How To Get Medicaid In Nc

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Medicaid Or Medicare Savings Programs

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

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.

Medicare Savings Programs To Help Pay For Medicare Health Care Costs

You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A and Medicare Part B deductibles, coinsurance, and copayments if you meet certain conditions. There are four kinds of Medicare Savings Programs:

  • Qualified Medicare Beneficiary Program – helps pay for Part A and/or Part B premiums, and in addition Medicare providers aren’t allowed to bill you for services and items Medicare covers like deductibles, coinsurance, and copayments.
  • Specified Low-Income Medicare Beneficiary Program – helps pay for Part B premiums.
  • Qualified Individual Program – helps pay for Part B premiums and funding for this program is limited.
  • Qualified Disabled and Working Individuals Program – helps pay for Part A premiums only.

If you qualify for a QMB, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.

Information You May Need When Applying For Services

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:

Name/Identity:

  • Mail received at your address

Earned Income:

  • Letter or note from your Employer
  • Employee W-2

Unearned Income :

  • Bank Statement
  • Benefit Award Letter/Benefit Payment Check
  • Child Support Agreement
  • Property Tax/Homeowners Insurance Statement
  • Day Care receipts

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What Healthcare Does Medicaid Cover In North Carolina

Through Medicaid, people gain access to health care services that may not be affordable without it. Additionally, some programs and benefits include special protectionssuch as provider network and payment methodsthat help ensure services are accessible. Medicaid also provides preventive care and other services help people stay healthy and avoid costlier care.

Medicaid covers medical and health care services such as:

  • Doctors visits

Medicaid does not cover the following types of medical services:

  • Cosmetic procedures or surgeries
  • Unnecessary hospital expenses, like TV rentals or meals for guests
  • Experimental treatments, supplies, equipment or drugs
  • Any services not covered under the State Plan for Medical Assistance

Learn more about medical and health care services that are covered by Medicaid in North Carolina on the Division of Health Benefits page here.

Apply For Medicaid In North Carolina

Personal info of thousands of children compromised in Medicaid mix up

Online at HealthCare.gov or at ePass. You can enroll by phone at 1-800-318-2596. You can also apply in person at your local County Department of Social Services office or complete a paper application.

Eligibility: The aged, blind, and disabled. Also, parents with dependent children are eligible for Medicaid with a household income up to 45% of poverty level, and children are eligible for Medicaid or CHIP with incomes up to 211% of poverty maternity-related coverage is available for pregnant women with incomes up to 196% of poverty.

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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.

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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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!

Nc Medicaid Eligibility Requirements

Do I need to choose a Medicaid Health Plan (North Carolina)

To qualify for NC Medicaid, you must meet the income requirements and be a legal North Carolina resident with a Social Security number. If you receive SSI , Work First Cash Assistance, or either State or County Special Assistance for the Aged or Disabled, you will automatically qualify for NC Medicaid . The chart below can help you determine whether or not you are eligible.

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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.

Nc Medicaid Managed Care Launches

Starting July 1, nearly 1.6 million Medicaid beneficiaries in North Carolina began receiving the same Medicaid services in a new way through NC Medicaid Managed Care health plans. Most beneficiaries are still getting care from the same doctors they saw previously, but they are now a member of a health plan. Some beneficiaries did not enroll with health plans and are remaining in NC Medicaid Direct.

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What Does Medicaid Cover

  • If you have Medicare and full Medicaid coverage, most of your health care costs are covered. You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan.
  • If you have Medicare and/or full Medicaid coverage, Medicare covers your Part D prescription drugs. Medicaid may still cover some drugs that Medicare doesnt cover.
  • People with Medicaid may get coverage for services that Medicare doesnt cover or only partially covers, like nursing home care, personal care, transportation to medical services, home- and community-based services, anddental, vision, and hearing services.

PACE is a Medicare and Medicaid program offered in many states that allows people who otherwise need a nursing home-level of care to remain in the community. To qualify for PACE, you must meet these conditions:

  • Youre 55 or older.
  • You live in the service area of a PACE organization.
  • Youre certified by your state as needing a nursing home-level of care.
  • At the time you join, youre able to live safely in the community with the help of PACE services.

