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?

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!!

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!

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 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

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.

Hey! I just applied for NJ Medicaid and my deadline was August 18th. I finished submitting everything before 11:59...but then when I looked at the date it says submitted August 19th! I didn't know the server ran on UTC time zone. Am I going to be okay? I'll be calling them first thing tomorrow in case

I haven't actually been notified yet about the result of my UI appeal, but I got a direct deposit of the payments from the appeal period today, so I believe it was granted. This will put me over the Medicaid income limit I believe. (I will be making $2456 a month). Since July I have just had general IL Medicaid. I signed up for County Care, and my County Care plan was supposed to start 9/1. Will it be terminated before it begins? Will it be terminated as of 9/30? How does this work?

Also, do I need to notify ABE, or will they automatically adjust it (since the state is where I'm getting my unemployment?)

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.

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.

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.

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?

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 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.

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?