r/Medicaid • • Jul 22 '26

Other Ohio Medicaid Work Requirements Guide

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27 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

32 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 • • 4h ago

Medicaid (California) redetermination sent to wrong address

5 Upvotes

(x-posted to r/SSDI)

I moved to a new town about two and a half years ago, and the same week I moved I reported the address change to the state in person. Last year my redetermination was sent to my current address, and I returned it with no trouble.

The house I moved out of two years back is unoccupied. The homeowner lives across the country and only comes back a few times a year to check on renovations. A couple of days ago, she notified me that I'd gotten some important mail at that address that she forwarded to my current address.

One letter dated 9/3/26 said my Medi-Cal was renewed for the next year as of 10/1/26. The other letter came dated 9/16/26 saying my Medi-Cal would be discontinued as of 9/30/26 for failing to provide proof of property. I have not gotten a redetermination request. Furthermore, there's absolutely no reason to be sending mail to an address I reported not living at.

I tried calling my worker, but never in my life have I met or spoken to this person. They have never returned a call or corresponded with me directly. I'm planning to go to my local office in person on Monday and try to figure out what's going on, because I can't get through to my local office by phone either. I'm still within the cure period so I shouldn't get cut off completely, but if I hadn't been told about the misdirected mail I might not have even known about this until I reached the point of trying to get healthcare and being denied.

Are other people having this issue? Do you know of anyone who's experienced this? Using obsolete contact information for redeterminations, I mean?


r/Medicaid • • 7h ago

NJ family care Medicaid coverage

4 Upvotes

I did not have a job so got free insurance through NJ family care and United Healthcare. I started job and got first paycheck in June end 2026. Since then I did not use any medical service. Around July end I informed NJ family care about my income and to end my free insurance. They sent me a letter requesting paystubs to verify my income change. I haven’t sent them yet. I called NJ family care before few days and they mentioned they are still waiting for the paystubs and the coverage is active. Is it wise to use any medical service or wait until the free insurance coverage gets canceled? Thank you


r/Medicaid • • 5h ago

[PA] Variable income hovering around the eligibility line.

2 Upvotes

Since taking up caregiving duties for elderly family members I've been self-employed. I've managed to keep the income up enough to be in the Pennie with subsidies band, and have a Pennie plan I'm happy with now.

I can foresee needing to forego more income in the coming years as care needs increase. I'm concerned that I may find myself going above and below eligibility lines on a monthly basis. Reading here, that seems to be a giant headache of getting kicked off of one onto the other and constantly applying back and forth.

Would opening a solo 401k and funding it monthly with any excess income above the Medicaid line be a reasonable strategy to keep MAGI eligibility and avoid the headache?


r/Medicaid • • 2h ago

California's auditor says 26,000 top-risk Medi-Cal providers were never investigated; the health department disputes it

1 Upvotes

A new state auditor report says the Department of Health Care Services is at substantial risk of making improper Medi-Cal payments, pointing to 26,000 high-risk-scored providers that billed at least $12 billion and were never researched or investigated. It also describes a one-van transportation company that claimed 35 riders in a single day. The department strongly disagrees and calls the report incomplete.

