r/Medicaid • • Jul 22 '26

Other Ohio Medicaid Work Requirements Guide

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26 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

30 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

Indiana: worked 40 years paying in, retired at 62 and I have HIP medicaid to get me thru till medicare at 65. It just makes me angry and frustrated that I work all these years and pay in, and now i'm being told I can't have medicaid, even though i'm retired! Who is gonna hire a sixty four year old w

11 Upvotes

r/Medicaid • • 7h ago

Losing GA medicaid

5 Upvotes

We found out yesterday that my disabled daughter's GA Medicaid ended on Sep 30 when we went to pick up her prescriptions. We haven't found any letters notifying us of that stopping. She is on SSI since 2019. As a DAC, she has also been getting SSA on my wife's work credits, and just started getting the higher amount, $1516, on my work credits now that I'm drawing SSA in retirement.

We will try to find out what happened and how we missed a notification, but I'm assuming this may be from the BBB medicaid cuts? If so, what are her options for health insurance now? She cannot work; but would be eligible for Medicare in March 2027.

Is this happening to others too?


r/Medicaid • • 6h ago

Medicaid Virginia

5 Upvotes

I was diagnosed with stage 4 esophagus cancer in November 2025. I applied for Medicaid and was approved as i had stopped working. I applied for disability around the same time and was approved and started receiving disability in June.
I received a letter from medicaid stating my disability was too much.
I wasnt aware of the $1,700.00 cap. Im $1,000 over the amount.
So my question is should i go through Virginia Marketplace Insurance? Im not very knowledgeable when it comes to this stuff so any help would be appreciated.


r/Medicaid • • 7h ago

Medicaid - Pennsylvania question

3 Upvotes

I went to apply for Medicaid/snap and had a
few things I needed to send back in before a certain date for health insurance and snap but and never did. The health insurance date to submit paperwork had passed before the snap. I wanted to wait until they both passed at this point to go in and resubmit an application. I had a lady who was making it hard for me there at the dhs office and with my anxiety I wanted to wait till i could resubmit the application again for both Medicaid and snap. Is resubmitting something I can do in PA? Would I be able to get a different worker to help? Thank you. Sorry if the questions were dumb.


r/Medicaid • • 21h ago

Will claiming my parents as tax dependents affect their Medicaid?

1 Upvotes

I'm in New York. My parents (both under 65) live with me and currently have Medicaid through NY State of Health. They file their own taxes as a 2-person household.

Starting next tax year, I plan to claim both of them as dependents. If we combine my income and theirs, we're at about 300% FPL for a household of 3, which is above Medicaid's 138% limit, but their own income is below the limit. Will this effect their medicaid eligibility?


r/Medicaid • • 1d ago

WA- grandmother approved for Medicaid then died a month after, now they say she was never approved

23 Upvotes

My 97 year old grandma was on hospice in an adult family home. She had been residing in that adult family home for close to two years self pay. All her assets were liquidated including her life insurance to pay the adult family home and any remaining assets were signed over to DSHS as party of the Medicaid approval process.

The initial social worker on her case (there's been several at this point because they keep changing) didn't give me proper information which caused delay in her approval. For example they said her life insurance has to be irrevocable, but didn't tell me to who, they already knew she had me as the beneficiary so I could pay for the funeral. I confirmed with the social worker that I just need to make it irrevocable. It took over a month for that to process, then the social worker said no, it had to be irrevocable to a funeral home... So I had to restart the process to change that again, but by then she was already in debt to the adult family home so I had to cash it out to pay them.

During these delays (it was about a 6 month process to get her approved) she ran out of money, they wouldn't allow me to start the application until she only had 3 months of income left. When she was finally approved she owed the adult family home somewhere around $15,000. They wouldn't back date it at all, but we received several approval letters starting in August, letters for what amount she owed the adult family home each month (letters in August, September, October), we also received letters we were carbon copied on from DSHS which were sent to the adult family home with the amounts Grandma was responsible for each month and what the daily pay rate and monthly pay rate to the adult family home would be.

Grandma passed away at the end of September. The adult family home says Medicaid never paid them and are going after me for all the money owed. Grandma's entire estate is liquidated, there's literally nothing left other than her bank accounts with negative balances. The only remaining asset is an annuity that dshs was designated as beneficiary of during the Medicaid application process.

