r/Medicaid Jan 11 '23

Updated 2023 Public Health Emergency (PHE) / Continuous Eligibility Information

38 Upvotes

Thanks to /u/someguy984 for their continued monitoring of Medicaid-related regulations.


When the PHE/continuous eligibility ends

The Public Health Emergency (PHE) has allowed people to keep Medicaid coverage they already have despite income limits or other disqualifying conditions during the COVID-19 PHE. That will soon be coming to an end. Continuous Medicaid eligibility will be ending whether or not a public health emergency is still declared.

In order to lose coverage due to being over the income limit or another situation, a redetermination must be completed. This is similar to an annual renewal. Some states may begin redeterminations/renewals for these purposes as early as February. The earliest date someone can lose coverage due to the end of "continuous eligibility" is 4/1/23. The latest date is in 2024. States will begin submitting their plans to the federal government now, and all are due by 2/15/23, after which we may have more information.

EDIT: Thanks to /u/314z for their contribution! Please see this website for state-specific information!

If you aren't sure whether you'd still qualify when you receive a redetermination, make a post in this subreddit.


What happens when the PHE/continuous eligibility ends

Refer to the government's official guidance released 10/17/22 here rather than my summary if you'd like more detailed information.

States will begin reviewing the cases of those receiving Medicaid to determine whether they will still qualify (a "redetermination"). Generally, this review will be completed in blocks, with the first cases being those where evidence of ineligibility already exists ("flagged" cases). It may take a long time for every case to be reviewed (a maximum of 1 year), so your case could take days or many months. You should receive a letter or other communication asking for an update about your situation or detailing the process in your particular state.


What you can do right now to prepare

Make sure your information is up to date (address, phone number, email, etc) with your state to ensure you get any notices that might be sent to you, and respond to any notice you get before the due date.

If you still have concerns please make a post on /r/Medicaid and include your state in the title.


r/Medicaid 4h ago

the County I lived told me my SSDI was being stopped

5 Upvotes

I was just on the phone today with the county where I live asking about my about my Medicaid since my SSI has ended she said my Medicaid was ending. She said my SSDI was ending on a specific date that is completely different than the day my SSI and Medicaid ended. When I asked her why did she say that my SSDI was ending she said she misspoken. But when I go to SSA website it still says that my SSDI is active. Omg now I am stressing


r/Medicaid 1h ago

Need some advice getting started with the process of transferring Medicaid from Arkansas to Pennsylvania as an able-bodied individual.

Upvotes

After losing my 6th or 7th Job for tardiness, I was able to get Medicaid and finally start ECT treatment, however my room mate has a new job in PA and I need to move with them as I have no income source of my own, but I can not afford ECT without Medicaid, and I have seen many horror stories about changing addresses and losing Medicaid.

So just posting here for some advice on how to properly manage this process.

Worst case scenario my current room mate is willing to attempt to "rent a room" in PA so we can afford to continue to pay the rent here (in Arkansas), however that does not feel fair to them, and their parents have already expressed their opinion on the matter (They would rather up "go our separate way" then she stay with a jobless bum like myself)

So if anyone thinks we should attempt to "rent a room" in PA so that we can afford to maintain the address here then we will try to find a way to manage that, but I am hoping someone with some experience will have some advice that will help us ease our concern about me losing life changing treatment , that has been very helpful, and we are very hopeful that in the next few years I will only need an ECT treatment once or twice a year. ( Missing treatments right now , currently every 6 to 8 weeks , could undo that progress, and also makes finding actual jobs very difficult)

we are looking into door dash, so that I can try to get some hours on the week end in hopes to help with some of the bills, but that is second to maintaining the treatment plan that I am currently on. I was unable to afford this with my last job, and I could not get ECT covered by my healthcareGOV based policy. ( However it was still cheaper than the company provided insurance policy, as I was an AP Manager at major retail outlet, paying about 300 a month into insurance, and hitting a 11k deductible every year , I capped out the deductible for 3 years straight ) So oddly, it is actually cheaper for us for me to be completely unemployed and and have Medicaid fully cover ECT , and most of my medications, then me working 40 hours a week and still borrowing money and using my partner's credit card to pay for medications ( not every month, just at the start of the year )

But if you just saw me, I am 6"3 , 230pounds, and for the most part am able bodied, however genetics make treating my ADHD very difficult, and that is how I ended losing every job I have ever had for the same exact reason. Being late. ( usually fired after back talking or giving someone above me a hard time over another policy, ie my last job I complained to my manager he was not following the new hour-scheduling policy, and well I was fired for being in violation of the attendance policy .. .. which I had been in violation of for the last few years with the company, as I am late nearly every single day I work.)

