Is There Medicaid In North Carolina

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Expansion Under The Affordable Care Act

Months after Medicaid transition, some providers still wait for payment

The Affordable Care Act provided for the expansion of Medicaid to cover childless adults whose income is 138 percent of the federal poverty level or below. The provision for expanding Medicaid went into effect nationwide in 2014. As of November 2018, a total of 36 states and Washington, D.C., had expanded or voted to expand Medicaid.

North Carolina had not expanded Medicaid under the Affordable Care Act as of June 2017. Governor Roy Cooper expressed support for Medicaid expansion, stating on his 2016 campaign website, “I am appalled by North Carolina’s failure to expand Medicaid to its neediest residents, especially when our tax dollars are already going to pay for it in other states.” In January 2017, Cooper notified the Obama administration of his intent to expand Medicaid in North Carolina, although it was not a formal expansion plan. The legislature subsequently filed a lawsuit to prevent the expansion, arguing that Cooper’s action violated a 2013 law prohibiting the governor from expanding Medicaid without legislative approval. Because Cooper did not submit a formal plan to the federal government, the legislature dropped the lawsuit in April 2017, but said they would file another lawsuit if the governor did submit a formal expansion plan to the administration.

Support

Opposition

Medicaids Income And Asset Limits

In addition to the other eligibility requirements for Medicaid, an applicant cannot have income nor assets that exceed the program limit. The income limit varies depending on the category under which an applicant applies and the applicants household size. Moreover, the income limit is tied to the Federal Poverty Limit which changes depending on where an applicant lives. The FPL also changes on a yearly basis. The asset limit, also referred to as the countable resources limit, may also vary depending on the program however, in most cases the limit is as low as $2,000 for an individual and $3,000 for a couple.

Medicaid Coverage And State

Private health insurance covers the cost of substance-use disorder treatment and services to varying degrees. Each insurer has its own policy, and insured individuals will need to refer to the policy of their respective insurance companies to determine the extent of services that are covered. Many women needing treatment, including pregnant women, may have once had private insurance but have lost that insurance. This section presents information for women who are uninsured, women who may qualify for Medicaid insurance, and women who are currently insured with Medicaid.

Medicaid Services for Women and Children

  • Medicaid for Infants and Children

Medicaid for Infants and Children provides medical coverage for children younger than 19 years old. The income limits are determined by the family size and the age of the child or children applying for benefits. There is no limit on resources.

  • Medicaid for Families with Dependent Children

Medicaid for Families with Dependent Children provides medical coverage for parent or other caretaker/relative with a child 18 years or younger in the household and for children under age 21. A pregnant woman may also qualify.

The family cannot have more than $3,000 in assets such as savings in the bank.

If the family income is above the cut-off and the child and/or family has high medical bills, the family might still qualify for Medicaid .

  • Medicaid for Pregnant Women

Medicaid for Pregnant Women covers only services related to pregnancy:

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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.

Rehab Centers That Accept North Carolina Medicaid

Selection, Enrollment, and Characteristics of North ...

There are over two million Medicaid beneficiaries in the state of North Carolina. The North Carolina Medicaid program may also be called NC Medicaid.

In 2020, the program reached its 50th anniversary, providing medical services for low-income people across the state.

Though not all treatment centers in North Carolina accept Medicaid, there are several programs that take the insurance program so individuals of all backgrounds can receive the addiction treatment they need.

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Medicaid Spending In North Carolina

This article does not contain the most recently published data on this subject. If you would like to help our coverage grow, consider donating to Ballotpedia.

Medicaid spending in North Carolina
Overview
  • 9Footnotes
  • North Carolina’sMedicaid program provides medical insurance to groups of low-income people and individuals with disabilities. Medicaid is a nationwide program jointly funded by the federal government and the states. Medicaid eligibility, benefits, and administration are managed by the states within federal guidelines. A program related to Medicaid is the Children’s Health Insurance Program , which covers low-income children above the poverty line and is sometimes operated in conjunction with a state’s Medicaid program. Medicaid is a separate program from Medicare, which provides health coverage for the elderly.

