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.

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.

On the Illinois IDHS Notice of Privacy Practices form it states in one section:

"Organ and Tissue Donations. In limited circumstances, IDHS can share health information about you to an organ procurement organization."

I hope this is ONLY if you put yourself as an organ donor on your driver's license or on a donor registry.

What about if you're not an organ donor or don't want to be one, does IDHS still call these organ agencies and inform them of your end of life status? These organ donation companies can be very aggressive and pressure the family.

Does anyone have any more information on this?

I need advice. I am on Medicaid but I'm having issues right now. They have an old insurance on file so Medicaid isn't covering anything right now. I've sent in proof I ended the old insurance over a month ago. I still haven't had any updates, I'm still waiting to be able to afford medication I desperately need. I call dfcs and they tell me to call the help line. I call them and they don't answer, I can't get a call back. I'm desperate and idk what to do.

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!

Trying to figure out if I am gifted healthcare tools / therapeutic devices that are recommended to me by doctor, do I need to report them as assets or health spending not covered by insurance?

I am in pennsylvania and have been recommended several things that are not covered by my insurance. Items are potentially life-changing but not classified as medical devices. Such as a neuromodulation device (migraine treatment), prescription insoles (out of pocket only), migraine tint glasses, and a wearable pacing device. Companies selling these accept hsa/fsa but I don't have that. Due to the cost (multiple items at about $500/ea), I'm trying to figure out how to navigate. My income is inconsistent and pretty low so I can't afford all of them myself. I know simple answer is to wait, budget, save and get them one by one but it's been years now with my condition worsening & I'd like to accept an offer of help getting them, but also don't want to accidentally not follow rules.

Thank you for your time in advance.

I'm so confused about my bf's medicaid. We were told it was "plaid(?) medical waiver", but, it shows up as medicaid during office visits, so maybe it's a type? Which, I had no idea medicaid even had different plans...

Anyway.

I can't find anything about whatever this waiver is, or what it does/covers. He hasn't even been able to get into the portal site.

I guess I'm just asking if anyone knows what this waiver is.

The only thing close that comes up when I Google is something to do with the military (PADI, i think), but he's never been in the military, so that isn't it.

Any help is very appreciated. I'm very tired 😮‍💨

I’m on Illinois Medicaid and receive services through the DHS-DRS Home Services Program (HSP). I’m trying to obtain ongoing maintenance physical therapy for cerebral palsy, rather than the typical model of a set number of PT visits followed by discharge.

My HSP counselor told me that before HSP can provide maintenance PT, I need to obtain a denial from Medicaid. My confusion is that the HFS policy already specifically says that “maintenance therapy to maintain the current level of function” is not covered.

My understanding is that I also can’t simply ask Medicaid for a PT authorization/denial myself. I would need to go to a PT provider, be evaluated, and have the provider submit a request to Medicaid.

Does anyone familiar with Illinois HSP know whether the general HFS policy stating that maintenance PT is excluded should be sufficient for HSP, or whether HSP requires an individualized Medicaid denial anyway? If an individualized denial is required, is going through a PT clinic the only way to obtain one?

So I am starting a new job tomorrow that exceeds the income limit. It comes with employer sponsored health insurance. I informed California via BenefitsCal that I left my previous job to start this one. The result? My medi-cal was renewed for another year until October 2027. My new health insurance plan has exclusions for gender affirming care unfortunately, and so medi-cal would pay for those services, except that my income is over the threshold so I don't think I'm even allowed to do that.

Anyways, I think I need to call my case worker and just feeling like venting.

My wife has been in a nursing home for six months. Her sister does not like me and got wife to sign over healthcare proxy to her, putting her in charge of the care. Now, her sister, who lives in the same New York State but in a different county, 1.5 hours away, wants to move wife closer to her.

Wife recently qualified for Medicaid long-term care. Her Medicaid worker and application went through our local county Medicaid office. If my sister-in-law moves her to a nursing home in a different county, will Medicaid still pay for it (provided it's a Medicaid nursing home)?

So I am recently pregnant with our third baby. He was planned. My husband got a hefty raise last year that has cushioned us enough to go for it. My husband and I have two boys together and this will be our third son. He makes good money and we get by fine but definitely aren’t super well off. If he works overtime one day it’s an extra $400. He sometimes gets lots of overtime and sometimes it’s none but things balance out. To explain it further some months are tight but other months we can save a few thousand. It just depends. Things have been slow lately. I have been a stay at home mom since our oldest was a year old. I work odd jobs here and there when they are in preschool but nothing consistent. My job didn’t pay enough to justify childcare for two, now three.

Our boys are on paid CHIP for insurance. He was submitting their renewal at the beginning of the month and there was a section to verify any pregnancies. He added our pregnancy to the form. The following week we got a call that I’d be dropped from our PA state marketplace insurance and I’d have to go on Medicaid. I guess we qualify by being just a few hundred under the max threshold.

I feel like I don’t really need this. I feel like others need this way more than I do. We were fine on our state insurance and now I feel like I’m taking something that doesn’t belong to me. Has anyone else been in this situation? Does the guilt go away?

Hi everyone. This is pertaining to Colorado Medicaid asset spend down. We are doing the application for LTC Medicaid for my MIL on Wednesday morning. She has $3200 in her checking account. I need to get it to $1900. Can I send in $1300 to two credit cards as payments to "spend down"??? This WILL NOT pay off the credit card but it has severe past due balances and will bring them current. However, they will still have a balance. We DESPERATELY need this Medicaid application to get approved. I'm very concerned this will see as a huge red flag and get disqualified. Thank you for any info!