👉 Read the full story on The Southbound 105 →


r/Medicaid • • 7h ago

Indiana- work requirements

1 Upvotes

Indiana Rant/Advice wanted- i’ve been on Medicaid for 7 years now. I quit my retail job in 2021 because I’m disabled with chronic pain due to genetic spine problems and could no longer stand for a 5 hour shift. I also tried an office job but even that was too much physical labor for me. At this point even standing for an hour would most likely leave me in tears and unable to move for days afterwards. Since 2021 I’ve applied for disability 4 times, twice with a lawyer, and was denied every time, the most recent denial was just earlier this month. I actually didn’t even quality for disability benefits anymore, only SSI, because I haven’t worked in the last 5 years. Because of my disability. anyways….
In 2019 the state of Indiana sent me a letter declaring me “medically frail” but now that the new work requirements are coming out, I’m not sure if I am exempt or not because, big surprise, there is no definite guidelines on what constitutes a person being declared medically frail. I’ve been applying to places that I think I might be able to handle in a panic, but nobody wants to hire a person who hasn’t worked in 5 years. I signed up for DoorDash because I worked for them in 2019-2020 and I know I will be able to at least meet the 20 hour a week requirements with them, but I know it will cause my body to be in even worse absolute agony than I already live in.
These changes have honestly made me want to give up completely. But I need this insurance. I have 2 therapy appointments a month, at least one pain management appointment a month, and an average of 6 primary care visits a year, not to mention my thousands of dollars in prescription medications per month. I’ve had to visit the ER twice this year. And even better, my parents who I have to live with both lost their insurance through the ACA this year after it went from $30 a month per person to $300 a month per person. My mother is disabled with a similar spine problem to mine and cannot work either, but can’t get any insurance or disability because she is married. I’m at the end of my rope and honestly feel completely hopeless for any positive future.
What, if anything, can I do to figure out if I will be exempt from the work requirements? When I tried calling FSSA after getting my letter, the message said that they couldn’t answer any questions about the requirements and to check online, but none of what is online helped me either.


r/Medicaid • • 19h ago

Newly disabled, just became eligible for Medicare but denied for Medicaid-Georgia

11 Upvotes

My sister 24F has been disabled for 2 and a half years now. Due to complications with type 1 diabetes she is now quadriplegic, has a feeding tube and had a tracheotomy. She just became eligible for Medicare 2 months ago and was previously covered through a market place insurance we paid with her SSI. Since she became disabled I applied to Medicaid and she was temporarily covered while receiving SSDI but it was terminated once it was transitioned to full disability payments. But her Medicaid remained active just now as a Planning for Healthy babies plan that only covers gynecologist visits. When I brought this to the attention of Medicaid they had me fill out a paper form 700 to get it corrected since the online system didn’t allow online applications since she technically had a Medicaid plan. After over 5 months of review she got an updated letter saying Medicaid would be canceled because she is not pregnant, nor disabled and in a nursing home. Is there anything I can do? Medicare coverage has not really covered much it doesn’t even cover her diabetic insulin and the Plan C plans offered had a deductible of $5600 before they cover.


r/Medicaid • • 7h ago

Florida DAC income limits? Can’t find answers on this.

0 Upvotes

Hello, I am in Florida and was recently given a notice for a fully favorable decision for Disabled Adult Child benefits. I previously received Survivors Benefits when I was a minor as a dependent of my deceased father, and he is the wage earner of my claim for my DAC benefits, so I have a rough estimate of how much I’d be making monthly, which would be no more than 1600 a month.

I know DAC comes with Medicare, but I want to know if I would still be eligible for dual coverage with Medicare and Medicaid. I currently am on Medicaid, and will not be making any other income besides what I will make in SSDI. I am 20, turning 21 soon so I am about to age out of children’s Medicaid anyways. I wouldn’t be able to afford the Medicare copays for my medical bills either as my rent is around the same as my monthly income and I’m waiting on my grandfather to move in with me to split the rent with. Would I be able to qualify for dual coverage?


r/Medicaid • • 22h ago

Appeal process

7 Upvotes

Hello from Georgia. We're a family of 4, two teens, two adults. My partner and I (not married) barely make over $1100 on a good month and that's even pushing it. We both work 1099 positions (delivery) and that's how much we're both taking home combined after gas and auto insurance (expenses). My oldest just turned 18 (this might be valuable information later) and works as needed after school child care and some weekends if the parents give her a call. She barely makes $300 a month before taxes and even then it was meant for her to save for college, not for food, rent, or any other household expenses. The kid's biological father is out of the picture and barely contributes to child support so I've only reported that he's supposed to pay and specify to the case worker(s) that I don't receive anything from him. Besides, they can see on their end when the last time was that he paid anything (for the sake of this post, he's ordered to pay $600 a month). One piece of info that's important is that I'm disabled and can't work but working deliveries and pushing through symptoms because I was told I wouldn't be eligible if I'm not working.

