Interim Director:
Denise Boyette
Send E-Mail
Physical Address:
DSS Building
714 North Street
Smithfield, NC 27577
 
Mailing Address:
P.O. Box 911
Smithfield, NC 27577
 
Phone: 919-989-5300
Fax: 919-989-5324
Medicaid for Families and Children

Medicaid for Infants, Children, and Families

Medicaid serves infants, children, and families in several ways:

When determining eligibility, Modified Adjusted Gross Income (MAGI) methodology is used to determine how income is counted and how household composition and a family size is constructed.  MAGI is the adjusted gross income, with specific exceptions, of a tax filer according to federal tax rules. MAGI-based income determines if you and/or your children qualify.  Your county worker will calculate your monthly family income.

Medicaid for Infants and Children

Medicaid for Infants and Children (MIC) provides medical coverage for children under age 19. The income limits are determined by the family size and the age of the child(ren) for whom you are applying.

There is no limit on resources.

Your monthly countable income cannot be more than the amounts listed below.

If your family income is greater than the income/reserve limits, your child(ren) age 6-18 may be eligible for NC Health Choice for Children or Medicaid with a Medicaid deductible.

 

Medicaid for Families with Dependent Children 

Medicaid for Families with Dependent Children provides medical coverage for parent(s) or other caretaker/relative with child(ren) age 18 and under in the household and for children under age 21. A pregnant woman may also qualify.

If the family income is over the income/reserve limits and your child(ren) and/or family have high medical bills, you may still qualify for Medicaid and have a Medicaid deductible.

 

Medicaid for Pregnant Women

Medicaid for Pregnant Women only covers services related to pregnancy:

  • Prenatal care, delivery and 60 days postpartum care
  • Services to treat medical conditions which may complicate the pregnancy (some services require prior approval)
  • Childbirth classes
  • Family planning services

A pregnant woman may apply for this program before or after she delivers. A woman who has experienced a recent pregnancy loss may also be eligible.

The monthly family income cannot exceed 196% of the federal poverty level. There is no limit on resources. If a pregnant woman is covered by Medicaid on the date she delivers, her newborn child may be eligible for Medicaid up to age 1 without a separate application.

 

Health Choice for Children

The North Carolina Health Choice (NCHC) Health Insurance Program for Children is a comprehensive health coverage program for low-income children. The goal of the NCHC Program is to reduce the number of uninsured children in the State. If your family makes too much money to qualify for Medicaid, but too little to afford private or employer-sponsored health insurance, your child (ren) may qualify for NCHC.

 

Adult Medicaid

You may be eligible for Medicaid if you are age 65 or older, blind, or disabled. Eligibility for Medicaid is based on your family’s monthly income and the amount of resources you own. To receive Medicaid for the blind or disabled, you must be evaluated by a doctor.

Effective November 1, 2008, a disabled and/or blind individual may be able to go to work or increase their hours of work and still receive Medicaid through the Health Coverage for Workers with Disabilities Act.

If you receive Supplemental Security Income, you are eligible for North Carolina Medicaid. You do not need to apply.

When you apply for Medicaid, your family’s monthly income is calculated by subtracting certain deductions from your gross income.  Social Security, veteran’s benefits, wages, pensions and other retirement income are counted.  The deductions vary with each Medicaid program.  Your county worker will calculate your monthly family income.

Your monthly countable income cannot be more than these Income/Reserve Limits (Updated June 16, 2015)

Your resources may not be more than $2,000 for an individual or $3,000 for a couple. Resources include the following:

  • cash
  • bank accounts
  • retirement accounts
  • stocks and bonds
  • cash value of life insurance policies
  • other investments.

The value of your home, a car, home furnishing, clothing and jewelry are not counted.

If your family income and/or resources are over the limit and you have high medical bills, you may still qualify for Medicaid and have a Medicaid deductible.

Medicaid may also help pay for nursing homes and intermediate care facilities, as well as long-term care in the home.

Medicaid for Long-Term Care

Medicaid may help pay for nursing homes and intermediate care facilities, as well as long-term care in the home. There are income limits, resource limits and transfer of asset requirements. You do not have to sell your house. The home, a car and all personal possessions are not countable resources.

Medicaid allows financial protection for the married spouse at home.

Nursing Facilities

Your income must be less than the cost of care in the facility at the Medicaid rate. Medicaid must approve the need for the level of care. You must use some of your income to help pay for the cost of care. This is called the “patient monthly liability.” Medicaid will pay the rest to the facility.

Your spouse can keep all of the income he/she receives for himself. He or she may be able to receive some of your income as well.

 

Community Alternatives Program (CAP)

Currently, there are four Community Alternatives Programs that help people who need long term care stay in their own homes. CAP provides both medical and non-medical services to prevent or delay care in a facility.

CAP funds are limited and only a specific number of people may participate in each program.

 

  • The Community Alternatives Program for Disabled Adults (CAP/DA) provides an array of home and community based services to adults with disabilities 18 years of age and older who are at risk of institutionalization. The services are designed to provide an alternative to institutionalization for beneficiaries in this target population who prefer to remain in their primary private residences, and would be at risk of institutionalization without these services.  The CAP/DA program is intended for situations where no household member, relative, caregiver, landlord, community, agency, volunteer agency, or third party payer is able or willing to meet all medical, psychosocial, and functional needs of the beneficiary.  There are two program options under the CAP/DA Program.

 

  • The two options under the CAP/DA Program are:
  •      1. CAP/DA, the traditional option; and
  •      2. CAP/Choice, the consumer-directed option.
  • CAP/Choice, an option under the CAP/DA program, is consumer-directed care for disabled adults who wish to remain at their primary private residence and have increased control over their own services and supports. Beneficiaries and their caregivers direct their own services and supports which are provided in their own primary private residence and community. It offers beneficiaries the choice, flexibility and control over the types of services they receive, when and where the services are provided, and by whom the services are delivered.