Medicaid

What is Medicaid? 

Medicaid is a federal program administered by each State that provides health insurance to low-income individuals and families who cannot afford healthcare costs. 

Medicaid may help pay for certain medical expenses, such as medical bills, prescriptions, family planning services, nursing home care, personal care services, and more. 

Who is Eligible? 

Medicaid may be available to people who are: 

  • Age 65 or older 
  • Blind or disabled 
  • Infants and children under the age of 21 
  • Low-income individuals and families 
  • In need of long-term care 
  • Receiving Medicare 

You also must: 

  • Be a US citizen or provide proof of eligible immigration status (individuals only applying for emergency services are not required to provide documentation of immigration status) 
  • Live in North Carolina, and provide proof of residency 
  • Have a Social Security number or have applied for one 

How Can You Apply for Medicaid? 

There are three ways to apply for Medicaid. 

  1. Apply online at ePass. 
  2. Apply in person at your county Division of Social Services (DSS) office. 
  3. Fill out a paper application and mail to or drop it off at your county DSS office. 

Call your county DSS office if one of these methods will not work for you. 

What should be included with the application? 

When applying for Medicaid, provide the following information: 

  • Birth certificate 
  • Social Security card 
  • Valid photo ID 
  • Proof of citizenship or immigration status (valid US passport, USCIS green card, employment authorization card) 
  • Paycheck stubs from the last month, a written letter from your employer with wage amounts, or tax records for the previous year 
  • Proof of all income from sources like Social Security, Veterans Benefits (VA), and retirement benefits – Bank statements are NOT an acceptable proof of income – MUST provide an award letter 
  • Bank statements from the last month for ALL accounts 
  • Copies of all life insurance policies 
  • Proof of any property that you own (home, land, vehicle, etc) 
  • Proof of residency (rent receipt, mortgage, lease, or written statement from landlord) 
  • Insurance benefit card, if you have any other health insurance 
  • Medicare card, if you have Medicare 

What happens after I have been approved for Medicaid? 

  • You will receive an identification card in the mail for each eligible person.  
  • Sign the ID card when you receive it. 
  • You must present your ID card to your doctor, pharmacist or other provider at each visit so they can verify your eligibility. 
  • If your name or primary care physician (PCP) changes, you will receive a new ID card with the updated information. 
  • If you lose your ID card, call your local Department of Social Services (DSS) office to request a replacement card. 

CLICK HERE to learn more.  

What is Medicaid Managed Care? 

Starting July 1, 2021, most Medicaid beneficiaries began receiving the same Medicaid services in a new way called “NC Medicaid Managed Care.” Beneficiaries choose a health plan and get care through a health plan’s network of doctors. Some beneficiaries are remaining in traditional Medicaid, which is called NC Medicaid Direct. Learn more 

A health plan is a group of doctors, hospitals and other providers. They work together to give you the healthcare you need, including physical health, behavioral health, and medicine. You will also be able to choose a primary care provider. All health plans offer the same basic benefits and services. CLICK HERE to learn more.  

What is NC Medicaid Direct?  

NC Medicaid Direct is North Carolina’s current health care program for people who are not enrolled in NC Medicaid Managed Care.  

Some people will be in NC Medicaid Direct because it provides services that meet specific needs. To ask to move to NC Medicaid Direct, including your LME-MCO, use the Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Beneficiary Form. 

How can I see options for health plans?  

All health plans offer the same basic benefits and services as NC Medicaid Direct, but some may offer added services. CLICK HERE to view your choices for health plans.  

How can I find a primary care provider?  

CLICK HERE to find a primary care provider (PCP).  

Need more information?  

CLICK HERE for answers to frequently asked questions. If you still have questions, call  1-833-870-5500 from 7am-5pm, Monday-Friday or contact the NC Medicaid Ombudsman at 1-877-201-3750, 8am- 5pm, Monday-Friday (ncmedicaidombudsman.org). 

SOURCE: NCDHHS

Last updated 4/1/2022

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