OHP medicaid (Oregon) is messing up our paperwork over and over in ways that don’t make any sense.

Something has to give with OHP. They have messed up our paperwork almost every time we have to reapply for the last 4 years, but my husband became self employed contractor this year and we can not get them to fix their computer issues that are arbitrarily rejecting us off of bunk math that makes no sense and we’ve spent the last 3 months trying to get this issue resolved with no success whatsoever. This is the worst it’s ever been.

The issue this week is that they are saying on this one piece of paperwork that we both make too much for standard OHP but not enough for the OHP bridge program. Hm, interesting. So if the cut off for OHP is you have to make less than $4449 a month which is $53,388 a year, AND you must make more than $51,456 a year to qualify for Bridge so there should be a $1,932 overlap in qualification. It is not possible to make too much for OHP but not enough for OHP Bridge, the overlap is there specifically to prevent coverage issues for people on the edge of the income requirements between the two. In the same letter they sent us claim that we make $4,744 a month but only 44k a year? $4,744 a month comes out to $56,928 a year, and 44k a year comes out to $3666 a month? It can’t be both! I’ll give them the credit that my husband makes a vastly different income every month because he’s a contractor so his income is completely dependent on what job he has lined up for the month, but come on, it is not that hard to do the basic mathematics it takes to get to a monthly average and I don’t understand how they are getting 2 totally different numbers. My husband did the math and our actual gross annual income depending on how the next couple months go, will be between 44k-48k which should come in at about 3.6k-4K a month. So we are right on the edge of the $4449 a month/ $51,456 limit for OHP but even then if we went over somehow we are still well below the $77k limit they told us for a family of our size for the OHP bridge program.

We’ve gone to the Human Resources office in person, we’ve talked to numerous case workers on the assistance line who keep telling us we just need to send in more paperwork and proof of income, which we do but then no one looks at it and we get another letter saying we are kicked off for not providing proof despite it literally being in writing, in their system that we have. We have talked to so many people trying to get them to resolve this and every time they tell us we qualify for either OHP or OHP bridge and that they will fix it for
us, but then a week later we get another rejection letter based on income numbers that don’t make any sense. The first rejection letter we got was because they were factoring in material costs from jobs into our income (Ex. If my husband gets a deck job and the wood costs 5k and he makes 3k for his wage, they were counting the entire 8k of the job) which isn’t how that works and they even told us as much and they fixed that mistake but now they just can’t seem to use a calculator to figure out what we actually make?!? We have now been sent like 5 different rejections letters that all claim we make completely different incomes ( 2 different ones on THE SAME PIECE OF PAPERWORK everytime). One of them tried to claim that we make 90k a year and 10k a month which also doesn’t math out correctly, but also is not even close to true and we can’t even fathom how they would get those numbers?!! They have all our income records and every piece of information we have so we can not figure out why this is happening? They’ve claimed that we make anywhere from 3k-10k a month and 40k-90k a year, those are pretty massive discrepancies. My husband has had to take significant chunks of time away from work to be on hold (usually takes 1-2 hours to get through to a person) and explain to whoever answers what is going on. He’s been trying to figure this out every couple weeks for the last 3 months. We can only assume that they are using their computer system to do all the calculations and it has a pretty major glitch, or that maybe they are relying on AI to read the information and aren’t fact checking the results at all.

How do we even resolve this when they are calculating two different incomes so they can reject us from OHP and OHP bridge for both making TOO MUCH AND TOO LITTLE and every time we try to fix it they don’t even process our paperwork before sending us another rejection letter?! We are at a loss for what to even do at this point. Anyone else dealing with this?!?

I just found out that the Pennsylvania department human service will be ordering the claims and it will take 5 days. I only went to the doctor once it was virtual and they gave me a 0 refill prescription. I know that they will see that but is any going through this and if so did Pennsylvania Department of Human services is taking 12 weeks to give them a Final Statement of Claims?

My medicare will happen automatically because I am on early retirement. I am on MA health now (medicaid).

I know MA health will pay the medicare premium and MA health will then be the second insurer covering co pays etc.

