Pages 24 through 27 in the updated “Medicaid Program; Community Engagement Requirement for Certain Individuals” (https://public-inspection.federalregister.gov/2026-11094.pdf) talk about in-kind and unpaid work counting towards the 80 hour monthly requirement.

What kind of documentation needs to be collected / put together to prove the in-kind work?

Asking primarily because I have a relative who lives with me and they take care of the home / do housekeeping in exchange for housing and material stuff they need. And so what would I need to do to create the proof / paperwork that there is an in-kind compensation so that they can keep their Medicaid come 2027.

If anyone if other states that already implemented this could also weigh in, that would be helpful too. Any help here would be amazing. Just want to make sure I’m setting up my relative properly so that they don’t lose their healthcare. They live with me because they aren’t eligible for disability but they also aren’t well enough to work consistently.

I had question about how the exclusion for being a caretaker worked with the upcoming changes. I’m in VA. I went on Medicaid due to serious health issues that left me unable to work and things became worse when I had a horrible fall that left my left foot with permanent damage (but as I can still walk though with pain, not a disability).

As some things have mended I have become a caretaker to my aging mom. Her mobility is extremely poor and she has a horrible bladder condition that has required many unfortunately failed surgeries. My life revolves around helping her right now. She is preparing for knee replacement surgery this month and hopefully if all goes well she can get the second one done.

My renewal was in April/May of this year. Is it possible if I am unable to complete my requirements due to fully taking care of her that I can report it as an exclusion for next year? I’m honestly freaking out. I have night terrors about it constantly but I have no other help and no family but can’t lose a job because she needs me during recovery or something else. If that is something I could bring up would I need notes from her doctors?

Also, just out of curiosity can the $580 come from selling things (not a flipper or anything, we just have a lot of old stuff to let go of) as income or only from an actual go to job since it says self-employment? I’m sorry I’ve been so busy prepping for her surgery I’ve barely scratched the surface of what is allowed.

Edit : word

My friend's daughter was recommended specialized lenses called Steĺlest for degenerative myopia, but she was also told Medicaid will not cover it.

They told her the minimum out of pocket cost would be about $500.

They also told her there's a high chance she'll be blind in a few years if she does not get these, for why these lenses are so important.

How does Medicaid in Texas provide coverage for this?
Do they ever?
Are there some missing steps for coverage?
Is there somebody to call in particular to assist with the situation?

Has anybody here experienced a personal injury and settled everything out of court to recover *only* for personal damages / expenses?

Meaning - if the victim in a PI case collects $1,000 for personal expenses and damages they paid, and are not trying to claim any expenses covered by Medicaid - does any notification have to be provided to Medicaid?

What about $10,000? $15,000?

Is it kind of like winning the lottery? Meaning, the focus is more on future implications of eligibility, rather than retroactive payments.

Does the right to recover only apply when there is a legal proceeding?

What about third party’s insurance getting involved? I’ve read about the defendant’s (calling them this for ease, but consider this still in a non-legal context) homeowner’s insurance stepping up for non-auto accidents / injuries. Has anybody ever done this?

Also, how in the WORLD are we supposed to access our bills. would like to have an idea of how much insurance has paid, but nobody seems to know or care about billing since Medicaid recipients aren’t billed.

Idaho

Long Term Care

Has anybody been able to make a successful case against being denied retro payments, as well as application denial, based on asset limit getting under the maximum allowed *on* the first of the month as opposed to *prior to midnight* of the 1st of the month?

I've been battling for 7 months to get my MIL approved. As far as we know, we have everything in order, except this situation.

We know that in order to qualify we are only allowed $2,000 in the bank account (there are no other assets) by the 1st of the month. Social Security deposits into the account typically the last week of the month, sometimes only leaving a couple business days to get the total amount under the limit. The past two bank statements showed the amount getting under $2,000 *on* the 1st of the month, but not *prior to* the first of the month, due to A. Not getting a check soon enough, B. The bank taking too long to post the transaction, C. The timing of social security deposits.

This wouldn't be a big deal except that in our case, it's a matter of tens of thousands $ that we were relying on getting covered in retro payments.

(I don't need anyone telling me what i should or shouldn't have done differently. I'm well aware of everything i *should* have done. Why it never occurred to me to take her debit card straight to the ATM instead of dealing with checks, i'm kicking myself for harder than any of you can. Now, i need to know if I'm royally screwed and why, or if there's any chance i can fight this.)

