Different Types Of Medicaid In Nc


North Carolina Medicaid Income Limit

Medicaid and NC Health Choice 101

The North Carolina Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.

To qualify, you must meet the North Carolina Medicaid Income limits listed below.

Here is the Federal Poverty Level for 2021.

2021 Federal Poverty Levels for the 48 Contiguous States & D.C.
Household Size

Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:

  • Children up to age 1 with family income up to 210 percent of FPL
  • Any child age 1-5 with a family income up to 210 percent of FPL
  • Children ages 6- 18 with family income up to 133 percent of FPL
  • CHIP for children with family income up to 211 percent of FPL
  • Pregnant women with family income up to 196 percent of FPL
  • Parents of minor children with family income up to 41 percent of FPL
  • Individuals who are elderly, blind, and disabled with family income up to 100% of the FPL

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Individual And Family Plans

UnitedHealthcare is offering individual and family plans in North Carolina that are designed to provide the best possible coverage at an affordable price.

We have plan choices in all three metal levels, bronze, silver and gold, offering a variety of benefits. And all of our plans come with reliable, friendly guidance from our experienced team.

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Prior Authorization And Notification Resources

Dual Complete Program

UnitedHealthcare Community Plan of North Carolina offers a Dual Special Needs Plan UnitedHealthcare Dual Complete , a state wide Medicare Advantage program.

Phone: 800-638-3302 available 8 a.m. to 6 p.m. Eastern Time

North Carolina Provider Contracting

UnitedHealthcare Community Plan of North Carolina

3803 N. Elm Street

Optum Behavioral Health – Phone: 877-614-0484 or email:

Optum Behavioral Health Providers – email:

NC Provider Relations – email:

Pharmacy Service Line

Join Our Network

To contract with the Community Plan of North Carolina Medicaid please contact the NC Health Plan Provider Call Center at 800-638-3302.

Behavioral Health Providers

Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health, you may also contact Optum Behavioral Health at 877-614-0484.

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

The state-specific requirements and process on how to join the UnitedHealthcare Community Plan network is found in the UnitedHealthcare Community Plan Care Provider Manuals.

The Centers for Medicare & Medicaid Services established the Medicaid Managed Care Rule to:

Member Information: Current Medical Plans, ID Cards, Provider Directories, Dental & Vision Plans

Plan information is available for:

  • Dual Complete Program
  • Medicaid

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What Type Of Dental Work Does Medicaid Cover

Medicaid frequently covers preventive dental treatments for adults. Preventive services might include regular oral exams, cleanings, and X-rays. These four states combine preventive care with emergency services but do not cover any additional restorative or major treatments except Florida which also covers dentures.

What Does Medicaid Cover In North Carolina

North Carolina Rx Assistance Programs

Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Medicaid may help pay for certain medical expenses including: Personal Care Services , Medical Equipment, and Other Home Health Services. In-home care under the Community Alternatives Program

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Unitedhealthcare Senior Care Options Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

History Of Medicaid Expansion

Expansion of Medicaid in North Carolina has been a topic of much debate by the states politicians, policy makers, and advocacy groups.

Expansion discussion during McCrory administration

Former Governor McCrory said that he was open to the idea of Medicaid expansion, but only after they fix the current system. This was a reference to the legislatures Medicaid reform efforts, primarily aimed at transitioning to Medicaid managed care. McCrory made it clear that he would want some sort of work requirement tied to Medicaid eligibility for able-bodied adults, but at that point, no states had successfully petitioned the Obama Administration to allow a work requirement and still receive federal funding for Medicaid expansion .

In January 2015, Brad Wilson, President and CEO of Blue Cross Blue Shield of North Carolina, threw his weight behind the push for Medicaid expansion, noting that expanding Medicaid is the right thing to do for North Carolinians.

Thom Tillis, who was sworn in as US Senator for North Carolina in January 2015, used to be strongly opposed to Medicaid expansion. But in October 2014, just two weeks before the election, he noted that were trending in a direction where we should consider potential expansion I would encourage the state legislature and the governor to consider it. .

