A new Medicaid expansion became effective on December 1, 2023, in North Carolina, which extended coverage to nearly 600,000 additional residents, broadening the criteria for income and household size eligibility.
As reported by WBTV News in Charlotte, this significant policy change has been welcomed by many, including 68-year-old cancer survivor DonnaMarie Woodson, who experienced the hardship of living without health care after losing coverage in 2010. Despite years of being vigilant about her health, Woodson was diagnosed with stage three colon cancer and breast cancer upon regaining her insurance.
Her story reflects the plight of many who, without coverage, remain unaware of serious health conditions. Woodson, who actively lobbied for this change, expressed profound relief and emotion upon learning that the law had been enacted, recognizing the potential for it to save many lives.
Who is eligible for Medicaid coverage in NC under the 2023 expansion?
Under the 2023 expansion, North Carolina’s Medicaid program now covers individuals aged 19 through 64 with higher incomes, including citizens and some non-US citizens. This expansion allows more people to access health care services, even if they previously did not qualify.
Eligibility for NC Medicaid under the new expansion is based on the following criteria:
- Residency in North Carolina
- Age between 19 and 64 years
- Citizenship status (applicable to both US citizens and some non-US citizens)
- Meeting specified income thresholds, which vary based on household size. For example:
- A single adult can earn up to $1,676 per month ($20,120 annually) before taxes.
- A family of 2 can earn up to $2,267 per month ($27,214 annually) before taxes.
- For larger families, the income limit increases by approximately $591 per month (or $7,093 annually) before taxes for each additional member.
Pregnant individuals may also qualify for other Medicaid programs offering full health benefits.
Importantly, the Medicaid program does not charge a monthly fee, and copays are capped at $4.
What is the maximum income to qualify for Medicaid in NC?
As of 2023, the maximum income to qualify for Medicaid in North Carolina varies based on household size. For single adults in North Carolina, the maximum income limit to qualify for Medicaid is $1,676 per month before taxes, which equates to an annual income of $20,120.
On the other hand, for a family of 4, the income threshold is higher, allowing a maximum income of up to $3,450 per month, or $41,400 annually before taxes.
These figures are set to accommodate more individuals and families under the expanded Medicaid eligibility criteria.
What benefits can I receive if I qualify for Medicaid in North Carolina?
If you qualify for Medicaid in North Carolina, you can receive a comprehensive range of health care benefits, often at little or no cost to you. These benefits include:
- Doctor visits. Regular appointments and check-ups with health care providers.
- Emergency care. Coverage for emergency medical situations.
- Dental care. Basic dental services including exams, cleanings and some treatments.
- Mental health services. Counseling, therapy, and treatment for mental health conditions.
- Prescription drugs. Medications prescribed by your doctor, typically with a low copay.
- Hospital services. Inpatient and outpatient hospital care.
- Maternity and postpartum care. Health services for pregnant women and care following childbirth.
- Vision and hearing services. Eye exams, glasses, hearing tests and hearing aids.
- Preventive and wellness services. Immunizations, screenings and other preventive health services.
- Behavioral health services. Treatment and counseling for substance abuse and other behavioral health issues.
- Medical-related devices. Necessary medical equipment and supplies.
It’s important to note that while most services are covered, some might require a minimal copay, generally not exceeding $4. The scope of coverage and any associated costs can vary depending on the specific Medicaid program for which you qualify.
How do I apply for Medicaid in North Carolina?
To apply for Medicaid in North Carolina, you should first check to see if you meet the eligibility guidelines. Even if you’re unsure, it’s recommended that you apply.
Next, choose an application method. You have several options to apply, including:
- Online. Visit the NC Medicaid website to apply online.
- By phone. Call your local Department of Social Services (DSS) to apply over the phone. If you’re unsure of your local office, you can call the NC Medicaid Contact Center at 1-888-245-0179 for assistance finding your nearest location.
- By email, mail or fax. Send your application via email, mail or fax to your local DSS office.
- In-person. Visit your local DSS office to apply in person.
Applications are accepted throughout the year, but it can take up to 45 days (or 90 days for disability applications) for a decision. If your application lacks information, it may take longer. You should apply as soon as possible, as you may be eligible for coverage for the last 3 months of medical bills starting from your application date.
Injured on the job in North Carolina? Get help from an experienced Charlotte work injury attorney.
The Medicaid expansion in North Carolina is a significant step toward increasing health care access for many residents. With nearly 600,000 additional people now eligible, this change offers vital health services to those who previously may have gone without. If you’re a resident of North Carolina who has recently become eligible for Medicaid, or if you’re unsure about your eligibility, it’s highly recommended to explore this opportunity and apply for coverage.
For those who have suffered work-related injuries or occupational illnesses in North Carolina, remember that you have rights and options. Navigating workers’ compensation claims can be complex, but you don’t have to do it alone.
The skilled attorneys at Wilder Pantazis Law Group specialize in workers’ compensation law and are committed to helping you secure the benefits you deserve. With our expertise and guidance, you can focus on your recovery while we handle the legal aspects of your claim.