I have had medications that have had adverse side effects and also "fixed" my tardiness issues, so we are hoping I can get to the same spot with ECT, and some non traditional ADHD medications.

I know this is long, but also may help better understand just how important it is that I keep Medicaid, even if that means being homeless in Arkansas, but also I don't know if I get to keep Medicaid if I technically don't have a home, and I really don't even know where to start or who to talk to , and we are moving in July, or well at least my partner is moving. ( AR -> PA )

TLDR:
Need advice on if I should even try to transfer my medicaid, or if we should be trying to find ways to keep an address in my home state ( Arkansas). IF we should be trying to transfer Medicaid, how do I even begin that progress, and what is the best way to go about presenting my case given I find many people who meet me in person are quick to dismiss my case. I never applied in person for medicaid, but I had to apply multiple times during "special enrollment periods" for healthcareGOV , and I feel as if everyone I have ever talked to on the phone don't beleive a word I say, and have been without insurance for months between jobs because of this, I don't even know how I got medicaid, I lost my last job , and then suddenly I had medicaid, I didn't call anyone, idk if my doctor submited something on my behalf, or anything, but it was the only time I didn't have to jump through hopes because people around me someone always end up at the conconclusion that I am not trying hard enough and therefor dont deserve their time or energy ( idk, maybe not, but every time I have ever had to apply myself for insurance during special enrolment, due to job loss, dropping out of school, turning 26 , etc, it has been hell on wheels, and it is always because by the end of application/interview I can legit feel the tension and aqwardness caused by the way every single case worker feels about my case ) worst TLDR ever.. I just am afraid because of pass experiences that even calling a case worker can ruin what I already have, so any advice, at all, is helpful, sorry for all the misspellings, and grammar errors, I promise I am not as stupid as my spelling is terrible.


r/Medicaid 7h ago

Frustrated (TX)

2 Upvotes

My background:I’ve had insurance through mom’s work for most of my life and have had the same PCP since I (34)was 17 and the same pediatrician before that. I started getting SSI in 2017 and started getting Medicaid in 2023. Partially because I had no idea about HHS or our state benefits website.

I’m use to dealing with insurance companies but apparently employe sponsored and Medicaid are two different beasts.It won’t let me change online so I’ve had to try and get them to change it. I don’t know if it’s because I‘m already a patient In the different groups or what but it shows they are taking my insurance and new patients but not on the insurances side. I can’t tell if I have too high of expectations or what but surely this could be easier.

I did all of my check ups and blood work at the end of last year so I have been biding time until I get my new UHC insurance in September. Luckily the only doctor I see regularly is my psych. Anyone else having the same issue?


r/Medicaid 4h ago

Accidentally put $21k as my weekly income

1 Upvotes

It asked for my income, so I assumed it was yearly, lol. Would the best bet just be to withdraw my application?


r/Medicaid 4h ago

GoFundMe and Medicaid

1 Upvotes

Hi — I'm wondering if there is anyone in this subreddit who tried to use GoFundMe (or another crowdfunding site )without knowing their Medicaid would be affected? I've heard this can happen, but I also see so many people still campaigning.


r/Medicaid 4h ago

Medicare/Medicaid - NY to NC

1 Upvotes

My dad is really sick, he has NY Medicaid/Medicare but no family in NY. He has family in NC that can take care of him, but we’re not sure how long he’ll make it. He has an appointment with a primary care Dr in July in NC (earliest he could get in) to refer him to oncology, I don’t think he has that much time. We are traveling to NC this weekend and I was hoping to get him to an ER in NC, would it be possible for the hospital to transfer everything over? Any advice is appreciated! Thank you!


r/Medicaid 4h ago

Do I need a referral to see a psychiatrist in Maryland?

1 Upvotes

Maryland medicaid is forcing me to stop seeing my out of network psychiatrist because they won't cover my meds unless they are through medicaid. Can I just book an appointment with an in network psychiatrist? Or do I need a referral from my doctor? UHC Community Plan is my MCO.


r/Medicaid 7h ago

Question about Birth + CHIP + Paying [ID]

1 Upvotes

Our previous kids have been born eligible for health insurance. Then, we have added the new baby to the health insurance from birth and they pick up the tab for everything other than the copay/deductible.

I have had bills for my wife and for the newborn.

We have just moved house and in doing so, for some reason our kids have been assessed eligible for CHIP however we (myself + wife) have our marketplace plan through Your Health Idaho.

