How To Apply For Pregnancy Medicaid In Nc


Family & Childrens Medicaid Or Nc Health Choice

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

Medicaid for Pregnant Women

Medical assistance is available for pregnant women who fall below the income guidelines. The coverage is for pregnancy related procedures only. Once determined eligible for MPW, the coverage continues through the postpartum period regardless of income or other changes.

Medicaid for Families

Medical assistance for low-income families with children under 19. To qualify the family must meet income guidelines and resource limits . This category includes 19 and 20-year-old individuals that may or may not have a child. Some families may have a deductible to meet before Medicaid coverage begins.

Medicaid for Infants and Children

Medical assistance for children or individuals under the age of 19. There are three different income categories based on the age of the individual. The income limits are highest for very young children. There are no reserve limits or deductibles for this program.

North Carolina Health Choice

Medical insurance administered by Blue Cross Blue Shield. This program is for individuals under age 19 whos income is too high for Medicaid and who do not have private insurance. Depending on the familys income there may be co-payments for prescriptions, doctor visits, and emergency room visits. Some families may need to pay an enrollment fee of $100 maximum before benefits are issued. This enrollment fee covers the child/children for one year.

Medicaid & NC Health Choice

North Carolina Medicaid Covers Pregnant Women

Medicaid is a public form of health insurance that exists in every state. Part of the Medicaid program is designed to cover the health care needs of women. In North Carolina, there is a Medicaid for Pregnant Women program.

Medicaid is a public, or government run, form of health insurance. It is designed to provide health insurance coverage for individuals and families who are low-income and who cannot afford to purchase a health plan from a private insurance company. Medicaid is funded, in part, by the federal government. It is also funded by the government of an individual state.

North Carolina has two Medicaid programs that will cover the health care needs of women who are pregnant and who are low income. One of them is the Medicaid for Families with Dependent Children program.

To qualify for this program, a woman must be pregnant. She must also have a monthly countable income that is lower than the amounts listed in a chart of the Medicaid website. The woman also cannot be from a family that has more than $3,000 in assets, .

The other program that covers women who are pregnant is simply called Medicaid for Pregnant Women. It only covers services related to pregnancy. Those services include: prenatal care, delivery, and 60 days postpartum care. It also includes services to treat medical conditions which may complicate the pregnancy, childbirth classes, and family planning services.

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If You Currently Have Marketplace Coverage

  • If you want to keep your current Marketplace coverage, dont report your pregnancy to the Marketplace. When filling out your application for Marketplace coverage, select the Learn more link when we ask if youre pregnant to read tips to help you best answer this question.
  • If you report your pregnancy, you may be found eligible for free or low-cost coverage through Medicaid or the Childrens Health Insurance Program . If you are found eligible for Medicaid or CHIP, your information will be sent to the state agency, and you will not be given the option to keep your Marketplace plan.
  • If you keep your Marketplace coverage, be sure to update the application after you give birth to add the baby to the plan or enroll them in coverage through Medicaid or CHIP, if they qualify.

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Medicaid Or Medicare Savings Programs

Medicare beneficiaries with limited income or very high medical costs may be eligible to receive assistance from the Medicaid program. There are also Medicare Savings Programs for other limited-income beneficiaries that may help pay for Medicare premiums, deductibles, and coinsurance. There are specified income and resources limits for both programs. Contact your local county Department of Social Services or SHIIP to apply for one of these programs.

Adult Medicaid And Long Term Care Medicaid

Income Limit For Pregnancy Medicaid Nc


Adult Medicaid is health insurance for low-income individuals, seniors, and people with disabilities. Eligibility is based on your familys monthly income and resources that are owned. To receive Medicaid for disability or blindness, you must meet Social Securitys definition of disability or blindness. Adult Medicaid covers individuals living at home in a Private Living Arrangement or individuals in Long Term Care living arrangements. The Medicare Savings Program is a limited assistance Adult Medicaid program for individuals enrolled in Medicare Part A and/or Part B. The Medicare Savings Program can help pay for Medicare premiums, coinsurance, and deductibles.