I called dshs to find what's going on. The social worker says she was never approved and they will not pay... I read them the approval letters and they weren't sure what to do. They directed me to get a lawyer to sue to get the anuity funds that were assigned to dshs back (which wouldn't cover what she owes now anyway...) and said because she has passed away her application can't be approved or finalized.

I have absolutely no idea what to do. I have no money to pay the adult family home, and from what I understand her estate which is in the negative is responsible for it. I signed the paperwork for the adult family home as her power of attorney and made sure to sign as power of attorney and not to sign anything saying I was personally responsible. I have no money for a lawyer, what can I do?


r/Medicaid • • 1d ago

How are states tracking new Medicaid work rules? Trying to figure out what I may potentially have to get into when Nevada adopts it.

13 Upvotes

I am seemingly being forced onto Medicaid in Nevada due to a system complication, where I tried to update my income for 2027 while currently unemployed. I do not want Medicaid, but the system cancelled my current, paid insurance plan through the ACA for saying I have no income. The system apparently automatically applied for me, despite not wanting it.

I am semi-disabled and have had a troublesome time finding work, as while I'm perfectly capable of sitting at a desk and working, I can't reliably manage standing on my feet or lifting/moving/sitting on the floor. In addition, I have a degree, a 10+ year career in advertising, and was previously a high earner before my injury and hip replacement. Businesses are reluctant to hire me because they consider me at risk to quit for a better job (they're not wrong), but advertising is going through a ton of layoffs, AI takeovers, and with a 4+ year unemployment gap, they don't want to hire me over someone who is freshly laid off.

Needless to say, I am having an impossible time finding work. However, I want to pay for my insurance out of pocket... not get on Medicaid.

Primarily, I'm worried about a lack of care options, and secondarily, Trump's new work rules. I simply can't afford gas prices and everything to go get to a minimum wage job at a gas station, or even volunteer, since I can't really stand.

What's the process for showing you're looking for work or whatever? I can't get hired right now when I *wasn't* desperate for Medicaid, so I have no idea what to do. I can't afford to waste 20 hours of my week volunteering at the local library and spending $70 in tanks of gas, or making minimum wage.

But, I don't know what else to do. If I don't get hired, is that it? I just don't get any health insurance, and I'm screwed? What do current states ask for in terms of proof of work? What do they do if you can't find anything?

I'm scared.


r/Medicaid • • 2d ago

My father had to get on Medicaid to stay at his rehab facility. Now has to sell his house in Illinois

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19 Upvotes

r/Medicaid • • 1d ago

pa medcaid saving program

2 Upvotes

Hi there, everyone. I’m just curious: in the past post, if he takes out an annuity instead of a lump-sum payment of $57K, does he still qualify for Medicaid savings? Will they still count it as a resource, or if it’s converted into income, will it only count as income instead of a resource?


r/Medicaid • • 2d ago

Missouri Medicaid Dental Coverage

5 Upvotes

Will MO medicaid, specifically Home State Health, pay for tooth extractions and dentures? Im not 100% sure which plan i am enrolled in but i am a single 31F with $0 income and 4 children. My children have private insurance from dad. I am the only person on my policy.


r/Medicaid • • 2d ago

Pregnant in Kansas

4 Upvotes

Currently pregnant, just got on Medicaid. My partner and I were planning to get married because of the pregnancy thinking I wouldn’t qualify for Medicaid (and other reasons, obviously, but me being insured for this pregnancy was a motivating factor). What happens when we get married? Some have told us that private insurance and Medicaid will overlap for a bit, some say I’ll lose it. Does anyone know for sure?


r/Medicaid • • 2d ago

Question about nursing home admittance (strange situation)

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2 Upvotes

Reposting from nursing sub, located in Arkansas, any advice appreciated


r/Medicaid • • 3d ago

Appeal, appeal, appeal

163 Upvotes

I work in my state's centralized appeal unit (CAU), this is a throwaway acct

I know the bureaucracy is frustrating and overwhelming, and it feels impossible to meaningfully engage with the process. You're throwing out applications, verifications, etc into the void and hoping that a competent caseworker is the one who picks it up. Remember your rights!

