I had Medicaid and now I was dropped. What the heck do I do?

Don't panic.

There are lots of proper American posters on this forum who really do know Medicaid inside out. I expect they will have a number of questions for you but there will be good answers.

Your profile says you were sent a letter but didn't receive it in time; so I'm guessing that you've been taken off Medicaid because you didn't reply to some critical form or other. If you had received the letter, would you have been okay with whatever the form was? How did you find out that you had been removed from Medicaid approval? What conversations have you had with anyone about it?

I'm sorry I can't be more help, sit tight just for a little while...

You did not receive a letter?

In what way did you discover you were dropped?

There are posters who know about Medicaid, so Countrymouse is correct, don't panic, and sit tight.

Plan to make some important phone calls, and obtain documentation necessary to make an appeal.

Call your doctor about your medication issues, maybe they can help.
Doctors can access the insurance coverage and print that out.

Hoping this is all a mistake that can be solved by re-submitting Rx through the pharmacy.

Go in to your local Department of Health & Human Services. You could call first, but experience tells me that going in will yield a better result. Take documents with you that determine eligibility for Medicaid, such as Social Security card, current lease, utility bills, and bank statements for the previous 6 months.

You missed a letter, I'm thinking, for your re-de, or redetermination. Since they didn't redetermine you to be eligible, you are discontinued.

It's a pretty straightforward fix -- if that's all it is due to, that you missed a re-de letter -- and there is also retroactive payment for appointments in my experience. I'm not sure if medicine costs would be reimbursed or not. This is something you could ask in person when you meet with a case worker.

Assuming that your doctor has approved the medication for you, and assuming the pharmacy had processed the claim to Medicaid, YES, as Ali has said, appearing to the Department of Health and Human Services will quickly get you the answers as to why you were dropped, a print out of your coverage now, and help to file an appeal. In that case, you will not need to call the doctor first.

If the imediate need is getting your meds in time, (so as not to be in withdrawal),
can the pharmacy just bill the Medicare Part D? Assuming you have Medicare.

Today is Thursday, go in about one hour before the DHHS closes, today, now.
Even with anxiety, you can do this.

Medicaid here comes from the Social Service agency. I guess by letter you mean your yearly recertification. Call the person who signed the letter you just received. Tell them you never received recertification info. They may allow you to fill out now.

Hoping the OP returns to clarify....
She did not receive a letter?

MJP1958 says on her profile:
About Me
For 60 years old Im in good shape except for a car accident in March that may need me to get a hip replacement. My medicaid was dropped. I never recieved a letter in the mail and now Im just worried as hell. I need the help. I have depression, axnsiity, just hurting and cant get my meds now.

Another source of paying for care and medications is the lawsuit, (if there is one,) if you were not at fault in the car accident. Receipt of income from a lawsuit can render one ineligible for Medicaid for a time, imo. Your attorney should know.

We need more information from MJP1958.

I really am concerned for patients who cannot get their medications and timely.

The scrutiny on pain meds is so grueling that (just guessing here) maybe the powers that be decided your time is up receiving pain meds for your condition
and the doctor, the pharmacy, and insurance has decided to cut you off.

Is your current address up to date?

1958....most likely does NOT have medicare so no, part D cant be billed.

MJP, hope you took the advice to call your local Medicaid office. There is a glitch somewhere that can be taken care of. Please, get back to us on what happened. It may help others.

Were you correctly dropped? If you understand why and it was correct, then talk to your prescribing physician about what to do. Free samples? Arrangements for discounts from the drug manufacturer? But be sure you were correctly dropped first.

MJP, First let me say I am sorry for your stress and situation. I get it. Here in NC the Medicaid process and recertifications are very strict and inflexible. So missing dates or late paperwork cause major issues quickly.

I have two medically fragile children and am disabled myself. I deal with Medicaid constantly and have for over 15 years. Beyond that I had to deal with the business side of it as a practice manager. The whole system is chaos. So "glitches" are all too common.