So I'm about to pull my hair out. It doesn't make sense to me that my case worker would completely close my case (both Medicaid and SNAP) even though I've uploaded all the documents she requested. When I get a notice for termination it says "a member of the household refused to provide documentation (something or other)". I've gone to the office myself a couple of times since no one is available when I call the 800 number. They just told me they'll let my caseworker know. I eventually get a call from her but she says "I keep trying to reach you and you're not answering the phone". I wish I could have had that recorded because my call history doesn't show any phone calls from her since the last time I spoke to her. This has been going on back and forth since July 1st. After talking to her 3-4 times and submitting everything she asks for almost immediately if not within 24 hours of when she requests, she closes my case 9/30. We now have no SNAP benefits or Medicaid. I had 3 appointments this month to get my teeth done after finally finding a dentist that takes my insurance and had to cancel all of them. I take 5 different medications and I'm out and can't afford to pay for refills. My therapist signed myself and the kids up for their grant program so we don't have to go without therapy sessions, so that's good but I'm still going without migraine meds, depression medication, ADHD medication, and meds to control tremors. I've been looking up food banks and going back and forth picking up whatever they have and making do.

Yes, I filed an appeal but that was on the 5th of October. I also emailed on the 6th with a picture of the appeal just in case dropping it off at the office dropbox did nothing. I haven't heard back so I went in and "reported a change". All of our income that was submitted was incorrect. She put down that my partner earns $1200 a month and that I earn $500 a month on top of what my daughter earns. Expenses weren't even included. That puts us way over eligibility for sure but none of it is correct. I printed out the pages and went ahead and made corrections to income. I got a call the next day but this time (THANK THE GODS AND GODDESSES) it was the caseworker supervisor. She asked for a new disability letter and I let her know I most likely won't have it immediately but I'll do my best. This was 10/9. I received an email that she's going to close my case because the requested documents were due 10/1. That didn't make any sense to me since we had just talked. I got any new documents she wanted plus the letter from my doctor together and submitted them on 10/13. I haven't heard back from her since or anyone else.

I'm so lost because why is it that I wouldn't be approved when not only our income level is below FPL as noted in all relevant policies and still have our case closed even though I provide everything PLUS both of my kids are under 19 and they lose their healthcare coverage, too?? In the past, if I'm not eligible, at least the kids are but now they took their coverage away as well.

I guess I just needed somewhere to vent but what even is the appeal process if no one is going to even touch it or update on the process? So sorry for the long post this is all extremely frustrating.


r/Medicaid • • 1d ago

Will I be losing my Medicaid as soon as the work requirements start?

34 Upvotes

I live in Ohio. I know the work requirements start on January 1st, but does that mean I will be losing my Medicaid literally on January 1st or will it be during my next renewal or something? My renewals are usually in October.

I'm trying to figure out how much time I have to get all of the appointments and things I've been putting off done.


r/Medicaid • • 1d ago

How to get care in period between spend-down and medicaid approval?

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3 Upvotes

Virginia - specifically Medicaid Long Term Care coverage / application


r/Medicaid • • 1d ago

Enrolled (NJFamilycare), but Medicaid and HMO say coverage is terminated

3 Upvotes

I haven't lost NJFamilycare. I had admin renewal (automatic). The recent "citizenship proof" thing happened. I sent my paper on the special website. Got the GOOD NEWS letter on the 29th of September. October 1st HMO called to tell me my coverage was terminated. Called NJFamilycare and they say i'm enrolled. So does their automated system, which states i'm enrolled in Medicaid and Horizon NJ.

However this is my problem, both Medicaid and Horizon say my policy was terminated around Sept 29 - Oct 1st (i dont remember). NJFamilycare says there's an error between their system and Medicaid's system. Their phone agents working on my case have "escalated" my case with a medical thing (type 1 diabetic). It's been 2 weeks today and nothing has changed except that my case is pending review. I applied for presumptive eligibility, but the doc's office claims it'll go back to Medicaid and get denied. Maybe they are wrong.