Thanks in advance for anything helpful.

If someone receives an $800 check every month for caregiving for a family member with Alzheimers but doesn’t file taxes, would this meet the 2027 income requirement?

Beginning in 2027, having monthly income of $580 or more means you have met the new Medicaid work requirement.

Does anyone know whether 401(k) withdrawals can count toward that $580/month income requirement?
I’m specifically asking about a withdrawal from an existing 401(k), not wages from employment.

Single PRN worker. I made well under the income limit each month until last month because of horrible staffing issues. Since Oklahoma looks at monthly income I lost coverage this month I updated my marketplace application but I still can’t buy any of the plans because I don’t make enough. Do I just need to appeal? What do I do until then if I have anything come up?

Hi all. So I got the notification about the new work requirements for Medicaid that is starting Jan 1, 2027. I'd like some clarification about my situation. I've tried calling NYStateofHealth and I've gotten like 3 different answers from 3 different people. I'll probably try calling again tomorrow, but I thought I might as well try here as well.

So basically my Medicaid coverage ends November 30, 2026. If I manage to renew my Medicaid coverage around the same time (before Jan 1 2027), will I be able to have Medicaid coverage for 1 year, or 6 months?

I'm currently unemployed and have no income. I've been taking care of family, but I'm going to have to juggle everything more depending on how things go. So do I need the work requirements by Jan 1 2027, or do I have some more leeway time if my Medicaid coverage ends November 2027 instead? If I end up not qualifying for Medicaid bc of the work requirements, would I be able to apply for the Qualified Health Plans (painful, but need health insurance)?

I'm just pretty confused about these rule changes and would like someone to just tell it to me straight. 2/3 of the people I called at NYStateofHealth didn't seem to know in regards to the policy changes so I just wanted to try here as well.

Any advice would be great so I can start planning things sooner. Thanks!

I am confused trying to figure out the timing of renewal for a family member.

If renewal for someone is in November 2026, and they get renewed, is this renewal for a full year meaning their next renewal will be in November 2027 and during the November 2027 renewal process they must prove work or exemption status and if approved again in November 2027, their next renewal period ends and needs documentation for April 2028 to be renewed? Also if this is a renewal initially to November 2027, is the look back period for documentation the entire year November 2026 to November 2027?

Thank you for helping if you can. The 800 number is swamped.

HFS website of Illinois says this:

"If you are currently enrolled in Medicaid and are an ACA Adult, you will need to meet or be exempt from work requirements starting at your first redetermination date on or after January 1, 2027. Details about how to meet the requirement or who can be exempt are below.

All ACA Adults will also be moved to 6-month redetermination cycles, rather than 12-month redeterminations, starting after their first redetermination date in 2027."

I am a 22 year old single mom to two young girls in Florida. I have been on Medicaid since falling pregnant with them, and have had no issues up until now. Both of my daughters have full coverage benefits and we also receive SNAP benefits. About 2 months ago they canceled my full coverage benefits due to a discrepancy with child support (my ex was supposed to sign a form but it was never turned in). I called regarding the situation and they gave me family planning which covers gynecological testing. They told me to resubmit for full coverage benefits and I’d be approved. Nearly 2 months later I got the notice saying that I didn’t qualify despite meeting all of the income requirements. I have chronic health issues and also require mental health care both of which I’ve been unable to treat for over 2 months. I have tried calling over a dozen times and every time I click to talk with a rep the line hangs up on me. I submitted an inquiry today to have someone reach out me.

I have lost over 30 pounds since December and have dealt with chronic GI issues for 9 months. I have been unable to get any of the required testing to diagnose what’s going on. On top of that I have bipolar disorder and ptsd. I don’t feel like I’m asking for much especially when I meet all the requirements for full coverage benefits. I just want to be happy and healthy for my children, but right now I feel like I’m being failed by the state of Florida. I’m already paycheck to paycheck I don’t know how they expect me to also cover thousands of dollars in appointments and testing.

From what I've read in a different thread on this sub, states do their eligibility checks in "batches". Now starting January states have to check at least twice a year and have a lookback period of at least one month but not more than three. I know that my state is choosing the least burdensome option (renewal checks twice a year with one month lookback).

Now this year and previous years, it was only a yearly eligibility check. So I receive the letter in May and it states that my time on Medicaid runs June 1 to May 30. Just this past May it said I was covered until May 30 2027.

