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Medicaid Expansion in North Carolina

Medicaid Expansion in North Carolina

Navin Khosla NowPatientGreen tick
Updated on 15 Feb 2024

Medicaid Expansion is a crucial step by the federal government towards providing accessible and affordable healthcare coverage for all residents of North Carolina. North Carolina becomes the fourth state to expand Medicaid during the Biden-Harris Administration. This initiative aims to expand the eligibility criteria for Medicaid, allowing more individuals to receive comprehensive health care services for the first time. In this article, we will explore the key aspects of Medicaid Expansion in North Carolina, including eligibility requirements, benefits, and the impact on the community.

North Carolina’s Medicaid Expansion: Quick facts

North Carolina has recently expanded its Medicaid program to include more individuals who were previously ineligible for coverage. Here are some quick facts about Medicaid Expansion in North Carolina:

  • Starting from December 1, 2023, North Carolina expanded Medicaid coverage to include adults aged 19 to 64 with incomes up to 138% of the federal poverty line
  • Eligible individuals can apply for Medicaid online through ePASS or HealthCare.gov, or in-person, phone, or mailed applications. Online applications are typically processed faster
  • Medicaid Expansion in North Carolina provides comprehensive coverage, including primary care, hospital stays, maternity care, vision and hearing services, dental and oral health care, and more
  • Medicaid covers doctor visits, check-ups, emergency care, mental health services, and more at little or no cost to the beneficiary
  • Current beneficiaries with full Medicaid coverage will not experience any changes under the expansion

General questions about Medicaid Expansion

Did North Carolina expand access to Medicaid?

Yes. Medicaid Expansion in North Carolina allows more individuals to access health care coverage through the Medicaid program. Before December 1, 2023, many North Carolinians did not qualify for Medicaid. However, the expansion has opened up coverage options for a wider range of individuals.

What health services will North Carolina cover?

Medicaid expansion in North Carolina offers comprehensive coverage for a variety of health services. Some of the covered services include:

  • Primary care allows individuals to visit a doctor for check-ups or when they are unwell
  • Hospital services, including inpatient and outpatient care
  • Maternity and postpartum care for pregnant individuals and those who have recently given birth
  • Vision and hearing services
  • Prescription drug benefits
  • Behavioral health services
  • Preventive and wellness services
  • Dental and oral health services
  • Medical-related devices and other therapies

These services are provided at little or no cost to the Medicaid beneficiaries.

Who will be able to get health coverage through NC Medicaid?

Most individuals can access health care coverage through NC Medicaid if they meet the following criteria:

  • They live in North Carolina
  • They are aged between 19 and 64
  • They are either a U.S. citizen or a non-U.S. citizen with qualified immigration status
  • They meet the income requirements based on the household size

The income limits depend on the household size, with larger households having higher income limits. For example, a single adult with an annual income of $20,120 or less would be eligible for Medicaid.

How many people are enrolling in Medicaid because of expansion?

The number of people enrolling in Medicaid due to expansion can vary. The NC Medicaid Expansion Dashboard provides up-to-date information on the number of people enrolled in NC Medicaid as a result of the expansion. This dashboard allows users to view and filter the data by health plan, demographics, or county.

Applying for Medicaid

How can I apply for Medicaid?

Applying for Medicaid in North Carolina is a straightforward process. You can apply online through ePASS, a secure self-service website specifically designed for Medicaid applications. Alternatively, you can apply online by completing a general health insurance application on HealthCare.gov.

If you prefer not to apply online, you have other options. You can apply in person at your local Department of Social Services (DSS) office or by calling your local DSS office. Mailed, emailed, or faxed applications are also accepted.

Can you pre-qualify for Medicaid under the expanded eligibility?

No, pre-qualification for Medicaid is not possible. The eligibility for Medicaid is determined through a comprehensive assessment of all Medicaid programs and their respective eligibility rules. It is important to be aware of potential scams that claim to offer pre-qualification for Medicaid.

Do parents have to meet additional requirements to get NC Medicaid?

Parents who do not meet the eligibility requirements for coverage as a Parent/Caretaker may still qualify for Medicaid under the expanded rules if they are aged 19 through 64 and meet other eligibility requirements. Additionally, all children in the household under the age of 21 must have health insurance that meets the Affordable Care Act requirements.

How long will it take to find out if I am eligible for Medicaid once I apply?

