Who Qualifies For Medicaid In North Carolina


North Carolina Medicaid Expansion Update

Open Enrollment for Medicaid begins in North Carolina

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.

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.

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.

Read Also: How Do I Qualify For Medicare And Medicaid

Healthy Weight Getting Exercise

Exercising – and being active – is important in helping lose weight and maintain a healthy weight. Be sure to talk to your doctor or provider before starting any exercies or weight-loss program

Try to get 60 minutes or more of exercise every day. If you’re not able to get to the gym, don’t worry. Below are ideas you can do at home.

Move! Dancing to your favorite tunes can help you burn more than 300 calories an hour.

If you do play video games, play games where you have to move. You dont even have to leave the house. Try exercises like jumping jacks, marching in place, going up and down stairs, push-ups or sit-ups at home.

North Carolina Medicaid Income Limits Summary

500K in NC left out of coverage in Medicaid reform ...

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.

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Be sure to check out our other articles about Medicaid.

Read Also: How To Apply For Women’s Medicaid

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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    North Carolina Medicaid History

    North Carolina was one of the last states to adopt the Medicaid program: Only two states took longer to implement original Medicaid coverage. The first states to provide Medicaid did so in January 1966, and North Carolinas program didnt become effective until January 1970.

    Move to Managed Medicaid

    On September 22, 2015, North Carolina lawmakers passed House Bill 372, known as the Medicaid Transformation and Reorganization Act, to privatize the states Medicaid system then-Governor Pat McCrory signed it into law the next day. Most states are already using Medicaid managed care systems for the majority of their enrollees.

    H. 372 called for the privatization of Medicaid in North Carolina, switching to a model that involves the state contracting with for-profit managed care companies. These managed care organizations, called Prepaid Health Plans , will receive a per-patient payment from the state Medicaid system, and will be responsible for any cost over-runs beyond what they receive up-front from the Medicaid system. This provision is designed to encourage innovation on the part of carriers and providers, in order to keep patients healthy and reduce overall healthcare costs .

    Governor Roy Cooper, who was North Carolinas Attorney General at the time, said that turning to MCOs is a risky move.

    Medicaid managed care repeatedly delayed now takes effect in 2021

    North Carolinas waiver proposal was approved in October 2018, and is effective from 2019 through 2024 .

    Also Check: Where Can I Get A Nebulizer With Medicaid

    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.

    Nc Medicaid Managed Care Launches

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

    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.

    Recommended Reading: Does Medicaid Cover Cochlear Implants

    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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    North Carolina Health Plans As Low As $0 Cost

    UHC NC Medicaid Plans:

    • Low income individuals and families
    • All ages

    NC Individual and Family Plans:

    • Up to 6 $0 virtual urgent care and virtual primary care visits
    • Digital fitness classes at no additional cost
    • $3 copays on Tier 1 generic drugs at Walgreens
    • $0 copay for 3 primary care visits
    • Earn a $25 gift card for visiting your doctor
    • $0 routine dental visits and preventive care for adults on select plans

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    See Why People Choose Unitedhealthcare In North Carolina

    • Regardless of the plan you choose, you’ll get the care you need at UnitedHealthcare.
    • Large variety and network of doctors/ providers
    • No cost virtual visits
    • Low or no cost prescriptions
  • View the video on the right to learn more about the NC Medicaid.
  • Stay informed about Coronavirus
  • Find Covid-19 resources and information on local vaccination sites in North Carolina.
  • Open Enrollment has begun for NC Individual and Family plans Marketplace health coverage. Open enrollment is now thru January 15, 2022. Learn More.
  • Its your health. Its your choice.

    Everyone deserves affordable health care, including you.

    That includes working adults, people with disabilities, pregnant women and children.

    If thats you, check out UnitedHealthcare Community Plan Medicaid.

    We have the Medicaid services and extras that can make a real difference in your life. All at no cost to you.

    • Find a doctor you trust in our network.
    • Unlimited doctor visits for adults.
    • Vision coverage.
    • Transportation to and from doctor appointments.
    • 24/7 NurseLine to answer your health questions.

    Sometimes, you might need a little extra help. Get extras not covered by Medicaid.