From this can I predict when CT will run the auto-recertification? Now that it has to occur every six months does that mean it will be every June and every December?

So I finally got that letter in the mail telling my that the new medicaid requirements will go into effect next year, the letter did have a page saying you could be exempt from the work requirements under certain conditions, one of them being if you were "medically frail"(Their words not mine)which entails things like drug/alcohol addiction, blindness or the one relevant to me-severe mental health issues. Late last year I got pretty bad OCD and it's never really truly gone away, i'm paranoid about germs and contamination quite a bit, so the idea of spending hours away from home someplace else that could be contaminated is definitely not appealing to me and I don't think I could do it without going nuts. I'm just wondering how to go about getting declared exempt? Do I see a psychiatrist and get officially diagnosed in order to qualify? I already took a test earlier this year that got me an official diagnosis of autism. If all else fails apparently the 80 hours also counts if you're self-employed and I have been selling stuff on Ebay for years and do taxes for that so hopefully that'll be enough, if not I guess i'll do volunteer or work stuff online.

I'm currently on MAWD in PA. I was putting some $ away every week into my employer based 401K. From what I know, the most I can have in that account is $10K and I have about $8500 in there now.

I've looked into the ABLE accounts but I haven't heard the best things about them. And I don't know if my disabilities are severe enough to even qualify for that program although my psychiatrist said that he had no problem writing a letter for me about my disabilities. It seems as though they don't ask for anything like that when you open an ABLE account but you do need to keep a letter about your diagnosis on hand in case of an audit.

I have the ability right now to put a small amount of $ away weekly and possibly invest that money in some different funds. I'm trying to figure out how to do that without losing my insurance, if there is even a way.

Am I understanding the MAWD program asset limit correctly? Is it true that if my assets reach $10K or more, I will no longer be eligible for the program? Are there other options to save and invest?

TIA!!

Ok so there are a lot of layers to this issue and I’m not sure what parts are relevant to the current outcome.
I live in PA. I had Medicaid for me and my daughter. I am also currently 29 weeks pregnant. My income alone 100% qualifies us. No doubt.

Previously my household was me and my daughter. We moved in with her father and also moved to a different county. His income is substantially more than mine and I’m honestly not sure where we land as a household on qualifying. I think if we do qualify it’s quite close to the limit for 3 person.

Within a month of moving I notified my previous county caseworker of new address and household info and asked what to do. I was advised to fill out an application for a new case in the new county.

I applied in the new county and went through the entire process but was ultimately denied because my Medicaid was active in a different county. The new county advised me to contact the old county to transfer my case. They said Medicaid was still active through the old county.

During the application process my renewal became due for the old county. To cover all my bases I filled out everything and included the information about my new address and household and submitted that with the previous county on time.

After being denied for the new county, I called the customer service hotline and talked to a very competent seeming worker who informed me that both counties could’ve transferred my case and she thinks the caseworkers were being lazy. She provided me a reference number for the phone call and said she’d be reporting about it since the work got pushed off. She said she would process my transfer to the new county and my Medicaid would remain active. Someone would reach out from the new county.

About two weeks after that call I realized I hadn’t heard from anyone and I was about to schedule an appointment, so I logged on to check. There are no active cases. I can’t even access my notices anymore because it says I have to have an active case to have notices. I had enrolled in the paperless but I hadn’t received any emails about a notice regarding cancellation.

I received no information about CHIP for my daughter. I haven’t gotten any info about Pennie for myself. I also technically wasn’t denied? They never gave me notice or a reason why any of my cases would just end randomly.

I am 29 weeks pregnant and a week overdue for an ultrasound to check on my baby. I was in the process of transferring medical records so I could schedule that appointment in my new area. But now I don’t think I should schedule. My current child is four years old and doesn’t have anything in case of emergency now and pre k starts in two days.

I plan to call again tomorrow since I found this on a weekend. I don’t know what to even ask about. I apparently don’t even have a case anymore? I don’t understand but I’m scared to go to the doc at the risk of getting billed flat out because I do not think I’m covered at all right now. But if at any point in my life I really needed insurance it is definitely now. This pregnancy has proven quite problematic, much more than my first.