The processing time for Medicaid applications can take up to 45 days. However, incomplete applications or applications requiring additional information may take longer to process. If your application is incomplete or requires further information, your local DSS office will contact you to request the necessary details. It is essential to ensure that your contact information is up to date to avoid any delays in the application process.

Once your application is processed, you will receive a letter in the mail informing you whether you have been approved or denied Medicaid coverage. Authorized Representatives will also receive the same communication.

When does my Medicaid health coverage begin?

The start date of your Medicaid health coverage depends on when you apply for Medicaid. Here are some scenarios that illustrate the coverage start dates:

  • If you apply for Medicaid in December but your application is not processed until January or later, your Medicaid coverage will be retroactive to December 1. This means that if you received care in December, your provider can bill for services covered by Medicaid, and you should not have to pay out of pocket (except for any applicable copays)
  • If you apply for Medicaid in January 2024 (or later) but have medical bills from services received in December 2023, you can request retroactive coverage for up to three months before the month you applied. For example, if you apply in March and are eligible, Medicaid can pay for covered services from December, January, and February

It is important to note that coverage under the expansion can only go back to December 2023.

What information do I need to apply?

When applying for Medicaid, you will need to provide various pieces of information for each person included in the application. The information typically required includes:

  • Full legal names
  • Dates of birth
  • Social Security numbers (or immigration documents for non-U.S. citizens)
  • North Carolina residency information
  • Income information, such as pay stubs, W-2 forms, tax returns, or business records

It is important to note that North Carolina uses external resources to verify the information provided in the application. If additional information is needed, your local DSS office will contact you by mail, phone, email, or text message. Therefore, it is crucial to ensure that your contact information is up-to-date and complete.

What documents can be used if DSS asks for more information?

When asked for additional information by your local DSS office, you may need to provide documentation for certain aspects. Here are some examples of acceptable documents for specific information:

North Carolina Residency:

  • A photo ID with your North Carolina address listed
  • A utility bill
  • A lease or mortgage agreement
  • Vehicle registration
  • Documentation of employment
  • If you do not have any documentation, you can declare your North Carolina residency using the “NC Residency Declaration” option in ePASS.

Income:

  • If you’re employed: pay stubs, employer verification, or your most recent tax return to demonstrate your income
  • If you’re self-employed: your most recent tax return or copies of your business records. If you don’t have these documents, you can fill out a verification form for self-employment income and expenses

Date of Birth:

  • A photo ID with your date of birth listed
  • Birth certificate

Social Security Number:

  • A copy of your Social Security card
  • Another official document containing your name and Social Security number
  • A military ID card

Citizenship:

  • Birth certificate
  • Passport

Immigration Status:

  • A copy of your visa or immigration card

These documents are examples and may not cover all possible scenarios. Your local DSS office will provide further guidance on acceptable documentation.

Who can I contact with questions about Medicaid expansion, eligibility, or my plan?

If you have any questions regarding Medicaid Expansion, eligibility, benefits, or your specific health plan, you can reach out to the appropriate resources:

  • For questions about NC Medicaid expansion, including eligibility, benefits, and enrollment, consult the Questions and Answers about Medicaid Expansion
  • If you want to check your eligibility for NC Medicaid, review the eligibility guidelines or contact your local Department of Social Services (DSS) office
  • If you have questions about standard plan benefits or need to change your primary care provider (PCP), contact your specific standard plan provider. Here are the contact numbers for some standard plans:
    • WellCare: 1-866-799-5318 (TTY: 711)
    • UnitedHealthcare Community Plan: 1-800-349-1855 (TTY: 711)
    • HealthyBlue: 1-844-594-5070 (TTY: 711)
    • AmeriHealth Caritas: 1-855-375-8811 (TTY: 1-866-209-6421)
    • Carolina Complete Health: 1-833-552-3876 (TTY: 711 or 1-800-735-2962)
  • If you need to change your PCP and you are in NC Medicaid Direct, contact the NC Medicaid Contact Center at 1-888-245-0179
  • For inquiries about your local Management Entity/Managed Care Organization (LME/MCO) or Tailored Care Management (TCM), contact your respective LME/MCO:
    • Alliance Health: 1-800-510-9132 (TTY: 711 or 1-800-735-2962)
    • Eastpointe: 1-800-913-6109 (TTY: 1-888-819-5112)
    • Partners Health Management: 1-888-235-4673 (TTY: 1-800-735-2962)
    • Sandhills Center: 1-800-256-2452 (TTY: 711 or 1-866-518-6778)
    • Trillium Health Resources: 1-877-685-2415 (TTY: 711)
    • Vaya Health: 1-800-962-9003 (TTY: 711)
  • If you have questions about the Eastern Band of Cherokee Indians (EBCI) Tribal Option, contact the EBCI Tribal Option at 1-800-260-9992 (TTY: 711)
  • For information about your health care options or to change your health plan, visit the NC Medicaid Plans website, use the NC Medicaid Managed Care mobile app, or call 1-833-870-5500 (TTY: 711 or RelayNC.com)
  • If you need assistance with resources or understanding your rights and responsibilities, call the NC Medicaid Ombudsman at 1-877-201-3750
  • For all other questions, refer to the NC Medicaid Beneficiary Portal or call the NC Medicaid Contact Center at 1-888-245-0179

Coverage and costs

If I already have Medicaid Coverage, will my benefits change?

If you already have full Medicaid coverage, your benefits will remain the same. The expansion of Medicaid does not impact individuals who were already covered under the program. However, it is essential to keep your contact information up to date to ensure you receive any communications from your local DSS office regarding your coverage.

Under the new rules, how much will people pay in monthly premiums and copays?

Under Medicaid Expansion, individuals do not have to pay any monthly premiums. Medicaid covers the costs of most healthcare services, and copays, if applicable, are typically low. The highest copay amount is $4, and it is only required for certain services.

What are the differences between Medicaid Expansion Coverage and other health care options?

Medicaid Expansion coverage is provided through different avenues, including Standard Plans, Medicaid Direct, Tribal Options, and Tailored Plans. These options allow individuals to choose the most suitable coverage based on their needs. Under the expansion, more people with disabilities can enter the workforce as Medicaid coverage is extended, helping them maintain their health care while working.

Can I have Medicare and receive Medicaid Expansion?

No, individuals who have Medicare coverage are not eligible for Medicaid Expansion. However, some individuals with Medicare may be eligible for other existing Medicaid programs, such as Medicaid through disability coverage for individuals aged 64 and under.

Are there other insurance options if I don’t qualify for Medicaid under the new rules?

Yes, there are other insurance options available for individuals who do not qualify for Medicaid under the new rules. These options include subsidized health coverage offered on HealthCare.gov. North Carolina health insurance navigators can assist with enrollment. Additionally, community health centers offer low-cost care based on a sliding scale, taking into account income and insurance status.

Will anyone be automatically enrolled in Medicaid under the new rules?

Yes, individuals who were previously enrolled in Medicaid’s limited Family Planning Program and are eligible have been automatically transitioned to full Medicaid expansion benefits. Those who are eligible for full Medicaid benefits will receive a letter from their local DSS office, notifying them of their newly acquired full Medicaid coverage. Health plans will also be assigned, and a packet containing a new Medicaid ID card and information about the assigned primary care doctor will be sent by the health plan. Individuals who have health coverage through HealthCare.gov will need to cancel their plan after receiving information from their new health plan through Medicaid.

However, not all individuals with limited Family Planning Program benefits were automatically enrolled in full coverage through NC Medicaid. Some individuals may have incomes that exceed the Medicaid eligibility levels. Suppose an individual’s income has changed recently and they believe they may now be eligible for Medicaid. In that case, it is recommended to update the information in ePASS or contact the local DSS office. It is crucial to ensure that contact information is up to date to receive important benefit-related information.

What is Limited Family Planning Medicaid, and who Is eligible?

Limited Family Planning Medicaid provides reproductive health care services at no cost to individuals with incomes up to 195% of the federal poverty level, which amounts to approximately $2,370 per month for a single person. The coverage includes various methods of birth control, testing and treatment for sexually transmitted infections, preventive services, and more.

If I currently receive Family Planning Benefits and am now enrolled in full coverage through NC Medicaid, what happens?

If you previously received Family Planning benefits and are now enrolled in full coverage through NC Medicaid, you will receive a letter from your local DSS office informing you of your new full Medicaid coverage. This letter has already been sent out to eligible individuals. You will also be assigned a health plan, and if you wish to change your health plan, you have 90 days to select a new one. Your health plan will send you a packet containing a new Medicaid ID card and information about your primary care doctor. You can change your assigned doctor by contacting your health plan. With full Medicaid coverage, you will have access to services such as doctor visits, check-ups, emergency care, mental health services, and more at little or no cost.

Why won’t everyone with Family Planning Program Benefits be automatically enrolled in full coverage through NC Medicaid?

Not all individuals with limited Family Planning Program benefits were automatically enrolled in full coverage through NC Medicaid. Some individuals may have incomes that exceed the Medicaid eligibility levels. Suppose an individual’s income has changed recently and they believe they may now be eligible for Medicaid. In that case, it is recommended to update the information in ePASS or contact the local DSS office. Ensuring that contact information is up to date is crucial to receiving important information about benefits.

Immigration status and eligibility for Medicaid Expansion

Are Non-U.S. citizens eligible for health care coverage through NC Medicaid?

Some non-U.S. citizens are eligible for health care coverage through NC Medicaid. To be eligible, non-U.S. citizens must live in North Carolina and have qualified immigration status. Qualified immigration status includes categories such as Lawful Permanent Residents (LPR/Green Card Holders), asylees, refugees, Cuban/Haitian entrants, and more. However, it is important to note that some non-U.S. citizens may have a waiting period of five years before becoming eligible for Medicaid. However, there are exceptions to this waiting period, such as pregnant women, children under 19, asylees, refugees, victims of trafficking, and individuals with connections to the military.

Can my information be shared for immigration enforcement?

No, Medicaid does not report any information to law enforcement or Immigration and Customs Enforcement (ICE). Your personal information will be kept private and confidential. This includes information about family members with different immigration statuses. Medicaid information cannot be used for immigration enforcement purposes.

Is applying for or receiving Medicaid considered public charge?

No, applying for or receiving Medicaid benefits does not make someone a “public charge.” It does not affect an individual’s immigration status or immigration applications. Only three benefits are considered negatively in immigration applications: Supplementary Security Income (SSI), Temporary Assistance for Needy Families (TANF), and Medicaid for long-term hospitalization or nursing home care. All other benefits and health programs, including Medicaid, have no impact on immigration applications.

Are undocumented immigrants eligible for Medicaid?

Undocumented immigrants are not eligible for full health coverage through Medicaid, CHIP, Medicare, or the Federal Marketplace. However, they may be eligible for emergency Medicaid or labor and delivery services.

What are emergency Medicaid Services, and who is eligible?

Emergency Medicaid services are available to individuals who meet the income and North Carolina state residence eligibility requirements. Emergency Medicaid covers the medical costs of treating emergencies such as heart attacks, strokes, or serious accidents. It also covers medical costs related to childbirth. Undocumented non-U.S. citizens who do not qualify for full health coverage under Medicaid may be eligible for emergency medical services. The coverage is limited to the dates of the medical emergency, starting from the date of the incident until the date the emergency is stabilized.

Are undocumented pregnant women eligible for Medicaid?

Undocumented, non-U.S. citizen pregnant women may be eligible for emergency services coverage during labor and delivery if they meet the income and state residence requirements. However, they are not eligible for full Medicaid benefits.

Who is eligible for Medicaid in a mixed immigration status household?

Eligibility for Medicaid in a mixed immigration status household depends on the specific circumstances. Parents who do not have a valid immigration status are eligible for emergency services only. However, their children may be eligible for full Medicaid if they have qualified immigration status, even if their parents do not.

What information do undocumented parents have to provide if their children are eligible for Medicaid?

Undocumented parents applying for Medicaid for their eligible children need to provide the following information:

  • Names of all household members
  • Mailing address
  • Verification of income, if applicable
  • Proof of state residency from the parent(s)
  • Signed application

Undocumented parents do not need to provide immigration information or a social security number for themselves if they are not applying for Medicaid for themselves. Medicaid does not report any information to law enforcement or ICE.

How can undocumented parents apply for Medicaid on behalf of their adult children (ages 18 and older) with disabilities?

To apply for Medicaid on behalf of an adult child aged 18 and older, a parent must be designated as an Authorized Representative. An Authorized Representative is an individual who is legally authorized or designated in writing by the person applying to act on their behalf. Only an Authorized Representative can complete a Medicaid application for someone else. Additionally, the local Department of Social Services (DSS) must complete a medical evaluation and request medical records to be reviewed by Disability Determination Services (DDS). If assistance is needed, the local DSS office can guide through the application process. The Authorized Representative does not have to be a parent; an adult with disabilities may designate anyone as their Authorized Representative.

Can people with temporary protected status (TPS) apply for Medicaid?

No, individuals with temporary protected status (TPS) cannot apply for full health coverage through Medicaid. However, they may be eligible for emergency Medicaid services if they meet the income and North Carolina state residency requirements. Pregnant women and children under 19 with TPS can apply for Medicaid if they meet all other eligibility requirements and are not subject to the five-year waiting period. People with TPS can also apply for coverage and assistance paying for insurance through the Health Care Marketplace.

Can deferred action for childhood arrivals (DACA) recipients get Medicaid?

No, Deferred action for childhood arrivals (DACA) recipients are not considered lawfully present for health coverage eligibility purposes. DACA recipients are eligible for emergency Medicaid services when needed.

Are farmworkers with an H-2A visa eligible for Medicaid?

Farmworkers with a lawfully present status may be eligible for Medicaid if they are pregnant women or children under the age of 19. All other individuals with an H-2A visa are eligible to receive emergency Medicaid services. Individuals with an H-2A visa can also apply for coverage and assistance paying for insurance through the Health Care Marketplace.

Are nonimmigrant Visa holders eligible for Medicaid?

Nonimmigrant visa holders, including students, tourists, and individuals with work visas, U visas, and more, are potentially eligible for Medicaid if they are pregnant women or children under the age of 19. Non-pregnant adults aged 19 and older are eligible for emergency Medicaid services only. Individuals applying only for emergency services are not required to provide documentation of their immigration status. Nonimmigrant visa holders who are residents of North Carolina can also apply for coverage and assistance paying for insurance through the Health Care Marketplace.

Can pregnant women without qualified immigration status get Family Planning Coverage in NC?

No, pregnant women without qualified immigration status are not eligible for Family Planning coverage in North Carolina. However, they may be eligible for emergency services coverage during labor and delivery if they meet the income and state residency requirements.

Expansion Benefits

How is North Carolina providing health coverage for more people through NC Medicaid?

North Carolina is providing health coverage for more individuals through Medicaid Expansion. This expansion allows individuals who were previously ineligible for Medicaid to access comprehensive healthcare services. By expanding the eligibility criteria, more North Carolinians can receive the care they need to maintain their health and well-being.

Why is expanding Medicaid good for my community?

Expanding Medicaid benefits not only individuals but also entire communities. Research has shown that expanding Medicaid coverage increases access to health care, improves health outcomes, creates jobs, and strengthens the economy. When more individuals have access to affordable health care, they can work, earn more, and contribute to the community’s well-being. Expanding Medicaid in North Carolina has the potential to increase state revenues, create jobs, save state funding, and prevent rural hospitals from closing. Furthermore, the expansion helps address the mental health crisis by improving access to mental health services and substance abuse treatment.

Will North Carolinians who already have insurance benefit from expansion?

Expanding Medicaid benefits everyone, including individuals who already have insurance. When more individuals have access to affordable health care, the overall health of the population improves. Taxpayers also benefit from Medicaid expansion because federal funds help cover more people, strengthen health systems, and reduce the cost of care.

Will expansion help improve access to Mental Health Services or Substance Abuse Treatment?

Yes, expanding Medicaid has the potential to improve access to mental health services and substance abuse treatment. In states that have expanded Medicaid, suicide rates have decreased, and access to substance use disorder treatment has increased. In North Carolina, approximately two million individuals experience mental illness and substance use disorders. However, due to cost barriers, more than 55% of individuals who needed treatment did not receive it. Expanding Medicaid can help address this issue by providing individuals with the necessary coverage for mental health and substance abuse services.

How can workers without Health Insurance Benefit from these new rules from expanding access to Medicaid?

Workers without health insurance can benefit significantly from Medicaid Expansion. Many individuals employed in important service industries and small businesses cannot afford health insurance. With Medicaid Expansion, more workers can afford to take care of their health while providing for their families. This benefits not only the workers themselves but also the employers and the overall economy. By raising income limits for Medicaid eligibility, more individuals can work without the fear of losing their healthcare coverage. Medicaid Expansion also helps individuals with disabilities enter the workforce, as they no longer need to live in poverty to maintain their Medicaid eligibility. This, in turn, builds a healthier workforce in industries like child care, restaurants, and the service industry.

Conclusion

Medicaid Expansion in North Carolina is a significant step towards providing accessible and affordable healthcare coverage for all residents. By expanding the eligibility criteria and offering comprehensive benefits, more individuals can access the care they need to maintain their health and well-being. Medicaid Expansion not only benefits the individuals who gain coverage but also strengthens the overall health of communities and contributes to the economic growth of the state. Through these new rules, North Carolina is taking a crucial step towards ensuring that health care is accessible to all its residents, regardless of their income or immigration status.

Sources

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