How does the Medically Needy Program ...

United States

#408 Jun 3, 2011
If your share of cost is only 5.00 as soon as you walk in the door you are covered. Therefore you are on straight medicaid so as soon as you meet your share of cost you need to tell them your on straight medicaid not share of cost medicaid. An easy way to meet your share of cost is every 1st of the month if you have any prescriptions to fill do that asap and then you are automatically covered from the first of the month til the end of the month and are on medicaid not share of cost. Most doctors usually take medicaid but not share of cost

Columbia, SC

#409 Jun 3, 2011
Could the Represented of the County that we live do something, who should we go to get help and amends these new issue?9878
Carol Jennings

United States

#410 Jun 4, 2011
Does anyone know of a Rheumatologist in Seminole, Orange or Volusia county that takes Medicaid?

Diane Anderson

United States

#411 Jun 4, 2011
I too need to find 2 specialists.

Ear nose & throat docs are impossible to find except in Jacksonville. Anyone know of one in Orange, Seminole or Volusia in Florida?

Also a Neurologist.

Thank you.

Jacksonville, FL

#412 Jun 14, 2011
WTF??? I had insurance when I got pregnant, but the insurance I had didn't have maternal coverage in Florida. And because I was already pregnant no other insurance company would enroll me because pregnancy was a pre-existing condition. So I tried to get medicaid because I can't afford it out of pocket. They put me on medically needy with a share of cost of $3627. Yea thats right. I've called every doctor in Duval and no one would take it. No one. They said I got share of cost because my income was too high.(Which I still don't understand. My husband is the only that works, and he doesn't make that much) And that I would have to go over that amount every month for them to pay anything. If the doctor even takes it. What am I supposed to with that. I'm 20 weeks now and still haven't had prenatal care because I have no insurance, and no one accepts medicaid share of cost. One doctor i went to said it would cost me 3200 for my prenatal care and delivery and they want 1500 up front. Where am I supposed to get that kind of money. By not paying my rent. Sure, I'd have prenatal care, but then I'd be homeless too. I don't understand it.
John Morgan wrote:
The following is the example they give...
"If your cost of share is $800 and you go to the hospital on May 10th and receive a bill for $1000, you have met the 'share of cost' and are Medicaid eligible from May 10th thru May 31st. If the bill from May 10th is a Medicaid covered service received from a Medicaid provider, Medicaid will pay the bill."
Are they saying that Medicaid will pay the entire $1000 bill...or are they saying Medicaid will pay the difference only between the bill of $1000 and your share of cost $800. It sounds like they are saying they pay all of the bill but then why do they say 'Your Share of Cost'?
Thank You

Huntington, IN

#413 Jun 14, 2011
Well.....the only thing you can do is go to a private doctor for a checkup out of pocket....tell them you have no insurance and see if they have a sliding far as hospital will turn you away and for damn sure you will meet the soc at that time...i would call dcf and make sure they didnt put the monthly salary as the weekly it just the 2 of u? did u qualify for foodstamps? if it is just the 2 of u...he may be making as they say too have 2 be just above poverty level...just enough to cover ur bills and there has 2 be rent being paid along with proof of a lease

Huntington, IN

#414 Jun 14, 2011
trish...u cannot tell a drs ofc that u r straight medicaid if u r soc..when they call 2 verify it will say eligible 4 otc items which is over the counter...that is red flag for soc only...once soc is met it will change 2 not eligible for nursing home which means medicaid is now open...all insurance billing personel know this..the other thin g about the prescriptions..u dont actually get them filled..u get a printout of the cost...fax 2 dcf and if it is enough to cover the soc ur medicaid is then open and active 4 that month..u can then pick up the prescriptions with no money out of pocket....hope this explains things a little better
Eileen Curras

Southwest Brevard Cnty, FL

#415 Jun 15, 2011
One thing is sure we cannot stay quiet.

West Palm Beach, FL

#416 Jun 15, 2011
I recently attended a Medicaid class at work. We were told if a client requests an office interwiew it will be scheduled.

West Palm Beach, FL

#417 Jun 15, 2011
Call 866-762-2237 and follow the automated system. You will be asked to enter your Social & DOB. The system will tell you the coverage. It sounds like you have Medicare primary & Medicaid or Share of Cost secondary. I hope this helps!

West Palm Beach, FL

#418 Jun 15, 2011
Jackson Memorial Hospital and the JMH Primary Care Centers accept Share of Cost Medicaid.

