How To Get Pregnancy Medicaid In Nc


Does Pregnancy Medicaid Cover Dental In Nc

How to Apply for Medicaid in North Carolina and What is Covered
  • North Carolina is in a better position than other states in several respects.
  • Even if a woman has an income that is too high to qualify for full Medicaid, she may still be able to get care throughout her pregnancy under the Medicaid for Pregnant Women program that is offered by the state.
  • The Medicaid program for pregnant women pays for medical treatment, including dental care, that is directly connected to the pregnancy.

Who Is Eligible For Medicaid

The general guidelines for eligibility for Medicaid are set by the Federal government however, each state sets up their own specific requirements for eligibility and these can differ from state to state.

All States are required to include certain individuals or groups of people in their Medicaid plan.

The state eligibility groups are:

  • Categorically needy
  • Medically needy
  • Special groups

In the categorically needy group, this will cover pregnant women whose income level is at or below 133% of the Federal Poverty level.

In the medically needy group, this will cover a pregnant woman who makes too much money to qualify in the categorically needy group. This means that women, who may have been denied Medicaid before, may be able to qualify now.

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.

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Family Planning Medicaid Or Be Smart Medicaid

The NC Medicaid Family Planning Program or Be Smart program is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina. Family planning, reproductive health and contraceptive services are provided to eligible men and women, whose income is at or below 195% of the federal poverty level, with no age restrictions.

Which Plans Are Good In North Carolina

Income Limit For Pregnancy Medicaid Nc

CHIP or Childrens Health Insurance Program is a program designed for families with children that are not eligible to receive Medicaid but still need medical insurance for their children. While they may seem as if they are part of the same program, the rules and regulations that govern them are different.

The eligibility requirements for CHIP are:

  • Applicant must be 19 or younger
  • Must be a citizen of the U.S or legal resident
  • Applicant must meet the income guidelines set for the program
  • Applicant must not be on any type of private health insurance or Medicaid

The services offered to those on CHIP are pretty much the same as those with Medicaid. From Doctors visits to prescription drugs and emergency services and transportation. CHIP may also cover some expenses that Medicaid does not cover. Applying for CHIP can be done in the same way as Medicaid, by phone, mail or in person at your local social services department. Be sure that when applying that you give all information that is required, as giving any false information can result in criminal charges being brought against you. For more info on the CHIP benefits, you can download the guide.

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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.

Submitting Requests For Prior Approval

The preferred method to submit prior approval requests is online using the NCTracks Provider Portal. However, providers can also submit paper forms via mail or fax. PA forms are available on NCTracks.

All requests for PA must be submitted according to DMA clinical coverage policies and published procedures.

Providers must request reauthorization of a service before the end of the current authorization period for services to continue. The date that the request is submitted affects payment authorization for services that are denied, reduced or terminated.

Providers must request authorization of a continuing services 10 calendar days before the end of the current authorization period for authorization to continue without interruption for 10 calendar days after the date an adverse decision notice is mailed to the Medicaid beneficiary or to the beneficiary’s legal guardian and copied to the provider.

Some requests are submitted for review to a specific utilization review contractor, as described on the Prior Approval Fact Sheet on NCTracks.

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Family And Childrens Medicaid

  • Covers children through age 20, parents and caretakers of minor children under the age of 18, and pregnant women who meet income requirements.
  • Family Planning Program is designed to reduce unintended pregnancies and improve the well-being of children and families. Services are provided to eligible persons of any age who are ineligible for all other Medicaid programs.
  • North Carolina Health Choice Health Insurance for Children provides reduced price comprehensive coverage for children six to 18 years whose family income meets certain limits but is too high to qualify for Medicaid.

What Is Pregnancy Medicaid

Medicaid and NC Health Choice 101

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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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

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

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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Can A Pregnant Woman Be Denied Medicaid

Medicaid eligibility can also be denied to pregnant women if their household income is too low in comparison to the size of their household. Since a result, you do not want to forget to count a dependant or include an additional income earner, as this might reduce the benefits to which you are entitled.

Maternity Or Pregnancy Insurance Options In North Carolina

Income Limit For Pregnancy Medicaid Nc

If you are currently pregnant, your options, in order of desirability, are Medicaid, group insurance, and prepayment plans. After you are pregnant, it is not possible to issue an individual policy. Application will automatically be declined. If you are in the process of planning your pregnancy, the best options for minimizing your maternity costs are Medicaid, group insurance, individual insurance with Blue Cross Blue Shield, prepayment plans, in order of descending desirability.