Adult Medicaid in NC is generally alloted in 6 month blocks. For children 15 and under its 1 year. Typically 60 days before the last day of coverage a letter is sent. Some workers will send a second letter if they get no response but not all. I have made it a practice to mark my calendar for when I anticipate paperwork and call when I do not see it timely. I have had mail go into the wrong mailbox, but addressed properly, all the way to Medicaid mailing letters to an address 5 years old that had not been used a single time up to that one letter. So the margin of error is huge.

1st, lets get those meds asap. You have a few options but like another poster suggested, the quickest most immediate one is to see if your doctor has samples they can provide. Sometimes they even have vouchers that will give you one month supply while things are worked out. If they don't inquire if his/her practice employs a social worker. If they do, that can give you a jump start. DHHS tends to sit up and listen when a medical social worker calls.

If the medications are mental health based, hopefully you have access to a mental health walk-in clinic that may have the ability to provide emergency meds. Even your pharmacist may have some resources for you. In fact my pharmacist will give me an emergency supply, (usually 7 -10 days) while the insurance issue gets resolved. As long as a valid prescription exist, they may be able to help a small portion especially for critical ones for mental health, heart conditions, diabetes etc.

Not all retail pharmacy locations allow this, so having a good relationship with a pharmacy manager helps. Its why I always advocate to avoid jumping from pharmacy to pharmacy. Now don't be surprised if they say no. Medicaid paid claims are a a touchy matter, as Medicaid pays them "very slowly", to begin with.

Regardless of what type of Medicaid you had, or how you qualified, the quickest solution if a phone call doesn't fix it, is to physically go into your local Department of Social Services office. Aside from an accidental "hold placement" on your active status, the dreaded visit is best. If you are still able to appeal the discontinued service, do so. There is a deadline for that as well. If you have missed it, you are starting from the beginning sorry to say.

If you have access, try to download the necessary forms and take them with you. They will also have listed the information that will help you qualify. I have learned this process to near perfection due to a continuous need for it. but that doesn't mean I haven't been in your shoes. It happens.

Hey maybe this will make you smile. This year I finally qualified for adult Medicaid on top of my Medicare. I was thrilled as I have been in desperate need of dental work. With sick kids I was unable to get to it until close to the end of the 6 month coverage. The day of my appointment I got a letter saying the decision had been reversed. I never saw a single notice asking for information. It came out of the blue. I knew it was bull because my award letter was from June 1, 2018 to October 31, 2018. The reversal letter said the benefits were "retro-reversed" back to April. Now how can the take away a benefit that was not even awarded yet. That was the states way of making sure any claims that occurred back in June did not have to get paid at all. Instead they automatically placed me back to Medicare premium coverage only.

Hang in there. -Pamela J

Did they tell you why you were dropped from the system? Depending on the state you live in they can NOT just drop you without a valid reason and notice. Did you call them too find out the heck is going on. I would definitely be on the phone trying to figure it out. Medicade isn’t allowed to drop anyone without a valid reason. Did you maybe forgot to send in some paperwork that they needed to update your account? I am just trying to think of anything that could help you. I hope you can call them and get this fixed. I am trying my to think about anything they could have sent you, check it. Maybe a simple signature was missing??
Call them and ask them as too why this happened.
I really hope you can get everything straightened out. I am sort of in the same situation with the exception of waiting for SSID too make a decision to keep my benefits. I am going through a review. So I completely understand what you are going through.
Call them and don’t give up until you get your benefits back!
Best of luck to you.

If you were dropped, you either missed a renewal deadline, a filling deadline, or were deemed as having too much income or assets. You need to contact Medicaid directly to get it sorted out. If your medication contains narcotics, such as opioids, physicians are not allowed to give out free samples of them by law. In fact, the drug reps who visit the offices are forbidden to supply them with samples of narcotic drugs - so the physicians would never have any on hand to give.

Contact your Caseworker who is Handling your Medicaid and Go in and Find out what this is All About.

If you really are dropped... get a $99.00 premium Sam's Club Membership. The medication without insurance is sometimes cheaper than with insurance. Some generic medications are free. If there is no Sam's Club near, check out Costco, & Walgreen's to see what they offer for people without insurance. Good luck.

