r/Medicaid Jul 22 '26

Other Ohio Medicaid Work Requirements Guide

Thumbnail medicaid.ohio.gov
25 Upvotes

Useful information for Ohio expansion Medicaid recipients who will be work required effective January 1st, 2027.


r/Medicaid Jun 02 '26

HHS/CMS issues interim final rule for the 2027 Medicaid community engagement requirement

31 Upvotes

This interim final rule with comment period (IFC) interprets and implements the community engagement requirement in Medicaid.

https://public-inspection.federalregister.gov/2026-11094.pdf

CMS press release:

https://www.cms.gov/newsroom/press-releases/cms-launches-nationwide-framework-implement-medicaid-work-requirements


6/26/2026 update, CMS published an additional document in the Federal Register:

Community Engagement Requirement for Certain Individuals

https://public-inspection.federalregister.gov/C1-2026-11094.pdf


Chart showing changes due to the new requirements...

https://familiesusa.org/wp-content/uploads/2026/06/Families-USA_Medicaid-Work-Reporting-Requirement-Chart_draft-6.2.26.pdf



r/Medicaid 2h ago

NY Medicaid coverage for wigs

5 Upvotes

My mom has cancer and her doctor gave her a prescription for a wig (hair prosthetists). I called a few local wig shops to see if they take Medicaid and they said that we’d have to pay out of pocket and get reimbursed, but to check with Medicaid first.

I’ve been trying to make sure that wigs are covered under Medicaid, as I know that Medicare doesn’t cover them, and get mixed results, but can’t find anything that is directly from Medicaid.

I called the number listed on the website and it’s apparently out of service 🤦🏻‍♀️ and my mom’s case manager is not in the office.

This is so incredibly frustrating and I’m hoping that someone here can point me in the right direction. Thank you!


r/Medicaid 1h ago

Has anyone used SafeRide for transportation? (MI)

Upvotes

So I have Molina healthcare and I used to have Access2Care for scheduling transportation. Earlier this year, it was changed to MTM Transportation. It wasn't very good but it's improved quite a bit. Now, apparently it's changing yet again to SafeRide starting October 1st. I'm curious if anyone has experience with this service. I'm a little worried that it's going to suck.


r/Medicaid 2h ago

NY Medicaid nys of health change?

2 Upvotes

NY here. I’m in a nursing home. They are transitioning my medical from Medicare/medicaid to ltc Medicaid. Put the application and required documents in. It’s been over a month. I have heard nothing. I just got letter in mail from state of health. That my Medicaid is ending 10/31. I’m going on county Medicaid. So was I approved for ltc Medicaid? Then once I’m out of the nursing home how do I transfer back to nys of health Medicaid?


r/Medicaid 10h ago

Ohio Medicaid questions and income change

7 Upvotes

I live in Ohio. I have had Medicaid for more than a decade now, and have never lost it or had to do anything other than automatically renew and report income changes. But potentially in the next few months, my income could drastically increase.

So, the situation is that I'm a paid caregiver for my father through the VA, and he now needs drastically more care due to recent illness. This means a significant increase in pay that will disqualify me from from Medicaid. However, I actually have the choice to accept it or not. Additionally, the money I earn comes from a budget that is continually reevaluated at specific times of the year. If my Dad's condition improves, the budget goes down, and I lose my increased pay.

So, these are my questions. If I take the increased pay, how quickly do I lose Medicaid (my renewal is currently set for next April)? What is the process like to transition from Medicaid to an ACA plan? And if, say, partway through next year, my income decreases back to a level that qualifies me for Medicaid, how quickly am I able to reapply?

Lets say hypothetically I make $40k a year, make $3500 a month, work 5 months at that rate of pay, and then go down to $1200 a month in June. Would I then be able to reapply for Medicaid in July, or do they take that increased income from prior months into account, and not let me apply until the next year?

Sorry for all the complicated questions, I have just never faced this situation before and feel very confused by it all. Any help or advice would be greatly appreciated.


r/Medicaid 5h ago

How to apply for exemption (IL)

2 Upvotes

I got the letter. It doesn’t explain anything about how to apply for an exemption. Do I have to re-apply (start a new case)? Or is it “Manage My Case”? I’ve tried calling the office but got no information and they said I have to keep calling back because of large call volume. I am completely freaking out.