    • Earn rewards for keeping you and your baby healthy.
    • Earn gift cards for getting preventative services.
    • Support and treatment to reach a healthy weight.
    • Members 18 and older can get free GED Exam Voucher and materials.

    We also offer resources to help you make the most of your plan. Including:

    • Member Advocates

    Helping you live a healthier life.

    What Does Medicaid Cover In North Carolina

    SC Medicaid: Healthy Connections South Carolina Medicaid ...

    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

    Also Check: Does Medicaid Pay For Assisted Living In Washington State

    How Can A Lawyer Help Me Meet The Medicaid Eligibility Limits

    An experienced Medicaid planning attorney can help you manage your assets in a way that maximizes your ability to secure Medicaid coverage when you need it. A lawyer can advise on the type of assets that will be counted when assessing your eligibility. A few examples of these complexities include:

    • Equity in a home is not counted for Medicaid purposes, but it is susceptible to Medicaid Estate Recovery after your death, meaning it could be sold to recover payments for Medicaid services.
    • A single individual can retain $2,000 in countable assets and still qualify for Medicaid, but you must understand what qualifies as a countable asset to make smart choices about what to accrue towards this limit.
    • If the individual who requires care has an independent spouse, a spousal allowance will be determined based on the marital assets in the 30 days prior to entering a nursing home. The couple should plan strategically to ensure the snapshot captures the maximum possible amount so that the spouse receives the maximum compensation.

    The above are just examples of the type of strategic planning a Medicaid attorney in North Carolina can provide.

    Contact us today to discuss your options when it comes to Medicaid eligibility in North Carolina.

    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:

    Read Also: Does Medicaid Cover Home Sleep Studies

    What Are The Financial Medicaid Eligibility Requirements In North Carolina

    Medicaid in NC can be granted to recipients who are age 65 or older and children/infants 21 and younger. Applicants that may require long-term care, are disabled or blind and are living on low incomes are likely eligible for Medicaid. Keep in mind that proofs of citizenship and NC residency are both essential to be eligible for Medicaid.

    Learn more about Medicaid requirements by downloading our comprehensive guide.

    When it comes to the financial eligibility for Medicaid benefits for North Carolinas residents, keep the following two details in mind:

  • Resources must not exceed $2,000 for individual beneficiaries. Couples applying for Medicaid coverage in NC must not exceed the $3,000 resource limit.
  • Monthly income must not exceed $867 for individual beneficiaries. What are the Medicaid application guidelines regarding the incomes of couples in NC? The number must not exceed the $1,167 monthly income limit.
  • What are the Medicaid application guidelines in regard to assets? To be eligible for Medicaid, stocks, bonds, retirement accounts, bank accounts, and real estate must be counted as resources, so long as real estate is not the recipients actual home. Clothing, furnishings and primary property are not considered resources.

    Medicaid benefits eligibility in NC states that a deductible must be paid by the beneficiary if monthly income limits are exceeded. The deductible is based on Medically Needy income guidelines $242 for single recipients and $317 for couples.

    View Or Download Our Free Guide

    North Carolina Medicaid recipients have just days to make plan changes

    While we are not affiliated with the government in any way, our private company engaged writers to research the Medicaid program and compiled a guide and the following answers to frequently asked questions. Our goal is to help you get the benefits that you need by providing useful information on the process.

    Our free Medicaid Guide is filled with helpful information about how to apply, program eligibility and how to get in touch with local offices. You can view or download our free guide here.

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    How To Qualify For Medicaid In North Carolina

    To qualify for Medicaid in North Carolina, you must:

    • Be a resident of North Carolina
    • Be a U.S. citizen or have a qualifying immigration status
    • Meet the Medicaid programs income limits
    • Be responsible for a child 18 years of age or younger, be pregnant, be disabled, or be at least 65 years old

    Income limits vary depending on household size, medical status and other factors and are subject to change annually. Find the current Medicaid income limits based on household size in North Carolina here.

    Learn what documents you can submit to prove your citizenship and identity here.

    Find further information on North Carolina Medicaid eligibility here.

    Apply For Medicaid In North Carolina

    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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