    This page provides information about Medicaid in North Carolina, including eligibility limits, total spending and spending details, and CHIP. Each section provides a general overview before detailing the state-specific data.

    HIGHLIGHTS

  • North Carolina had not expanded Medicaid under the Affordable Care Act as of June 2017.
  • Governor Roy Cooper expressed support for Medicaid expansion, stating on his 2016 campaign website, “I am appalled by North Carolina’s failure to expand Medicaid to its neediest residents, especially when our tax dollars are already going to pay for it in other states.”
  • Will Medicaid Cover Incontinence Supplies

    Yes, North Carolina Medicaid will cover your incontinence products if you have the following qualifications:

    • Must have a qualifying medical need, such as autism, diabetes, overactive bladder , Parkinsons Disease, or Down syndrome.
    • Children must be 4 years of age or older.
    • Must be enrolled in a North Carolina Medicaid program.

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    Overview Of Medicaid For Long

    Long-term care becomes medically necessary for many individuals as they age, and as the number of people requiring care increases, so do the costs of services. According to Genworth Financial, a North Carolina resident can expect to spend between $53 – $250 per day on long-term care, making it difficult for low-income seniors to pay for their care.

    The increasing costs of long-term care have encouraged thousands of seniors to apply for Medicaid in hopes of receiving assistance to pay for their care. Medicaid is funded and operated jointly by the Federal government and the State of North Carolina, with the Federal government paying for 66.9% of Medicaids budget. For every $1 North Carolina spends on Medicaid, the federal government will spend $2.02.

    Medicaid for long-term care is available to anyone over the age of 65 who meets the programs medical and financial requirements. If a person requires a nursing home level of care and they fall within Medicaids income and asset limits, they may receive benefits to pay for long-term care. Those who do not meet Medicaids income requirements may also qualify to receive benefits if they participate in a spend down program.

    Nc Medicaid Managed Care Launches

    Open Enrollment for Medicaid begins in North Carolina

    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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    Where Can I Apply For Medicaid In North Carolina

    Medicaid is administered by the State Department of Health and Human Services in North Carolina. You can apply for Medicaid or an MSP using this website or by visiting your county Division of Social Services.

    Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in North Carolina City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked on Medicare and Medicaid related client projects.

    Life Estates In North Carolina

    Setting up a life estate can protect a home from estate recovery. However, proceed in this area with caution, and only after getting advice from a qualified and experienced elder law attorney. There are traps for the unwary in life estates, and many people dont find about them until its too late.

    A life estate is a form of co-ownership of real property between two or more people. They each are an owner of the property, but for different periods of time. The person owning the life estate has the current right to the property for the rest of his or her life. The other owner has a current ownership interest but has no right to control the real estate until the life estate owner dies causing the end of the life estate. The owner of the life estate is often called a life tenant while the other owner is called the remainderman because he or she owns the remainder of the property.

    When Sally dies, the house will pass directly to John and Peggy as remaindermen and it will not go through probate. Because the property is not part of Sallys probate estate, it is exempt from North Carolina estate recovery. Another benefit of the life estate is that for tax purposes, the property will get a stepped up basis at Sallys death. That can meana significant reduction in capital gains taxes payable when Robert and Mary sell the property after Sally dies.

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    Copayments For Some Services

    NC Medicaid requires copays for some services, including treatment for mental health and behavioral health.

    When assessing your final costs, factor in the following copays:

    • outpatient services: $3 per visit
    • generic and brand prescriptions: $3 per prescription
    • non-emergency emergency department visits: $3 per visit

    If youâre one of the following, you do not need to cover copays:

    • under 21
    • an American Indian or Alaska Native
    • a beneficiary of the North Carolina Breast and Cervical Cancer Control Program
    • a child in foster care
    • living in an institution covered by insurance or Medicaid

    Where Can Medicare Beneficiaries Get Help In North Carolina

    My Turn: Medicaid mix up released personal information

    Seniors Health Insurance Information Program

    Free volunteer Medicare counseling is available by contacting the Seniors Health Insurance Information Program at 1-855-408-1212.

    The SHIIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. SHIIP counselors may also be able to provide referrals for home care agencies or long-term care services. This website has more information about the services HIICAP offers.