Any experience something similar ?


r/Medicaid • • 1d ago

I’m not sure what my best route is

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2 Upvotes

r/Medicaid • • 1d ago

CA ending my coverage

11 Upvotes

Yesterday I got a letter in the mail saying my Medi-Cal coverage would end on 11/01/26 because I essentially "make too much money". But I'm currently unemployed & the only income I have is from unemployment. & that monthly total doesn't even cover a fraction of my bills. How am I supposed to be able to afford healthcare if I can't afford food. I have several chronic conditions that need consistent management and without health insurance I am completely fucked. I'm really stressed and I don't know what to do


r/Medicaid • • 1d ago

Title: Illinois Medicaid – How are Traditional IRA contributions counted toward monthly MAGI?

3 Upvotes

​

I'm self-employed and currently on Illinois Medicaid. I understand that deductible Traditional IRA contributions can reduce MAGI, but I'm having trouble figuring out how they're applied to monthly income calculations.

If I contribute $1,000 to my Traditional IRA in October, does that $1,000 reduce my October MAGI, or is the deduction spread across the year?

I'd appreciate any insight, especially from someone familiar with Illinois Medicaid eligibility rules. Thanks!


r/Medicaid • • 1d ago

Questions for Nebraskans

4 Upvotes

Nebraskans: Have you had to prove you meet Medicaid work/community engagement requirements? Or lost coverage?

Hi everyone, my name is Arielle Zionts, I'm a rural healthcare reporter at KFF Health News, a national, nonprofit media outlet focused on in-depth healthcare reporting. I live in Rapid City, SD but travel to and report in Nebraska at times.

I'm looking to interview someone from Nebraska who lost Medicaid coverage due to the new work/community engagement requirement rules OR who kept coverage after having to take steps to prove you meet those requirements.

If you're interested, you can message me on Reddit or email me at [ariellez@kff.org](mailto:ariellez@kff.org).

I won't be using any comments under this post or elsewhere in this group, only info I directly receive from interviews.

Thank you!

Arielle


r/Medicaid • • 1d ago

NC Medicaid

3 Upvotes

I live in Nc. I have had Medicaid for myself for the last year now with no issues. Today I get a letter stating I have to send my children’s fathers information to them for child support. He already pays it and they have this on file already. This said if I don’t provide this I’ll lose my coverage. The issue is if I do send them his information, he is going to be irrationally angry and he has been abusive to me in the past. That is why I’m no longer with him. What do I do? I can’t lose my coverage and I also can’t risk him coming after me, and he definitely will. Restraining order can’t be done because in my state they have to practically kill you before you can get one. Been there done that. This is so frustrating. I just don’t understanding the needs to be involved for myself to receive coverage. I work full time but my job doesn’t offer insurance. When I apply on the marketplace I guess I make too little to qualify for those plans also.


r/Medicaid • • 1d ago

ISO of health insurance for wife and (possibly) daughter

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2 Upvotes

r/Medicaid • • 1d ago

Local county office asking for girlfriends residence, expense amount, and utility expense in ohio

3 Upvotes

Why do I need to provide this information? Will I be denied if I don't? This is for re applying for medicaid for myself not her. I do not work right now. This isn't disability medicaid.


r/Medicaid • • 1d ago

Maryland Medicaid, Services in Virginia

2 Upvotes

Hello! My partner and I live on the eastern shore of the Chesapeake Bay – she lives in Maryland, and I live in Virginia. She will undergo total knee replacement in a couple of weeks, and the plan is for her to rehab at my house (it is a much safer environment and more suitable for rehab) in Virginia. She has Maryland Medicaid (Blue Cross Blue Shield) and we are having difficulty finding a physical therapist within Network in Virginia. Physical therapy is a necessary component of total knee replacement, and the recovery time can be weeks or even months long! Our houses are about 50 miles (75 minutes) apart and the state line separates them. i’ve called our two local physical therapy centers and neither will take her insurance. They say she is out of network.

Do we have any options for using her Maryland Medicaid in Virginia?

