Paul Sanchez
North Carolina Medicaid provides health care coverage to people between the ages of 19 and 64. To apply, you must be a US citizen or have an eligible immigration status, live in North Carolina, and have a Social Security number. You can apply for your child even if you are not eligible for coverage, and your immigration status will not be affected. If you are eligible for full Medicaid benefits, you will receive a letter from the NC Department of Health and Human Services, informing you that you have been enrolled, along with a new Medicaid insurance card.
| Characteristics | Values |
|---|---|
| Who is eligible for North Carolina Medicaid? | People aged 19-64, including non-US citizens and those without a Social Security number |
| How to apply for North Carolina Medicaid | Download, print, and fill out an application form from the NC Department of Social Services website or by calling 1-888-245-0179 |
| Additional forms | May be required in certain situations, as determined by the local Department of Social Services |
| Documents to include with the application | Copies of relevant documents, such as a driver's license |
| How to submit the application | Mail, email, fax, or bring the application to the local Department of Social Services |
| Notification of Medicaid coverage | A letter from the NC Department of Health and Human Services informing of full Medicaid coverage and a new Medicaid ID card |
| Changing health plans | Possible within 90 days of receiving the initial health plan |
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What You'll Learn
Eligibility requirements for North Carolina Medicaid
North Carolina's Medicaid program is jointly funded by the state and federal government but administered by the state. The program provides health care coverage to eligible low-income adults, children, pregnant women, seniors, and people with disabilities. The best way to find out if you are eligible is to apply. Here are some of the eligibility requirements:
Citizenship and Residency
To be eligible for North Carolina Medicaid, you must be a U.S. citizen or have eligible immigration status and live in the state of North Carolina. Families that include non-U.S. citizens can apply, and one can apply for their child even if they are not eligible for coverage themselves.
Income Requirements
North Carolina Medicaid is available to individuals with lower incomes. The income limits vary based on family size, and the figures are valid until April 1, 2026. The income requirements change annually and are further complicated by the fact that North Carolina offers alternative pathways to eligibility. For instance, the Medically Needy Pathway allows applicants with income over the eligibility limit to still qualify if they have high medical bills.
Long-Term Care Services
There are three categories of Medicaid long-term care programs, each with different financial and medical eligibility criteria:
- Institutional/Nursing Home Medicaid: Benefits are provided only in nursing homes.
- Medicaid Waivers/Home and Community-Based Services (HCBS): Benefits are intended to delay nursing home admissions and may be provided at home, adult day care, family care homes, or assisted living.
- Regular Medicaid/Aged Blind and Disabled: An entitlement where anyone who meets the eligibility requirements receives assistance.
Social Security Number
To be eligible for North Carolina Medicaid, you must have a Social Security number or show that you have applied for one if you are eligible.
If you are unsure about your eligibility, you can connect with a health insurance expert from the NC Navigator Consortium, who provides free advice and assistance with the application process.
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How to apply for North Carolina Medicaid
To apply for North Carolina Medicaid, you must be a US citizen or have an eligible immigration status, live in North Carolina, and have a Social Security number or proof that you have applied for one. Families that include non-US citizens can apply, and you can apply for your child even if you are not eligible for coverage.
To apply, you must first download and fill out a printable application. If you are a single adult with no dependents or health care coverage from your employer, use the "short form" application (DHB-5201-ia). Additional forms may be needed in certain situations, and your local Department of Social Services (DSS) will let you know if you need to complete any of these. You can find your local DSS by using this directory or calling the NC Medicaid Contact Center at 1-888-245-0179 (TTY Relay Services: Call 711).
You can also make a free appointment with an NC Navigator or call 1-855-733-3711 for help filling out the application or to explore health insurance options. A Medicaid Ambassador can also guide you through the online application and answer questions, but they cannot complete an application on your behalf.
Once you have completed your application, mail, email, fax, or bring it to your local DSS, along with any necessary additional documents. A driver's license, for example, can prove both your name and address. The DSS will then decide whether or not you qualify for Medicaid. This process can take up to 45 days, or up to 90 days for disability applications. You will receive a letter in the mail informing you of their decision.
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Medicaid coverage for people with disabilities
Medicaid is a health care program for low-income people of all ages. North Carolina's Medicaid program is jointly funded by the state and federal government but administered by the state. The program now provides health care coverage to people ages 19-64.
