In North Carolina, individuals and families meeting specific income and other eligibility criteria can receive comprehensive health insurance coverage through Full Medicaid. This program provides access to essential medical services, including doctor visits, hospital care, prescription drugs, and preventive care.
To qualify for Full Medicaid in North Carolina, households must have an income below certain limits set by the federal and state governments. Additionally, there are specific rules for pregnant women, children, people with disabilities, and elderly adults. Individuals can apply for Full Medicaid through their local Department of Social Services or online. Eligibility is typically determined based on income, assets, and household size. Full Medicaid coverage in North Carolina offers a wide range of benefits to eligible individuals, ensuring access to necessary healthcare services.
Who Qualifies for Full Medicaid in North Carolina?
Medicaid is a government-sponsored healthcare program that provides comprehensive health coverage to individuals who meet certain eligibility requirements. In North Carolina, full Medicaid coverage (also known as NC Medicaid Managed Care) is available to:
- Low-income families and pregnant women
- Children under the age of 19
- Adults with disabilities
- Seniors aged 65 and older
- Individuals receiving Supplemental Security Income (SSI) or certain other public benefits
Low-Income Adults
To qualify for full Medicaid as a low-income adult in North Carolina, you must meet the following criteria:
- Be a North Carolina resident
- Be between the ages of 19 and 64
- Have a household income at or below 138% of the federal poverty level
- Not be eligible for any other health insurance coverage
The federal poverty level (FPL) is a measure of income used to determine eligibility for various government programs. In 2023, the FPL is $12,840 for a single person and $26,500 for a family of four.
If you meet all of the eligibility criteria, you can apply for full Medicaid coverage through the North Carolina Department of Health and Human Services (DHHS). You can apply online, by mail, or in person at your local DHHS office.
| Income Level | Medicaid Eligibility |
|---|---|
| 100% of the FPL | Yes |
| 138% of the FPL | Yes |
| 150% of the FPL | No |
For more information about Medicaid eligibility in North Carolina, please visit the DHHS website or call the Medicaid helpline at 1-800-433-6699.
Who Is Eligible for Full Medicaid in North Carolina
Medicaid is a government health insurance program that provides low-cost or free health coverage to eligible individuals and families. In North Carolina, full Medicaid is available to individuals and families who meet certain income and asset guidelines.
Children
- Children under the age of 19 are eligible for full Medicaid in North Carolina, regardless of their family’s income or assets.
- Children who are eligible for Medicaid may receive a wide range of benefits, including doctor visits, hospital care, prescription drugs, dental care, vision care, and mental health services.
Other Individuals and Families
In addition to children, other individuals and families may also be eligible for full Medicaid in North Carolina. These individuals and families include:
- Pregnant women
- Parents of children under the age of 19 who are eligible for Medicaid
- Individuals with disabilities
- Individuals who are blind or have low vision
- Individuals who are elderly and meet certain income and asset guidelines
The income and asset limits for full Medicaid vary depending on the individual’s or family’s circumstances. However, in general, individuals and families who have incomes at or below 138% of the federal poverty level (FPL) are eligible for full Medicaid.
| Family Size | 138% of Federal Poverty Level |
|---|---|
| 1 | $18,754 |
| 2 | $25,465 |
| 3 | $32,176 |
| 4 | $38,887 |
| 5 | $45,598 |
| 6 | $52,309 |
Individuals and families who are interested in applying for full Medicaid in North Carolina can do so by visiting the North Carolina Department of Health and Human Services website or by calling the department’s Medicaid Customer Service Center at 1-800-662-7030.
Who Qualifies for Full Medicaid in North Carolina?
Full Medicaid coverage in North Carolina is available to North Carolina residents who meet specific eligibility requirements. Broadly, these include individuals and families with low incomes and limited assets. The program covers a wide range of medical services, including doctor visits, hospital stays, and prescription drugs. The following are groups of people who are eligible for full Medicaid coverage in North Carolina:
Pregnant Women
Pregnant women whose income is less than 200% of the federal poverty level (FPL) are eligible for full Medicaid coverage. Here are the specific criteria for pregnant women’s eligibility:
- Income: Pregnant women with incomes below 200% of the federal poverty level (FPL) are eligible. The FPL is a measure of poverty used by the U.S. government. For a pregnant woman, the FPL is $27,750 per year for a single person and $36,620 per year for a family of three.
- Residency: Women must be residents of North Carolina.
- Citizenship or Lawful Presence: Women must be U.S. citizens, permanent residents, or otherwise lawfully present in the United States.
Note: If a pregnant woman does not meet the income eligibility requirements, she may still be able to qualify for Medicaid if she has a disability or other special circumstances.
Infants and Children
Infants and children under the age of 19 are eligible for full Medicaid coverage if their family’s income is less than 138% of the FPL. Children who are U.S. citizens or permanent residents are eligible, regardless of their parents’ immigration status.
Parents and Caretaker Relatives
Parents and caretaker relatives of children who are eligible for Medicaid may also be eligible for coverage. The income limit for parents and caretaker relatives is 138% of the FPL.
People with Disabilities
Adults with disabilities who meet the Social Security Administration’s definition of disability are eligible for full Medicaid coverage. The income limit for people with disabilities is 200% of the FPL.
People Aged 65 and Older
People aged 65 and older who meet the income and asset limits are eligible for full Medicaid coverage. The income limit for people aged 65 and older is 138% of the FPL, and the asset limit is $2,000 for individuals and $3,000 for couples.
| Eligibility Criteria | Details |
|---|---|
| Income | Less than 200% of the federal poverty level (FPL) |
| Residency | Must be a resident of North Carolina |
| Citizenship or Lawful Presence | Must be a U.S. citizen, permanent resident, or otherwise lawfully present in the United States |
Note: The income and asset limits for Medicaid eligibility may change over time. For the most up-to-date information, please visit the North Carolina Medicaid website or contact your local Medicaid office.
People with Disabilities
People with disabilities may be eligible for full Medicaid in North Carolina if they meet certain criteria.
Who is Eligible?
To be eligible for full Medicaid in North Carolina as a person with a disability, you must:
- Be a resident of North Carolina.
- Be a citizen or legal resident of the United States.
- Meet the Social Security Administration’s definition of disability, which includes:
- Being unable to work due to a physical or mental condition.
- Having a condition that is expected to last for at least 12 months or result in death.
You may also be eligible for full Medicaid if you are a child under the age of 19 and have a disability, or if you are a pregnant woman with a disability.
How to Apply
To apply for full Medicaid in North Carolina, you can:
- Apply online at the North Carolina Department of Health and Human Services website.
- Call the North Carolina Medicaid helpline at 1-888-245-0042.
- Visit your local county Department of Social Services.
You will need to provide proof of your identity, residency, income, and disability when you apply.
Benefits
Full Medicaid in North Carolina provides a wide range of benefits, including:
- Medical care, such as doctor’s visits, hospital stays, and prescription drugs.
- Mental health care, such as therapy and counseling.
- Dental care, such as cleanings, fillings, and extractions.
- Vision care, such as eye exams and glasses.
- Nursing home care, if necessary.
| Category | Eligibility Criteria |
|---|---|
| Adults |
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| Children |
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| Pregnant Women |
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Contact Information
For more information about Medicaid in North Carolina, you can contact the North Carolina Department of Health and Human Services:
- Website: www.ncdhhs.gov
- Phone: 1-888-245-0042
- Address: 2101 Mail Service Center, Raleigh, NC 27699-2101