You can get lower priced drugs through GoodRX.

MJP is not responding.

MJP, please get back to us with what you have found out. 😊

CostCo may not always be the lowest-price source for your prescription medications, though often they are. 

Start by subscribing to an email newsletter from Good Rx (https://www.goodrx.com). Enter your medications and respective dosages; they'll show you a comparison among five area pharmacies offering the lowest prices.

I recently applied to Rx Outreach (https://rxoutreach.org/patients/), an online pharmacy. Their application is super simple, not labor intensive. Just add your credit card data, take the application to your doctor, and your doctor will write a prescription for 90- to 180-day supplies and submit it to Rx Outreach. They will be sending several of my prescription medications at considerably lower prices, either to me here at home or, in one case, to my doctor's office for pickup.

Visit Needy Meds online (https://www.needymeds.org). They are a fantastic, comprehensive source of Patient Assistance Program applications. They directed me to the manufacturer of my most-expensive prescription medication. That pharmaceutical company's application was nine pages long and more than moderately labor intensive. Your doctor will have to complete one of the pages and sign another. It's been two weeks since I submitted my application to the pharmaceutical company for financial consideration, and I have heard nothing from them; so I plan to place a follow-up call this week, to see where things stand.

Allergan (https://www.allergan.com/responsibility/patient-resources/patient-assistance-programs) is another valuable source for finding help for some of your harder-to-find prescription medications. Like Needy Meds, mentioned above, they directed me to the manufacturer—this time, of my most-expensive antidepressant. I downloaded and completed their application (a bit labor-intensive), submitted it, and am waiting to hear from the pharmaceutical company.

My ten months with Medicaid were an ABSOLUTE NIGHTMARE. They are a bunch of highly-skilled coverage deniers who seem to relish what they do. Between them and my insurance carrier (Amerigroup), I truly don’t know which is worse. I had to contact Amerigroup countless times by phone, for their intervention. I had to submit appeals for THREE denials of prescription medication coverage. One of them escalated all the way to the highest of heights, to an internal hearing and to an independent external fair hearing. Just coincidence? Shortly after the hearing ordered Amerigroup to cover the medication that had been in dispute for eight months—EIGHT MONTHS!—Medicaid dropped me. No warning, nothing. I went to my pharmacy to pick up prescription refills, and the cashier informed me I was no longer covered. After I called my insurance carrier, only then did I find out WHEN Medicaid had dropped me, but they couldn't tell me why. I am seeking advice now about the most effective way to mount an official investigation into both Amerigroup and Medicaid for what seemed to me to be highly arbitrary, heavy-handed, unscrupulous and even DANGEROUS business practices that show little regard to the very ones they are charged by our government to serve and assist. Phooey on Medicaid!

I wish you all the success possible. Unfortunately, Medicaid doesn't make things easier for those of us who need it. Though being dumped by them will increase the legwork you'll need to do for a while, you may ultimately end up with a much better deal from these various entities mentioned above. Let’s hope so anyway.

First question: where do you live (just zip code) and what is your age? There are additional rx benefit resources.
Thanks

You probably have too much money for Medicaid.... They look back 5 years....find an elder care lawyer and ask for help....

Medicaid is such a joke! I had a hysterectomy 12 years ago due to fibroids; the doctors were going to do another D & C, and those fibroids were so big, the only way to remove them was to have a hysterectomy. I had it, all went well, and the only thing I had to worry about in the hospital was use of the telephone, that was $10.00 which was pocket change. The hospital that I was operated in thought that my Medicaid was a joke! The US of A should follow Canada's example and become a socialized nation. At times I think the US of A is a joke!

Why were you dropped? They don't drop a person for no reason. They either found income you didn't report, assets you didn't report, etc. Before ur question can be answered the reason for why they dropped you needs answered as this will determine what is out there to help you.

MJP1958 is like 60, so likely on whatever community Medicaid program her state has requirements for low income Medicaid. She’s not on MediCARE, not an elderly parent in or needing AL or NH.

I’m guessing that Medicaid was dropped or suspended because there’s something going on from the auto accident.