Learn About Requirements For Medicaid In North Carolina

North Carolina Rx Assistance Programs

What are the requirements for Medicaid in North Carolina? is a crucial question for applicants, because understanding how to qualify for Medicaid assistance is the first step toward receiving benefits. Whether or not an applicant meets Medicaid eligibility requirements in NC is determined by a local county Division of Social Services caseworker based on various established Medicaid benefits eligibility criteria involving age, health needs, income and resources. To find out who is eligible for Medicaid in North Carolina and to learn more about the states established qualifications, review the sections below.

What are the requirements for Medicaid in North Carolina?

North Carolina Medicaid eligibility is based on a number of factors. In order to meet the basic eligibility requirements for Medicaid assistance, you must satisfy one of the following criteria:

  • You require long-term care.
  • You are a low-income individual or family.
  • You are younger than 21 years of age.
  • You are blind or disabled .
  • You are 65 years of age or older.
  • You are/were recently pregnant

Medicaid benefits are available for pregnant women before or after the baby is delivered, and in cases where women experience pregnancy loss.

What are the income requirements for Medicaid in North Carolina?
  • Stocks and bonds.

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How To Apply For Medicaid In North Carolina

Where do you sign up for Medicaid in North Carolina? may be the top question for individuals seeking Medicaid coverage in the state. To learn how to apply for Medicaid in NC, applicants must find the correct, reliable information. Individuals can apply for Medicaid online, in-person, by mail or on the phone, but the process is generally the same. Petitioners simply need to complete their Medicaid application correctly and accurately in order to be reviewed to receive benefits. Applicants only need to submit one application, and their local county Division of Social Services will determine if they are eligible for Medicaid or the North Carolina Health Choice . There is no deadline to apply for Medicaid in North Carolina. Individuals may apply and receive benefits at any time of the year. Learn where to apply for Medicaid, and get information about alternative application methods by reading the following sections.

How to Apply for North Carolina Medicaid Online
How to Apply for NC Medicaid in Person
How to Apply for North Carolina Medicaid by Mail
How to Apply for NC Medicaid by Phone

Applicants who require help filling out their Medicaid application form can opt to apply for benefits by phone. Petitioners must simply call their local DSS office and inform them that they would like to apply for Medicaid by phone. A caseworker will guide the applicant through the process and also be able to determine whether the applicant qualifies for benefits.

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, you’ll:

  • Get help paying your Medicare drug plan’s 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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North Carolina Medicaid Income Limit Charts

The North Carolina Medicaid eligibility income limit charts are divided by groups.

For example, the first chart is focused on income limits for children who qualify for Medicaid.

Similarly, the second chart below focuses on the Medicaid income limits for adults in North Carolina who qualify for Medicaid.

North Carolina Medicaid Income Limit for Children

Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.

North Carolina Medicaid Income Limit Children
Children Medicaid Ages 0-1
N/A

How to Read the North Carolina Medicaid Income Limits Charts Above

You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.

Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.

For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 196% of the Federal Poverty Level which for a family of two is $34,143 as shown in the chart above.

Medicare Faqs And Information To Consider

How to Navigate The NC Medicaid Transformation

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 www.socialsecurity.gov, 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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Adult Medicaid And Long Term Care Medicaid

ADULT MEDICAID AND LONG TERM CARE MEDICAID PROGRAMS

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.

APPLYING FOR ADULT MEDICAID & LONG TERM CARE PROGRAMS:

  • 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 .

ADULT MEDICAID & LTC RECERTIFICATIONS AND CHANGES:

Report changes by calling 919-731-1022

RELATED LINKS:

Health Choice For Children

North Carolina Health Choice offers health coverage for children whose families make too much money to qualify for Medicaid, but do not make enough money to afford private or employer-sponsored health insurance. View more information apply through the North Carolina Health and Human Servicess online program.

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What Happens To My Medicaid If I Move

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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