How does the Medically Needy Program ...

Dunedin, FL

#326 Dec 15, 2010
Kathleen wrote:
i feel you on that.....becuaes you are right
<quoted text>
Once your share of cost is met...which is only $5.00 then you are on straight medicade for the month! You dont need to say medically needy...just say you are on medicade...many doctors take me....I have gone through hoops this month to find this just need to talk to the right people....try works...not great but it will work...

Tampa, FL

#327 Dec 15, 2010
In Hillsborough Co., It's the same. My husband is a diabetic and has share of cost. No doctor will see him other than the free clinics and even then on a sliding scale fee. And you DO have to state share of cost. Medicaid is a separate insurance plan. Medicaid is given to people that fall under 150% below the poverty level. It is NOT a monthly plan based on a designated amt that you have to meet before Medicaid will pick up the rest. If your monthly medications meet or exceed your monthly amt, it is best to go to the pharmacy, have them send in ALL your medications for the month, and your share of cost will be met for the month. Sadly, it is best to choose pharmacies that are the highest priced as it will benefit you to run up the bill. I believe it would be more cost-efficient to put medically needy individuals on Medicaid, which would lower the state's expenses. Most have ongoing needs that due to NOT receiving ongoing care through doctors results in more ER and hospitalizations.My husband's diabetes will NOT go away, there is NO cure. He will require insulin for the rest of his life, NOT just a month.

Ocala, FL

#328 Dec 17, 2010
Former AHCA employee wrote:
Heather, what is your monthly income? No, you don't have to answer that but the reason your SOC is so high is because of your income. If you are meeting your share of cost each month, then there must be some reason that can't get medical insurance as that kind of money would pay for a really good plan.
Now, if you don't qualify for medical insurance because of pre-existing conditions, I'm sorry but the plan isn't there for to give medical help away, that's why you have to QUALIFY.
Now, all that being said, if you've squeezed DirecTv, cigarettes, booze, and Air Jordans out of your budget and STILL are having trouble, go back and get requalified, and ask to see a supervisor when you are done.
That last remark was so uncalled for .NOT ALL people on food stamps and medicaid live the good life.I have not had any kind of cable tv in almost 6 years since my husband became unemployed due to the housing industry going under. We now live off of my salary of 7.95 an hour 30 hrs a week with a family of 5. We get no luxeries I am lucky to pay bills and have 10 dollars to last me my 2 weeks for my next pay date.

Now all the sudden I am told my medicaid is medically needy and because I work and if one adult works all the adults recieve the MN program. WHY??? it is a waste of time they know i can not afford medical let alone afford to live and keep the kids fed and clothed. Cost of living and pay scale does not meet one another at all. Just hoping things change this year now that my husband is out of school.

Kansas City, MO

#329 Dec 21, 2010
hayvi wrote:
well, i have a share of cost of 310 and i've been to the hospital but i've faxed the bill to the medicaid billing office and they dont pay the bills. i have an unpaid bill for over a year
I also have same problem.
I have SOC of $1778 and I had Chemo and radiation therapy.
I faxed the bill, and I also sent all my bills to DCF office becuae they insisted that they have not recived the bills that I faxed.
Anyway, they haven't done anything.
they never pay my bill.
my balance is more than $50K cuase those treatments are so expensive.
Now the Chemo office forced me to pay my bills...

Hollywood, FL

#330 Dec 22, 2010
This is really insane I am a mother of 6 kids and they have taking me and 3 kids and put us on share of cost and my kids father and the other 3 kids stay with full medicaid. Please tell me where this make since.. I do not make enough money to pay this
Over it all

Saint Petersburg, FL

#331 Dec 30, 2010
Be happy your share of cost is low, mine is $3997.00 and Im pregnant so can't be seen. There telling me my income is too high and I have to pay every prenatal visit out of pocket and the only thing my SOC will cover is labor. I called a dr. office the first visit is 1400.00 then another one I tried calling Im soo pissed off about this I thought I had a Dr that could give me one lump some of 3k and have my SOC cover it but then the Dr. told me they don't accept SOC but they accept Medicade. WTF .. Im so frustrated and have been dealing with DCF for over a month and have got know where! Looks like my baby wont get a prenatal check up.. This whold system sucks I cant get coordinated child care or food stamps and now cant get insurance because im 22 and go to college and have a job ??? but If I was a crackhead with 8 kids I would get help ASAP. Maybe the moral of the story is dont try in life? Is that what there telling me?
Heartless-Crooke d

Grovetown, GA

#332 Dec 30, 2010
Hard to find a Doctor that accepts Medicaid. Never came across one that accepts share of the costs. Is there a list of them somewhere ?
Former AHCA employee

United States

#333 Dec 30, 2010
Call the Medicaid area office. They will Find you a doctor.

Bradenton, FL

#334 Jan 2, 2011
The share of cost program sucks big time.
my share of cost is $1252.00 a month and the only way that i can get any help is to go to the emergency room and make sure that the bill will be over $1252. even if it means lying to them and making sure i do it at the begining of the month, so that i can then go for a mamogram. a mamogram and ultra sound cost 472 dollars and i need to get this done every 6 months to monitor a lump and i can not afford this along with other things to be payed out just to survive in this county.
It would be less momey if the goverment was just to approve medicaid and issue a large co-pay for people who abuse it for a simple cold and seek treatment at the emergency room.
James and Wandy

Casselberry, FL

#335 Jan 4, 2011
We are in desperate need of a few name and numbers. Can you share your doctors info. with us. We are having alot of issues finding providers. We told them that it is medicaid/medically needy and they all say they don't except it. We even having problems with finding straight medicaid providers as well. We called Family and Childrens Service @ Tampa, FL, Our Area Medicaid offfice and well as medicaid office and all say we have to call doctors and verify if they take our insurances. So please help us out if you have some information on providers that do.
CHANEL wrote:
That's not true. I for providers in the Seminole and Orange county area that do accept Medicaid. You can't ask them if they accept Share of Cost. You have to aske them if they accept Medicaid.Maybe you need to research a little more, because I know for a fact that there are many providers there that accept it.<quoted text>

United States

#336 Jan 7, 2011
i live in escambia county,and just learned that i got medically needy with share of cost. im in bad need of a doctor and knowone will except me so i have to suffer with extreme amount of pain.and the operators on the phones at children and family are useless.and the website is useless to. can someone tell me how u get a doctor out here please.