If a hospitalization or health care was needed due to an auto accident and auto insurance paid towards care or a lawsuit was filed or a settlement paid, Medicaid needed to be informed. It’s now well over 6 mos, so payments have surfaced causing ineligibility.

For MediCARE there is now (like in 2010) a required “secondary payor notification act” and most states Medicaid follow what Medicare does for this as well. (Through CMS - Centers for MediCARE and medicaid- the services and payment history is just keystrokes to surface) So due to Secondary Payor Act, if her state does this and if Medicaid paid for care and later on state finds out that MJPs auto insurance did a copay to her or she filed a lawsuit or got a settlement from a lawsuit, then Medicaid must be reimbursement to the penny what they paid initially. If not, they are suspended or ineligible.

A better tort attorney would place the settlement into an escrow like account to use to pay any outstanding claims against the settlement and hold fund for a period of time. Like repay Medicaid what Medicaid paid for. $ left then becomes income month paid to MJP and then an asset the months after. $ could take her over her strict low income eligibility for Medicaid.

MJP if there was insurance claim or lawsuit you need to contact your atty or auto insurance to figure out what they paid & what you owe Medicaid. ASAP.

If this is due to Secondary Payor Act, a state can dog it down if they want to. There was a post on Secondary last year from an ex wife, the exhubs got 6 figure $ settlement from car crash. He was on MediCARE and daughter (with mental & dependency issues) was POA. Major hospitalization then into a NH & onto Medicaid, sounded quadriplegic situation. The settlement $ surfaced. Daughter MIA. State appointed guardian for father was looking for daughter & contacted the mom as to daughters whereabouts, as mom was prior address. Mom had to fill out a form as to her knowledge or lack of on daughters addresses. As they were divorced, she couldn’t be held financially responsible. Daughter in her 40’s was sadly decades of issues.

Contact the people at healthcare.gov or 1-800-318-2596 IMMEDIATELY. Assuming you are under 65, if you were dropped from medicaid because you have too high an income you may be able to get an insurance policy where the government pays the entire or most of the premium. There are cost savings possibly on deductible, and out of pocket maximim. This is why the affordable care act, aka obamacare, is so important. Everything depends on why you were dropped and the state you live in.

see a lawyer..now if you got married...get a divorce. Household income can get your coverage dropped. i know someone who divorced to get Medicaid.

You could pay for it?

I don't have the time right now to read through each response but have you called your Social Worker or the Medicaid office? They have to inform you of all decisions and judgements about you.

As for medications, go back to your doctor's office, explain the situation and ask if they have samples from the drug reps. Often drug companies will give small bottles or packs of the medicine they manufacture to give away so the doctor will prescribe their product.

Contact the manufacturers of the meds you take. They all have programs to help people who cannot afford their medications. Government is always the most expensive and least helpful solution for any problem. The reasons costs are so high now is due to government getting involved in the first place.

They could drop you if you got a settlement from an accident!

Dear JoAnn29: Your reasoning is logical, ethical, and, one would think, correct. But Medicaid “thinks” otherwise. We can say “thinks,” because what they don’t do is “feel.” Three weeks after I was dumped without written notice, I spoke to a kindly Medicaid representative in person. I told her that, thanks to Medicaid, I was both uninsured and uninsurable. “How is it you’re uninsurable?” she wanted to know. “Because I have no letter saying Medicaid has terminated coverage, so no other insurance carrier will touch me.” She said I should have received notice of termination, and I said she was right, I SHOULD have received such, but never did. The September letter inviting the insured to reapply and the October reminder letter merely threaten that coverage WILL BE terminated if … The representative was unable to believe no written confirmation reached me, so she checked. “I see we didn’t send you notice of coverage termination,” she said, whereupon she promptly printed one and gave it to me. Three weeks LATER—six weeks after termination—Medicaid’s letter finally arrived. By then, I had already been hunting for coverage for three weeks. What’s an abandoned insured supposed to do for coverage in those intervening weeks and months, before any coverage elsewhere—if you can get it—can begin? That question doesn’t much concern the good folks at Medicaid.