Medicaid in North Carolina provides health insurance coverage to children, pregnant women, people with disabilities, and low-income adults. It covers a wide range of medical services, including doctor visits, hospital stays, prescription drugs, mental health care, and substance abuse treatment. Medicaid also provides coverage for long-term care services, such as nursing home care and home health care. The program is funded by both the state and federal governments.
Eligibility Requirements in North Carolina
To be eligible for Medicaid in North Carolina, you must meet certain requirements. These requirements include:
- Being a resident of North Carolina
- Being a U.S. citizen or a qualified non-citizen
- Meeting income and asset limits
- Being pregnant, a child, or a parent or caretaker of a child
- Being disabled or blind
- Needing long-term care services
The income and asset limits for Medicaid in North Carolina vary depending on your household size and composition. In general, you must have a low income and few assets to qualify for Medicaid. For example, in 2023, the income limit for a family of four is $3,622 per month.
If you are unsure whether you are eligible for Medicaid, you can apply online or contact your local Medicaid office. You can also get help from a community health center or a legal aid office.
Once you have applied for Medicaid, you will be interviewed by a Medicaid caseworker. The caseworker will ask you about your income, assets, and household members. They will also ask you about your health and your need for medical care. After the interview, the caseworker will make a decision about your eligibility for Medicaid.
| Requirement | Description |
|---|---|
| Residency | Must be a resident of North Carolina |
| Citizenship | Must be a U.S. citizen or a qualified non-citizen |
| Income | Must meet income and asset limits |
| Pregnancy | Pregnant women are eligible for Medicaid |
| Children | Children under 19 are eligible for Medicaid |
| Parents | Parents or caretakers of children are eligible for Medicaid |
| Disability | Disabled individuals are eligible for Medicaid |
| Blindness | Blind individuals are eligible for Medicaid |
| Long-Term Care | Individuals needing long-term care services are eligible for Medicaid |
If you are approved for Medicaid, you will receive a Medicaid card. Your Medicaid card will allow you to get free or low-cost health care services from doctors, hospitals, and other healthcare providers. Medicaid also covers prescription drugs, dental care, and vision care.
Covered Medical Services and Treatments
Medicaid in North Carolina provides comprehensive medical coverage to eligible individuals and families. The program is designed to provide access to necessary medical services, helping individuals and families maintain their health and well-being.
Medicaid in North Carolina covers a wide range of medical services and treatments. Some of the covered services include:
- Doctor’s visits
- Hospital care
- Prescription drugs
- Dental care
- Vision care
- Mental health services
- Substance abuse treatment
- Long-term care
- Home health care
In addition to these basic services, Medicaid in North Carolina also covers a number of additional services and treatments. These services may include:
- Family planning services
- HIV/AIDS treatment
- Cancer treatment
- Kidney dialysis
- Organ transplants
- Assistive technology
- Durable medical equipment
The specific services and treatments covered by Medicaid in North Carolina may vary depending on the individual’s eligibility category. For more information on the covered services and treatments, individuals should contact their local Medicaid office.
Medicaid in North Carolina covers a wide range of medical services and treatments, making it an essential program for millions of North Carolinians. If you are struggling to afford health care, Medicaid may be able to help.
| Service | Covered |
|---|---|
| Doctor’s visits | Yes |
| Hospital care | Yes |
| Prescription drugs | Yes |
| Dental care | Yes |
| Vision care | Yes |
| Mental health services | Yes |
| Substance abuse treatment | Yes |
| Long-term care | Yes |
| Home health care | Yes |
Medicaid Coverage in North Carolina: Limits and Restrictions
Medicaid is a government-funded healthcare program that provides coverage to low-income individuals and families. In North Carolina, Medicaid is administered by the North Carolina Department of Health and Human Services (DHHS).
Medicaid covers a wide range of medical services, including:
- Doctor’s visits
- Hospitalizations
- Prescription drugs
- Mental health services
- Substance abuse treatment
- Dental care
- Vision care
- Hearing aids
- Durable medical equipment
- Home health care
- Nursing home care
However, there are some limits and restrictions to Medicaid coverage.
