What Does Medicaid Cover In North Carolina
North Carolina Medicaid recipients will receive a copy of the program when they enroll in the program. The main things covered in the Medicaid program are as follows:
- Personal care services. Medical equipment as well as other types of home and health services
- Nursing home care
The income guidelines for those seeking Medicaid in North Carolina vary from one group of people to the next. The Aged, blind and disabled have a set amount based on family size, while a pregnant woman will have a different amount of their income based on family size. You can view all of the criteria on the North Carolina Medicaid webpage.
The cost of Medicaid will vary depending on the type of service that you are using. The price can run anywhere from $1 to $100 however, most are usually under $30. Some of the things that you will be expected to make a co-payment on are:
- Services provided to CAP participants
- Services that are covered by both NC Medicaid and Medicare
- Brand name and generic prescriptions
- Going to see an ophthalmologist, dentist, podiatrist, and doctors
- Chiropractic care
- In-home care for adults and children
- Services in a psychiatric hospital that are run by the state
- Non-Hospital dialysis facilities
- Non-emergency visits to the emergency room
What Are The Medicaid Plans In North Carolina
Carolina ACCESS
Carolina ACCESS , the states PCCM program, was launched in 1991 in five counties and offered beneficiaries a designated medical house plus a primary care physician to coordinate care.
Community Care of North Carolina
For the primary care practices in CCNC/Carolina Access, Community Care of North Carolina pays 14 community health networks a monthly fee for case management, data analysis, quality improvement, and training activities.
Waiver for Mental Health , Developmental Disability , and Substance Abuse Services.
The initiative started as a Piedmont region 5-county pilot but is expected to go statewide in 2013.
Program for All-Inclusive Care for the Elderly
North Carolina also supports PACE, or Program for All-Inclusive Care for the Elderly, which covers all Medicaid and Medicare services for people over 55 who need nursing home-level care.
Personal Needs Allowance In North Carolina
If you receive Medicaid and live in a nursing home, you will be expected to spend almost all of your income on your care. North Carolina allows nursing home residents receiving Medicaid to keep just $30/month as a personal needs allowance.
Read on to find out about when Medicaid will pay for assisted living or home health care in North Carolina.
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How To Qualify For Medicaid In North Carolina
To qualify for Medicaid in North Carolina, you must:
- Be a resident of North Carolina
- Be a U.S. citizen or have a qualifying immigration status
- Meet the Medicaid programs income limits
- Be responsible for a child 18 years of age or younger, be pregnant, be disabled, or be at least 65 years old
Income limits vary depending on household size, medical status and other factors and are subject to change annually. Find the current Medicaid income limits based on household size in North Carolina here.
Learn what documents you can submit to prove your citizenship and identity here.
Find further information on North Carolina Medicaid eligibility here.
Move To Managed Medicaid
On September 22, 2015, North Carolina lawmakers passed House Bill 372, known as the Medicaid Transformation and Reorganization Act, to privatize the states Medicaid system then-Governor Pat McCrory signed it into law the next day. Most states were already using Medicaid managed care systems for the majority of their enrollees, but the idea remains controversial.
H. 372 called for the privatization of Medicaid in North Carolina, switching to a model that involves the state contracting with for-profit managed care companies. These managed care organizations, called Prepaid Health Plans , will receive a per-patient payment from the state Medicaid system, and will be responsible for any cost over-runs beyond what they receive up-front from the Medicaid system. This provision is designed to encourage innovation on the part of carriers and providers, in order to keep patients healthy and reduce overall healthcare costs .
Governor Roy Cooper, who was North Carolinas Attorney General at the time, said that turning to MCOs is a risky move.
Medicaid managed care repeatedly delayed took effect in mid-2021
North Carolinas waiver proposal was approved in October 2018, and is effective from 2019 through 2024. Initially, it was to take effect in January 2019, but that was delayed quite a bit.
The state had originally planned to have the managed care transition take effect in , with a phased-in transition .
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What Is The Nc Medicaid Ombudsman
The NC Medicaid Ombudsman helps NC Medicaid and NC Health Choice beneficiaries understand the changes happening as the state moves to NC Medicaid Managed Care. The NC Medicaid Ombudsman helps Medicaid beneficiaries when they cannot solve problems with their provider or health plan. They offer free, confidential support and education about the rights and responsibilities of Medicaid beneficiaries.
