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Disability-Based NC Medicaid

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    Disability-Based NC Medicaid

    Frequently Asked Questions

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

    There are four ways to apply for NC Medicaid:

    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.

    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 FNS (Food Stamps), 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.

    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 information about different ways to get NC Medicaid:

    No, countable income is not the same as how much you make. When public programs look at your income to figure out if you should qualify, they don’t always count all of your income. What they do count is called “countable income.” This benefits you, because it means that you might have more income than the income limit for a program, but still qualify.

    When NC Medicaid reviews your income to see if you qualify for disabiilty-based NC Medicaid, only about half of your earned income (money you get from work you do) is counted. For example, if you make $4,000 per month at a job and have no other income, that’s only $1,957.50 in countable monthly income.

    Note: This countable income calculation is only used for for disability-based NC Medicaid. If you apply for income-based NC Medicaid, almost all of your income is counted. Learn more about income-based NC Medicaid.

    Try this tool to get an idea of how much countable income you have:

    Your Countable Income:

    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 your disability began before you turned 26, you can open an ABLE account where you can save up to $19,000 each year and not have it counted by NC Medicaid. Learn more about ABLE accounts.

    Yes, if you're getting Supplemental Security Income (SSI), you automatically get NC Medicaid as well. You do not need to file an additional application.

    If you’re on SSI and NC Medicaid and your monthly SSI benefits drop to zero because your earned income goes up, Social Security’s 1619(b) provision lets you keep your NC Medicaid coverage. If you are on 1619(b), you can have up to $46,540 in total income per year, as long as your resources don’t go above the SSI resource limit ($2,000 for an individual, $3,000 for a couple).

    There are different health coverage options as your income goes up.

    If you have a disability and are working, you may be able to get NC Medicaid coverage through Health Coverage for Workers with Disabilities (HCWD). With HCWD, you can make any amount of money at work and still get NC Medicaid, as long as you have $30,828 or less in resources and have $1,956 or less in monthly unearned income. You may have to pay a small annual fee and a monthly premium, depending on your income.

    If you have been getting NC Medicaid through Supplemental Security Income (SSI) benefits, you may be able to keep your NC Medicaid coverage if you go back to work through SSI's 1619(b) provision. If you're on 1619(b), you can have up to $46,540 in total income each year and still keep your NC Medicaid coverage.

    If your income is above 138% of the Federal Poverty Guidelines (FPG) , you may be able to get government help to pay for individual insurance plans on HealthCare.gov.

    The bottom line: There should be a health coverage option for everyone. If you have questions about the impact work will have on your health care, talk to a benefits planner or get an idea of your options with DB101’s Benefits and Work Estimator.

    NC Medicaid is a public health coverage program. There are different ways to qualify for NC Medicaid, depending on things like your age, income, resources, and whether you have a disability.

    Regular NC Medicaid: You may qualify for regular NC Medicaid coverage based on the income-based rules described in DB101’s Income-Based NC Medicaid article or based on disability rules, if you have low income and low resources. You automatically qualify for NC Medicaid if you get Supplemental Security Income (SSI) or qualify for SSI’s 1619(b) provision. With regular NC Medicaid, you only have to pay small copayments for medical services.

    NC Medicaid with a spend down: You may qualify for NC Medicaid with a spend down if you meet all other requirements for disability-based NC Medicaid, but your income is more than 100% of the Federal Poverty Guidelines (FPG). If you are in this situation, you can "spend down" your income by paying the first part of your medical costs, and once you have paid the spend down amount in a six month period, NC Medicaid will cover your medical expenses for the rest of the six months. Note: NC Medicaid with a spend down is often very expensive. Health Coverage for Workers with Disabilities (HCWD) is usually a better option, if you qualify.

    Health Coverage for Workers with Disabilities (HCWD): HCWD is a way for people with disabilities who work to get NC Medicaid coverage no matter how much money they make at their job. Depending on your income, you may have to pay a small annual fee and a monthly premium, in addition to small copayments for some services.

    Read about the different ways of qualifying for NC Medicaid on DB101.

    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 have NC Medicaid and employer-sponsored coverage, 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 employer-sponsored coverage premiums, you must have a high-risk illness, not be able to afford your premiums, and not have Medicare coverage.

    Note: If your job offers you affordable insurance, you cannot get subsidies for purchasing an individual health plan through HealthCare.gov.

    Yes, if you qualify for Medicare and NC Medicaid, it is helpful to have both at the same time. NC Medicaid covers many more services than Medicare, so by having both you’ll have better health care coverage. Also, NC Medicaid will usually pay your Part A and Part B premiums, and it may also pay your Medicare deductibles, co-insurance, and copayments. With Medicare Part D, you’ll likely have cheaper prescription drug costs by enrolling in both programs.

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

    Learn more

    Health Coverage for Workers with Disabilities (HCWD)

    HCWD is NC Medicaid for people with disabilities who work.

    Buying Health Coverage on HealthCare.gov

    You can get private health coverage on HealthCare.gov. The government may help you pay for it.