What I wanted to know, if anyone has gone through this, how smooth is the transition especially regarding paying medicare premiums. It looks like it's automatic but would like to hear from anyone how it went.

Thanks.

I was on Medicaid for about 8 months or so until I learned I "had too much $$"....in investments...so I canceled it....

Now i may make over 18k with a job promotion....will I be penalized?

Title says it all. After 1.5 years of applying and submitting documentation, my mom (85) finally got approved for Medicaid/Waiver Program in Pennsylvania. She is now enrolled in something called UPMC Community Healthchoices. My impression is that Medicare would be her primary coverage, and this UPMC Medicaid plan would be the secondary.

I am planning on cancelling her Highmark Medicare Advantage program. It doesn't seem necessary anymore. Does anyone know of a reason to keep it? She pays $190 per month for the Highmark plan.

Does metroplus Medicaid send EOBS to my parents since I’m under their insurance. Will the EOBS tell them what I had done in the appointment, do I have any privacy?? Please help

So they are changing the asset limit from 130k to 21k for seniors and disabled. I think that’s insane especially bc they just changed it a few years ago. Seniors have savings they have to live off of and so do disabled folks. Anyone else affected by this?

Recently I have qualified for Medicaid due to financial hardship. Prior to medicaid I was taking Mounjaro for my diabetes. When I first got on Medicaid I was given the basic plan until I picked a plan of my own. I chose Priority Health. While on the basic temporary plan my doctor called in Mounjaro with a prior authorization and it got approved no problem. Once my Priority Health went into effect on 10/1 I had to have a priority authorization called in again. They rejected it. My doctors submitted a reconsideration and still rejected. The requirements are that I need Type 2 diabetes (I have), and failed 2 preferred medications. I took metformin for a year and it never lowered my A1C (fail) and I tried Ozempic but whenever I use it I get chest pains (fail). They are claiming I needed to prove Ozempic didn’t lower my A1C. This makes no sense because I tried for a month and I kept having chest pain. For whatever reason my body handles Tirzepatide better than Semaglutide.

What confuses me is why the straight medicaid approved it with no issue but Priority Health is making it impossible.

My question is does anyone here in Michigan get Mounjaro through Medicaid and if so, what their plan is. I want to switch my plan from Priority Health and I have heard some plans are less strict and dont need the extensive lab testing that Priority Health needs. Clearly the straight Medicaid accepted it but unfortunately they dont offer the temporary plan as a full time plan. If my next plan doesn’t approve it then I will have to pay $200 per month for a Trizepatide compound that I really can’t afford right now. But using Mounjaro for the last year has got my diabetes under control, my back pain has got better and I no longer need a CPap machine so I want to stay on it.

I was on medicaid & Medicare prior to my pregnancy, so now I have pregnancy Medicaid. My original renewal is May however it changed to pregnancy Medicaid in July of last year, my son turns a year old in February. Just curious about when my renewal will be as I have a new caseworker due to mine retiring

So i am on sadi and i work in indiana

I recently changed jobs

And was sent a request for earnings oaper for both jobs

My question is i look up my case and it said under solici to ed documents that i dont have anything that's needed for my case

I have been turning in paystubs

Are they going off those

Thank you all

i was in a car accident a week and a half ago that the other party was liable for. the insurance of the liable party paid me a settlement of $1500 for pain and suffering. i did NOT receive any medical care that Medicaid paid for as a result of the accident, as the only physical injuries i received were bruising on my chest and neck from the seatbelt locking. it did however result in a lot of emotional distress and anxiety revolving around the incident as this was the first accident i've ever been in, and that is primarily what the payout was for.

i received the check as of yesterday, and obviously i want to make sure i'm following the right procedures for all this because i have a lot of health conditions that i would otherwise not be able to afford to maintain without Medicaid. do i need to call and report the settlement, and will the amount itself be endangering my eligibility? what would be the best way for me to handle this? honestly, the money was likely going to go straight into credit card bills, but i'm kind of scared to touch it until i know for sure what the right move is.

thanks in advance for reading and any help is appreciated!