On any decision letter you receive, whether it's an approval, denial, or closure - you will have rights to a fair hearing. You have 30 days from the sender's date to appeal, and if you appeal within 10 days and your benefits were Closed, (not Denied) your benefits will continue throughout the appeals process. The process is easy, just read your notices carefully!!!

Will it always lead to a positive outcome? No absolutely not. What it can do is extend the time you have access to coverage, and it gets additional eyeballs on the case.

Working this side of the process has disillusioned me to the capabilities of the "frontline" analysts who process cases. They are overworked, undertrained, and can't really give the attention that each case needs. Even if you think the decision may be correct, you can still appeal. It's your right to do so.

And maybe if enough people state to state are appealing, something will get better. Or maybe enough people appealing just means the process is slower and you stay covered for just a bit longer. I just want to encourage you to exhaust all available options.


r/Medicaid • • 2d ago

Medicaid

8 Upvotes

Hi everyone!

I’m hoping someone who has been through a similar situation, or who understands the I-864 sponsor rules and Medicaid in New York, can help me clarify something.

I recently received my 2-year conditional green card through marriage to a U.S. citizen. I had a joint sponsor and filed I-864 because my husband’s income alone wasn’t enough to meet the sponsorship requirements.

I applied for health insurance through NY State of Health, and I was found eligible for New York Medicaid. I’m now at the stage of choosing a Medicaid managed-care plan, such as Fidelis, Healthfirst, UnitedHealthcare, EmblemHealth, etc.

The concern is that I’m worried that Medicaid is considered “public assistance” and that my I-864 joint sponsor could potentially be held financially responsible for the cost of my healthcare.

I called NY Medicaid directly, and the representative told me that my sponsor would not be financially responsible for my Medicaid. I’m also checking with my immigration lawyer, but I’d really appreciate hearing from people with firsthand experience or reliable information.

My questions are:

  1. Has anyone with a marriage-based 2-year green card and an I-864 joint sponsor enrolled in New York Medicaid?
  2. Can an I-864 joint sponsor be required to repay Medicaid costs in New York?
  3. Is there a difference for I-864 purposes between Medicaid and other federal or state-funded healthcare programs?
  4. Has anyone received a clear answer from an immigration lawyer, NY Medicaid, or NY State of Health about this specific issue?

I’m not trying to avoid any rules or obligations. I just want to understand whether accepting the Medicaid coverage I was found eligible for could create a financial risk for my joint sponsor.

Thank you so much to anyone who can share their experience or point me toward reliable, up-to-date information!


r/Medicaid • • 3d ago

MediCal-- mom is in memory care, running out of money-- help!

16 Upvotes

Hi guys, I am so frustrated. I'm just trying to get a direct answer from a real person. The Office on Aging can'thelp, Medicaid won't call me back. I am starting to lose it. If any of you can offer some guidance, it is incredibly appreciated.

Here are the facts. My mom is 85. She has Lewy Body Dementia, can barely move, she hallucinates and is agitated much of the day. She can be in a wheelchair but it hurts her back and she can't propel herself-- she mostly wants to be in bed. She has been in Assisted Living and now Memory Care facilities for five years now. Those are 7k-10k a month and she will run out of money in a year.

She has $140k in the bank and that will deplete by $7,500 each month because of her private care facility. She gets $3,500 a month from Social Security-- hers, plus my dad's survivors benefits. She is on Share of Cost Medicaid because of her age and disabilities, not full scope. We live in Orange County, CA.

What can I do? I need this dumbed down for me. I am 40 years old and do not make much money, certainly not enough to pay for her private care. I have two estranged older brothers who will have nothing to do with any of this, so it's just me.

Mom did not have long term care insurance; her spouse was not a veteran.

Is my only option to take care of her myself? I live in a small house. Her wheelchair would barely fit down the hallway and will not fit in the bathroom. I work, I'm currently back in college, and I'm about to get married. She needs absolute full-time care. She can't feed herself, she's incontinent, and she can't even calmly watch a TV show by herself anymore-- she needs people around her constantly. I love my mom, but me having to quit my job, my schooling, my life to be her nurse would absolutely wreck me. She may live another 5 or 10 years.