The NC Medicaid Ombudsman can help Medicaid beneficiaries get access to health care and connect beneficiaries to resources like legal aid, social services and other programs. To learn more, call the NC Medicaid Ombudsman toll free at 1-877-201-3750, 8 a.m. to 5 p.m., Monday through Friday, except state holidays. Or visit them online at ncmedicaidombudsman.org.
You should call the NC Medicaid Ombudsman when you:
- Are not getting the care you need
- Have questions about a notice or bill
- Have talked with your provider or health care option and cannot solve a problem
- Have questions about the complaint or appeal process
North Carolina Medicaid Eligibility Requirements
This page provides general guidelines for the North Carolina Medicaid eligibility requirements. This is an assistance program that provides medical coverage for low-income people of all ages. The department that handles the Medicaid program is North Carolina Department of Health and Human Services. If you have questions or issues about the Medicaid application or the eligibility requirements, contact the North Carolina Medicaid office.
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What Is Nc Medicaid Direct
NC Medicaid Direct is North Carolinas health care program for Medicaid beneficiaries who are not enrolled in health plans. It includes care management by Community Care of North Carolina , the primary care case management entity for physical health services.
Six Local Management Entity-Managed Care Organizations coordinate services for a mental health disorder, substance use disorder, intellectual/developmental disability or traumatic brain injury .
Some people are enrolled in NC Medicaid Direct because it provides services that meet specific needs. To learn more about NC Medicaid Direct, call the NC Medicaid Contact Center at 1-888-245-0179.
Healthy First Steps Rewards
Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up.
We will help you:
- Choose a pregnancy provider and a pediatrician .
- Schedule visits and exams and arrange rides to your visits.
- Earn rewards for going to visits throughout your pregnancy and babys first 15 months of life.
- Get supplies, including breast pumps for nursing moms.
- Connect with community resources such as Women, Infants and Children services.
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Has Medicaid Coverage Expanded In Nc
At the time, North Carolina has not chosen to expand Medicaid coverage under the new healthcare reform. For this reason, any NC residents who previously did not qualify for Medicaid will most likely not qualify under the Affordable Care Act.
Of course, individuals are still encouraged to apply for North Carolina Medicaid, particularly if there have been any changes to household income or family size. Need more information on your coverage? Just call us and ask.
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 A Tailored Plan
A Tailored Plan is a North Carolina Medicaid and NC Health Choice health plan. It offers physical health, pharmacy, care management and behavioral health services. It is for members who may have significant mental health needs, severe substance use disorders, intellectual/developmental disabilities or traumatic brain injuries . Tailored Plans offer added services for members who qualify.
Tailored Plan auto-enrollment began . If you are auto-enrolled in a Tailored Plan or have the option to choose a Tailored Plan, you will receive a notice in the mail. Tailored Plans will start .
There are six Tailored Plans. These include:
Alliance Health
See Why People Choose Unitedhealthcare In North Carolina
- Regardless of the plan you choose, youll get the care you need at UnitedHealthcare.
- Large variety and network of doctors/ providers
- No cost virtual visits
- Low or no cost prescriptions
Its your health. Its your choice.
Everyone deserves affordable health care, including you.
That includes working adults, people with disabilities, pregnant women and children.
If thats you, check out UnitedHealthcare Community Plan Medicaid.
We have the Medicaid services and extras that can make a real difference in your life. All at no cost to you.
- Find a doctor you trust in our network.
- Unlimited doctor visits for adults.
- Vision coverage.
- Transportation to and from doctor appointments.
- 24/7 NurseLine to answer your health questions.
Sometimes, you might need a little extra help. Get extras not covered by Medicaid.
- Earn rewards for keeping you and your baby healthy.
- Earn gift cards for getting preventative services.
- Support and treatment to reach a healthy weight.
- Members 18 and older can get free GED Exam Voucher and materials.
We also offer resources to help you make the most of your plan. Including:
- Member Advocates
Helping you live a healthier life.
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North Carolina Medicaid History
North Carolina was one of the last states to adopt the Medicaid program: Only two states took longer to implement original Medicaid coverage. The first states to provide Medicaid did so in January 1966, and North Carolinas program didnt become effective until January 1970.
Move to Managed Medicaid
On September 22, 2015, North Carolina lawmakers passed House Bill 372, known as the Medicaid Transformation and Reorganization Act, to privatize the states Medicaid system then-Governor Pat McCrory signed it into law the next day. Most states are already using Medicaid managed care systems for the majority of their enrollees.
