Medicaid benefits and eligibility vary according to a person's
circumstances. Following is a brief explanation of eligibility for Medicaid, Medicare-Aid, and NC Health Choice for
are several different groups of individuals who qualify for Medicaid benefits. All have income limits and some have
resource limits. Individuals who are eligible for full Medicaid benefits receive an annual Medicaid card. Medicaid
may also be retroactive to cover medical bills from the 3 months prior to the month of application.
· Medicaid for Aged (65 and older), Blind and Disabled
Persons. The income limit is equal to 100% of the
poverty level. There is a limit on resources.
· Medicaid for Long Term Care. Medicaid pays for medically necessary nursing home care for patients in
skilled or intermediate care nursing homes or in intermediate care facilities for the mentally retarded. The
patient's income must be less than the cost of care in the facility at the Medicaid rate, and there is a limit on
resources. If the patient or his representative gives away assets or sells them for less than market value, he may
be ineligible for payment of the cost of care. The sanction period is based upon the value of the assets
· Medicaid for Pregnant Women. The family income limit is equal to 185% of the poverty level. There is no
limit on resources. If a pregnant woman is covered by Medicaid, her newborn child is automatically eligible for
Medicaid up to age 1. This benefit is available even if the pregnant woman has no other children.
· Medicaid for Infants up to age 1. The family income limit is equal to 185% of the poverty level. There is no
limit on resources.
· Medicaid for Children from age 1 through age 5. The family income limit is equal to 133% of the poverty level. There is no
· Medicaid for Children from age 6 through age 18. The family income limit is equal to 100% of the poverty level, which is
lower than the income limit for younger children. There is no resource limit.
· Medicaid for Caretakers and Children age 19 and
20. The income limit is lower than the income
limit for children through the age of 18. There is a limit on resources.
· Medicaid for Medically Needy coverage for parents and children whose incomes are higher than those
allowed in other coverage groups. Families must meet a deductible based on the amount by which their income exceeds
the MAF-MN income limit. There is
a limit on resources.
Automatic Eligibility for Medicaid
Individuals who qualify for certain cash assistance programs automatically
qualify for Medicaid without a separate application. If cash assistance ends, the Medicaid may be continued if the
individual meets the eligibility criteria for another type of Medicaid. The programs which include automatic
· Work First Family Assistance for families with children Supplemental
Security Income (SSI) for elderly, blind and disabled individuals
· State/county Special Assistance (SA) assistance for payment of rest home
expenses for elderly, blind and disabled individuals
Individuals who have Medicare coverage may be eligible to have their
Medicare premiums paid by Medicaid if their income is between 100% and 135% of the poverty level. There is a limit
N.C. Health Choice for Children
Children who are under age 19 may qualify for free or low cost health
insurance if they are uninsured and if the family income is higher than the Medicaid limits but less than 200% of
the poverty level. There is no limit on resources. The coverage is similar to that of Medicaid. Eligible children
receive a card which is valid for one year (unless they move out of state or become insured through another
How to Apply
Applications are taken at the Department of Social Services during normal
hours of operation. Normal hours are Monday thru Friday, 8:00 a.m. until 5:00 p.m. An application may also be
picked up and taken home to fill out for Children’s Medicaid or NCHC for Children. The two-page application may
also be mailed back to the DSS or returned in person. An interview is completed at DSS. The application must first
be made for Medicaid eligibility. Anyone not eligible for Medicaid is then evaluated for NCHC. In order to complete
the application more quickly, verification of the previous month’s income, proof of residency, and social security
number(s) and birth certificate(s) of all applicants and caretakers should be attached to the application. The
family will be notified of the approval or denial of benefits as soon as eligibility is determined.
Begin the Application Process On Line Through
ePASS is a tool that lets
you check on the Internet to see if you may be eligible for several North
Carolina benefits and services. ePASS shows you the benefits for which you may be
eligible. It can also help you decide if you want to apply for assistance. It may also make it easier to
apply for benefits. You can complete and print off an application for Food and Nutrition Services and
Medicaid and mail it or bring it to DSS.
Visit the ePASS website for more information.