Gadsden, AL

#419 Jun 15, 2011
Medicaid Area Office wrote:
Medicaid will pay the bill because "share of cost"(SOC)is not a deductable in the traditional sense. Another example would be if you went to the emergency room on Monday and got a $500 bill and again on Tuesday for another $500, you would have met the SOC on Tuesday and that bill would be paid, the first $500 would not be paid. Once you meet the SOC, Medicaid opens from that date until the end of the month. After that, you must again meet the monthly SOC.
Its too bad that these idoits don't know what theyre talking about because that's not how it works. I have it and it pays all unpaid medical bills for the month you meet SOC,and the previous two, and for some reason mine didnt end on the last day of the month, SOC was met It seems to me that the program is flawed and not true either.If you read the web site its not accurate, and the mediciad employes dont know either. I dont understnd why they wont tell us who the doctors are that we can go to becasue nobody will see a share of cost patient, why?

Powder Springs, GA

#420 Jun 16, 2011

Fort Myers, FL

#421 Jun 19, 2011
My share of cost is 973.00 and I need to be followed regularly by a Dr for lupus, diabetes and RSD (AND I have been on ssi/di since Jan 2010) I need to make a drs appt. Ever dr turns me down because they call medicaid to check my status it is not open for that month as there are no chgs. I cant accrue chgs monthly if no one will book me an apt. I have been driving 276 miles round trip to Tarpon Springs from Cape Coral to see my old PCP. She does NOT accept medicaid but sees me for free because of her concern for my health. That practice also writes all my prescriptions for me, which only total between 500.-750. a month. So I still do not meet my share of cost. Not only do I not meet my soc, but my pharmacy holds my drugs knowing they will never get approved by medicaid to dispense as the don't reach the SOC amount and I cannot afford to purchase them on my own, since I am not working and trying to live on 1100. a month.
I called medicaid and was told I needed to go to the ER in the beginning of each month ("like everyone else"), which would max my SOC and then I would be free to make appts throughout the rest of the month AND get my meds, "just to remember to have an ailment of sorts" I called back and asked the same question since committing fraud seemed a tad extreme. To my surprise I was given the same answer...and the third time I called and was told the same with the added tip of...maybe your dr can "prescribe" a few "things" that might not be a "necessities", to push the total higher (that I know is illegal, more fraud.(Really, what kind of training do your medicaid trainees get?? I used to be a trainer for a LARGE National ins co, constantly in trouble for having no ethics and we NEVER advocated fraud, especially over the phone.)I stopped calling after that and asked my dr. She recommended I do NOT try the ER as I have no control or idea what someone in the might give me and with my complicated medical history and organ damage, the ER with an unknown Dr and no Dr knowing my case in the area.
Now here I am asking again. How do I get treatment and medication??? Please? I have not had any of my meds, insulin included in two months.(one month I got lucky and was really sick and the expensive antibiotics tipped my scripts enough where I got all my meds.
Right now my mantra, repeated also by my drs and my family is " gotta make it till January." In January I would have been legally disabled for two years and am entitled to Medicare. If I can stay alive until then, we will assess the organ damage from being unmedicated, neglected and under treated for two years.
Any legal ideas to navigate the system more efficiently would be greatly appreciated.

Huntington, IN

#422 Jun 19, 2011
They are not holding the meds to hurt u or keeping them because they know you will never hit them...they hold them untilthey are authorized for payment...i agree with getting ur dr to write another dont have to actually have to pick them up..get the list of the cost to fill them...the pharmacy knows how this works...fax the list to medicaid...will b opened in 2 to 3 days

Fort Myers, FL

#423 Jun 20, 2011
I didn't mean that the pharmacists were holding my meds. They feel awful about it. They call me weekly to see if anything has changed. And they constantly resubmit the claim, "just in case"
If the state of fl. were as concerned as my drs and my pharmacy at Walmart,I would probably be shooting my morning insulin right now.

Southwest Brevard Cnty, FL

#424 Jun 20, 2011
Amy wrote:
Yes, unfortunately u do.... it sucks big time!
The only thing that I can get is that the system here in the State of Florida wants to make a bussiness of even a medically needy h share of cost program. Yes, I agree with you that thi is insane. Always is more than having an insurance. Yes, Medicaid is crappy and the health providers are the ones making money. This program has always confused me. No one has the answer.

Hollywood, FL

#425 Jun 20, 2011
healthcare providers don't get all that much I can promise you...I work in the healthcare system and their payments to us suck! I don't know why my cell shows IL but I live in South Florida...the system does and always will stink on ice!

Winter Park, FL

#426 Jun 27, 2011
The entire concept doesn't make sense for people with higher shares of cost. My share of cost is 700.00, and I make just under 1000.00 per month Social Security and nothing else. So they're telling me that if my doctor bills were 699.00 a month I wouldn't need help. It makes it look like they're helping you on paper but it's not useable. It's a scam.

Winter Park, FL

#427 Jun 27, 2011
p.s. And I've never even been told what my Medicare number is for doctors to even reference.

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