Expansion discussion during Cooper administration

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What Is Amerihealth Caritas North Carolina

AmeriHealth Caritas North Carolina is a prepaid health plan and a member of the AmeriHealth Caritas Family of Companies, a national leader of Medicaid managed care. AmeriHealth Caritas North Carolina is honored to have been selected as one of the prepaid health plans to administer health care services to participants in the NC Medicaid managed care program.

Headquartered in Raleigh, AmeriHealth Caritas North Carolina is a mission-driven health care organization. We emphasize preventive care, health maintenance and community outreach programs.

At AmeriHealth Caritas North Carolina, care is the heart of our work.

American Disabilities Act Notice

2019 06 25 NC Medicaid Managed Care Webinar

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

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What Do I Need For Proof Of Income

In order to prove that you fall within the limit for income eligibility, you will need to provide documentation of all sources of income that you have.

Documents to include are things like pay stubs from wages, copies of social security deposits, copies of alimony checks, and award letters from any other monthly financial benefit that you may receive.

It would also be helpful to have all of your most recent income tax returns and any other tax forms that would be relevant to verifying your income.

Some states are able to electronically gather the resources to verify your income, which does simplify the process as well as eliminate fraud. To find out if your state has this technology for your application, click here to learn more about the application process in your state of residence.

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North Caroline Cap/da Medicaid Waivers Program

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Important Facts To Know / Eligibility

  • Persons who are eligible will get a Medicaid card each month. Medicaid can also cover medical bills from the three months before the month you apply.
  • Families with children through age 20. The parent may be able to receive Medicaid if only one parent is in the home and the child is under age 19. Both parents may be able to receive Medicaid if both are in the home, but one of the parents is out of work or has an illness or injury unemployment and underemployment.
  • Children through age 20 who live with both parents or other adults.
  • Individuals through age 20 who live apart from their parents or other adults.
  • Children under age 1 whose parents’ income is equal to or less than 185% of the poverty limit. The limit is higher than for older children. There is no resource limit.
  • Children from age 1 through age 5 whose parents’ income is equal to or less than 133% of the poverty level. This limit is higher than for children ages 6 and over. There is no resource limit.
  • Children from age six through age 18 whose parents’ income is equal to or less than 100% of the poverty level. There is no resource limit.
  • Pregnant women, with or without other children. The income limit is 185% of the poverty level. There is no resource limit.
  • Newborn child of a Medicaid authorized mother – Automatic coverage of newborn .
  • Does Medicaid Cover Dental And Vision

    North Carolina Medicaid Transformation  RMM

    States are not required to offer dental, vision, or hearing services to adult Medicaid enrollees. Even in states that offer some coverage, enrollees access to care is inconsistent: the scope of the benefits varies widely between states, and states often cut these benefits when facing budget shortfalls.

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    You Have Chosen To Enroll In

    • What is DSNP?

      A Dual Special Needs Plan is a type of health insurance plan for people who have both Medicaid and Medicare. It works together with your Medicaid health plan. You’ll keep all your Medicaid benefits. Most dual plans also give you more benefits and features than you get with Original Medicare. All for a $0 plan premium.

    • Who is eligible?

      You might qualify for Dual Eligibility Plans if

    • You are under age 65, eligible for state Medicaid benefits, and qualify on the basis of disability or other special situation.
    • You are at least 65 years old and receive Extra Help or assistance from your state.
  • The Medicare Annual Enrollment Period happens once a year in the fall. If you qualify for a Dual Special Needs Plan, you may not have to wait.

    You may be able to enroll right away if you

  • Are 65 and newly eligible for Medicare or have a qualifying disability
  • Are retiring and losing your current coverage
  • Have moved out of your current Medicare plan’s service area
  • Have a chronic condition like diabetes or chronic heart failures
  • Receive Medicaid benefits
  • Discount valid until 12/31/22. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members.

    Looking for the federal governments Medicaid website? Look here at Medicaid.gov.