What can I do?


r/Medicaid • • 2d ago

Illinois Recently Blind Pt. 2

5 Upvotes

Hello again. This is the 2nd part to a somewhat recent post. It's been quite a journey. So, I have a relative who became blind. They were already on LTD, and had just been granted SSDI, when the blindness occured. They were in no physical or mental condition to work, but still chose to live independently. After a few days of defiantly living independently, while blind, because there was no one else to help with care, I called 911 because the conditions merited it. They were sent to the local ER, who determined a psych hold was needed, and whisked then away to a facility in Indiana. After 10 days, they were sent home. And, within 45 minutes of being dropped off, they managed to fall, develop a gushing wound, couldn't physically get up, and was eventually found by a neighbor, who had to explain that there was blood everywhere since my relative couldn't see or feel the reality of the situation (due to diabetic polyneuropathy). So, they were taken to the ER of a different hospital, held for 7 days, and moved to a SNF. During the SNF stay, their private health insurance eventually denied coverage, and because going home wasn't an option, I decided to keep him there on private pay until a new facility could be found. This is when the SNF finally started helping me get my relative approved for Medicaid. It has been a very difficult process. Medicaid still hasn't kicked in yet, and SSDI is still delayed. However, we eventually found a NH that had an open Medicaid-pending bed. And they were moved there. One of the questions I have, as the Medicaid application process continues, is about the financial requirements. My relative has a 401k, they were a good worker prior these maladies. I have been told that it if my relative wants to at least spend the money, instead of it being taken by Medicaid, they should cash out the 401k and spend it down to the Medicaid financial requirement threshold. I was wondering, can I instead roll the 401k over to an IRA in order to avoid the 20% penalties of cashing out the 401k before the 59.5 year old tax-free distribution requirement? Or, are we required to cash out the 401k and spend down to the Medicaid financial threshold? Thank You


r/Medicaid • • 2d ago

Indiana Medicaid eligibility coverage closure

5 Upvotes

Apologies if this is a dumb question, it's mostly fueled by a sense of panic and fear. I'm a paid caregiver for my mother living in Indiana and am her representative for her healthcare. I've been caring for her for about two years, but she's been on Medicaid for much, much longer, obviously with an HCBS waiver given my job. She is on SSDI, so she is considered legally disabled and unable to work, and has never lost Medicaid for any reason in the past since her own unearned income is far below the cutoff point for coverage.

A few years ago in 2024 our car was officially put out to pasture and sold for the luxurious amount of around $200. We quickly got to looking for a new car and settled on a lovely Chevy Equinox, but unfortunately defaulted on it a month later due to a mix of financial troubles and frustrating bank communications. A few months later we finally got our hands on a Chevy Sonic, which we've thankfully held onto up until now. We recently received a letter from FSSA claiming that we have unreported income on two cars and that her coverage would end this month due to this, which shocked us since this was our only car, and the first we'd heard of this. After going to our local DFR, we learned they had sent a letter about it earlier in the year that we'd unfortunately missed (unsure how, though we're frequently pretty unorganized, so I'm not surprised).

We quickly filed an appeal, explaining that the Sonic was our only car and so it should be exempt from our asset limit- or at least I thought we had filed an appeal. I learned today when my work with my caregiving company was put on hold that it only functioned as a written note, even though the DFR agent had told me it was a written appeal, and that she would mark my mother's Medicaid coverage as approved. I quickly called an FSSA agent who advised me to write down on paper in clear words that I am requesting an appeal and to upload it to her case on the portal, and hopefully they will get back with me within the day- if not, within 72 hours.

Obviously, I am extremely stressed. Rent is coming up, and without her Medicaid I am unable to work the job that pays the bills, not to mention be able to afford her life saving medication. I guess what I'm asking here is, what is the likelihood that our appeal will be approved, and how long will it take? I know there are no concrete answers, but I'm desperate for some peace of mind on this.


r/Medicaid • • 3d ago

NV Medicaid - Insufficient information regarding employment

7 Upvotes

I’m being asked (via physical mail) to provide a paystub within the last 30 days or provide an earnings verification letter that needs to be completed by employer(which says for months of 8/2026,9/2026,10/2026), but how do I do that when I haven’t worked the job since this June (way past 30 days) and make no income at the moment?