Income Limits
To be eligible for Medicaid in North Carolina, you must meet certain income requirements. The income limits are based on the federal poverty level (FPL). For a family of three, the income limit is 138% of the FPL. This means that a family of three can earn up to $35,535 per year and still be eligible for Medicaid.
Asset Limits
In addition to income limits, there are also asset limits for Medicaid eligibility. The asset limits are also based on the FPL. For a single person, the asset limit is $2,000. For a couple, the asset limit is $3,000.
Services Covered
Medicaid covers a wide range of medical services, but there are some services that are not covered. Some of the services that are not covered include:
- Cosmetic surgery
- Elective surgery
- Experimental treatments
- Weight-loss surgery
- Dental implants
- Private-duty nursing
Prior Authorization
Some Medicaid services require prior authorization before they can be covered. This means that you must get approval from Medicaid before you can receive the service.
Copayments and Deductibles
Medicaid recipients may have to pay copayments and deductibles for some services. The amount of the copayment or deductible will vary depending on the service.
| Service | Copayment | Deductible |
|---|---|---|
| Doctor’s visit | $3 | $0 |
| Hospitalization | $10 per day | $0 |
| Prescription drugs | $1 per generic drug, $3 per brand-name drug | $0 |
| Mental health services | $3 per visit | $0 |
| Substance abuse treatment | $3 per visit | $0 |
| Dental care | $3 per visit | $0 |
| Vision care | $3 per visit | $0 |
| Hearing aids | $100 per hearing aid | $0 |
| Durable medical equipment | $10 per item | $0 |
| Home health care | $3 per visit | $0 |
| Nursing home care | $40 per day | $0 |
Applying for Medicaid in North Carolina
To apply for Medicaid in North Carolina, individuals can use any of the following methods:
- Online: Applicants can apply online through the North Carolina Department of Health and Human Services (NCDHHS) website.
- By phone: Applicants can call the Medicaid Customer Service line at 1-888-245-0042.
- By mail: Applicants can download a Medicaid application form from the NCDHHS website and mail it to the address provided on the form.
- In person: Applicants can visit their local county Department of Social Services (DSS) office to apply for Medicaid.
When applying for Medicaid, individuals will need to provide the following information:
- Proof of identity, such as a driver’s license or birth certificate.
- Proof of income, such as pay stubs or tax returns.
- Proof of assets, such as bank statements or investment account statements.
- Information about household members, such as their names, ages, and relationships to the applicant.
The Medicaid application process can take several weeks to complete. Once an application is submitted, the NCDHHS will review the information and determine if the applicant is eligible for Medicaid. If an applicant is approved for Medicaid, they will receive a Medicaid card in the mail.
The following table provides an overview of the Medicaid benefits covered in North Carolina:
| Medicaid Benefit | Description |
|---|---|
| Medical care | This includes doctor’s visits, hospital stays, and prescription drugs. |
| Mental health services | This includes therapy, counseling, and medication management. |
| Substance abuse treatment | This includes detoxification, counseling, and medication management. |
| Dental care | This includes routine checkups, cleanings, and fillings. |
| Vision care | This includes eye exams, glasses, and contact lenses. |
| Hearing care | This includes hearing exams, hearing aids, and assistive listening devices. |
| Long-term care | This includes nursing home care, assisted living care, and home health care. |
Thanks for sticking with me to the end. You’re probably feeling a bit overwhelmed with information by this point. Medicaid is a complex program, and it can be hard to keep up with all the details. That’s why I started writing these articles—to collect all the information you need about the program in one place. I hope they’ve been helpful. If you still have any questions, feel free to reach out to me directly. I’m always happy to chat about Medicaid. Of course, things can change with Medicaid, so be sure to check back here from time to time for the latest updates. In the meantime, take care and stay healthy.