North Carolina Medicaid Eligibility and Enrollment
- Interested in applying for Medicaid in North Carolina? Get the essentials, including what it is, the programs available, eligibility criteria and how to apply.
More than 2.3 million individuals were enrolled in North Carolina Medicaid and CHIP programs as of January 2023. This is up 20% from 2013, when targeted enrollment strategies were introduced. For older North Carolina residents who meet the eligibility criteria, the program can be an essential block in building an independent and healthy retirement.
What Is North Carolina Medicaid?
North Carolina Medicaid is a health insurance program that helps pay the medical expenses of low-income individuals. It’s jointly funded by the North Carolina and federal governments and is administered by the North Carolina Division of Health Benefits. North Carolina Medicaid has a number of programs that can help pay for everyday medical expenses as well as provide long-term care and services to older adults.
What Are the Different Types of Medicaid in North Carolina?
Regular Medicaid is aimed at low-income people that are in certain categories. In particular, children, parents with children and pregnant women as well as the aged, blind and disabled are able to access Medicaid. In North Carolina, Regular Medicaid covers a wide range of services, including hospital visits, dental services, medical equipment and vision and hearing treatment. Regular Medicaid also includes the Personal Care Services program, which may be of interest to older adults. This program provides assistance with activities of daily living in the home or residential care homes, including some assisted living facilities.
North Carolina also has one waiver program available for older adults, known as Community Alternatives Program for Disabled Adults (CAP/DA). This has services available that help people who need assistance to remain living in their homes. It includes personal care, home care supplies, minor home modifications and case management. Medicaid in North Carolina also helps recipients pay for care in a nursing home.
Who Is Eligible for Medicaid in North Carolina?
People wishing to enroll in Medicaid in North Carolina must meet certain eligibility requirements. The criteria relate to a person’s financial circumstances as well as their health, age and citizenship status.
Financial Eligibility Criteria
The financial eligibility criteria for Medicaid are split into income and asset limits. All of a person’s income is countable, including Social Security, pensions, IRA withdrawals and alimony payments. The government doesn’t count all assets when calculating for Medicaid purposes. Personal belongings, furnishings, a vehicle and burial trusts are excluded. In addition, a house isn’t counted if it’s the applicant's primary home or their spouse still lives there.
In North Carolina, income and asset limits are the same for Regular Medicaid and Medicaid Waivers. For singles, the income limit is $18,954 per year, with a $2,000 asset limit. Married couples where both spouses are applying can have an income of up to $25,636 per year and assets of $3,000.
For Nursing Home Medicaid, the asset limits are the same as for Medicaid Waivers. Whether single or married, the applicant’s income must be below the amount that Medicaid pays for nursing home care. This differs depending on where the nursing home is located; however, the Medicaid-funded rate generally ranges from around $5,000 to $7,000. All of a recipient's income must be paid to the nursing home, minus a small personal needs allowance and possibly an income allowance for a non-applicant spouse. Any unpaid fees for the nursing home are paid through Medicaid.
People who don’t meet the income limits may be able to use the medically needy pathway to access Medicaid. This is designed to help people who have high medical bills by allowing them to spend excess income on these expenses. Once their income reaches the Medicaid limit, they gain access to Medicaid for the remainder of the period, which is six months. People with large amounts of assets may be able to spend down the excess on home modifications, home improvements or debt payments. However, they must not transfer or sell these assets for less than fair market value, or they may become ineligible for Medicaid for a period of time. Speaking to a Medicaid planner can help older adults make these decisions.
Other Eligibility Criteria
All applicants must be a resident of North Carolina and a United States citizen, permanent resident or legal alien. In addition, applicants must fit one of the eligible categories. Most older adults applying for Medicaid will fit in the category of 65 or older. However, people younger than this may be eligible on the basis of having a disability or a person in the household having a disability. Those responsible for a child aged 18 or younger are also eligible for Medicaid, which may be relevant for grandparents with legal custody of a grandchild.
Some types of Medicaid also require certain medical criteria, known as functional criteria. This does not apply to regular Medicaid. Applicants requesting a Medicaid waiver must require assistance with at least two activities of daily living, while those applying for nursing home Medicaid must need a nursing home level of care.
How Do I Enroll in Medicaid in North Carolina?
The easiest way to apply for Medicaid in North Carolina is online through the ePass system. For people who prefer not to enroll online, applications can be made in person at a local Department of Social Services office, or a paper application can be mailed or dropped off to a local DSS office.
Contact Information for North Carolina Medicaid
Older adults looking for more information about Medicaid can contact the North Carolina Medicaid Contact Center at (888) 245-0179. The local Department of Social Services office can also answer questions and assist with applications.