United States

#337 Jan 14, 2011
I have SOC medicaid. My limit is $1000 a month. When I found a doctor that would take it, we found out that I no longer have it because i dont use a 1000 or more a month. I need to see a dentist, but can not find one that will take SOC medicaid. I get social security every month, and it is nowhere near a 1000 a month. I dont understand why my SOC is so high, and why I cant get any medical, dental, or vision help. I know people who do not work, have no children, no bills, and get full medicaid without a SOC. I was hurt in a car accident and am no longer able to work. Believe me, its not by choice. Why is it so hard to get help? I have worked since I was 14, up until 2 years ago. I need more surgeries, and medication, and can not get either because of this insurance. What are we supposed to do?

United States

#338 Jan 14, 2011
You do have to tell them that you have SOC. They will find out once they run your ss# and then they tell you that they do not take it. I knw this, because I have been through this countless times. It is not regular Medicaid, and you can not tell them that is what you have.
CHANEL wrote:
That's not true. I for providers in the Seminole and Orange county area that do accept Medicaid. You can't ask them if they accept Share of Cost. You have to aske them if they accept Medicaid.Maybe you need to research a little more, because I know for a fact that there are many providers there that accept it.<quoted text>

Clermont, FL

#339 Jan 16, 2011
Evelyn wrote:
I agree totally! I am having the same exact problem and it seems no one will help!
<quoted text>
well u tell me how it works ,cause my husband is diabetic and needs his meds

Lehigh Acres, FL

#341 Jan 20, 2011
What do you do when your share cost is high. My share cost is $1500.00.How do i met that at doctor's office.Most doctor's office on charge a few hundred dollars.

Bethesda, MD

#342 Jan 26, 2011
I'm enrolled in the medically needy program and my share of cost is $1,026 a month. I have end stage kidney failure and I need to take medicine for the rest of my life. I really do not go to the hospital for anything at this point only everyfew onths for my normal followup. My question is does this share of cost program only good for hospitals? Or is it good for prescriptions too? I just moved to FL from up north a few months ago and I have had nothing but problems after problems with my prescriptions at CVS. Since I've been here I've had to pay over $100 a month for my medicine when I didn't pay anything more than my $2.50 co pay for each medicine up north. Can someone please help me understand this. Also when i call DCF I can't through to anyone...It's very aggrivating...Thank you

Bethesda, MD

#343 Jan 26, 2011
Does my pharmacy or I have to fax over the list of medications over to medicaid every month. And also when The medications are faxed by either myself or the pharmacy to Medicaid is it?, What happens next? Does Medicaid pay the bill and your Doctor is then paid? I just want to understand why I've heard of bills not being paid therefore being stuck with a huge bill and being in collections. Who is the final point person that has to get paid? The doctor?

Bethesda, MD

#344 Jan 26, 2011
Diane wrote:
I agree with all those that think this program is insane. MY soc is $1036. I only make 1236.00 per month on disability. I have many physical problems and am dealing with a mental condition as well, so In my eyes , I have basically no coverage worth a damn. And I am stuck. I was on Health Care District which paid for everything, but the minute they found out that I was receiving disability, They canceled me, and that was 6 days prior to a sugery I was booked for. Somebody needs to take a 2nd, 3rd, 4th look at what they've gotten us into, and soon. God help us all!!

Jacksonville, FL

#345 Jan 26, 2011
My fiance has cancer. His share of cost is around 970 as he is on ssdi. Since chemo is expensive he meets his share of cost on his first treatment. He makes sure his 1st appointment is on the first few days of the month, he goes in every week.

His chemo is done in a local private hospital. They bill him on his first visit and THEY send the bills to dcf. Takes about 3-5 days for his medicaid to kick in.

Yes, it is medicaid. He called his other docs and the pharmacy, imaging, etc. They all took it as medicaid and did not ask if it was soc nor did he tell them. He piled up on his meds as much as he could, as medicaid does limit how many scripts you can get. He is set for the month. Actually it has been a breeze as far as billing hassles.

Of course he is lucky that a) the hospital he gets chemo in is willing to bill him (they know he will meet his share of cost) b)the hospital really sends the bills to dcf unlike some facilities. He has had no problems with it and has not paid a dime.

I know this does not work for everyone as some people cannot meet the soc with an occassional docs visit.
Medically needy

Hollywood, FL

#346 Jan 29, 2011
Educated In Orlando wrote:
oh, forgot to mention the cost of living to top it off is alot better in iowa too. SO HOW CAN YOU LOOSE BY NOT MOVING!!!
Simple: most people would rather forgo health insurance than live in a fly-over state! eh BTW, I would love to know how a person receiving "full/straight Medicaid" in NY suddenly becomes "medically needy" when said person moves to FLA. The income is still the same. So how can one receive too much SSI/SSDI? LOL!

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