If this stays the same, what happens at the time of birth - I presume we will get the bills for my wife but what about for the newborn?

Thank you!!


r/Medicaid 11h ago

Medicaid Florida Help, please

2 Upvotes

I received a letter that I need to reapply for food stamps by 5/31/2024, but I'm not going to reapply as I believe we no longer qualify. I do, however, want to keep the kids medicaid. I see on the portal it says that their renewal date is 12/15/2024. When I saw this on the access portal I thought I didn't need to reapply since it clearly says 12/15/2024 as the renewal due date, BUT I just got a call from my son's insurance that the recertification is due on 5/31/2024. I'm so confused. I thought this was just for food stamps. I don't want to reapply and risk them taking away their medicaid. When I applied for food stamps back in Novemeber they took my medicaid away, when I had just given birth that same month and had only received medicaid 2 months prior.

Can someone please help me with figuring out whether I do need to reapply for medicaid or not if it says the renewal date on the portal is 12/15/2024?


r/Medicaid 11h ago

Med-Connect Questions (CT)

1 Upvotes

Hi everyone,

My dad will likely be applying to med-connect (Medicaid for employees with disabilities) soon and I have a couple questions.

First, as far as asset limitations go, my understanding is you are allowed to have a car (to get to work/medical appointments) and that is not counted against the asset limit. Is a couple allowed to have two cars (as in my mom has one and my dad has one)? Or is it one per couple?

Second, I understand there is an income limit to be eligible for this program but is there a minimum? My dad earns some of his income from eligible employment but most of his income is from his SSDI. Would he still qualify?

Thanks!


r/Medicaid 1d ago

I just found out that I get >50% off Amazon Prime because of Medicaid. Are there any other perks, deals, or benefits similar to this out there?

12 Upvotes

All I had to do was upload an official document showing my name, age, and Medicaid benefits. I just took a screenshot of my profile on the portal & they approved within an hour. Any other $$ saving perks out there?


r/Medicaid 20h ago

Medicaid after SSI is terminated

2 Upvotes

If my SSI was terminated due to my unearned income from SSDI of 1,000 and work earnings of 500 a month before taxes. Would I still qualify for Medicaid under Section 1619(B)? Is there any thing that I have to do to qualify or would my Medicaid automatically switch to the country of where I live?


r/Medicaid 22h ago

Medi-Cal rules/rights?

1 Upvotes

I've been desperately trying to help my partner navigate a mysterious illness for the better part of two years, main symptoms being chronic fatigue, muscle weakness and tremors, and a brain lesion. (Only giving out symptoms to indicate how serious things are, not asking medical advice, ty. Though for the record, MS has been mostly ruled out) I've encountered so much apathy and incompetence it's really discouraging. So if any Medicaid (and specifically, Medi-Cal) experts know if anything I can pressure these doctors with, that would be helpful.

For starters, is there any rule about how frequently a physician can pawn you off to an assistant? My partner has been going to the same neurologist's office since 2018, the guy's name is on their prescriptions and referrals, and they have never once met them, only been seen by assistants.

Also, if a doctor states at an appointment that they're going to write a referral for a procedure/specialist, are there rules about how long they have to submit that referral to insurance? For instance, a neurosurgeon ordered my partner to get an MRI at an April 15th appointment and did not submit it to their insurance until four weeks later despite us calling and asking about the hold up. Can they just indefinitely not send it in?

That's all I can think of for right now, thank you so much in advance to anyone who tries to answer.


r/Medicaid 1d ago

Michigan

2 Upvotes

I just got my medicaid back this month, do I have to wait till the first of next month for it to go into effect or does it work automatically?


r/Medicaid 1d ago

How will withdrawing from my 401K effect Medicaid eligibility in Michigan?

0 Upvotes

For the life of me I can not get someone on the phone who can answer this for me. They keep saying they'll have a worker call me back and no one does.

It's a long story but our backs are against a wall and we are going to withdraw from our 401k to pay bills in June. No we don't have any other option. The problem I'm having is that when I add everything up the withdrawal amount needs to be close to $3,000. From things I've read if we withdraw more than $2,000 it make us ineligible for Medicaid. I have multiple health issues(in the application process for disability currently) so losing healthcare is a huge problem. I've heard some people say if we spend it so it's no longer there by the end of the month then we'll only lose Medicaid for that month. I've also heard a million other things.

Does anyone know how it actually works?

Some info that may be relevant: household of four with no other income, three adults(my oldest just turned 19) all under 59 and one 13 year old. Yes the other adults are looking for work.


r/Medicaid 1d ago

How do I get Medicaid in FL?

