Benefits for Young People

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      Benefits for Young People

      NC Medicaid Eligibility for Young People

      NC Medicaid helps people with low income pay for their visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services. Depending on your income, your age, and whether you are disabled, blind, or pregnant, there may be more than one way for you to qualify for NC Medicaid.

      If you qualify for Supplemental Security Income (SSI), you also qualify automatically for NC Medicaid and don't need to worry about the rules on this page.

      To get NC Medicaid, you have to meet certain rules. These rules can seem confusing at first, but they are actually pretty simple. First we will present the rules for young people under the age of 19, then we’ll present them for anybody 19 or older. Read the section that is appropriate for you.

      If you have any questions, talk to a benefits planner.

      How to Apply for NC Medicaid

      After you learn about eligibility, you can apply for NC Medicaid:

      No matter how you apply, it is important to know that if you are not eligible for NC Medicaid, you may be able to get private insurance subsidized by the government.

      NC Medicaid If You Are 18 or Younger

      If you are 18 or under, there are two common ways to get NC Medicaid. You can qualify:

      1. If your family has low income, regardless of whether you have a disability, or
      2. If have low income, low resources, and you have a disability or are blind.

      Income-Based NC Medicaid

      Whether or not you have a disability, you can qualify for NC Medicaid for children if you and your family's income is at or below 216% of the Federal Poverty Guidelines (FPG) ($5,787 per month for a family of four). It doesn't matter how much your family has in resources.

      If your family's income is at or below 138% of FPG ($3,697 per month for a family of four), your parents may also qualify for NC Medicaid.

      Use the tool below to see if your family may qualify for income-based NC Medicaid.

      Health Coverage Income Limits for Your Family
      Is the income limit for NC Medicaid for children 211% or 216% of FPG?

      You may see the children's income limit for NC Medicaid for children listed as 211% of the Federal Poverty Guidelines (FPG). However, when NC Medicaid counts your income, they’ll knock 5% of FPG off your household income if you make more than 211% of FPG. That's why we say that you can make up to 216% of FPG, because it more accurately shows how much income you could have and still get NC Medicaid for children coverage if you are under 19.

      If you are or have been enrolled in foster care
      If you are 17 or younger and in foster care, you may qualify for NC Medicaid no matter how much money you make. If you are 18-25 years old and were in foster care on your 18th birthday, you also may qualify for NC Medicaid no matter how much money you make.

      Disability-Based NC Medicaid

      If you are 18 or younger and have a disability, you may get NC Medicaid through disability-based rules.

      If you get SSI, you automatically get NC Medicaid and do not have to fill out an additional application. You can read more about how to qualify for SSI on the SSI Eligibility page.

      If your income is too high to get SSI, you may still qualify for disability-based NC Medicaid if you:

      When you're under 19, some of your parents' income and resources may be counted as your income and resources. NC Medicaid counts your income the same way Supplemental Security Income (SSI) does: almost all of your unearned income is counted, but less than half of your earned income is counted. Because of these counting rules, you may be eligible even if it seems like your income is over the limit, so you should apply even if you think you won't qualify.

      Note: If your countable income is higher than 100% of FPG, you may still be eligible for NC Medicaid, but you will have to spend some of your own money on your medical bills before NC Medicaid will start paying. This is called NC Medicaid with a spend down. However, NC Medicaid with a spend down can be very expensive. You should see if you qualify for income-based NC Medicaid, Health Coverage for Workers with Disabilities (HCWD), or private health care subsidies before you sign up for NC Medicaid with a spend down.

      NC Medicaid if You Are 19 or Older

      The rules for NC Medicaid if you're 19 or older are a little different than the rules used for people under 19. There are two common ways to get NC Medicaid. You can qualify:

      1. If you have low income, regardless of whether you have a disability, or
      2. If have low income, low resources, and you have a disability or are blind.

      Income-Based NC Medicaid

      When you are 19 or older, you can qualify for NC Medicaid if your income is at or below 138% of the Federal Poverty Guidelines (FPG) ($1,800 per month if you are single). NC Medicaid no longer looks at your parents' income.

      If you are pregnant, you can qualify if you have income at or below 201% of FPG ($3,543 per month if you are single and pregnant with your first child; the baby is counted as a member of the family).

      For income-based NC Medicaid, there is no limit on how many resources you can have.

      Disability-Based NC Medicaid

      If you are 19 or older and have a disability, you may get NC Medicaid through disability-based rules.

      If you get SSI, you automatically get NC Medicaid and do not have to fill out an additional application. You can read more about how to qualify for SSI on the SSI Eligibility page.

      If your income is too high for SSI, you may still get disability-based NC Medicaid if you:

      Once you turn 19, NC Medicaid will only look at your income and resources when deciding whether you qualify, and will not look at your parents’ income and resources. You may qualify for disability-based NC Medicaid even if you did not qualify when you were younger than 19.

      Your countable income is not the same as your real, full income. NC Medicaid counts your income the same way Supplemental Security Income (SSI) does: almost all of your unearned income is counted, but less than half of your earned income is counted. For example, if you make $2,000 per month at a job and have no other income, that’s only $957.50 in countable monthly income.

      Use the tool below to figure out your countable income and see if you may qualify:

      Your Countable Income:

      You can also get an idea of whether you would qualify for NC Medicaid by using DB101's School and Work Estimator.

      Note: If your countable income is higher than 100% of FPG, you may still be eligible for NC Medicaid, but you will have to spend some of your own money on your medical bills before NC Medicaid will start paying. This is called NC Medicaid with a spend down. However, NC Medicaid with a spend down can be very expensive. You should see if you qualify for income-based NC Medicaid, Health Coverage for Workers with Disabilities (HCWD), or private health care subsidies before you sign up for NC Medicaid with a spend down.

      SSI's 1619(b) rule

      If you’re on Supplemental Security Income (SSI), there is a rule called 1619(b) that lets you keep your NC Medicaid coverage even if your earned income becomes too high for you to keep getting an SSI cash benefit. With 1619(b), you can make up to $46,540 per year without losing your NC Medicaid.

      While 1619(b) means that you can get NC Medicaid while earning way more than the program’s normal income limit, your resources have to stay below SSI’s $2,000 resource limit. If your resources go above that limit, you should consider Health Coverage for Workers with Disabilities (HCWD). Learn more about HCWD.

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