The average total maternity charges submitted to Blue Cross Blue Shield of North Carolina in 2007 was $20,015 per pregnancy 1. A patient may be required to pay this full amount, however many families negotiate with hospitals and providers to pay a discounted rate when the only option is to pay out of pocket.

When planning to cover the costs of maternity the four primary options in North Carolina are as follows:

1. Group maternity insurance coverage. This is often the most advantageous way to pay for maternity costs because many group policies cover maternity for all females on the policy without an additional rider. Also, if you are already pregnant, and dont meet the income requirements for Medicaid, this is your best shot at getting your pregnancy covered by an insurance company. Additionally, some group policies do not consider pregnancy a preexisting condition, so this is a good option to consider if you are already pregnant.

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How Long Does Pregnancy Medicaid Last In Nc

  • Beginning April 1, 2022, the duration of time eligible residents of North Carolina will have access to postpartum medical care under Medicaid will increase from sixty days to twelve months.
  • People who are qualified for Medicaid and are pregnant or have just given birth during the period beginning February 1, 2022 and ending March 31, 2022 will be eligible for an additional 12 months of continuous postpartum coverage.

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.

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Medicaid For Pregnant Women

We can provide Medicaid to help with the cost of prenatal and postpartum care, up to 60 days following termination of pregnancy, either due to delivery or miscarriage. Must meet eligibility requirements.

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What Does Medicaid Cover In North Carolina

Months after Medicaid transition, some providers still wait for payment

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:

  • Hospital Bills
  • Personal care services. Medical equipment as well as other types of home and health services
  • Nursing home care
  • Prescriptions

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

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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.

Help us spread the word! If you found this post on North Carolina Medicaid Income Limits helpful, help us spread the word by sharing it using the Share this button below.

Be sure to check out our other articles about Medicaid.

Smart Start For Your Baby

We want to help you and your baby grow healthy and stay healthy. Start Smart for Your Baby® is our program for pregnant and new moms. It is designed to customize the support and care you need for a healthy pregnancy.

Carolina Complete Health members get up to $100 value for an infant car seat, diaper bag, or a breast pump. To receive one of these items, please complete the form below.

Eligibility Statement: Eligible members may choose only one of the below items. Do not fill out multiple forms as you will only receive one item. Eligibility will be confirmed by the Carolina Complete Care Management Team and include members who are expecting a new baby or have given birth to a new baby within the past 60 days. To qualify, you should have filled out a Notification of Pregnancy form. One request every 12 months.

Note: Please allow a minimum of 14 days for review and processing of your request. If you need one of these items faster, please call us at .

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North Carolina Medicaid Income Limit

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

Option 1 Apply Online

Medicaid Coverage of Pregnancy and Perinatal Benefits â Survey Results ...

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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Medicaid For Infants And Children

Through the Medicaid for Infants and Children program, medical needs for infants and children within a certain age range, and who meet income criteria, are met through the Medicaid program.

The income limits under MIC are higher than the MAF limits, and there are no reserve limits for this program. In addition, children who qualify for assistance under this program can receive Medicaid without meeting a deductible.

What Benefits Does Pregnancy Medicaid Provide

Similar to other health care assistance programs, Medicaid does not pay monetary benefits directly to covered participants. Certain health care providers and health care facilities have a contract with Medicaid to treat those who are covered by Medicaid insurance.

When receiving Medicaid benefits, you should be given a list of medical providers who accept Medicaid or given a website to look for a provider in your area. As long as you receive care from a Medicaid provider, your health care costs will be submitted through Medicaid and will be covered. Pregnant women are covered for all care related to the pregnancy, delivery and any complications that may occur during pregnancy and up to 60 days postpartum.

Additionally, pregnant women also may qualify for care that was received for their pregnancy before they applied and received Medicaid. Some states call this Presumptive Eligibility and it was put in place so that all women would start necessary prenatal care as early in pregnancy as possible.

Talk with your local office to find out if you qualify for presumptive eligibility.

Pregnant women are usually given priority in determining Medicaid eligibility. Most offices try to qualify a pregnant woman within about 2-4 weeks. If you need medical treatment before then, talk with your local office about a temporary card.

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