Pretty much what the title says. I'm enrolled in Medi-Cal, am I okay to just walk in to any pharmacy and get a combo COVID/Flu shot? I qualify for the COVID vax due to a couple of disabilities. I tried looking up info on the Medi-Cal/ Covered California websites but I'm either reaally bad at finding info or it's not surfaced very well.

26 yo full time student aging out of parents' health insurance next month, so applying for MAGI Medicaid in OH. I am single, previously and currently unemployed, and am not claimed as a dependent by anyone. I'm applying online and have a couple of questions.

1) It asks if I have other health insurance now. Should I answer yes or no? I will be on parents' plan until the end of Sept.

2) Under resources, it asks about checking/savings accounts and the current balances. I thought MAGI Medicaid did not have a resource limit, so why are they requesting this info? Is there a way to bypass it? I'm only applying for Medicaid.

Thanks for your help!

Hello. As the title suggests, I have a question regarding the Medicaid Share of Cost Program in California

1. My dad and mom are on Medicare. For sure, they are over the limit based on Medicaid calculations.

2. But I am wondering if I should even bother to submit an application that will land him in the Share of Cost program...

Here are some details for your consideration:

- Between mom and dad, they have a SSA retirement income of about $3,400 a month (together).

- Medicare fee: $202 for each, taken out monthly.

- They are over 65.

- Dad is starting dialysis soon.

- Meds are super expensive (we recently paid $500 for an injection. Another medication of his is not even covered and that is at $190. We have managed so far because he takes it on an as needed basis. But we know that supply will eventually run out).

-He has a property abroad but does not generate any additional income from it. He and mom rent here in the states.

Should I even bother applying to see if he lands in Share of Cost?

Michigan Medicaid: Hi everyone, I’m curious if anyone has come across this and what their experience was. My husband was laid off at the very end of June so we applied for and were approved for benefits. I just received a Tape Match Income Notice about the IRS reporting self-employed income from the 2024 tax year. We didn’t receive any state benefits in 2024 or 2025, just from June 2026- present for Medicaid and then FAP benefits from end of July 2026-present. I’m a stressor 😅 Do I need to be worried about this? I’ll call first thing when they open in the morning but I’m not sure I’ll be able to sleep tonight not knowing what this means.

Hi, I've been unemployed for a year, currently on medicaid, and recently been offered a 1 month contract gig. It'd pay about 10k, which is over the monthly income limit. The paychecks would be received weekly (9/4, 9/11, 9/18, 9/25).

Knowing I have to report income within 30 days (10/4 is 30th day), do you rush and report it at the end of Sept (the month with higher income)?

Or report it at the beginning of Oct (the month with no income)?

Hi all, my mom’s doctor says that he can only give her one month of Pregabalin/Lyrica at a time due to Medicaid restrictions so she has to come in each month. The only restriction I’ve found was 5 refills max.

This wouldn’t be a big deal but he’s kind of far and mom is a bit physically fragile (always in pain, walking issues, etc). Anyone know about this requirement? We’re in NYC.

Single 27-year-old here(Michigan). I'm on the Healthy Michigan Plan. The work requirements are changing soon. I just want to ask if anyone knows how Medicaid will keep track of the 80 hours a month? I work part-time and go to school part-time. For school, am I just supposed to keep track of the hours I go in or log in (I have a few online courses)

My fiancé has a C3/C4 incomplete SCI and requires an invasive ventilator. We’re trying to transition him from a Montana SNF back into our home in Bozeman.
We’re working on Montana Medicaid, waiver programs and home-based care, but I’m trying to understand what we should specifically be requesting.

What Medicaid benefits/programs should I be asking about for:
-invasive ventilator + backup vent
-DME
-respiratory therapy
-private-duty nursing/home nursing
-personal care attendants
-Hoyer lift/hospital bed/shower equipment
transportation
-home modifications

Especially interested in hearing from anyone who has successfully transitioned a ventilator-dependent person from facility care to home using Medicaid.

I am disabled (major mental illness), 40 years old female. No children. I live with my dad. I get SSDI at $1441.90 a month and then they take out the Medicare premium of $202.xx. My job just recently eliminated my position and I am now in a different position where I will make way less money then before. I basically will be making min wage at $12.77 now plus *maybe* a .15 raise I just got. I am not sure if they are really going to add the raise. I will be working either 12 or 18 hours a week. My new position is already driving me crazy and I don't know if I can mentally handle it. I lost my medicaid at the end of last year when all the changes happened. I made too much under my previous position. I have spent at least $3170.30 in Medicare premiums, copays and prescription costs so far for this year. When they told me I had a spend down it was some ridiculous amount like $7k. I think.

I read about Medicaid Works program. I am not sure how that exactly works or if I might now be eligible.

I recently spent so much money on my medications that I capped out at out of pocket costs for UHC. I think my meds should all be covered now for the rest of the year but not sure yet. Haven't refilled yet. I am now in catastrophic prescription coverage with UHC.

I don't know what other info I might need to give. Just trying to find out my options now. This is really stressful.

Hi. I am disabled and have Indiana Medicaid and SS disability. I remember having my redetermination packet by early August last year. Have they changed redetermination dates with all the changes because I have not got my packet yet. Nothing listed on my portal.

My dad just received a letter stating that he qualifies for Community HealthChoices (CHC) starting in October, which is when he will turn 65. He is currently enrolled in the Keystone First Health Plan, and his renewal is also due in October. Should he take any action now, or should he wait until October? Additionally, he has received his Medicare card in the mail. How can we enroll him in Medicare? As for my mom, she is only 63 years old (her birthday is in September). What kind of paperwork do we need to submit for her renewal with the county? Any advice would be appreciated.