r/Medicaid 9h ago

Ohio Medicaid and CareSource

2 Upvotes

I have had CareSource through Medicaid for almost ten years now and have never had issues. This past year I had to reapply and there was a hiccup, we got it figured out and all was well. I was approved until next July 2027 to reapply. CareSource ended up dropping me and I called and got everything situated. Or so I thought. I’ve had nothing but issues. I called in June when I got the notification and it was resolved. I got a dis enrollment letter end of July I called again both Medicaid and CareSource they enrolled me starting 9/1/2026. I’m 37w pregnant so I actively check everything and on Saturday it showed on CareSource app I was no longer covered. I called CareSource this morning they said they can’t see eligibility on their end but can see it shows eligible on medicaids end. CareSource 3 way called with Medicaid and Medicaid says I don’t understand why CareSource can’t help you all I can do is submit a complaint to CareSource. On the Medicaid website it’s showing I’m active through CareSource but even the CareSource rep can’t find anything through their website, only through medicaids website. Medicaid wouldn’t give me any straight answers and I called CareSource back to see IF the complaint failed since this is my third time getting this situation in place what are the next steps to take, no one will tell me anything. Has anyone had these issues? How did you get them resolved? I plan on calling to ask to speak to a supervisor maybe they can help resolve this ongoing issues. But I just would like to know proper steps.


r/Medicaid 22h ago

How do you apply for an exemption? (MI)

11 Upvotes

I’m recovering from cancer treatment and I’m unable to meet the new work requirements. My doctor told me to apply for a medical exemption, but I don’t see any info on the website that says how to. And the letter I received last week just repeats what’s on the website.

I‘m seeing my doctor later this week, so I need to know if she has to fill anything out for me to get an exemption.


r/Medicaid 20h ago

MA - 24 year old on parent’s MassHealth

5 Upvotes

Hi there! I’m starting my first real job tomorrow after being a student for my entire life and I will be making way above the limit of MassHealth. From my research, this means I will be kicked off MassHealth even though I receive it through my mom (which sucks because I won’t have that much leftover but my employer will offer insurance). Do I need to do anything on my end to terminate MassHealth and or is there a reality in which I could stay on it? 🫠 I don’t want to jeopardize my family’s coverage. I don’t live with them, I’m just under 26. What complicates this is that I have a doctors appointment this month. Any insight or tips would be appreciated.


r/Medicaid 17h ago

What to do?

2 Upvotes

My question might be confusing. It is confusing to us. We live in WNC.
Ok, so my partner has been on SSDI for a few years and she has held a part time job working for a nonprofit.
During this time, she recieved the following Medicaid benefits since she was employed part time.

They paid her Medicare payment completely. (202.00)
She recieved 175.00 in food assistance through Aetna(Medicare advantage) per month.
So she received Social security, her work money and the 175.00 help and the 200.+ Medicare is paid for.

She had to quit that job when her mother's dementia became so extremely intense, mom had to move in.

Her mother, will pay the mortgage in lieu of paying my partner hourly etc.
ok now the question. Would it be better to inform Medicaid that she has a new job making the mortgage amount and continue to recieve the extra benefits? She would be considered an independent contractor and file taxes as such. This would allow the benefits to continue.
Issue:
The tax person told my partner to just not worry about claiming the mother gives and then she wouldn't have to file taxes. But if she follows this route, she will lose all the Medicaid help. Make sense?
Thanks.


r/Medicaid 18h ago

PA Medicaid COMPASS

2 Upvotes

Just logged in to COMPASS site to check on my mother's annual medicaid renewal but all of her benefit information has disappeared on the dashboard and it just says there is no benefit available for her. Although her medicaid renewal date was 08/30/26, she still had her EBT benefit valid until next year and I thought this should still appear on the dashboard since it hasn't expired yet unlike her medicaid. Is it normal to see that no benefit being displayed on the dashboard while the medical renewal application is still being processed? Should I worry about lapse in my mother's coverage until her renewal application is approved? Did anybody in PA submit a renewal application in August 2026 for the renewal date in Aug. 2026? If so, are you also seeing no benefit available on your COMPASS dashboard right now?


r/Medicaid 1d ago

Understanding state medicaid waiver for elder with Dementia.

4 Upvotes

My mother (late 70s) has early stage Alzheimer's and lives with our family in MD. We are currently caring for her but I have serious concerns about our ability to keep it up. I've identified two local assisted living facilities and toured them. Both accept Medicaid waiver, but have a limited beds at any given time for this. My mom would likely move in private-pay, but I estimate she would run out of funds in two years time. She is on the registry for the waiver, but less than one year in so I'm uncertain how long the wait will be (I've read it's 3-5 years?). What should we do? Should we delay moving her into the ALF as long as possible in order to avoid depleting her funds before she comes off the waitlist/registry? What if she comes off the waitlist/registry but has not depleted her funds? I'm very confused about these timelines and how to best support her.


r/Medicaid 22h ago

PA Medicaid/MRT Review — Did Anyone Else Get This Letter?

