Frequently Asked Questions

It depends on how you qualified for NC Medicaid. Income-based NC Medicaid has no resource limit. However, some people with disabilities and seniors may qualify for disability-based NC Medicaid or Health Coverage for Workers with Disabilities (HCWD), which do have resource limits.

If you need more help in understanding NC Medicaid, you can:

• Talk to a health insurance navigator. Make an appointment online or by calling 1-855-733-3711.
• Visit or call your local Department of Social Services (DSS) office.
• Get local help from HealthCare.gov.
• If you have a disability, talk to a benefits planner to learn more about health programs for people with disabilities.

There are four ways to apply for NC Medicaid:

• Online using North Carolina ePASS. North Carolina ePASS lets you apply for other programs, like Food and Nutrition Services (FNS) or Work First (WF), at the same time. Note: On the ePASS website, NC Medicaid is called "Medical Assistance."
• Online using HealthCare.gov, an online one-stop shop where you can learn about your public and private coverage options.
• In person at your local Department of Social Services (DSS) office. You can also call them to apply over the phone.
• Using a paper application and faxing or mailing it in to your local Department of Social Services (DSS) office.

Note: If you get Supplemental Security Income (SSI) or used to and now are on SSI 1619(b), you automatically get NC Medicaid coverage. You do not need to apply for NC Medicaid.

No, income-based NC Medicaid is available to many people. To get income-based NC Medicaid, most people must:

• Be under 65 years old
  • You can be 65 or older if you are the parent or caretaker of a child
• Not be eligible for Medicare
  • You can be on Medicare if you are the parent or caretaker of a child or are pregnant
• Be a U.S. citizen or meet specific noncitizen requirements, and
• Have income below certain limits.

There are additional ways to get NC Medicaid if you have a disability or are a senior. When you apply for NC Medicaid, the person reviewing your application will figure out which type of NC Medicaid is best for you.

Note: Some people who do not qualify for most NC Medicaid benefits, such as undocumented immigrants, may qualify for coverage in emergencies only.

You and your family can usually get income-based NC Medicaid if your family’s income is at or below 138% of the Federal Poverty Guidelines (FPG) ($1,800 per month for an individual, $3,697 for a family of four).

Children under 19 can get NC Medicaid for children if their family's income is 216% of FPG or less ($5,787 per month or less for a family of four). Pregnant women can get NC Medicaid if their family's income is 201% of FPG or less. (For the purposes of calculating a pregnant woman’s family income, the unborn baby is counted as a family member.)

Income-based NC Medicaid counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based NC Medicaid eligibility.

You may see the income limit for NC Medicaid listed as 133% of FPG in some places. However, when NC Medicaid counts your income, they’ll knock 5% of FPG off your income if you make more than 133% of FPG. That's why we show the limit as 138% of FPG, because it more accurately shows how much you could make and still get NC Medicaid.

Note: The income limits may be different if you have a disability. Read DB101’s article about disability-based NC Medicaid.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,650
	$5,500
	$15,060
	$5,380
	216
Income-based NC Medicaid, adults (138% FPG)
NC Medicaid for children (216% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). Disability-based NC Medicaid eligibility is not included here. For private plans with subsidies, your monthly premium amount depends on your income.

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Yes, if your family’s income is low enough for you to qualify for NC Medicaid, you may do so even if your job offers insurance.

If you are eligible for NC Medicaid and have insurance through an employer, NC Medicaid may help pay your employer-sponsored coverage premiums, if NC Medicaid would save money by doing so. In order to qualify for help paying your premiums, you must have a high-risk illness and not be able to afford your premiums.

You must be a U.S. citizen or meet specific noncitizen requirements to be eligible for NC Medicaid:

• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for the same programs that U.S. citizens can get, including NC Medicaid.
• Most immigrants who have been lawfully present for less than five years do not qualify for NC Medicaid. However, they may qualify to get private coverage subsidized by the government through HealthCare.gov.
• Undocumented immigrants do not qualify for NC Medicaid, but they may qualify for Emergency NC Medicaid. To learn more about this, contact your local Department of Social Services (DSS) office.

In most cases, it does not matter how you qualify for NC Medicaid, because the actual medical coverage you get from NC Medicaid will be the same. Generally speaking, the big difference is that people with disabilities get extra ways to qualify and if you have a disability and start working, you can earn more while still getting NC Medicaid coverage.

DB101 has four articles about different ways to get NC Medicaid:

• The income-based NC Medicaid article explains the most common way to qualify, which does not require you to have a disability.
• The disability-based NC Medicaid article explains a common way for people with disabilities who have low incomes to qualify.
• The Health Coverage for Workers with Disabilities (HCWD) article explains a way that people with disabilities who work can get NC Medicaid coverage by paying a premium.
• The SSI article explains how people with disabilities may qualify for NC Medicaid automatically if they qualify for SSI.

If you are not sure how you qualified for NC Medicaid, you can ask your local Department of Social Services (DSS) office.

If you make more than the income limit for NC Medicaid, the government may help you pay for a private insurance plan though HealthCare.gov. This option is only available if you can’t get affordable health coverage through your job.

You can read more about this option in DB101’s article about Buying Coverage on HealthCare.gov.

North Carolina ePASS is the easiest way to apply for NC Medicaid if you think you might qualify. North Carolina ePASS also lets you apply for other benefits, like Food and Nutrition Services (FNS), at the same time.

HealthCare.gov is a good option if you don’t think you will qualify for NC Medicaid, because it will also check and see if you can get private coverage with subsidies. If HealthCare.gov sees that you are eligible for NC Medicaid, your local Department of Social Services (DSS) office will contact you about enrolling.

The bottom line: Both systems will help you find the benefits you need. The big difference is that, depending on your situation, one might be a bit faster than the other.