What Is The Medicaid Income Limit In North Carolina For Nursing Home Care
Medicaid is a needs-based program for people 65 years of age or older, or who are permanently blind or disabled. They must also meet certain income requirements and asset limits for their state. If someone receives Supplemental Security Income , then they are automatically eligible for Medicaid benefits and do not need to go through the application process.
Additional requirements:
- A U.S. citizen or show proof of eligible immigration status,
- Live in the state in which they are applying for benefits, and
- Have a social security number .
There isnt one set income limit for being able to use Medicaid for nursing home care in North Carolina. Rather than having an established income limit, Medicaid simply requires that all of your income be put towards your cost of care, outside of a few allowances.
The first allowance for any applicant is a $30 per month personal needs allowance. This personal needs allowance could be used for things like clothing, magazines, books, stationery, etc. Federal regulations require nursing homes to provide basic hygiene items like a toothbrush and toothpaste, so the personal needs allowance would not need to be used for those types of items.
Medicaid also allows every applicant an allowance for any uncovered medical costs, such as health insurance and Medicare supplement insurance premiums.
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.
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.
Read Also: Private Obgyn That Accepts Medicaid
Top Rated Assisted Living Communities By City
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through Medicaid Waivers, which are also called Home and Community Based Services Waivers or Waiver Funded Services.
Help Paying Your Medicare Costs
To let you know you automatically quality for Extra Help, Medicare will mail you a purple letter that you should keep for your records. You don’t need to apply for Extra Help if you get this letter.
- If you aren’t already in a Medicare drug plan, you must join one to use this Extra Help.
- If you’re not enrolled in a Medicare drug plan, Medicare may enroll you in one so that you’ll be able to use the Extra Help. If Medicare enrolls you in a plan, you’ll get a yellow or green letter letting you know when your coverage begins, and you’ll have a Special Enrollment Period to change plans.
- Different plans cover different drugs. Check to see if the plan you’re enrolled in covers the drugs you use and if you can go to the pharmacies you want.
- If you have Medicaid and live in certain institutions or get home and community based services, you pay nothing for your prescription drugs.
Drug costs in 2022 for people who qualify for Extra Help will be no more than $3.95 for each generic drug and $9.85 for each brand-name drug. Look on the Extra Help letters you get, or contact your plan to find out your exact costs.
NOTE: When you apply for Extra Help, you can also start your application process for the Medicare Savings Programs. These state programs provide help with other Medicare costs. Social Security will send information to your state unless you tell them not to on the Extra Help application.
There are 4 kinds of Medicare Savings Programs:
Recommended Reading: Income For Medicaid In Michigan
How To Apply / Learn More
In some counties, wait lists for services may exist.
This program is available in all NC counties. However, enrollment is limited, as each county is assigned a specific number of slots for participation. While overall the program has not reached maximum enrollment, it may have done so in specific counties.
To begin the application process, interested parties should contact their countys Department of Social Services. A complete list of counties with contact information is available here.
The application process will include a comprehensive assessment of the applicants care needs, their familys ability to provide for them, as well as a review of their financial situation. Limited information is available on the Health and Human Services website. Additional information can be found here.
Are You Or A Family Member Eligible For Medicaid’s Personal Care Services
If you or your family member has a physical or developmental disability, cognitive impairment, or chronic condition and need help with Activities of Daily Living , then you may be eligible for Medicaid’s Personal Care Services . There are a number of requirements you need to meet in order to apply for this program.
Once your medical provider completes the DHB 3051 PCS Request for Services Form, he or she will send it to Liberty Healthcare of North Carolina. Liberty Healthcare is an Independent Assessment Entity and is responsible for evaluating requests for personal care services.