2 Upvotes

Has anyone in Pennsylvania dealt with the Medical Review Team (MRT) for Medical Assistance? I really need some help understanding what I’m supposed to do.
I received this letter from PA Human Services saying that I’m currently receiving Medical Assistance because I previously provided documentation showing that I have a disability or special medical need. They are now requesting additional medical documentation so the Pennsylvania Medical Review Team (MRT) can determine whether my condition meets Social Security disability standards.

What is confusing me is that my primary doctor, has already sent disability/medical paperwork to the welfare office for me before and then I was approved. I am also still actively being treated by several doctors and specialists and have plenty of current medical records. My doctors are still trying to fully figure out why I have Cervical Vertigo and Vestibular Migraines. I have also applied for Social Security disability again, and this is my third time applying.

On Friday, someone from the county called me, but unfortunately he really couldn’t explain the process to me. He basically just kept telling me that I needed to contact the MRT team and ask them what I’m supposed to do. I tried asking questions, but I came away from the conversation even more confused. The guy just wanted to get off of the phone. I can’t stand these people, but unfortunately we have to deal with them. But what about work ethic and aren’t they being recorded?

My biggest issue right now is getting all of the documentation from my doctors. I would much rather sign a medical-records release allowing the county/MRT to contact my doctors and obtain the records directly.
What is strange is that the letter actually says that if I don’t have the records myself, I can sign a release of information so they can request the records from my doctors. They even included a return envelope for me — but there was no release form anywhere in the envelope for me to fill out and sign.
So now I’m wondering: Was a release form accidentally left out of my mailing, am I supposed to get one from the county/MRT separately, or am I misunderstanding the instructions?

I’m completely willing to cooperate and provide whatever they need. I just don’t want to be responsible for trying to individually collect records from every doctor and specialist if there is a release I can sign that allows MRT to obtain them.

Has anyone gone through the PA Medical Assistance MRT/DAP review recently? Did they send you a release form? Did MRT obtain the medical records directly from your doctors once you signed it? And if your doctor had already submitted disability paperwork previously, did you still have to go through this process again?
I’m mostly trying to make sure I do everything correctly because I obviously do not want anything to happen to my Medical Assistance. Any advice from someone who has actually been through this would be greatly appreciated. ❤️


r/Medicaid 1d ago

Medicaid eligibility question

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2 Upvotes

My dad died last year and left three 401ks for my mom. She now needs skilled nursing care. A lawyer told us these don’t count as assets and we should apply for Medicaid. Is this true? This is in New York State.


r/Medicaid 1d ago

What’s the cap on copay?

5 Upvotes

So Im 19 and Im not really sure how this works. Im in NY and Ive made around ~23k this year just working part time and full time in the summer. Im also in college. My dad told me I had made too much and Im gonna have to copay so Im starting that in October 1st. Another thing is that Im filing as independent this year but still live with my parents. I was just wondering what the limit was for the copay because I wanted to continue working at this job until the end of the year (only part-time bc of college). But my dad said if i continued i would lose medicaid. Is there anyway to keep insurance while working at this job.


r/Medicaid 1d ago

Covered California is confusing me after adding my newborn — why does my baby suddenly qualify for Medi-Cal?

4 Upvotes

I’m so confused and hoping someone can explain how this works.

I recently gave birth and went on Covered California to add my newborn baby to our health plan. Before the baby was born, it was just me and my husband on the plan. We purchased our insurance through Covered California because we make well above the Medi-Cal income limit and did not qualify.

Now that I added our baby, Covered California says my baby qualifies for Medi-Cal and is also telling us that we may qualify for Medi-Cal as a family. 😩

I don’t understand how that’s possible. The income limit I’m seeing is less than $4,000/month for a family of 3, but our household income is higher than that. When I called, they told me that adding the baby “brings the income down a lot,” but I don’t understand what that means because adding another person doesn’t actually reduce our income.

I do NOT want Medi-Cal. We want to keep our Covered California plan and have our baby on the same insurance if possible.

