Medicaid Expansion in North Carolina

On December 1st 2023, North Carolina expanded its Medicaid program, significantly increasing the number of residents eligible for health care coverage.

More information is available at https://medicaid.ncdhhs.gov/north-carolina-expands-medicaid

Here are the key details about this expansion:

1. **Eligibility Expansion**: Starting December 1, 2023, Medicaid in North Carolina has been expanded to include adults aged 19 to 64 who earn up to 138% of the federal poverty line. This includes singles earning around $20,000/year and families of three earning approximately $34,000/year.

2. **Application Process**: Residents can apply for Medicaid online through ePASS, in-person, by phone, or by mailing in applications. Online applications may be processed faster, and it generally takes up to 45 days to find out if you are eligible.

3. **Coverage Details**: Medicaid coverage is comprehensive, covering primary care, hospital stays, maternity care, vision and hearing, dental/oral health care, doctor visits, yearly check-ups, emergency care, mental health services, and more, usually at little or no cost to the applicant.

4. **Non-U.S. Citizen Eligibility**: Qualified non-citizens residing in North Carolina for at least five years may be eligible for Medicaid. Exceptions include refugees, asylees, and certain lawful permanent residents. Undocumented individuals are not eligible unless in emergency situations.

5. **Required Documentation**: Applicants need to provide their full legal name, date of birth, Social Security number or immigration documents, proof of North Carolina residency, and income information. Various documents such as photo ID, utility bills, lease agreements, pay stubs, tax returns, and business records are accepted for verification.

6. **Costs and Benefits for Current Beneficiaries**: Those already on full Medicaid coverage will not see changes. There are no monthly premiums for Medicaid under the new rules, and the highest copay required for some services is $4.

7. **Additional Options for Non-Qualifiers**: Those who do not qualify for Medicaid can explore subsidized health coverage options on HealthCare.gov. Community health centers also offer low-cost care based on income and insurance status.

8. **Automatic Enrollment for Some**: Individuals already enrolled in Medicaid’s limited Family Planning Program and eligible for full Medicaid benefits are automatically moved to full Medicaid expansion benefits.

9. **ePASS and Application Assistance**: ePASS, the online portal for Medicaid application, supports various functionalities, including application submission, document upload, and case tracking. Assistance is available for those who don’t speak English or need help communicating.

10. **NCID Accounts**: An NCID account is required for applying through ePASS, designed to protect personal information. Different types of NCIDs (individual and business) are available based on the applicant’s needs.

11. **Role of Authorized Representatives**: Authorized Representatives can apply for Medicaid on behalf of others. They need to have an NCID and provide specific documentation to act in this capacity.

This Medicaid expansion in North Carolina is a significant step towards increasing access to healthcare for a larger portion of the state’s residents, aiming to improve overall health outcomes and provide financial relief for medical expenses.