North Carolina Medicaid Application Information

North Carolina Medicaid is a health care coverage program meant for low-income parents, children, seniors, and people with special needs residing in North Carolina. There are different types of coverage depending on people's different needs which may include income and resource limits. In North Carolina alone, one in five individuals receives Medicaid. This makes the budget for Medicaid second only to that of public education. This program is administered by the state of North Carolina and grants comprehensive and quality health care coverage to those who might not otherwise afford it.

You qualify for this benefit program if you are in need of health insurance assistance and your financial situation is classified as low income or very low income. Medicaid programs in North Carolina require a household income of less than 100 to 200 % of the federal poverty level. On top of that, you must fall into one of North Carolina's Medicaid eligibility categories listed below. Eligibility summary can also be accessed online by clicking here.

  • A resident of North Carolina
  • A US citizen, a permanent resident or a legal alien
  • Receiving Cash Assistance (SSI)
  • Receiving work first family assistance.
  • Receiving State/ County Special Assistance for the aged or Disabled.
  • Receiving Special Assistance for the Blind
  • Pregnant
  • Over 65 years old
  • Blind or have other special needs.
  • Children between the ages of 6 and 19 years
  • Suffering from breast or cervical cancer

Under normal circumstances, it is not mandatory to undergo a medical exam to determine your eligibility. However, the following conditions require medical confirmations from a doctor:

  • If you are applying because you are pregnant, a pregnancy confirmation from the doctor is required.
  • If you are applying because you are disabled, a medical exam from the doctor is required.

Coverage

Doctor Services

North Carolina Medicaid program offers a number of doctor's services including outpatient services such as routine physician care or physical therapy. All drugs and supplies needed in these procedures are fully covered by Medicaid. Medicaid also covers any medically necessary laboratory and X-ray services Procedures ordered by a doctor. Most services are free of charge, though some outpatient hospital services may require a $3 co-payment.

Hospital Services

Medicaid covers inpatient hospital visits in North Carolina and all the qualifying expenses accumulated during each visit e.g. specialist care and supplies. Medicaid will also cover ambulance transportation for a maximum of 24 visits a year.

Dental Care

North Carolina Medicaid program offers full dental coverage. Beneficiaries can visit the dentist for treatment of any oral conditions and checkups. Those with oral related abnormalities also qualify to receive the required dental procedures.

Preventive Care

North Carolina Medicaid participates in Early and Periodic Screening Diagnosis and Treatment Program uniquely known as Health Check in North Carolina. Health Check offers preventive screenings for Medicaid beneficiaries under the age of 21. The screening includes a full physical checkup, nutritional checkup, vitals, immunizations, hearing and visual screenings.

5. Case Supervision

North Carolina Medicaid offers the services of a social worker to provide case management for some beneficiaries. This includes children who have been abused or neglected, or persons living with HIV and AIDS.

6. Non-emergency Transportation

North Carolina Medicaid beneficiaries who lack access to a reliable means of transport can apply for non-emergency transportation, which includes bus vouchers or cab ticket in order to get to and from a Medicaid covered destination.

Eligibility Requirements

To be eligible for Medicaid you must fall into one of the following categories: a parent, a children, a senior, or a person with disabilities. People with different needs will have access to different services. The financial limits for each groups vary, please see the links below for more information:

In order to receive Medicaid you must also be the following:

  • Be a U.S. citizen or have an eligible immigration status. (If applying for emergency services, you are not required to provide show immigration status).
  • Have a Social Security number (applied for SSN).
  • Live in North Carolina (show proof of residency).

If you are enrolled to receive any of the following benefits, you are eligible for Medicaid:

  • Supplemental Security Income (SSI)
  • Work First Family Assistance
  • Special Assistance to the Blind
  • State/County Special Assistance for the Aged or Disabled(Adult Care Home Assistance )

You usually would not have to get an exam to receive Medicaid. Only if you are apply because of a disability or to prove that you are pregnant.

Click here to view the Medicaid Eligibility Chart.

Medicaid Application Instructions

Families interested in applying for the North Carolina Medicaid program have several options listed below. Detailed application directions are available by clicking here.

Apply in Person

You may apply at the County Department of Social Service (DSS) in your local County. The county representative may require the following documents to complete your application:

  • Current Bank Statements
  • Current Payroll Stubs
  • List of assets such as real estate and vehicles
  • Identification documents for individuals applying for Medicaid such as genuine birth certificates and proof of citizenship or immigration status
  • Social Security Card
  • Copies of any other insurance or medical policy
  • Recent statements from any other source of income e.g. child support, pensions and retirement benefits

You are not mandated to bring an application form with you. However, printing and filling out as much of the application as you can prior to your visit may expedite the process. An application form can be downloaded by clicking here.

Mail Application

You can also apply via mail by downloading and printing the application, click here to download an application. Fill the details requested and mail the form to your local DSS office. You may also call your local DSS office on 800-662-7030 and ask a representative to mail you an application form. Hearing impaired callers can dial (TTY):877-452-2514.

Please note applications received via internet and faxes are not considered.