    If The Medicaid Applicant Is Married

    For Medicaid applicants for long-term care who are married, the healthy spouse is referred to as the community spouse.

    The income of the healthy spouse living in the community is not counted in determining the applicants eligibility.

    Only income in the applicants name is counted in determining his or her eligibility.

    Therefore, even if the community spouse is still working and earning income, he or she will not have to contribute to the cost of caring for his or her spouse in a nursing home if the spouse is covered by Medicaid.

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    Is Circumcision Covered By Medicare

    Health insurance plans such as Medicare or private insurance will k pay for circumcision? A Medicare rebate can only be obtained from your child who goes through a circumcision if there is a medical reason for it. Depending on the health insurance you possess, a portion of the cost could be covered by the rebate.

    What Will I Receive As A New Member

    How to Apply for Medicaid in North Carolina and What is Covered

    Once you are enrolled with AmeriHealth Caritas North Carolina, you will receive a Welcome Kit. The information in this kit tells you about our plan, benefits and services. The kit will include the member handbook and Medicaid card. It will also have information on how to change your primary care provider. You can also access this information online through our New Members section.

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    Unitedhealthcare Connected Benefit Disclaimer

    This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

    You can get this document for free in other formats, such as large print, braille, or audio. Call , TTY 711, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

    You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

    Language Line is available for all in-network providers.

    Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al , TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

    Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

    Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

    How Much Can A Family Make To Qualify For Medicaid

    In the 36 states that expanded coverage to low-income adults after the Affordable Care Act was passed, you can generally qualify for Medicaid if your monthly modified adjusted gross income is less than 138% of the federal poverty level. Thats $1,467 per month for an individual or $3,013 for a family of four.

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    Different Types Of Adult Medicaid & Ltc Medicaid


    Private Living Arrangement Medicaid : PLA Medicaid is health insurance for individuals and couples aged 65 and older, and individuals blind or disabled according to the Social Security definition of disability, who live in their own homes, or the homes of relatives or friends. Applicants must also meet income and resource eligibility requirements. There are co-payments for some services. Individuals and couples with income greater than the federal poverty levels may have to meet a deductible before Medicaid can be authorized.

    Medicare Savings Programs : The Medicare Savings Programs are limited assistance Medicaid programs that can help individuals and couples enrolled in Medicare Part A and/or Part B. The programs pay for Medicare premiums, coinsurance, and Medicare deductibles. The process where Medicaid pays the Medicare premiums is called Buy-In. Buy-In can take 3 to 4 months from the date approval of the application. If Medicaid terminates for any reason, the Medicare premiums will no longer be paid. Individuals and couples whose income falls within federal poverty level guidelines may be dually eligible for a Medicaid Card and the MQB programs.

    Is Circumcision Covered By Mothers Insurance

    Managing Medicaid

    Routine infant circumcision will be covered by California health plans. Under the Affordable Care Act, maternity care coverage has been provided to virtually every employer plan. It is noteworthy that the average private health plan includes the practice of routine infant circumcision as an essential service.

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    North Carolinas Medicaid Income Limit

    People who receive SSI already qualify to receive Medicaid long-term care in North Carolina. If you donât receive SSI, and you are 65 or older, blind, or disabled, you must have income below $1,012/month for a household of one or $1,372/month for a household of two .

    If your income is above the limit, you still might be able to qualify for Medicaid if you have medical expenses that meet or exceed the amount of extra income you have. The Division of Medical Assistance will calculate how much your monthly income exceeds the Medicaid income limit and then will multiply that amount by six. This amount is your Medicaid deductible. Once you satisfy your deductible, you are eligible for Medicaid for a period of six months. After six months, DMA will assess another deductible.

    You can satisfy your deductible by showing DMA that you have medical expenses, including nursing home charges, that equal or exceed your deductible. You do not have to pay medical bills for them to count towards your deductible you just need to show proof that you incurred the expenses. Because nursing homes are so expensive, the Medicaid deductible is a common way for nursing home residents to become eligible for Medicaid.


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