H. 372 called for the privatization of Medicaid in North Carolina, switching to a model that involves the state contracting with for-profit managed care companies. These managed care organizations, called Prepaid Health Plans , will receive a per-patient payment from the state Medicaid system, and will be responsible for any cost over-runs beyond what they receive up-front from the Medicaid system. This provision is designed to encourage innovation on the part of carriers and providers, in order to keep patients healthy and reduce overall healthcare costs .
Governor Roy Cooper, who was North Carolinas Attorney General at the time, said that turning to MCOs is a risky move.
Medicaid managed care repeatedly delayed now takes effect in 2021
North Carolinas waiver proposal was approved in October 2018, and is effective from 2019 through 2024 .
How Do I Go Paperless
It’s easy to go paperless. Paperless means you stop getting paper letters by mail and get them online instead. You can get an email, text message or both when you have a letter to view online. All of your letters will be online in your NC Medicaid Managed Care account.
Once you enroll in a health plan, you may choose to go paperless. There are three ways to sign up:
- Online: Log in to your NC Medicaid Managed Care account.
- Mobile app: To get the free mobile app, search for NC Medicaid Managed Care on or the App Store.
- Phone: Call us at 1-833-870-5500 . The call is toll free.
You may sign up for emails, text messages or both.
Once you go paperless, you will not get any letters by mail about your health plan. All of your letters will be online in your NC Medicaid Managed Care account.
Going paperless is faster than getting letters by mail. You can view the letters in your NC Medicaid Managed Care account as soon as they are ready, so you do not have to wait for the mail.
Going paperless is also easier. The letters in your NC Medicaid Managed Care account will never be removed, so you do not have to keep copies of letters mailed to you. You can go back to read them in your NC Medicaid Managed Care account at any time.
You may stop going paperless at any time. If you do, you will get letters by mail again.
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Family & Childrens Medicaid Recertifications And Changes:
When information is required to complete your FCH Medicaid Recertification, documents must be returned by the due date on the request sent to you. Documents can be mailed in, dropped off using the DSS drop boxes located outside of the DSS building, or dropped off at the scanning area on the 1st floor of the DSS building.
to turn in information on the floor at the receptionist desk.)
For more information contact: 910-323-1540
Do I Qualify For Medicaid
Medicaid provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels. Medicaid qualifications depend partly on whether your state has expanded its program.
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North Carolina Medicaid Income Limits Summary
We hope this post on North Carolina Medicaid Income Limits was helpful to you.
If you have any questions about Medicaid in the state of North Carolina, you can ask us in the comments section below.
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Be sure to check out our other articles about Medicaid.
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What Do You Need To Apply For Adult Medicaid
The process of making an application for Medicaid can be complex and require a considerable amount of information. Here is a list of information that may be needed in making an application:
- Recent Medical Bills
- Canceled checks to medical providers
- Health insurance receipts
- Proof of medical transportation costs
- Statements and payments made to medical providers
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Do All Health Plans Offer The Same Services
All health plans offer the same basic benefits and services. Some health plans also offer added services.
Tailored Plans offer certain services that Standard Plans dont have. These include services for a mental health disorder, substance use disorder, intellectual/developmental disability or traumatic brain injury .
Confirming Medicaid Coverage For Beneficiaries Providers And Pharmacies Should Always Use Nctracks To Confirm Eligibility
NC Medicaid has received reports of confusion in the field by providers and pharmacies when members do not present an ID card or when presented with a Medicaid member ID card that differs from the data shown in the NCTracks system.
To mitigate any confusion associated with newly issued Medicaid Managed Care member ID cards, providers and pharmacies should always use NCTracks Recipient Eligibility Verification/Response to confirm eligibility and not rely solely on the information shown on a Member ID Card.
Health plans are required to generate an identification card for each Member enrolled in their health plan that contains the Members North Carolina Medicaid or NC Health Choice Identification number. Some health plans also include their health plan member ID as well. However, member ID cards are not required to provide service, and this includes pharmacies as well. Therefore, members should not be turned away due to the lack of a Member ID card in their possession.
Follow these steps when an NC Medicaid or NC Health Choice member presents at your office:
Additionally, the health plan will honor existing and active prior authorizations on file with the North Carolina Medicaid or NC Health Choice program for services covered by the health plan for the first 90 days after launch or until the end of the authorization period, whichever occurs first.
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