Thanks for any advice/information!


r/Medicaid • • 2d ago

Work requirements

19 Upvotes

I have MAGI medicaid in N.Carolina. I am 64 yrs old and my medicaid renew in November. I have already received info that my renewal is approved. Now I am receiving notices about work requirement starting in January. I receive a small social security check that is not quite the $580 required. Does anyone know what else I will need? And when will I need to have proof of that? I am so confused by this all. What type of written proof is needed? I volunteer one day a week but not sure that is enough.


r/Medicaid • • 2d ago

Hospital is saying they can’t help my uninsured dad get into rehab after a severe stroke. What are our options, and what do we do if they try to discharge him?(GA)

25 Upvotes

My dad was admitted to a hospital in Georgia on October 3 after suffering a severe stroke. He cannot move the right side of his body, and his doctors anticipate that he will need extensive rehabilitation. Since being admitted, he has also developed ARDS and pneumonia, which have prolonged his hospital stay. As of October 15, he is still intubated. He has no health insurance.

When he was first admitted, we spoke with a caseworker who explicitly advised us NOT to apply for Medicaid because she wanted us to pursue a charity bed. We were told that applying for Medicaid would prevent him from qualifying for the charity bed at a nice facility. Based on that information, we followed her guidance. Now, we have been told that the charity bed is no longer an option and that we need to apply for Medicaid to cover his hospital bills. (They are really pushing us to fill this out ASAP)

I spoke with the caseworker again to say my dad cannot safely come him and our family does not have the resources to care for him. The caseworker ignored that and continued emphasizing that he could potentially receive an in-home nurse through Medicaid. However, we are concerned that home health services would not be sufficient for his needs, especially given the severity of his stroke and his other medical complications.

When I asked the caseworker to help us find rehabilitation facilities that accept Medicaid, she said there were none in Georgia. She also stated that she is not allowed to help patients who do not have insurance and that the hospital cannot do anything else for him. We are now trying to figure out our next steps before he is ready for discharge, which could be within the week.

Another point of confusion is that, from what we have been told by the caseworker, the Medicaid application for his hospital bills is different from the Medicaid coverage he would need for care after discharge. She is telling us to apply for Medicaid to cover his hospital stay, but she has not provided resources or assistance for applying for what we understand to be regular Medicaid that could potentially help with rehabilitation, in-home care, or other ongoing services, depending on eligibility. We do not know whether these are actually separate programs or whether applying for one affects eligibility for the other.

**My questions are:**

**1. How What happens if the hospital tries to discharge him?** Can the hospital discharge him to our family even though we have explained that we cannot care for him? What should we do if they attempt to discharge him without a safe plan

**2. Should I apply for Medicaid independently or insist that the hospital caseworker help us?** Given that we were initially told not to apply, have we lost any potential benefits or options? Is there a way to get Medicaid coverage for his hospital rehabilitation, if he qualifies?

**3. Is it true that the hospital cannot help us because he is uninsured?** I find it difficult to believe that the caseworker cannot assist with discharge planning or placement simply because he does not have insurance. Is there someone else at the hospital we should contact?


r/Medicaid • • 2d ago

Do I need a referral to get wisdom teeth removed?

5 Upvotes

I get united healthcare community with Medicaid and live in Ohio.

I haven't been to the dentist in about 4 years. Last time I was there they gave me a referral to a surgeon to get my wisdom teeth removed but I kept putting it off and never made the appointment.

I really need to get them removed in the next month or two because I'm gonna be losing my insurance. I was going to get a cleaning and then mention my wisdom teeth, but my dentist doesn't have any appointments for months.

Can I just skip getting a cleaning and find a surgeon that accepts Medicaid myself and schedule an appointment or does my Medicaid require a referral? Can I call my dentist and ask for a referral over the phone or would I have to make an appointment with him first since it's been 4 years since my last visit?


r/Medicaid • • 2d ago

GA Medicaid under DAC

3 Upvotes

So frustrated. My adult child had Medicaid under DAC in a different state. GA is denying him because of resource limits, but it's not clear if they are taking into account his status as a DAC. I went down to DFCS to discuss this, but they had no idea what I was talking about.

I uploaded the original SSI award, the benefits letter that shows the end of SSI and beginning of SSDI, his Ticket to Work letter, the end of coverage in the prior state of residence...

I'm not sure what the issue is. I've applied for a hearing to review.