If anyone can offer assistance or insight please help. If I have to pay for private insurance now I’m not sure we can even afford that. And with copays on top and being high risk, (the last month of pregnancy that’s high risk they require weekly apts that include ultrasound, fetal stress test and doc follow up which is 3 apts weekly!!) I don’t even know if we can afford that.

I cannot be covered by my partners either as we are not married. My job is part time and does not offer insurance to me. I know my daughter will get CHIP and my baby even if I don’t qualify. But I need this now more than ever.

I'm needing some help to understand the system. Family member went blind 5 months ago. I reached out to Agency for Aging, got as far with medicaid as the assessment. Financials, bank statements, etc we're next and she said they would be in touch. We were looking at him coming to live with us. I work from home, but not confident I would have time for all the care. Medicaid lady said that's ok, you'll choose an administrator and you can work out what you can provide and what you'll need someone else to come in for. In the process family member gets sick, goes to the hospital and now is in skilled nursing to rehab. Nursing home says they'll take it from here... They're planning on him converting to long term care when he's done with rehab. The woman there told me he wouldn't get approved if he didn't go through them. He's gone blind at 65 and wasn't taking care of himself which caused the hospital stay. I felt confident he would be approved. I'm no longer sure where we stand in the process, can we still bring him home? We've left it up to him as the weather he comes to live with us or he stays where he is. Not sure how to navigate this and hoping someone has been in a similar situation or can offer some insight.

Currently single living in Alabama, soon I will be married to someone in the UK. He makes about 100k yearly. Within the next 6 months I’ll be moving to Ohio and then working towards his spouse visa. While waiting on the visa (can take up to 2 years) he will not be living in my house. I am currently unemployed, I’m undergoing treatment for numerous nodules, and some other health issues. He pays all the bills directly and even though he makes 105k yearly the UK taxes a ton of it plus our bills in America and the UK he barely has 100 left each month. I worry that they will think he is sending me money, or will take his income into account and I won’t be able to get the medical treatment I need.

Asking for a friend;

An older friend has a brother that is in a nursing home Medicaid bed in Missouri. His Social Security goes to the nursing home and Medicaid makes up the difference.

His assets are essentially zero…well except he is on the deed of a farm that he and two sisters inherited in Ohio. Many years ago(10-15 years), one of the sisters bought most of his percentage which left him with a 10% ownership. 

The family thinks his ownership would be roughly $60K.

1. On his death, does the family need to liquidate his share of the farm and remit that amount to Medicaid?

2. If they bought out his share of the farm now, would MO Medicaid ask for verification of fair market value and possibly want more than the $60K?

Thanks in advance with any help on this....

What is the current Medicaid reimbursement rate for speech treatment code 92507 in Virginia?

I am the only driver for my family and my mom, who does not live with us. I'm her ride for everything. When she had a heart attack in January she put me on her bank accounts to help with finances.

Through the past 7+ months I've been her ride to the hospital(s) both local and 1.5hrs away, including visits to help manage her inpatient care, which has been rough on my car. Now a few things have converged and I want to keep on the correct side of various regulations, but my car needs some major repairs.

I need to help her apply for Medicaid after a recent stroke that means she will likely live in a care facility long term. She has a savings that would need to be spent down before Medicaid would be approved. She wants to buy me a new car and I told her that's not how it works, that the state would raise some pretty hefty eyebrows at that. They do a 5-year look back process and are pretty thorough.

Is it plausible for her to pay for or reimburse just car repairs if I'm her transportation for health and personal needs? I feel like it is a very gray area. I am waiting for a callback from a lawyer (but it's the weekend and I'm anxious) and Reddit often has pretty decent real-experience advice.

Thank you!

I have a question
I’m on TMA now
before 6th month my income was about $25 dollars but now I switched jobs and making about $27 an hour
Do you think I will be qualified? In Pa with dependent
Thanks

When I was 18, I was admitted to invol psych, but didn't have insurance coverage at the time (parents' insurance was HMO for only the state they lived in and I left to different state for university). One of the workers submitted an emergency Medicaid application for me, but I have no idea what's on it. They basically filled out the entire form for me except my signature I think? I was too disoriented to remember any of it.

A few months later, I got a letter in the mail saying that I was approved for Medicaid.

I've been on it for 2 years, and I'm not sure if the information they submitted was correct. I am claimed as a tax dependent on my family's returns, but I viewed the Medicaid case management portal for the first time today and it says that my household size is 1 on the website.

I have billed to Medicaid many times already. What should I do?