  • Apply online at or print here to mail in the application.
  • You may also request that an application be mailed to you by calling 919-580-4034.
  • Applications can be dropped off in the Social Services mail drop box located in the parking lot of Wayne County Social Services at 301 N Herman St, Goldsboro, NC 27530.
  • Apply in person at the Wayne County Dept. of Social Services located on the 2nd floor at 301 N. Herman St, Goldsboro NC. Applications are taken between 8:00 am to 5:00 pm, Monday Friday .


Report changes by calling 919-731-1022


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If You Have Medicaid Or Chip

  • If found eligible during your pregnancy, youll be covered for 60 days after you give birth. After 60 days, you may no longer qualify. Your state Medicaid or CHIP agency will notify you if your coverage is ending. You can enroll in a Marketplace plan during this time to avoid a break in coverage.
  • If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage, and theyll remain eligible for at least a year.

Option 1 Apply Online

You can apply online through the North Carolina ePASS Portal as shown in the image below.

If you have an account, you can log in or create your North Carolina ePASS Account. to be taken to the website.

The video below, from the North Carolina Department of Health and Human Services does a great job of walking you through how to apply for Medicaid online.

We highly encourage you to watch it if you are planning to apply for NC Medicaid online.

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Food And Nutrition Services

The Food and Nutrition Program is a federal food assistance program that provides low-income families a monthly supplemental allotment of benefits issues via Electronic Benefit Transfer cards . The Food stamp program is an entitlement program, so all eligible individual and households can receive assistance.

You may be eligible for Food and Nutrition Services if your total income falls below the appropriate gross income limits for your household size. Eligibility workers determine which income limit applies to your household.

Eligible individuals will receive Food and Nutrition benefits no later than thirty days from the date of application. Individuals with special circumstances will be given an opportunity to receive Food and Nutrition benefits within seven days of the application. View more information apply through the North Carolina Health and Human Servicess online program.

What Happens To My Medicaid If I Move

Medicaid in NC Expansion and debate

North Carolina Medicaid recipients must report changes that can influence their eligibility status, including relocating to a new address.

If you move to a new residence within North Carolina, you can update your address with the North Carolina Division of Social Services in the following ways:

  • By phone at 1 662-7030.
  • In person at a local Division of Social Services office. Find contact information for local DSS offices in North Carolina here.

Note: Medicaid benefits do not transfer. If you move to a new state, you must reapply for Medicaid in your new location. If you have further questions about moving with Medicaid, visit the national Medicaid Contact Us here.

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Family & Childrens Medicaid

Is a health insurance program that serves low-income individuals, children, and parents. For information regarding the different types of Medicaid in North Carolina and to see if you are potentially eligible, visit the Division of Medical Assistance web site at

Extra Help To Pay For Medicare Prescription Drug Costs

Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help if your yearly income and resources are below these limits in 2021:

  • Single person yearly income less than $19,320 and less than $13,290 in other resources per year

You may qualify even if you have a higher income . Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual RetirementAccounts . Resources dont include your home, car, household items, burial plot, up to $1,500 for burial expenses , or life insurance policies.

If you qualify for Extra Help and join a Medicare drug plan, youll:

  • Get help paying your Medicare drug plans costs.
  • Have no late enrollment penalty.

You automatically qualify and will receive Extra Help if you have Medicare and meet any of these conditions:

  • You have full Medicaid coverage.
  • You get help from your state Medicaid program paying your Part B premiums .
  • You get Supplemental Security Income benefits.

Drug costs in 2021 for people who qualify for Extra Help will be no more than $3.70 for each generic drug and $9.20 for each brand-name drug.

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Who Can Get Medicaid In North Carolina

You should apply for Medicaid if your income is low and you match one of the descriptions below:

  • You think you are pregnant
  • The parent or caretaker of a child and/or teenager under the age of 19.
  • You are a child or teenager age 18 or under.
  • An adult age 65 or older.
  • You are legally blind.
  • Living with a disability or disabled.
  • You are in need of nursing home care.