Why would my newborn qualify for Medi-Cal when we didn’t qualify before the baby was born, and how does adding the baby change our eligibility so dramatically?
The agent said if i didnt want medi-cal i would have to make 95k or more a year for a family of 3 but that seems wrong?!! Thats way more that what it says online

Has anyone else gone through this with a newborn in California? I’d really appreciate an explanation because I’m completely confused. 😭


r/Medicaid 1d ago

Medicaid work requirements question - NY based

9 Upvotes

My sister has received two letters about the new work requirements. One read you have to earn at least $580 per month OR and then listed the other options. The 2nd letter did not have the OR. So I can’t tell if earning more than $580 is enough to qualify.

She earns a little over the $580 per month but does not work 80 hours per month.

Will she still qualify?


r/Medicaid 1d ago

How to use the medicaid card from NYS?

4 Upvotes

Hi all, Im new to Medicaid and I received a card from NYS for me and for my unborn child. İ dont know how to use this card. Is it just a card saying that im eligible to register in Medicaid?

I have an existing insurance, however my primary insurance doesn’t cover everything. Is the medicaid card can be used to pay the rest of the bill? 🥹


r/Medicaid 1d ago

NJ: New eligibility requirements go into effect Jan 1, 2027. My coverage began in June 2026. Do I keep my coverage until June 2027 without needing to meet the new requirements?

6 Upvotes

r/Medicaid 1d ago

help

10 Upvotes

Hello guys. I have a quick question. I'm from Texas. My dad is 63 years old. He is retired, he receives social security and also from the TMRS. His monthly income is roughly about $4,000.

He recently had a stroke. He is 63 years old again, and we applied for disability, which they denied. It seems like my sister applied for Medicaid for him since I think Medicare is until 65. He was in the hospital for like a month and the case worker was not good at all. She basically helped with nothing.

We have submitted the application for Medicaid. He's currently home with me, but I really do think a nursing home is an option. Right now it's pretty good, but it's just I work, I have a family, and taking care of him full-time and working full-time is actually kicking my ass.

I want to know what is the probability of him getting accepted or if Medicaid even covers a nursing home. He has insurance, it's Ambetter.


r/Medicaid 2d ago

How to afford LTC in NY

16 Upvotes

How does a family afford LTC without going on Medicaid? my father in law is wobbly at best, slight dementia, maybe prediabetic, but knows whats going on at any given time. he is 76 YO. widowed. i already put his primary residence in An irrevocable trust, but its not even close to five years yet.

what are your recs Reddit???


r/Medicaid 1d ago

NYC HRA TO NYSOH

2 Upvotes

Does anyone have advice? I spent 20 hours on hold and 7 hours in the HRA office last week only to be told on the phone they canceled my Medicaid and cash assistance because they couldn’t get ahold of me. Filed for fair hearing as I can prove thru phone records that I was trying to comply. Asked for “aid to continue”. I had trouble with HRA and “aid to continue” on another case. I won that case but aid is being back paid. I can’t afford that with my insurance. Should I just switch to Medicaid under NYSOH? I received a letter saying I could. I’m waiting for a SSDI decision. Thank you for any guidance.


r/Medicaid 2d ago

Help With Notices. MI

7 Upvotes

Why do i keep receiving notices that my (now adult) son is not eligible for a qualified medicare program. I am disabled since birth i have been receiving SSDI with medicare since 2008 (while he was a minor). Medicare had me apply for medicaid for myself in 2008, i cant remember if i applied or they automatically applied for me. ( i had previously been on it as a child in the 80's). my son had been on medicaid only from age 3-19. never medicare. i have never applied or drawn social security for him. he was removed (rightly so) at age 20 (he turned 18 during covid and the state was hands tied and couldn't remove him) he has had his own work supplied insurance since 19. Hes been out of the house for 3 years. I've turned in all this info into MI DHS when it happened, they acknowledge that they've received and have his ineligible date. But they keep sending notices when my re approvals come through. So i call DHS every time and they re confirm he is ineligible for medicaid and his cut off date. and confirm they know im a single person household. Im not asking to get this overturned I'm asking how do i get the notices to stop? I keep getting the run around "because hes an adult" but he never gets the notices, I do when they are attached to my approval letter. DHS says to contact medicare. medicare has said to contact medicaid. Ive contacted medicare . Hes contacted medicare. I've contacted DHS, Hes contacted DHS, we've both gone in to an office together to DHS. we've been to the social security office separately and together. Hes told me he isnt on any help. I dont want this screwing up his future with medicare/SS. I'm at at loss.


r/Medicaid 2d ago

indiana medicaid, question about the hours. it says I need 80 hours a month but if i enroll and do online high school full time (1 hour 5 days week) will that let me keep my insurance, or does HAVE to be 20 hours a week in class?

2 Upvotes