Consumer Guide: Health Insurance Program for Families and Children (PDF, 849KB)

Health Check and EPSDT: Medically Necessary Services

Report Fraud and Abuse

Health Choice for Children

Health Insurance Premium Payment Program

N.C. Healthy Start Foundation

 

Who is Eligible - Infants, Children, & Families

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

• Family Planning: Be Smart
• Medicaid for Infants and Children
• Medicaid for Families with Dependent Children (for parents or other caretakers)
• Medicaid for Pregnant Women
• Community Alternatives Programs: For children who need long-term care
• Maternal Support Services
• Care Coordination for Children (CC4C)
• Health Check and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) covers medically necessary health care services to Medicaid-eligible children.

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 classes
• Family planning 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.

If you think you may be eligible, see "How to Apply."