What is Medicaid?

Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors, and people with disabilities.

Medicaid is a little different, depending on who you are and your situation. See who is eligible.

What does Medicaid Cover?

Medicaid may help pay for certain medical expenses such as:

• Doctor Bills
• Hospital Bills
• Prescriptions (Excluding prescriptions for Medicare beneficiaries)
• Vision Care
• Dental Care
• Medicare Premiums
• Nursing Home Care
• Personal Care Services (PCS), Medical Equipment, and Other Home Health Services
• In-home care under the Community Alternatives Program (CAP)
• Mental Health Care
• Most medically necessary services for children under age 21

Who is Eligible for Medicaid?

Medicaid serves low-income parents, children, seniors, and people with disabilities. There are different types of coverage for people with different needs.  Income and resource limits for each of these groups vary:

To be eligible for Medicaid, you must also:

• Be a U.S. citizen or provide proof of eligible immigration status. Individuals only applying for emergency services are not required to provide documentation of immigration status.
• Live in North Carolina, and provide proof of residency.
• Have a Social Security number or have applied for one.

You are automatically eligible for Medicaid if you receive any of the following benefits:

• Supplemental Security Income (SSI)
• Work First Family Assistance
• State/County Special Assistance for the Aged or Disabled (Adult Care Home Assistance )
• Special Assistance to the Blind

To receive Medicaid, you do not have to go through a physical or other type of exam. However, if you are applying because you are disabled, a medical exam may be required. If you are applying for Medicaid because you are pregnant, proof of pregnancy is required.

See the Medicaid North Carolina Services (80 KB PDF)

Who is Eligible – Infants, Children, & Families

Medicaid serves infants, children, and families in several ways:

Your family’s income, the number of people in your family, and the age of your children determine if you or your children qualify.

When you apply for Medicaid, your family’s monthly income is calculated by subtracting certain deductions from your gross income. Certain deductions are given for work-related expenses, child care costs, and court-ordered child support or alimony. The deductions vary with each Medicaid program. Your county worker will calculate your monthly family income.

Medicaid for Infants and Children

Medicaid for Infants and Children (MIC) provides medical coverage for children under age 19. The income limits are determined by the family size and the age of the child(ren) for whom you are applying.

There is no limit on resources.

Your monthly countable income cannot be more than the amounts listed below.

If your family income is greater than the amounts listed above, your child(ren) age 6-18 may be eligible for NC Health Choice for Children or Medicaid with a Medicaid deductible.

Medicaid for Families with Dependent Children

Medicaid for Families with Dependent Children provides medical coverage for parent(s) or other caretaker/relative with child(ren) age 18 and under in the household and for children under age 21. A pregnant woman may also qualify.

Your monthly countable income cannot be more than the amounts listed below.

You cannot have more than $3,000 in assets such as savings in the bank.

If the family income is over the limit and your child(ren) and/or family have high medical bills, you may still qualify for Medicaid and have a Medicaid deductible.

Medicaid for Pregnant Women

Medicaid for Pregnant Women only covers services related to pregnancy:

• Prenatal care, delivery and 60 days postpartum care.
• Services to treat medical conditions which may complicate the pregnancy.(some services require prior approval)
• Childbirth and parenting classes
• Family planning services
• Maternity Care Coordination services

A pregnant woman may apply for this program before or after she delivers. A woman who has experienced a recent pregnancy loss may also be eligible.

The monthly family income cannot exceed 185% of the federal poverty level. There is no limit on resources. If a pregnant woman is covered by Medicaid on the date she delivers, her newborn child may be eligible for Medicaid up to age 1 without a separate application.

Your monthly countable income cannot be more than the amounts listed below.