Medicaid Eligibility Summary

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 Children.

Basic Medicaid Eligibiliry Chart - Effective April 1, 2008

Medicaid

There 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 a Medicaid card each month. 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. More on eligibility

• 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 transferred away. More on long-term care

• 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. Baby Love

• 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. More on Medicaid for Families and Children

• Medicaid for Children from age 1 through age 5. The family income limit is equal to 133% of the poverty level. There is no resource limit.

• 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.
  
  
• Medicaid "Be Smart" Family Planning Program. Be Smart is a Medicaid "waiver" program that is available to North Carolina residents who do not qualify for other Medicaid benefits. The Medicaid "Be Smart" Family Planning Program is limited to services related to family planning. More on the "Be Smart" Family Planning Program

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 Medicaid are:

• 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

Medicare-Aid

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 on resources.

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 source).

Updated April 3, 2008