Information You May Need When Applying For Services

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To assist you with the Medicaid and Food and Nutrition Services applications, listed below are verifications you may be asked to provide in order to determine your eligibility. If you do not have any of this information you may still complete an application and interview for services. Individuals can apply at or in person at the Social Service building, no appointment is necessary.

To submit required verification electronically, email them to:


  • Mail received at your address

Earned Income:

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Where Do I Apply For Medicaid

Applications are taken daily Monday through Friday from 8:00 am to 5:00 pm and no appointment is needed. You may apply at The Department of Social Services.

741 North Highland Avenue Winston-Salem, NC 27101

The process of making an application for Medicaid can be complex and require a considerable amount of information.

If you have questions, please call 703-3800. We are here to answer your questions!

What Is Pregnancy Medicaid

Medicaid is a government-sponsored health insurance program for low-income families who have no medical insurance or inadequate insurance. All states offer Medicaid or a program similar to Medicaid to help pregnant women receive adequate prenatal and postpartum care. Medicaid also offers health insurance to seniors, children, and people with disabilities.

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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.

Medicaid And Health Choice Programs

Medicaid and NC Health Choice 101

Medicaid is a federal program designed to assist families and children with the cost of health care. Health Choice is North Carolinas free or low-cost health insurance plan for children ages 6-18 whose families cannot pay for private insurance and who do not qualify for Medicaid.

Medicaid also offers assistance to the uninsured with breast and cervical cancer. Other programs offered are Medicaid for pregnant women, family planning Medicaid, and emergency Medicaid for undocumented aliens.

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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.

Medicare Faqs And Information To Consider

Automatic Enrollment:

If you are already receiving Social Security benefits, Railroad Retirement benefits, or Federal Retiree benefits, your enrollment in Medicare is automatic. Your Medicare card should arrive in the mail shortly before your 65th birthday. Check the card when you receive it to verify that you are entitled to both Medicare Parts A and B.

Initial Enrollment Period:

If you are not eligible for Automatic Enrollment, contact the Social Security Administration at 800-772-1213 or enroll online at, or visit the nearest Social Security office to enroll in Medicare Part A and Medicare Part B. You have a seven month window in which to enroll in Medicare without incurring a penalty. If youre not automatically enrolled in premium-free Part A, you can sign up for it once your Initial Enrollment Period starts. Your Part A coverage will start six months back from the date you apply for Medicare, but no earlier than the first month you were eligible for Medicare. However, you can only sign up for Part B during the times listed below.

General Enrollment Period:

  • General Enrollment Period for Medicare Parts A & B

If you have coverage through a current employer, you are not required to enroll in Medicare Part A and B. Below are some things to keep in mind about each part of Medicare.

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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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    What Is Nc Medicaid/health Choice Outreach

    Medicaid Coverage for Pregnant Women

    NC Medicaid and Health Choice are publicly funded childrenâs health insurance programs open to North Carolina residents who meet income, age, and immigration guidelines. Your child may qualify for healthcare coverage through Medicaid or Health Choice, NCâs CHIP program â both offer free or low-cost health insurance for children and teens. For more information on wellness visits, and treatment services, click here.

    To meet outreach goals, our staff work with community and faith-based organizations across the State to:

    • Partner with local family-centered activities: health fairs, school sports/events, community-ethnic festivals.
    • Distribute materials to families by ordering available materials at no cost or downloading copies of PDFs provided.
    • Partner with local minority media outlets to extend the reach of critical enrollment and reenrollment messages as needed.

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    North Carolina Medicaid Expansion Update

    North Carolina is one of 12 states that has not yet expanded Medicaid under the Affordable Care Act .

    If Medicaid is expanded in North Carolina, it is estimated that 624,000 residents would become newly eligible for coverage.

    Governor Cooper has long pushed for Medicaid expansion, but GOP lawmakers oppose expansion.

    North Carolinas Medicaid program is transitioning to a managed care model in 2021 after several delays.


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