    Elder Law Attorneys

    Elder law attorneys can help individuals plan for Medicaid long-term care benefits. The National Academy of Elder Law Attorneys has a search feature beneficiaries can use to find an elder attorney locally.

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    Nc Medicaid Managed Care Started July 1 2021

    NC Medicaid Managed Care health plans are now active. This means that you will now get care through your health plan. If you have questions about benefits and coverage, call your health plan. You can find the number on your new Medicaid ID card or visit View health plans.

    You can also contact the NC Medicaid Ombudsman if you have questions or problems your health plan or provider could not answer. Call 1-877-201-3750 or visit ncmedicaidombudsman.org.

    Meetings and events

    You can schedule rides to medical appointments. Learn more about transportation services.

    Get the free mobile app

    To get the app, search for NC Medicaid Managed Care on or the App Store.

    Use the app to find and view primary care providers and health plans for you and your family. Learn more about the free mobile app at Get answers.

    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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    How To Get Incontinence Supplies Through North Carolina Medicaid

    At Aeroflow Urology, your dedicated Continence Care Specialist will verify your coverage and handle the paperwork required to receive incontinence products through your Medicaid benefits. Aeroflow Urology is a durable medical equipment supplier that provides high quality products from brands you can trust such as Attends, Prevail, Cuties, and TENA. We work with you to help find the right mix of products to fit your individual needs. Whether you need an adult brief, bladder control pad, or catheter, Aeroflow Urology can help you stay dry and protected with confidence with our wide variety of different product types and various absorbency levels.

    After confirmation of benefits and supplies, your Continence Care Specialist will contact you to go over sizing and product needs. Once your incontinence products are confirmed, we will discreetly package and ship your products directly to your home each month in unmarked, brown boxes.

    If you or your loved one uses incontinence products, you could save money each month through your Medicaid health plan. To check your eligibility for coverage, simply provide your health insurance information through our quick and easy 2-step form, and your dedicated Continence Care Specialist will contact you via phone or email in 1-2 business days with an update on your coverage options.

    Which Plans Are Good In North Carolina

    Medicaid enrollment begins in 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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    Trusts In North Carolina

    Trust often are a preferred way of protecting the home from estate recovery, using an irrevocable trust. Trusts are more flexible and protective than life estates, but they require drafting of a comprehensive trust agreement with the right provisions. Deciding which would be better, a life estate deed or an irrevocable protector trust, requires careful consideration.

    Often the trust will be structured as a Medicaid Asset Preservation Trust or MAPT. The parent is the Grantor and the initial Trustee of the trust. The parent are completely in control over what happens to the house while its in trust. If the house is sold by the parents as Trustees, the sales proceeds must go back to the trust, not to the parents. The parents will then be able to receive income from the trust based on interest and dividends in the trust. However, the principal must stay in the trust, unless the Trustee decides to distribute it to a permitted beneficiary .

    You should contact your attorney to find out what method will work best for you. If your attorney is a general practitioner, you might ask whether they would recommend that you talk with an experienced elder law attorney who specializes in this type of Medicaid planning.

    Money Follows The Person

    The Money Follows the Person program aims to bring seniors home from inpatient facilities and make it easier for them to cope with their transition. North Carolina instituted the program in 2007, and it began to provide benefits for North Carolinians in 2009. Since then, thousands of North Carolina residents have used the MFP Program to pay for their facility-to-residence transition.

    North Carolina enacted the MFP to make it easier for seniors to afford home and community-based care. Transitioning from a nursing facility to a residence can be an expensive and stressful process for Medicaid applicants, and the MFP makes the process much easier and more affordable for participants. By introducing easier methods of paying for home-based long-term care, the MFP program eliminates many roadblocks which prevent seniors from receiving long-term care in the environment of their choice.

    Those who qualify for CAP or CAP Choice may qualify for MFP, and they may receive benefits and supports from both programs simultaneously. Only applicants who reside in nursing facilities when they apply may receive MFP in addition to CAP or CAP Choice benefits, as MFPs primary objective is to pay for the transition from institution to residence.

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