We have scoured the internet to provide you with all you need to know about the North Carolina Medicaid Benefits.
Medicaid is a joint federal-state initiative that covers health insurance for low-income people who qualify, including children, pregnant women, the elderly, and people with disabilities. It is simple to apply for Medicaid in person, over the phone, or online.
This post will teach you all you need to learn about Medicaid in North Carolina.
Table of Contents
What is the North Carolina Medicaid Program?
North Carolina Medicaid is a service for people and families with income and resources that fall within certain parameters. Resources primarily apply to the elderly, blind, or disabled population within the bounds of specified rules.
Who is eligible for the North Carolina Medicaid Program?
North Carolina Medicaid offers certain limited Medicare beneficiaries who are not eligible for the full Medicaid benefit package some partial financial help with Medicare premiums, copayments, or coinsurance through the Medicare Savings Plan.
- Expectant mothers
- People who are blind or disabled or who have a spouse who is blind or disabled;
- People whom someone adopts;
- People whom someone adopted;
- People who are blind or disabled or have a spouse who is disabled.
The Annual Household Income Limits (before taxes)
| Household Size* | The Maximum Income Level (Per Year) |
| 1 | $18,075 |
| 2 | $24,353 |
| 3 | $30,630 |
| 4 | $36,908 |
| 5 | $43,186 |
| 6 | $49,463 |
| 7 | $55,741 |
| 8 | $62,018 |
*For households with more than eight people, add $6,277 per additional person.
How do I contact Medicaid in North Carolina?
Phone
888-245-0179
Mailing Address
Division of Health Benefits, 2501 Mail Service Center
Raleigh NC 27699-2501
What are the Medicaid plans in North Carolina?
Carolina ACCESS (CA)
Carolina ACCESS (CA), the state’s PCCM program, was launched in 1991 in five counties and offered beneficiaries a designated medical house plus a primary care physician to coordinate care.
Community Care of North Carolina (CCNC)
For the primary care practices in CCNC/Carolina Access, Community Care of North Carolina (CCNC) pays 14 community health networks a monthly fee for case management, data analysis, quality improvement, and training activities.
Waiver for Mental Health (MH), Developmental Disability (DD), and Substance Abuse (SA) Services.
The initiative started as a Piedmont region 5-county pilot but is expected to go statewide in 2013.
Program for All-Inclusive Care for the Elderly (PACE)
North Carolina also supports PACE, or Program for All-Inclusive Care for the Elderly, which covers all Medicaid and Medicare services for people over 55 who need nursing home-level care.
How do I apply for North Carolina Medicaid?
Call 888-245-0179 to enroll.
Apply in person at the Division of Health Benefits
Online: Download and print the application.
Mail: To 2501 Mail Service Center, Raleigh NC 27699-2501
What is covered by North Carolina Medicaid?
North Carolina Medicaid covers the following services:
| Ambulatory surgery | Hospital stays |
| Audiology services | Laboratory tests |
| Behavioral health services | Vision care |
| Women’s health care | Non-emergency transportation |
| Dialysis | Orthotic and prosthetic devices |
| Doctor visits | Occupational therapy |
| Smoking cessation services | Pharmacy (medications) |
| Emergency care | Physical rehabilitation |
| Family planning services | Preventive care |
| Hearing aids | Hospital outpatient care |
| Home health care | X-rays and other radiology services |
Can I have both North Carolina Medicaid and Medicare?
You can sign up for Medicare and Medicaid if you are dually eligible. Medicaid can pay for services like long-term care that Medicare does not.
North Carolina Waiver
- Comprehensive Waiver
- Supports Waiver
- CAP Choice – IP
- CAP / DA
- Community Alternatives Program (CAP) for Children
- Innovations Waiver
Copayments?
They do not have to pay a copayment. When a member is
- under 21 years old;
- pregnant;
- Held by the state
- Placed under government supervision
- Native American participants who qualify for Contract Health funding
- Services or Tribal Union of Indian Health Services
- The hospital (inpatient)
- A facility for skilled nursing
- A nursing home
What is not covered by North Carolina Medicaid?
Medicaid is not required to pay for private nursing or home care services given by family members. Bandages, adult diapers, and other disposable items are frequently excluded from insurance coverage, as well as cosmetic surgery and other elective procedures.
What is the highest income limit for North Carolina Medicaid?
Full Medicaid has an income cap of $1,012 for individuals and $1372 for couples.
What if a person’s income is too high to qualify for regular Medicaid benefits?
If your income is too high, you may still be eligible for North Carolina Medicaid, thanks to the asset spend down option.
What documents do I need to apply for Medicaid?
The following documents are required with the application:
- The Social Security Number;
- Evidence of citizenship or authorized residency in the United States, such as a passport, driver’s license, birth certificate, green card, or job authorization card
- Evidence of all income sources, both legal and illegal
- Proof of origin
- Proof of residency
- Including the Medicare card, any insurance cards
- Pregnancy (doctors’ certification of the pregnancy and, if applicable, the expected delivery date);
- When non-parents apply for Medicaid on their behalf, they must provide proof of their financial position.
What is the best Medicaid in North Carolina?
The best plan for you is the one that meets your demands and offers the most benefits in terms of health insurance and monetary help because it varies from person to person.
Where do I find the letter showing the reason(s) for denial or discontinuance from North Carolina Medicaid?
By signing into your account at Portal, you can see the progress of your North Carolina Medicaid application.