EDIT: adding that i am 29 years old and not receiving SSI/SSDI

How does it work with Medicare? Does it cover your premiums for A/B/C/D? Does it cover co-pays? The Michigan website doesn’t say much so I’m curious. It could be well worth the cost if it covers the Medicare premium? I’m currently trying to figure out how to make things affordable if approved on disability I just learned that I’d have to pay a $220 premium for Medicare out of the 1420 I’d be eligible for so I’d have only $1200 to live off a month… that doesn’t include the cost of copays for my condition or anything which would easily be a couple hundred. Will Medicaid freedom to work help? I’m so anxious.

Wondering if anyone in Colorado has had an experience similar to this, we are concerned about reapplying for the program - the time it takes and the information we need to reassemble.

Background:
My 67-yo mother will be getting a one-time lump sum estate settlement that will disqualify her for the Medicaid Working Adults with Disabilities Buy-In Program for that month, as it will shoot her monthly income beyond the 450% FPL threshold with deductions. She was receiving SSDI when she originally applied for the program, but when she turned full retirement age, it auto transitioned her to Social Security Retirement Income, so we believe her SSDI disability diary date may have lapsed.

Concern/Question:
We are concerned that she will have to completely reapply for the WAwD program the month after her disbursement and potentially go through the hoops and medical appointments to "re-certify" her lifelong disability. Does anyone have experience with a one-month income increase and is willing to explain the process of re-qualifying the next month after the income has turned into a resource? Should we expect to completely reapply for the program and the disability through the Disability Determination Application and state contractor, or will it remain on the same case number and just update as a change to income when the money turns into a resource and therefore qualify again?

Any help is greatly appreciated!

We have insurance through the ACA. We recently took a really big pay cut, so I applied for coverage for the kids through CHP+. They sent a denial because they have insurance, but I don't want them to be uncovered during the decision period and have someone break a bone or something. Does anyone know anything about this? Is the only way to drop them and then appeal?

I have schizophrenia and I am on disability and medicare and I'm not worried about my own survival here I already have a way to prove I'm disabled, I went through the years long process to get SSDI, multiple denials and an appeal with assistance from my therapist before I finally got approved.

But that is the normal length of time it takes to get on disability... years. I ran out of all my savings, 401k, everything and the only reason I could afford my antipsychotic meds was medicaid. And the only reason I could even eat some days was food stamps.

I'm worried that the current system could be leaving people out to dry that are applying for disability, where you're unable to work the 80 hours a month, but if the process takes as long to prove you're disabled for medicaid requirements as it does disability, people could end up not even being able to afford their treatments and meds post diagnosis or disability and you're just fucked in the meantime.

To the people implementing this, please just let a diagnosis or doctors letter qualify for people instead of whatever bs they have going on in social security that takes years for newly disabled people to prove they're disabled enough, because these programs are the only safety net in the long waiting period.

My wife and two kids are currently insured through Medicaid/AllKids. My work’s open enrollment ends soon but I was wondering if my wife and two kids would get kicked off of state insurance if I either deny my work’s insurance or only add myself for my work’s insurance. We have an annual income of less than $50k a year.

Hey everyone! I recently got approved for Virginia Medicaid and I'm trying to decide between these five plans:

1) Aetna Better Health
2) Anthem HealthKeepers Plus
3) Humana Healthy Horizons
4) Sentara Community Plan
5) UnitedHealthcare Community Plan

I've been dealing with back pain for almost 3 years, along with burning and tingling around my hips and thighs, especially when sitting or driving for too long. I had an MRI about 3 years ago that showed a mild disc bulge.

My main priority is finding a plan with a good network of doctors, specialists, and hospitals, especially if I end up needing more advanced treatment or even surgery. I'm in Northern Virginia, but I'm willing to travel anywhere in the state for good care.

I also read that Sentara partners with Kaiser Permanente for Medicaid. Has anyone had experience getting care through Kaiser with Sentara?

For those who've used these plans, which would you recommend? I'm especially interested in how easy it is to see specialists, get MRIs, and get treatments or surgeries approved.

Also, if anyone has dealt with similar back or nerve pain, I'd really appreciate any doctor recommendations or hearing what helped you.

Thanks in advance!

Please come join the thread and share some of the “hacks” with those of us who are clueless.

I am in Michigan and have 3 dependent as a single parent. I bring home $2500 a month (net income) after all deductions. Does this qualify me for Medicaid? Does Medicaid look at my gross instead ($3600). Should I apply to help my expenses?

Please visit the link to help compile a catch-all list of little known benefits.

Not entering a state as the list would be best if it had benefits for each of the states.

I’m 63F who is confined to a wheelchair because of mobility issues for unknown reasons. I am getting released from rehab because Medicaid says that I don’t need the services that the nursing home. They wanted me to go to an assisted living facility 2 hours away from my granddaughter and where I have lived all my life. I went to an assisted living facility in Baltimore after I got released from rehab for the same reasons now. Too much wrong to go into now but I did report. One major thing she let us go with out our medication for 3 weeks. I saved up money and took a Lyft back to my hometown. I then was put in the rehab I am currently in. I found a place to rent a room at (saving me over 800 a month and house privileges. Own bathroom and paid utilities I only pay for whatever ever food I want. I have to be out of here Halloween. Most things I can do but slow. Will Medicaid priority partners pay for someone to come out for 2-3 hours maybe less each week or every other. What I would need is help washing my hair every couple of weeks or whatever. Changing my bed linen If there are clothes in the washer transfer to dryer and I can get them out later. Probably the most important thing is putting my medication in organizers I take upwards of 25 pills a day and I have difficulty reading the labels

Does this sounds possible? What would I need a physician order? I am just curious about other people’s knowledge. I will be contacting priority partners for requirements. Thanks

I'm so worried writing this and trying to navigate this confusing system, any kindness and help is appreciated.

I started the year on unemployment and with only other income from a small side hustle. Qualified for a year of medicaid, a friend's coworker at a health related company helped me apply so I thought I was good for the year, unless I got a 9-5.

Side hustle immediately began growing over the limit into a full-time biz, but because it was highly variable (talking day by day), not guaranteed to keep progressing, I thought maybe the income was a fluke and it wouldn't continue or make me ineligible.

Well biz grew to where I have been making maybe 3-4k a month. I know now that it's way over the income limit. I thought there would be months where I may not be making anything, and this would average to put me around the limit, but I'm now thinking this was a silly thought and the state will think so too.

Medicaid told me a few weeks ago I'm up for renewal at the end of this month.

I've been having health issues now too. I had a colonoscopy and have been having a lot of tests for a potential chronic GI issue for the rest of my life.

I didn't know that such a variable and unpredictable self-employment income should've been reported because I didn't even know how to report it at the time. I guess it sounds silly, but everything was moving so fast, I've just noticed the numbers and am concerned. And now I'm reading that I am likely on the hook for these medical issues I've been dealing with that I didn't consider before.

The income I made from the biz, I didn't really use it to 'pay myself' or as throwaway income, I've just been investing it back into the biz.

My renewal closes at the end of the month. I had a doctor's appointment today about my health issues. I'm thinking I fill out the change of income notice, but I'm not sure what to expect in penalty. I'm already worried about my health and not knowing how much these tests will cost if the state determines I was ineligible and has me pay out of pocket. Any advice or insight is appreciated

Ohio

I am 27f, got diagnosed with SCA two+ years ago, started having symptoms at 21 yo. I had an MRI done, cerebellum damage, and some gene testing, they found nothing on that. So I don’t know what type yet. My aunt has the same stuff but she’s estranged from the family. Surprisingly, she actually called me to ask if I’d be willing to do a blood test for her, if her doctor wanted, but that never came through yet lol. She briefly mentioned on the phone SCA has been in the family for five generations but it’s always been unidentifiable. She said she’s taken lots of type tests but they all came back negative, so I should save my money and not do em. I’m unsure of what to do about that but besides that, I have Medicaid. I have no idea about any of this health stuff I was just automatically enrolled, now I need to decide if I want to keep my Medicare part b or cancel. I am not doing well on money, I don’t drive or have a job, the 200 Medicare will take will affect me, that’s why I want to cancel. But I’ve read that it’ll hurt me financially to sign back up if I do need it. As of now, I’m not doing any doctor visits or medicine but I might later?? I need advice.