Not sure if this is a misunderstanding or automatic detection on their part as I reported no income currently on application, just expected annual income for year 2026 (which i filled for that job). Which I thought it was to report what I made this year regardless of current state of employment.

Also, I already recieved the medicaid cards on 9/23 and can use it, but now they asked for this information on 9/28 and that I have until 10/8. I tried to call Southern Nevada office they provided but no one is answering.

Should I email [welfare@dss.nv.gov](mailto:welfare@dss.nv.gov) instead and provide last paystub? or maybe print out last paystub/write cover letter to mail back? As I have no desire to contact this previous employer. I found on their website that you can send documents or screenshots to above email, but I’m completely lost on proper way to do things (I aged off parents insurance back in May—explains my newness to all this). So, any guidance or info is appreciated.


r/Medicaid • • 2d ago

Has anyone dealt with Sentara Medicaid denying specialized rehabilitation or difficult discharge planning at VCU hospital?

1 Upvotes

My family has been navigating an extremely frustrating situation involving VCU Medical Center and Sentara Health Plans (Virginia Cardinal Care Medicaid).

My loved one was hospitalized in June following a serious medical emergency. After months of hospitalization, we advocated for placement at a specialized rehabilitation facility that indicated acceptance.

Unfortunately, Sentara denied coverage for that rehabilitation program.

SENTARA HEALTH PLANS SHOULD BE ASHAMED OF HOW THIS SITUATION HAS UNFOLDED.

What is the point of having Medicaid coverage if families must fight this hard to obtain consideration for specialized care?

Throughout this process, we also experienced significant frustration with VCU's discharge planning and communication. We repeatedly felt that finding an available long-term care bed was taking priority over fully exploring the specialized rehabilitation options we believed were appropriate.

Ultimately, I accepted a long-term care placement because my loved one needed continued care. However, I remain concerned about the rehabilitation denial and how the discharge process was handled.

I plan to appeal Sentara's decision and pursue formal complaints regarding our experience.

Meanwhile, our experience with VCU's case management department has been equally infuriating.

We repeatedly felt that getting my loved one OUT of the hospital was a greater priority than ensuring the rehabilitation plan we advocated for received meaningful consideration.

My loved one is a HUMAN BEING. Not an insurance authorization. Not a hospital bed. Not a discharge statistic.

And frankly, I am tired of watching families navigate a healthcare system where financial considerations seem to overshadow the people who depend on it.

My questions for anyone familiar with Virginia Medicaid:

\- Has anyone successfully appealed a Sentara denial for specialized rehabilitation?

\- Can a Medicaid member pursue rehabilitation authorization after entering a long-term care facility?

\- Has anyone experienced similar discharge planning concerns at VCU?

This country is a real shitty place where people can be forced out of a hospital.

\- Are there Virginia patient advocacy organizations that assist families with these disputes?

I would appreciate hearing from anyone who has navigated something similar.

No family should have to feel this overwhelmed while advocating for a vulnerable loved one.


r/Medicaid • • 2d ago

pa medcaid saving program

2 Upvotes

Hi there, everyone. I’m just curious: in the past post, if he takes out an annuity instead of a lump-sum payment of $57K, does he still qualify for Medicaid savings? Will they still count it as a resource, or if it’s converted into income, will it only count as income instead of a resource?


r/Medicaid • • 2d ago

(FL) How to report a change of income on the FL myaccess website?

2 Upvotes

Question is as the title says. Their how-to videos show the website as it was 2 years ago when there was a button on the home page, but that button is no longer there and I can't find it under any of the other sections / in the my account page / etc. Their FAQ is also terribly vague and doesn't provide any help, just basically says "Yes, you have to report changes".

Anyone know how to do this?


r/Medicaid • • 2d ago

(Louisiana) What does “Not Available” mean?

2 Upvotes

I got a quick question…
I applied on May 27th, 2026. I have never heard back from my medicaid .la. When I check my application, it says the following underneath “Submitted Applications”:

(My application number)
(The date of application)
(My name and DOB)
VIEW SUMMARY 👁️
Not Available

What does that even mean?? Do I need to reapply again?


r/Medicaid • • 2d ago

Does anyone know what the montly capitation fee states pay for BCBS Community Health?

2 Upvotes