Read Also: Is Texas Children’s Health Plan Medicaid
Nc Medicaid Managed Care Excluded
- Some beneficiaries will remain in NC Medicaid Direct, which is the fee-for-service program. This is how you receive health care services now. This means you cannot choose a health plan and you do not need to choose a new PCP unless you want to change to your current PCP. You will stay in NC Medicaid Direct if you:
- Receive Family Planning Medicaid, Refugee Medicaid, Foster Care/Adoption Medicaid , or must meet a deductible before getting Medicaid benefits
- Are part of the Health insurance premium payment or Program of all-inclusive care for the elderly programs, or
- Have both Medicare and Medicaid or receive long-stay nursing home services,
- Receive Innovations Waiver services, Traumatic Brain Injury Waiver services, or Community Alternatives Program for Children or Community Alternative Program for Disabled Adults services.
North Carolina’s Medicaid Resource Limit
To qualify for Medicaid in North Carolina, you must have no more than $2,000 in resources . Some property does not count toward the resource limit. In North Carolina, your home is exempt up to an equity value of $585,000 , as long as you intend to return there or if your spouse or another dependent relative lives there. In addition, one car is exempt if it is used for transportation for yourself, your spouse, or a dependent relative. Personal belongings and household goods are also exempt. Retirement accounts are counted as assets to the extent you can withdraw money from them.
Don’t Miss: Vermont Medicaid Dental Fee Schedule
Spouse And Dependent Allowances
If an applicant is married, there are additional allowances that the applicants spouse may be able to receive.
- If the spouses income is less than the applicants, then the spouse can use some of the applicants income rather than requiring it to be contributed towards the applicants cost of care. This allowance is known as the Minimum Monthly Maintenance Needs Allowance .
- The current MMMNA in North Carolina is $2,178 per month, so if the applicants spouse makes less than $2,178 per month, the difference can be made up with the applicants income.
- The MMMNA can be increased up to $3,435 per month depending on the applicants circumstances. The increased allowance is for shelter costs, which can include rent or mortgage payment, taxes on the home, homeowners or renters insurance, required maintenance charges or homeowners association fees, or utility costs.
If an applicant is married with a dependent at home under the spouses care, then there is an additional income allowance the applicant can claim for the dependent. The current dependent income allowance for an applicant is $726 per month .
If you are unsure if you or a loved one would currently qualify for Medicaid benefits and may need to apply soon, please give our office a call at 919-443-3035 or visit our website to schedule a free needs assessment call.
Long Term Care Medicaid
Medicaid helps pay for medically necessary nursing home care for a Medicaid eligible person in a nursing home or an intermediate care facility for those with intellectual disabilities.
Long Term Care Medicaid is for those 65 or older, blind or disabled individuals of any age or couples who have been in a hospital or nursing facility for 30 days or longer.
Medicaid beneficiaries must use their income to pay for nursing home care. Medicaid pays the difference between the recipient’s income and the nursing home rate. The beneficiary keeps $30 per month for personal needs not provided by the nursing home. An additional amount may be set aside for a spouse living at home or for special needs such as health insurance premiums and charges not covered by Medicaid.
Don’t Miss: How Can You Qualify For 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 be evaluated by a doctor. 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. Click here for more information regarding the different types of Adult Medicaid and Long Term Care Medicaid programs.
APPLYING FOR ADULT MEDICAID & LONG TERM CARE PROGRAMS:
- Apply online at
- Apply at Johnston County DSS at 714 North Street Smithfield NC 27577. Applications are taken between 8:00 am to 5:00 pm, Monday Friday
- Mail In Application:
- Request that an application be mailed to you by calling 919-989-5300
ADULT MEDICAID & LTC RECERTIFICATIONS AND CHANGES:
For more information contact: 919-989-5300
RELATED LINKS:
North Carolina’s Medicaid Program Will Pay For A Nursing Home Only If You Have Limited Income And Assets And You Need Skilled Nursing
In North Carolina, Medicaid is a common source of funding for long-term care, particularly when people have already used up all of their own assets to pay for private care. And this doesn’t take longin 2018, the average daily cost of a private room in a nursing home in North Carolina was $254. Plus, private health insurance policies generally do not cover long term care, very few people purchase private long-term care insurance policies, and Medicare coverage for long-term care services is very limited.
