Anyone familiar with the Medicaid "medically needy" program?

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Regular Member

Date Joined Jun 2006
Total Posts : 39
   Posted 1/27/2008 12:30 AM (GMT -6)   
My husband Nathan (ucreallysucks) does not have health insurance but we did qualify for a program called "medically needy," with a "share of cost," which basically means that anything we pay above approximately $1600 a month (in our case) the state will pay for.  This is ALL the information they gave us.  They didn't say how to file a claim, or if there a network doctors that have to be used, if something has to be approved first, etc.    We've had this for a while but didn't use it because his bills don't amount to that high and if they did we would be homeless because $1600 is just barely less than what I net per month anyway. 
To get to the point, I had a brainstorm this evening and realized that we could use our tax return money to pay for his medically needy share of cost for a one month period and that would be all we would pay if he was able to get the colostomy surgery done.  Nathan is afraid Medicaid won't approve getting the surgery done because he hasn't ever been on Remicade (tried everything else), but his immune system is so low right now, if he starts any new treatments that lower his immune system any further he will die from the next cold virus, which usually takes him about 2 months to fully recover from right now. 
Are any of you familiar with the restrictions of this program?  I can't even find any information out about it searching online, and I'm usually pretty good at that. 
Thanks soo much for your help !!!

Elite Member

Date Joined Mar 2003
Total Posts : 10407
   Posted 1/27/2008 12:34 AM (GMT -6)   
Medicaid regulations can vary from state to state. Your best bet is to get on the phone Monday and call them. If you look up the state department that administers it where you live, they should have a toll-free number.

Medicaid is a federal program and one would think it would be the same everywhere, but it isn't. It has basic required coverages, then a whole menu list that are optional for states to provide. Some states provide all, some none.
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Colazal,  Remicade, Nature's Way Primadophilus Reuteri.
In remission since April, 2006. Remicade has been my wonder drug.
Co-Moderator UC Forum

Veteran Member

Date Joined Feb 2007
Total Posts : 640
   Posted 1/27/2008 11:24 AM (GMT -6)   
Be sure to check with your county human services. There may be some emergency funds to help you through this difficult time.

I'm sorry you're both going through this.

Sporadic proctitis since about 1985. Mother had J-pouch surgery 1983.
DX'd with clostridium difficile in 2000. Pred, two courses of Flagyl, then Vancomycin finally got rid of it. 2001 colonoscopy dx'd left-sided UC. . Treated with prednisone, Rowasa, Asacol. Asacol not working, switched to Imuran. Three small flares since in 2002, 2005, and 2007, brought under control with steroid and Rowasa enemas. Lap Chole performed October 26, 2007, after gall bladder attack in June, '07.
Daily meds: 100 mg Azathioprine and 225 mg Effexor XR (for chronic, longstanding depression), many vitamins and Primadophilus Reuteri

Regular Member

Date Joined Jul 2007
Total Posts : 172
   Posted 1/27/2008 7:45 PM (GMT -6)   
There may also be some community agencies that the human services folks could refer you to. We have a program here in Georgia that helps with medical and prescriptions for a short time and maybe they have a program like that to help out until paperwork and all the ins and outs are sorted out with the program you are looking at. Don't give up!
Pancolitis diagnosed 5/07 
4 Lialda/day since 8/01/07
Started 40 mg. Prednisone on 9/16/07 and DONE as of 11/26/07!Canasa suppositories 1000mg 2X/day as of 1/22/08

Veteran Member

Date Joined Dec 2005
Total Posts : 3238
   Posted 1/27/2008 7:53 PM (GMT -6)   
Definitely don't give up! I would start calling everyone you could think of for info. Your hubby's pharmacist and GI could probably help you w/ contact #s as well. Hang in there and keep us posted!
Tabitha (Tab)

100mg Azathioprine, 2 Fibercon, Colazal-9 a day, Acidopholis Pearls, Nexium
Co-Moderator UC Forum

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