Individuals with disabilities who are working may receive Medicaid through the Health Coverage for Workers with Disabilities (HCWD) Act. HCWD provides full Medicaid coverage for workers with disabilities ages 16 through 64. To be eligible, the individual must meet the basic Medicaid eligibility requirements. Their unearned income must not exceed 150% of the federal poverty level (FPL). Federal poverty levels are updated effective April 1st each year. Those with countable incomes above 150% of FPL must pay an annual $50 enrollment fee. Those with incomes above 200% of FPL must pay an annual $50 enrollment fee and HCWD monthly premium.
Medicaid beneficiaries ages 16-20 are also entitled to additional services under Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). To apply for Medicaid, individuals can fill out a "short form" application (DHB-5201-ia) if they are a single adult with no dependents or health care coverage from their employer. They can also call their local Department of Social Services (DSS) to determine if they need to complete any other forms.
North Carolina also offers the Community Alternatives Program for Disabled Adults Waiver, which will pay for adult day health care, in-home personal care assistance, minor home modifications, and other services that help disabled people live at home. This program includes CAP/Consumer-Directed, which allows beneficiaries to choose their own care providers and permits family members to be hired and paid by the Medicaid program.
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Medicaid coverage for mental health services
North Carolina Medicaid does not automatically send out forms for insurance coverage. However, you can apply for Medicaid online, by mail, or by fax. You can also request assistance with the application process from a Medicaid Ambassador or an NC Navigator.
The 1915(i) Option Respite Draft Policy, which is currently in the stakeholder engagement phase as of December 2022, applies to children ages 3-20 with mental health or substance use disorder support needs and children and adults with I/DD or TBI support needs who live with a primary caregiver.
The NC Medicaid Ombudsman helps beneficiaries understand their rights and responsibilities and offers free, confidential support.
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Medicaid coverage for substance use disorder treatment
North Carolina Medicaid provides health care coverage to people between the ages of 19 and 64. This includes doctor visits, yearly check-ups, emergency care, dental care, and mental health services. North Carolina offers several Medicaid-managed care plans that provide substance use treatment services coverage.
Substance use disorder treatment is covered by Medicaid in North Carolina. The state offers a range of treatment services, including inpatient and outpatient treatment, medication-assisted treatment, and recovery support services. Additionally, the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services helps treatment programs become part of Recovery Oriented Systems of Care (ROSC). ROSC focuses on promoting systems that support a lifetime process of recovery, including ongoing treatment and a network of person-centered services.
To apply for North Carolina Medicaid, individuals can use the "`short form`" application (DHB-5201-ia) if they are single adults without dependents or health care coverage from their employer. Additional forms may be required, and these can be obtained from the local Department of Social Services (DSS). The DSS can also provide guidance on the application process, and there are Medicaid Ambassadors available to answer questions.
Once approved for Medicaid, individuals must select a managed care plan that includes substance use treatment services coverage. It is important to work closely with the selected Medicaid-managed care plan to understand the specific coverage and benefits. Prior authorization requirements, copays, and limitations on the number of visits or treatments may apply.
There are also drug rehab centers in North Carolina that accept Medicaid. These centers offer a range of treatment programs, including detox, intensive outpatient programs, medical detox, substance abuse counseling, and more.
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Frequently asked questions
You can apply for North Carolina Medicaid by downloading, printing, and filling out an application form. You can find the form on the NC Medicaid website. You can also call the NC Medicaid Contact Center at 1-888-245-0179 to find your local Department of Social Services.
To be eligible for North Carolina Medicaid, you must be a U.S. citizen or have eligible immigration status, live in North Carolina, and have a Social Security number. Families that include non-U.S. citizens can apply, and you can apply for your child even if you are not eligible for coverage.
North Carolina Medicaid covers doctor visits, yearly check-ups, emergency care, mental health services, and more. Beginning December 1, 2023, NC Medicaid will cover people aged 19 through 64 years with higher incomes.
The best way to find out if you are eligible for North Carolina Medicaid is to apply. You can also contact a health insurance expert or your local Department of Social Services for more information.
Yes, if you are approved for full Medicaid benefits, you will receive a notification in the mail from the NC Department of Health and Human Services. You will then be assigned a health plan and receive a new Medicaid insurance card.
