In North Carolina, if a person with a disability is found eligible to receive Supplemental Security Income (SSI) and meets the SSI citizenship and residency requirements, they automatically qualify for Medicaid. Proof of disability is required with the application, and a person must apply for both SSI and Medicaid. SSI is a federal program that provides monthly cash payments to adults and children with disabilities who have limited income and resources. Medicaid is a joint federal and state health insurance program that provides a variety of medical services for eligible individuals. Once approved for SSI, Medicaid coverage begins the first of the month after the application is approved.
Eligibility Requirements for Medicaid in North Carolina
Medicaid is a health insurance program that provides coverage to low-income individuals, families, children, pregnant women, and people with disabilities. In North Carolina, Medicaid is administered by the North Carolina Department of Health and Human Services (DHHS). To be eligible for Medicaid in North Carolina, you must meet certain income and resource requirements. You must also be a resident of North Carolina and a U.S. citizen or qualified non-citizen.
Income Requirements
- For individuals, the income limit is 138% of the federal poverty level (FPL).
- For families, the income limit is 138% of the FPL for the family size.
- The FPL is updated each year by the U.S. Department of Health and Human Services (HHS).
- You can find the current FPL levels on the HHS website.
Resource Requirements
- For individuals, the resource limit is $2,000.
- For couples, the resource limit is $3,000.
- Resources include cash, bank accounts, stocks, bonds, and real estate (excluding your home).
- Vehicles are not counted as resources.
Disability Requirements
- To qualify for Medicaid based on disability, you must have a disability that prevents you from working.
- Your disability must be expected to last for at least 12 months.
- You must be unable to perform substantial gainful activity (SGA).
- SGA is defined as earning more than $1,350 per month for individuals and $2,260 per month for couples.
How to Apply for Medicaid
- You can apply for Medicaid online, by mail, or in person at your local DHHS office.
- You will need to provide proof of your income, resources, and disability.
- The DHHS will review your application and determine if you are eligible for Medicaid.
Table of Medicaid Eligibility Requirements in North Carolina
| Category | Income Limit | Resource Limit | Disability Requirement |
|---|---|---|---|
| Individuals | 138% of FPL | $2,000 | Disability that prevents work for at least 12 months |
| Couples | 138% of FPL | $3,000 | Disability that prevents work for at least 12 months |
| Families | 138% of FPL for family size | $2,000 per person | Disability that prevents work for at least 12 months |
Types of Disability Covered by Medicaid in North Carolina
There are specific disability categories that Medicaid covers in North Carolina. If you fall under any of these categories, you may qualify for Medicaid benefits:
- Physical disability: This includes any physical impairment that results in a substantial limitation of one or more major life activities, such as walking, seeing, hearing, or working.
- Intellectual disability: This includes a severe impairment characterized by significant limitations in intellectual functioning and adaptive behavior that begins before the age of 22.
- Mental illness: This includes any disorder that substantially interferes with a person’s ability to work, go to school, or maintain relationships.
- Chronic medical condition: This includes any condition that requires ongoing medical care and results in a substantial limitation of one or more major life activities.
In addition to these general categories, Medicaid in North Carolina also covers certain specific conditions, including:
- Spinal cord injury
- Traumatic brain injury
- Cerebral palsy
- Multiple sclerosis
- Autism spectrum disorder
If you have a disability that meets one of these categories or specific conditions, you are encouraged to apply for Medicaid benefits in North Carolina. You can apply online, by phone, or in person at your local county Department of Social Services office.
| Disability Category | Definition | Examples |
|---|---|---|
| Physical disability | A physical impairment that substantially limits one or more major life activities | Blindness, deafness, paralysis, amputation |
| Intellectual disability | A severe impairment of intellectual functioning and adaptive behavior that begins before age 22 | Down syndrome, autism spectrum disorder, cerebral palsy |
| Mental illness | A disorder that substantially interferes with a person’s ability to work, go to school, or maintain relationships | Major depression, schizophrenia, bipolar disorder |
| Chronic medical condition | A condition that requires ongoing medical care and results in a substantial limitation of one or more major life activities | Cancer, heart disease, kidney disease, diabetes |
Application Process for Medicaid in North Carolina
Applying for Medicaid in North Carolina is a relatively straightforward process. Here’s what you need to know:
Step 1: Determine Your Eligibility
To qualify for Medicaid in North Carolina, you must meet certain eligibility criteria, including:
- Being a U.S. citizen or lawful permanent resident
- Residing in North Carolina
- Meeting income and asset limits
- Meeting disability requirements (if applying based on disability)
Step 2: Gather Required Documents
Once you’ve determined your eligibility, you’ll need to gather the following documents:
- Proof of identity (driver’s license, state ID, or passport)
- Proof of residency (utility bill, lease agreement, or mortgage statement)
- Proof of income (pay stubs, Social Security benefits, or pension statements)
- Proof of assets (bank statements, investment account statements, or vehicle titles)
- Proof of disability (doctor’s statement or Social Security Disability Determination)
Step 3: Submit Your Application
You can apply for Medicaid in North Carolina online, by mail, or in person at your local Department of Social Services office. You can find the application form and instructions on the North Carolina Department of Health and Human Services website.
Step 4: Wait for a Decision
Once you’ve submitted your application, the Department of Social Services will review your information and determine your eligibility. You can expect to receive a decision within 45 days of submitting your application.
Step 5: Appeal a Denial
If your application is denied, you have the right to appeal the decision. You must file an appeal within 30 days of receiving the denial letter. You can appeal by submitting a written request to the Department of Social Services or by requesting a hearing.
| Household Size | Monthly Income Limit |
|---|---|
| 1 | $1,778 |
| 2 | $2,393 |
| 3 | $3,008 |
| 4 | $3,623 |
| Each additional person | $615 |
Medicaid is an assistance program jointly funded by the federal and state government for people with low incomes and limited resources. Medicaid provides coverage for a variety of medical services, including doctor visits, hospital care, prescription drugs, and mental health services.
In North Carolina, there are various Medicaid programs available, including:
- Program for Children and Families
- Supplemental Security Income (SSI)
- Aged, Blind, and Disabled (ABD)
- 1915(c) Home and Community-Based Services (HCBS) Waivers
- Medicare Savings Programs
Benefits Covered by Medicaid in North Carolina
North Carolina’s Medicaid program covers a wide range of medical services for eligible individuals and families, including:
- Doctor visits
- Hospital care
- Emergency services
- Prescription drugs
- Dental services
- Vision care
- Mental health services
- Substance abuse treatment
- Physical therapy
- Occupational therapy
- Speech therapy
- Durable medical equipment
Coverage for services may vary depending on the specific Medicaid program you are eligible for. To learn more about the benefits covered under your Medicaid program, you can contact the North Carolina Medicaid office or visit their website.
And that’s the scoop! I hope this article helped you navigate the ins and outs of Medicaid eligibility in North Carolina for individuals with disabilities. Remember, the rules can be tricky, so if you need more guidance, don’t hesitate to reach out to a local Medicaid office or disability advocate. I want to thank you from the bottom of my heart for taking the time to read this piece. Your curiosity and desire for knowledge keep me going. While you’re here, be sure to check out some of my other articles. I’ve got a treasure trove of information just waiting to be discovered. And remember, keep an eye out for new content because I’m always cooking up something fresh. Until next time, stay informed and empowered, my friends!