Eligibility for Medicaid in North Carolina

LOOKING FOR ADDITIONAL INFORMATION?

“What are the requirements for Medicaid in North Carolina?” is a crucial question for applicants, because understanding how to qualify for Medicaid assistance is the first step toward receiving benefits. Whether or not an applicant meets Medicaid eligibility requirements in NC is determined by a local county Division of Social Services (DSS) caseworker based on various established Medicaid benefits eligibility criteria involving age, health needs, income and resources. To find out who is eligible for Medicaid in North Carolina and to learn more about the state’s established qualifications, review the sections below.

What are the requirements for Medicaid in North Carolina?

North Carolina Medicaid eligibility is based on a number of factors. In order to meet the basic eligibility requirements for Medicaid assistance, you must satisfy one of the following criteria:

  • You require long-term care.
  • You are receiving Medicare.
  • You are a low-income individual or family.
  • You are younger than 21 years of age.
  • You are blind or disabled (doctor evaluation required).
  • You are 65 years of age or older.
  • You are/were recently pregnant

o Medicaid benefits are available for pregnant women before or after the baby is delivered, and in cases where women experience pregnancy loss.

Additionally, to qualify for Medicaid benefits, candidates must also be U.S. nationals or citizens, or they must be able to provide proof of legal immigration status. Individuals who are only applying for emergency services are not required to provide documentation of immigration status.

Concerning automatic Medicaid eligibility in North Carolina, petitioners are automatically qualified for medical assistance if they already receive benefits from any of the following: Supplemental Security Income (SSI), Work First Cash Assistance or State/County Special Assistance for the Aged or Disabled.

What are the income requirements for Medicaid in North Carolina?

To meet the NC Medicaid eligibility qualifications, you must satisfy the state’s income requirements, resource requirements and more. A DSS caseworker will calculate your household’s total income and resources to determine your Medicaid income eligibility and the amount of benefits your household will receive, if accepted into the program. As they pertain to income requirements for Medicaid in NC, resources include:

  • Stocks and bonds.
  • Retirement accounts.
  • Bank accounts.
  • Cash.
  • The cash value of life insurance policies.
  • Other tangible investments.

Medicaid income limits are established by the NC General Assembly. If an applicant’s income and resources are over the Medicaid limits and he or she has high medical bills, eligibility is still attainable. However, such petitioners will only obtain medical assistance with an accompanying Medicaid deductible. Under Medicaid deductible coverage plans, married couples have their income evaluated to determine a deductible amount. For a child, his or her parents’ income is used to decide the deductible. If granted NC Medicaid eligibility under the deductible plan, applicants will be authorized for Medicaid benefits on the day that the medical costs add up to the amount of the deductible.

Solutions If You Do Not Qualify For Medicaid in North Carolina

Individuals who do not meet Medicaid eligibility requirements because their income is too high or because they do not fall into one of the established medical assistance eligibility categories have other health care solutions that they can apply for. Denied applicants who do not qualify for Medicaid can participate in a number of programs under Medicaid, which offer options to pregnant women and individuals in need of a more affordable health care plan. Children can also get low-cost health insurance through the Children’s Health Insurance Program.

What are the Medicaid application guidelines in North Carolina?

Once you understand the requirements for Medicaid, the next step toward obtaining medical assistance is to review the Medicaid application guidelines. The state of North Carolina makes applying for Medicaid a simple and efficient process by providing various application methods to eligible petitioners. Those who prove their eligibility for Medicaid assistance with their submitted applications will be granted benefits from the medical assistance program.