Medicaid is a health insurance program for low-income families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors and people with disabilities.
Medicaid may help pay for certain medical expenses such as: doctor bills, hospital bills, prescriptions, vision care, dental care, nursing home care, mental health care, etc.
To be eligible for Medicaid you must:
Be a U.S. citizen or provide proof of eligible immigration status. Individuals only applying for emergency services are not required to provide documentation of immigration status.
Live in NC, and provide proof of residency.
Have a Social Security number or have applied for one.
Each program will have additional requirements.
Your family’s income, the number of people in your family, and the age of your children determine if you or your children qualify.
Medicaid for Infants and Children
Medicaid for infants and children (MIC) provides medical coverage for children under age 19. The income limits are determined by the family size and the age of the children for whom you are applying. There is no resource limit.
NC Health Choice for Children
NC Health Choice (NCHC) for Children is a free or reduced price comprehensive health care program for children ages 6-18. The goal of the NCHC program is to reduce the number of uninsured children in the State to ensure that the population served will be healthy and ready to learn and work. If your family makes too much money for Medicaid but too little to afford health insurance premiums, your children may qualify for NCHC. You cannot receive NCHC if you are already active on another plan.
NCHC covers hospitalization, physician and clinic services, prescriptions, dental care, vision care, hearing services, laboratory and radiology services, etc.
The income limits are determined by the family size and the age of the children for whom you are applying. There is no resource limit. If your monthly income is above 159% of the federal poverty level there is an enrollment fee. If your family income is at or below the 159% poverty level, there is no enrollment fee.
Medicaid for Families with Dependent Children
Medicaid for Families with Dependent children provides medical coverage for parent(s) or other caretaker/relative with children age 18 and under in the household and for children under age 21. A pregnant woman may also qualify. If the family income is over the limit and your family has high medical bills, you may still qualify for Medicaid and have a Medicaid deductible.
NC Be Smart. Family Planning
The Be Smart Family Planning Waiver (FPW) program is designed to reduce unintended pregnancies and improve the well-being of children and families in NC. FPW provides family-planning and birth control services. FPW is for women and men who are US citizens, eligible immigration status, NC residents who are not pregnant, not been sterilized and their income must be at or below 195% of the federal income limits.
Medicaid for Pregnant Women
Medicaid for Pregnant women only covers services related to pregnancy:
- Prenatal care, delivery and 60 days postpartum care
- Services to treat medical conditions which may complicate the pregnancy
- Childbirth classes and family planning services
A pregnant woman may apply for this program before or after she delivers. A woman who has experienced a recent pregnancy loss may also be eligible. If a pregnant woman is covered by Medicaid on the date she delivers, her newborn child may be eligible for Medicaid up to age 1 without a separate application. (An unborn child is always counted in the family size.)
Aged, Blind & Disabled
You may be eligible for Medicaid if you are age 65 or older, blind, or disabled. Eligibility for Medicaid is based on your family’s monthly income and the amount of resources you own.
When you apply for Medicaid, your family’s monthly income is calculated by subtracting certain deductions from your gross income. Social Security, veteran’s benefits, wages, pensions and other retirement income are counted. The deductions vary with each Medicaid program. Your county worker will calculate your monthly family income.
If your family income and/or resources are over the limit and you have high medical bills, you may still qualify for Medicaid and have a Medicaid deductible.
Medicaid for Long-term Care
Medicaid may help pay for nursing homes and intermediate care facilities, as well as long-term care in the home. There are income limits, resource limits and transfer of asset requirements. You do not have to sell your house. The home, a car and all personal possessions are not countable resources.
Medicaid allows financial protection for the married spouse at home.
Nursing Facilities and Intermediate Care Facilities
Your income must be less than the cost of care in the facility at the Medicaid rate. Medicaid must approve the need for the level of care. You must use some of your income to help pay for the cost of care. This is called the “patient monthly liability.” Medicaid will pay the rest to the facility.
Your spouse can keep all of the income he/she receives for himself. He or she may be able to receive some of your income as well.
In-Home Long-Term Care
Community Alternatives Program (CAP)
Currently, there are four Community Alternatives Programs that help people who need long term care stay in their own homes for the state.
CAP provides both medical and non-medical services to prevent or delay care in a facility.
CAP funds are limited and only a specific number of people may participate in each program.
- Community Alternatives Program for Children
- Community Alternatives Program for Disabled Adults (CAP/DA) provides a package of services to allow adults (age 18 and older) who qualify for nursing facility care to remain in their private residences. The program is available in all North Carolina counties. CAP/DA LeadAgency List CAP Lead Agency List
- The Community Alternatives Program for Persons with Mental Retardation or Developmental Disabilities (CAP-MR/DD) provides community services to individuals of any age who qualify for care in an intermediate care facility for the mentally retarded (ICF-MR). The program is available statewide through local area mental health, developmental disabilities and substance abuse programs.
Medicaid for Medicare Recipients
Medicaid serves Medicare recipients in two ways:
- Medicare-Aid for people who have Medicare and also have limited income and resources.
- Medicare-Aid for working individuals with a disability
Medicaid does not pay for prescription drugs for people on Medicare.
See Medicare Part D: Prescription Drugs and the NCRx.
Medicare-Aid is a free Medicaid program for people who have Medicare and also have limited income and resources. The program can help pay your Medicare premiums, co-payments and deductibles. It is also known as Medicare Savings Program. There are three different levels of Medicare-Aid. All are based on an individual’s countable income.
Comprehensive Medicare-Aid (MQB-Q) covers:
- Medicare Part B premium
- Medicare Part A premiums (when applicable)
- Medicare hospital deductible
- Medicare annual deductible
- 20% Medicare co-payment
- If you go into a nursing home, Medicare-Aid only covers the first 20 days.
Limited Medicare-Aid (MQB-B) covers: