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1. Can I get Medicaid?

Beginning December 1, more people in North Carolina will be eligible for health care coverage through Medicaid. Current recipients will still be eligible for health care coverage under the new Medicaid expansion. You are eligible for Medicaid if you meet the criteria below:

• You live in NC
• You are a US citizen *Some non-U.S. citizens can get health care coverage through Medicaid. To learn more, go to medicaid.ncdhhs.gov
• Age 19-64
• Your annual household income fits within the chart below:

HOUSEHOLD SIZE	ANNUAL INCOME (before taxes)
Single adult	$1,676 per month or less $20,120 annually
Family of 2	$2,267 per month or less      $27,214 annually
Family of 3	$2,859 per month or less  $34,307 annually
Family of 4	$3,450 per month or less  $41,400 annually
For each additional person in your household	add $591 per month add $7,094 annually

2. What information do I need to apply for Medicaid?

Prepare the following documents below for each person applying to help complete your application:

• Full legal name
• Date of birth
• Social Security number (or immigration documents)
• North Carolina residency
• Income information (from paystubs, W-2 forms, tax returns or business records)

North Carolina uses external resources to verify the information you provide. If more information is needed, you will receive a letter in the mail from the Department of Social Services requesting additional documentation, including:

Type of verification needed:	Accepted type of documentation:
North Carolina Residency	A photo ID with your NC address listed, or A utility bill, or A lease or mortgage agreement, or Vehicle registration, or Documentation of employment, or If you do not have any documentation, you can check a box in ePASS labeled “NC Residency Declaration.”
Income	If you’re Employed - pay stubs, employer verification or your most recent tax return to show proof of your income. If you’re Self-Employed - your most recent tax return or copies of your business records. If you don’t have that, you can fill out a Verification Form for Self-Employment Income and Expenses form.
Date of Birth	A photo ID with your date of birth listed, or Birth certificate
Social Security Number	A copy of your Social Security card, or Another official document containing your name and social security number, or A military ID card
Citizenship	Birth Certificate, or Passport
Immigration Status	A copy of your VISA/immigration card

3. How do I apply for Medicaid?

Beginning December 1, more people in North Carolina will be eligible for health care coverage through Medicaid. Current recipients will still be eligible for health care coverage under the new Medicaid expansion. You are eligible for Medicaid if you meet the criteria below:

• You live in NC
• You are a US citizen *Some non-U.S. citizens can get health care coverage through Medicaid. To learn more, go to medicaid.ncdhhs.gov
• Age 19-64
• Your annual household income fits within the chart below:

HOUSEHOLD SIZE	ANNUAL INCOME (before taxes)
Single adult	$1,676 per month or less $20,120 annually
Family of 2	$2,267 per month or less      $27,214 annually
Family of 3	$2,859 per month or less  $34,307 annually
Family of 4	$3,450 per month or less  $41,400 annually
For each additional person in your household	add $591 per month add $7,094 annually

Prepare the following documents below for each person applying to help complete your application:

• Full legal name
• Date of birth
• Social Security number (or immigration documents)
• North Carolina residency
• Income information (from paystubs, W-2 forms, tax returns or business records)

North Carolina uses external resources to verify the information you provide. If more information is needed, you will receive a letter in the mail from the Department of Social Services requesting additional documentation.

You can apply for Medicaid:

• Online at epass.nc.gov
• Over the phone by calling 910-798-3500, select option 4 when prompted
• Print the application (English and Spanish) and return by mail or fax:
  • Mailing address: 1650 Greenfield Street, Wilmington, NC  28401 
  • Fax number: 910-798-7824
• In person at 1650 Greenfield Street, Wilmington, NC  28401

If you are pregnant and/or have a child/children age(s) 5 and under, you may be eligible for Women Infants and Children (WIC) services by calling 910-798-3500, select option 5 when prompted.

Applications may be mailed upon request. Applications and supporting documents can be emailed to dssinfo@nhcgov.com as needed. 

4. How much does Medicaid cost me?

You do not have to pay any monthly premiums. 

Medicaid pays the cost for most health care services. 

The highest copay is $4 and that is only required on some services.

5. After I apply, how long does it take to find out if I can be covered through Medicaid?

It may take up to 45 days after you apply. Incomplete applications may take longer. 

You can help the process go faster by: 

• Applying online at ePASS and providing all information requested. If the application is incomplete, it may take longer to process. DSS will reach out to you if they do not have what is needed to complete your application, so be sure to respond to mail or phone calls. 
• Keeping your contact information up-to-date in ePASS, so you don't miss important information about your Medicaid benefits.
  • Sign up for an enhanced ePASS account. An enhanced ePASS account allows you to keep your information updated without having to contact the local Department of Social Services (DSS) office

6. Are immigrants now eligible for Medicaid?

Some non-U.S. citizens can get health coverage through Medicaid. To be eligible you must be: 

• A person living in North Carolina
• A non-citizen with qualified immigration status. Most people must wait five years. Qualified immigration status includes:
  • Lawful Permanent Residents (LPR/Green Card Holder) 
  • Asylees 
  • Refugees 
  • Cuban/Haitian entrants 
  • Paroled into the U.S. for at least one year 
  • Conditional entrant granted before 1980 
  • Battered non-citizens, spouses, children or parents 
  • Victims of trafficking and his or her spouse, child, sibling or parent or individuals with a pending application for a victim of trafficking visa 
  • Granted withholding of deportation 
  • Member of a federally recognized Indian tribe or American Indian born in Canada 
  • Citizens of the Marshall Islands, Micronesia and Palau who are living in one of the U.S. states or territories (referred to as Compact of Free Association or COFA migrants)

Non-citizens without documents who do not qualify for full health coverage under Medicaid may be able to get temporary coverage for emergency conditions that need to be treated in an emergency room.

7. Which doctors or dentists accept Medicaid?

Medicaid benefits and eligibility vary according to a person’s circumstances and what Health Plan you are linked to. 

If you are not linked to a Health Plan you should call the Enrollment Broker to see what your options are based on the Health Plan you choose.  https://ncmedicaidplans.gov/enroll/online/find/find-provider?lang=en

8. How can I get a new Medicaid card?

Call the Primary Health Plan that is on your Medicaid card.  If you are not enrolled with a plan, call Social Services at 910-798-3500 option 4.

9. What is the definition of disability?

As defined by Social Security, it is a physical or mental impairment which prevents an individual from engaging in any substantial, gainful activity, and which has lasted or is expected to last for at least 12 months, or is expected to result in death. To apply for disability benefits, you must apply through the Social Security Administration offices, 800-772-1213 or 800-325-0778 (TTY).

10. Will Medicaid pay for my care in a nursing home?

If you meet eligibility requirements, Medicaid will pay for some portion of your cost of care in a long term skilled or intermediate care facility as well as medical expenses.

11. My Mother needs to be placed in a Nursing Home. What can I do?

• First, speak to your mother/father’s physician and see if they are recommending them being placed in a nursing home. Does your parent have the capacity to make decisions for themselves? 
• We then talk about the placement process and refer them to come into the agency to pick up a placement packet to assist them in this process.
• For more information call 910-798-3719.

12. Where can I get an FL-2 form for the nursing home?

• By downloading the FL-2 form 
• By call 910-798-3460 and request one to be sent to you through the mail. 
• In person at 1650 Greenfield Street, Wilmington, NC  28401.

13. Can I get a check along with Medicaid?

Medicaid pays the medical provider directly. No payment is made to the recipient. Persons residing in Adult Care Homes (often called rest homes) may be eligible for a check under the Special Assistance Program to help pay for their monthly cost of care in the home. Clients who qualify for Work First Family Assistance “WFFA” get a check.

14. Will the State take my home if I get Medicaid?

If you receive CAP or are in a long term care facility, estate recovery may apply to you. This means at the time of your death the government may make a claim against your estate to recover the money paid to medical providers on your behalf.