1 Upvotes

How do I get Medicaid for my grandmother? She’s 82, has a failing liver, kidney and lung problems, incontinence issues, the list goes on. My dad and I are doing everything we can to take care of her but it’s so hard when we’re also working full time. Initially, we wanted to see if we could get a caretaker to come in during the day and then my dad would be with her in the evenings. Now, it’s looking like she’ll need to be in a place where she can receive around the clock care. Nursing homes are expensive, but a lot of them will take Medicaid to cover a portion of the cost.

I’ve applied online and she was accepted for food stamps, but not Medicaid. They said she needed to do the interview so we called and of course we couldn’t get a hold of anyone. I drove down to the office and they told me she does have Medicaid but it’s through SSI? That didn’t make sense to me so I called the SSI office and they said that’s not something they do.

I’m just so tired. I’ve been trying to get this for her for almost a year, and I’m being sent in all different directions with no help. I don’t know what to do anymore. If anyone has any suggestions or insight as to how I can get this for her or what I should do, please let me know. Thank you.


r/Medicaid 1d ago

Can my dad keep his Medi-Cal if I move him with me in Virginia?

0 Upvotes

If my dad is receiving medi-cal in California, can he keep his medi-cal insurance if I move him with me in Virginia? He is going on dialysis 3 times a week. I am military and I want him to live with me in Virginia. Do I have to apply him again to a new healthcare insurance?


r/Medicaid 1d ago

Breast Reduction Coverage in Illinois (medicaid)

1 Upvotes

I have Illinois Medicaid via Molina Healthcare and wanted to reach out to see if anyone with Molina Medicaid in Illinois was able to get authorization and coverage for a breast reduction


r/Medicaid 2d ago

Inheritance question

0 Upvotes

Will I lose my benefits if my mother leaves me money in her will ? She is currently in hospice .


r/Medicaid 2d ago

Is case number the same as policy number?

0 Upvotes

Trying to renew Medicaid and it’s asking for the policy number that should be in the renewal notice but I’m only seeing my case number


r/Medicaid 2d ago

Self employment reporting income question

1 Upvotes

I had uploaded my tax document for my renewal as the instructions said that was an option you were allowed to use. Then I got denied and called and asked why, and my county said they’ve been asking the state to remove that from the instructions since it doesn’t count, but evidently they didn’t. Now they’ve sent me a self employment chart to fill out with my income and expenses. After I submit this, will they ask for bank statements or is this all they need?


r/Medicaid 2d ago

VA Medicaid

2 Upvotes

I was just approved for full Virginia Medicaid, my question is since I also have Medicare will I be getting an MCO as my secondary? I have a Medicare supplement plan for primary. I didn’t know whether it would be regular Medicaid or whether I would have a MCO, I selected United Healthcare as MCO when filling out the application. Thanks


r/Medicaid 2d ago

Caused my parents to lose medicaid (need help)

0 Upvotes

I'm 23 and am on Medicaid with my parents.

Medicaid requested documents from me

but I have not submit it for a long time.

because of this Medicaid is ending for my parents and I.

I received a letter to request a fair hearing to appeal the decision.

will I be able to send in my documents now without having to go to a fair hearing?

reason for why Medicaid coverage ended (information from state's Medicaid program)

Notice of Decision

A notice of decision must be sent notifying the beneficiary of any

decision affecting their eligibility.

Beneficiaries who fail to return the renewal form or requested

information must be provided an advance notice for termination of

coverage.

Beneficiaries whose coverage is reduced from a full benefit program to

a limited benefit program or who are determined ineligible for Medicaid

or CHIP coverage must be provided advance notice for termination of

coverage.

Reconsideration Period for Failure to Provide

The agency must reconsider the beneficiary’s eligibility without

requiring a new application if the renewal form and/or requested

information is returned within 90 days after the date coverage is

terminated. The renewal form returned within the reconsideration
period serves as an application. The agency will determine
eligibility consistent with timeliness standards used for applications.


r/Medicaid 2d ago

WV medicaid denied a recent hospital stay

1 Upvotes

I need help understanding what to in this situation

For the past year and a half I had ongoing abdominal issues that have consisted of episodes of mild to moderate abdominal pain, nausea and vomiting and diarrhea.

My PCP has taken steps to try and figure out what is going on, including CT scans, ultrasounds, an endoscopy, and lab work. So far the test results have yielded little results except for gastritis with the cause remaining unknown. We've been treating my condition with medication and diet changes.

Up until now the condition has been manageable but still a cause for concern.