In North Carolina, Medicaid is administered by the Division of Medical Assistance . To apply for Medicaid, contact the Department of Social Services office in your county. You can also apply online.
Not everyone can get Medicaid to pay for nursing home care in North Carolina, however. You must medically require skilled nursing care, and your income and assets must fall under the state Medicaid limits. The eligibility rules for long-term care services like nursing homes are different than for other Medicaid services.
Read Also: What Are The Qualifications For Medicaid In Michigan
Spousal Maintenance Allowance In North Carolina
If you have a spouse who is going to continue to live independently while you go to a nursing home, then North Carolina will allow you and your spouse to keep more income and assets to support that spouse.
Income. First, your spouse may be allowed to keep some of your income each month. The amount that DMA determines that your spouse can keep will depend on how much separate income your spouse has and also how much he or she spends on housing. In 2019, the minimum monthly “community spouse income allowance” is $2,058, and the maximum is $3,090.
In addition, if you have dependents who will remain in the community while you go to a nursing home, these dependents might be entitled to keep some of your income. This is called the dependent family member allowance. Your dependents must be claimed as dependents on your tax return to qualify for this allowance. The amount your dependent can keep from your income depends on whether they have income of their own. The maximum that a dependent can keep is $686/month.
The amounts that DMA calculates for your community spouse’s income allowance and your dependents’ family member allowance reduce the amount of your Medicaid deductible. So, if you have a spouse receiving $3,090 and a dependent receiving $686 , then your six-month Medicaid deductible is reduced by $22,656 .
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.
Copyright ©2022 MH Sub I, LLC dba Nolo ® Self-help services may not be permitted in all states. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. The attorney listings on this site are paid attorney advertising. In some states, the information on this website may be considered a lawyer referral service. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. Do Not Sell My Personal Information
Also Check: Rehab Centers In Utah That Accept Medicaid
What Medicaid Covers For Medicare Enrollees
Medicare has four basic forms of coverage:
- Part A: Pays for hospitalization costs
- Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
- Part C: Medicare Advantage Plan offered by private companies approved by Medicare
- Part D: Assists with the cost of prescription drugs
Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid . Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state’s payment limit.
Nc Medicaid Managed Care Exempt
Some beneficiaries can choose to stay in NC Medicaid Direct. This means you are not required to choose a health plan and a PCP. NCDHHS – Division of Health Benefits will send you a letter that tells you if you have the choice to enroll. You have the option to choose a health plan if you:
- Are a federally-recognized tribal member or individual eligible for services through Indian Health Service .
- Need certain services to address needs related to developmental disability, behavioral health or traumatic brain injury. BH covers MH and SUD
If you are transitioning to NC Medicaid Managed Care and want to keep the PCP you have now:
- Choose a health plan that your provider works with. If you have questions about the instructions in the letter you received ,
To find a doctor, go to Find a provider.
Also Check: How To Apply For Senior Medicaid
When A Nursing Home Is Considered Medically Necessary In North Carolina
Medicaid will pay for a nursing home only when it is medically necessary. You must show that you “meet the nursing facility level of care,” meaning that you need the kind of care that can only be provided in a nursing home.
To show that you meet a nursing home level of care, your physician must think you need the kind of services that are only offered in a skilled nursing facility. For example, you can meet the nursing facility level of care by showing that you need the services of a registered nurse for several hours a day, or by showing that you need daily assessments of your condition by a licensed nurse, or by showing that you need medication administered frequently by a nurse. If you have a nasogastric tube, require dialysis, frequent injections, or respiratory therapy, you are more likely to meet the nursing facility level of care.
If you need only custodial care such as help with activities of daily living , you are not likely to meet the nursing home level of care.
