisation I got was justified by an assessment from 7.2024(the client was 4 y.o. back then, non verbal w/ dangerous behaviors). I still got preauthorised though and have an opportunity to bill until the end of august.

Am I screwed in case of an audit? Or since I got the preauthorisation(they request the copy of the assessment report)I’m ok?

Recently I updated my status on the FL website. What I got back shocked me. The vehicles we own were re-valued. I know what I paid for each, and that was 10 years ago. Now they are valued at 25-40% higher than I reported them.

Bank accounts. At the time I did my update, I had $80 in my checking account. Without my knowledge, my husband spoke to his mum in England, who then sent a wire transfer of what remained of his father's death payout. His father died of work related injuries and left him a small amount of money for a rainy day. It was under $3k. But just as the wire transfer happened, an app crawled through my finances leaving me with even less cash per month.

Let me explain about the wire transfer. It wouldn't cover cremation if one of us dies. Some of you spend more on rent per month.

Combined assets are what? 5k per month? They just jacked me up over the limit. How do I prove each thing, line for line? I have 30 days to figure this out and no idea where to turn.

Can I upload pictures of my vehicles? Kelly Blue Book the VINs?

Smh

Hello all, how do you calculate income for self employed partner and W2 for myself? Trying to get my baby's on Medicaid again, but i did not understand the Social worker really good due to language barrier this morning. i am in the state of Texas

I was approved for medicaid at the beginning of this month (07/06) and received a letter with two cut-out paper cards that I am supposed to sign and carry with me, but they only have basic info on them including my case number and a billing number. I have yet to receive anything else from my state, like an actual insurance card like I had a few years ago when I had received benefits. Am I missing something? I will be calling my JFS office in the morning, but was wondering if I just misunderstood something or am not reading a notice properly. Any insight is appreciated; thanks!

Hello, my mom is currently in the Pace program, but we are having a hard time finding her Medicaid memory care facilities. I read about the transitions waiver/mi choice . If I apply for this, could I possibly lose benefits /ovelap and is it worth the risk?
Thank you for your time to read my post and any insight☮️

Hi there! I work as an RBT in Utah. I just learned about the Medicaid requirements of those providing ABA to those with ASD to be registered behavior technicians. I worked at a clinic where I know unregistered BTs (still working on 40 hour training, not yet BACB certified as RBTs) saw clients who used Medicaid. Is there some billing loophole that allows for this? Or a way for clinics to pay without billing insurance or something? I'm guessing no and that this would be fraudulent, but I also don't have a good understanding of billing/insurance.

Hello, I am posted in hopes someone will be able to give me some information on getting assistance for my sister in law who was employed at a local casino for over 25 years, she’s 61 years old & owns her house with her ex husband & currently lives with her adult daughter & her three grandchildren in her house. Going on 17 weeks ago she went in for brain surgery after having a seizure unexpectedly & finding out she had a brain tumor. After this surgery her she was faced with many more complications. At this point her medical is only claiming to cover her rehabilitation for 45 days & after being in bed, not being able to eat, talk, or move her legs, we just don’t feel like this is realistic at this time. Our family feels she’s going to need extensive therapy & rehabilitation but her main stressor seems to be if applying for Medicaid/SSDI will have to sell her house because they of course want to make sure you liquidate all of your assets? Does anyone know if this is something that we need to worry about. We are not looking for any handouts, she has been a hard worker her entire life, she doesn’t have money in the bank or multiple homes, she lives a very simple life. I feel like this is crazy that this is our main priority when we are just hoping to get her back to herself & eventually hopefully be able to get her home & if possible get her live her normal life. Any information would be appreciated!

Hi, I’m unable to find reviews for the professionals listed on the site for my MCO (Carefirst Community Health) and am a little concerned. I couldn’t find many of them on the Internet either. Is there a platform where we can view/post reviews of professionals from Medicaid/partnered MCOs? Is a third party reviewing platform even legal?

I’m looking into Medicaid assistance through the state of Missouri for my wife (33yo female), my son (8yo male), and my daughter (5yo female). We are also planning to have a third child at some point in 2027.

I currently have insurance through my full time job but, I am unable to financially afford to put my entire family on my work insurance while also trying to meet our monthly finances.

My wife is unemployed and she is a stay at home mom. Her and my children do not have any disabilities, or chronic medical issues, and neither my wife nor I are former military.

I’m trying to read through the Missouri Medicaid income eligibility charts and I’m likely over thinking this but I’m having a tough time figuring out the calculations; as well as which program type my family would fall into.

What is the financial cut off for a family of 4 in regards to either gross or net annual/monthly income? What about for a family of 5?

Any help or info at all is much appreciated.

Thank you!

I moved to California in February and wasn’t able to get Medi-Cal coverage until May, so I went months without consistent psychiatric care. I have bipolar disorder and take a mood stabilizer, an anti-anxiety medication, and Vraylar. I’ve been on Vraylar for about four years after my psychiatrist in New York prescribed it, and it’s been a stable part of my treatment ever since.

I’ve had Medicaid in both New York and Colorado, and getting Vraylar covered was never an issue. I know it’s an expensive brand-name medication (over $1,000/month without insurance), but Medicaid always covered it.

Now that I’m on Medi-Cal, it’s been an absolute nightmare. I’ve gone through four different psychiatrists, and every one of them says they’ve submitted the prior authorization. Meanwhile, multiple pharmacies (Capsule and others) keep telling me they either never received it or that it’s still not approved.
I’ve now been without Vraylar for five weeks. I’m spending hours going back and forth between doctors, pharmacies, and my insurance with no answers, and my mental health is starting to unravel. I even went to Exodus Mental Health last week because I was feeling suicidal, and even they haven’t been able to get this sorted out. It’s been a week since that visit, and I still don’t have my medication.
Has anyone dealt with this in California, especially with Blue Shield Promise Medi-Cal? Is there a way to get a continuation-of-care medication approved faster or escalate a prior authorization that’s been stuck for weeks? Who is actually responsible when the doctor says they sent the PA, the pharmacy says they don’t have it, and nothing moves?

If anyone has specific advice, contacts, or departments (member services, grievance, case management, ombudsman, etc.) that actually helped resolve something like this, I’d be incredibly grateful. I honestly don’t know what else to do.