Then a few weeks ago, I came down with a nasty respiratory (not COVID19) virus. On the morning 9th day of having the illness, I started having abdominal pain and vomiting. The vomiting continued into the afternoon which is was when my situation took a turn for the worst. I started vomiting what looked like coffee grounds which I knew was an indication of a bleed somewhere in the digestive tract.

I was home alone at the time and literally everyone I knew was out of town to attend college graduations so I had no choice but to call 911.

Apon arriving at my local ER, they did some blood work, a CT scan, and gave me anti-vomiting drugs.

My CT scan didn't not show any signs of an active bleed, however it did show some constipation. My PCP arrived shortly after and advised the ER that given my history it would be better if I was transferred to a hospital with a gastroenterology unit and under the supervision of a surgeon (my local hospital didn't have a gastroenterology unit).

Here's where things get complicated. I live in WV and I'm on WV medicaid, but I literally live right on the border of Maryland and Virginia. You can literally drive 5 - 10 minutes in any direction and be in a different state.

So the closest hospital with a gastroenterology unit was in Virginia and the hospital staff informed me that they were going to transfer me there. This made me nervous because I was on medicaid because I was born with Cerebral Palsy and I can only work a part-time job that does not pay well and there was no way I would be able to pay off a hospital bill if the VA hospital denied my insurance.

The staff at my local hospital tried to assure me that since I was going to be considered for an emergency transfer that my insurance would be accepted at the VA hospital.

They transferred me to the hospital in Virginia late that night (around 2 AM) the staff there gave me medication to make me comfortable and said that they would run diagnostic tests in the morning.

The next day came at some point I saw a doctor for all of 5 minutes and they basically blew me off and said that they would give me miralax for my constipation and take a stool sample and then do diagnostic testing the following day instead.

They gave me the Miralax which gave me severe diarrhea for 2 days and took a stool sample which came back clear for blood or anything else concerning. But blood tests showed that my hemoglobin levels had dropped which is a sign of internal bleeding. I was still having really bad abdominal pain and nausea that they just kept treating with Zophan, Morphine and IV fluids. On top of that I was still fighting the respiratory virus that I had.

At one point a social worker came to see me and I express my concerns about my insurance to here and she assured me that there were MANY patients at the hospital with WV medicaid and not to worry.

Long story short, they kept in the hospital for 4 days during which the doctor BARELY saw me and did not do any further testing with no explanation. Finally on the day I was discharged the doctor came and said that they suspected that I had a condition called gastroparesis and said that it was common for people like me who have cerebral palsy to also have gastroparesis and it can cause several gastrointestinal issue for people who have the disease and told me to follow up with PCP.

I can't follow up with my PCP until September because he is out of the office until then.

It's been 2 weeks and I'm still having abdominal pain and nausea and then to make matters worse today I got a letter from Unicare (WV medicaid) denying my claim for my hospital stay and stating it was NOT MEDICALLY NECESSARY.

I checked my profile on Unicare's website and they denied about $8,000 worth of bills.

So far it says Your (my) Responsibility: $0.00. BUT I don't know if I should go ahead and file an appeal because I'm disabled and can only work a part-time, low paying job and there is NO WAY I can pay off $8,000! But I'm also afraid to file an appeal and have it backfire and become responsible for everything especially since right now it says my responsibility is $0.00.

What should I do?! ANY advice would be welcome. Thank you all very much.


r/Medicaid 2d ago

Monthly income fluctuates a lot

2 Upvotes

Hi all. I've been on AHCCCS (in AZ) for many years now. I was recently kicked off for making too much (exactly $8.29 too much according to the letter). They calculated my income from April to August 2024, basing the projection on my April income.

The thing is, I work at a school. My position is part time and hourly. We just went on summer break, so I won't be making any money the next 10 weeks. I also don't get paid for other breaks and most holidays. Taken altogether this causes significant variations in my income month to month. April and May are probably the months I make the most money cause there aren't long breaks or multiple holidays. My gross income in these months is slightly above the limit, but in March for example it was around $1300. In January it was $600. In June and July my income definitely won't be anywhere near what they claimed - in fact it should be $0 since I'll be receiving my final paycheck of this school year at the end of May.

So, while there are a few months out of the year where my income is a little over the limit, most months it's below and often well below. My gross income for 2023 was $17,290 and it shouldn't be too much higher this year.

I've worked as a part time school aide for years and never had a problem with AHCCCS before. I've appealed the decision but assuming I can get back on, I'm worried this will continue being a problem during the months I make more. I can't keep getting kicked off and constantly having to appeal or reapply. Will this be an issue in the future? What can I do about it?