Adult Medicaid FAQ
Q. Can I receive Medicaid if I don't have children?
A. Adults (people who are age 21 and over) may be eligible for Medicaid if they are:
� Age 65 or older
� The caretaker of (living with and caring for) a child under the age 19 who receives Medicaid
Q. What are the monthly income limits for Medicaid for Adults? (Effective 04/2011)
Monthly Income Limit
If monthly income exceeds these amounts the person must meet a deductible based upon the Medically Needy income limits below:
Monthly Income Limit
Q. How much money can I have for reserve?
A. For an individual the reserve limit is $2,000.00 or $3,000.00. For a couple the reserve limit is $3,000.00 or $6,000.00.
Q. What does Medicaid cover?
A. If you are eligible for Medicaid, you will receive a Consumer's Guide to North Carolina Medicaid Programs, which contains listings of covered services. This list is not all-inclusive and does change. For more accurate information, ask your medical provider or pharmacist or call the CARE-LINE at 1-800-662-7030.
Q. How do I let my doctor know that I have Medicaid?
A. When you are approved for Medicaid, you will receive a Medicaid ID card yearly. You must take your current card with you each time you go to the doctor, hospital, pharmacy, or any other medical provider. It is very important to keep up with your Medicaid card! It works just like a health insurance card. If you do not show your card to the medical provider you may become responsible for paying the full cost of the medical bill or prescription.
Q. How can I get a new Medicaid card?
A. New Medicaid cards are mailed annually. It may take up to the first 14 business days of the month to receive your card. If you do not receive your card, contact your Medicaid worker regarding a replacement card.
Q. How long can I receive Medicaid after I am approved?
A. You may receive Medicaid as long as you continue to meet the requirements. Your caseworker will review your situation every 6 to 12 months depending on what type of Medicaid you receive. You must report all changes in situation to your caseworker within 10 days.
Q. When will I receive my Medicaid card?
A. Medicaid cards are mailed annually.
Q. What is the definition of a disability?
A. As defined by Social Security, it is a physical or mental impairment that prevents an individual from engaging in any substantial, gainful activity, and which has lasted or is expected to last for at least 12 months, or is expected to result in death. To apply for disability benefits, you must apply through the Social Security Administration offices, 1-800-772-1213 or 1-800-325-0778 (TTY).
Q. What is Carolina access?
A. Carolina Access is a Medicaid managed care program. As a Medicaid recipient you must participate in this program unless you meet one of the exemption requirements.
Q. Will Medicaid pay for my care in a nursing home?
A. If you meet eligibility requirements, Medicaid will pay for some portion of your cost of care in a long term skilled or intermediate care facility as well as medical expenses.
Q. Will the state take my home if I get Medicaid?
A. If you receive CAP or are in a long-term care facility, estate recovery may apply to you. This means at the time of your death the government may make a claim against your estate to recover the money paid to medical providers on your behalf.
Q. If my income is over the limits and I can't meet a deductible, are there other programs?
A. Yes, the following programs are for adults who have Medicare. These programs may be referred to as Medicare Savings Programs.
� The MQB-Q program (or Comprehensive Medicare-Aid) pays the Medicare Part A and B monthly premium, Medicare deductibles, and co-insurance, the Part A hospital deductible, 20% co-payment of Part B approved costs and co-payment for Medicare approved skilled nursing home care.
� The MQB-B (or Limited Medicare-Aid) program and the MQB-E (Limited Medicare-Aid Capped Enrollment) program both pay the Medicare Part B monthly premium.
� MQB-E (Limited Medicare-Aid Capped Enrollment) also covers only the Medicare Part B premium for those people whose income is too high to qualify for MQB-B.
� MWD pays the Medicare Part A premium for disabled individuals who have lost eligibility for Medicare Part A due to earnings greater than the amount allowed by the Social Security Administration.
� Some individuals who live in nursing homes qualify for Medicaid to pay for their cost of care. In addition, some individuals who are in need of nursing care can receive benefits under the Community Alternatives Program (CAP), which enables the person to stay home and receive needed services. There are additional requirements that must be met to qualify for these extra services. For example, there must be documented proof that the individual has a medical need for the services.
� Some individuals in adult care homes (rest homes) are eligible for a check from the Special Assistance program to help pay for their care in the home. These individuals also receive Medicaid to help pay for their medical care.
Q. What is Medicare-Aid?
A. Medicare-Aid is a special Medicaid program for people who have Medicare and also have limited income and resources. It is a free program that helps pay your Medicare premiums, co-payments and deductibles. There are several Medicare-Aid programs which are also known as Medicare Savings Programs: MQB-Q, MQB-B, and MQB-E.
Q. What are the monthly income limits for these programs? (Effective 04/2011)
Number in Family
To be eligible for these programs, you must have Medicare and meet income and resource limits. You may apply for the Medicare Aid programs at your county Department of Social Services (DSS).
Q. Can I have Medicare Aid if I have private Medi-gap insurance?
A. Yes, you can apply for Medicare Aid if you have private Medi-gap insurance. However, you cannot receive both benefits at the same time. If you are approved for Medicare Aid, your Medi-gap insurance will be suspended for up to 24 months. This means you can resume your Medi-gap insurance policy during that 24 months if your Medicare Aid benefits stop. After 24 months if your Medicare-Aid benefits stop, you must reapply for Medi-gap insurance. You are not guaranteed to be approved.
Q. Will Medicare Aid pay for my prescriptions?
A. No. Medicare Aid only pays your Medicare premiums, co-payments and deductibles.
Q. What happens if I have to go into a nursing home?
A. If you need help with the cost of care in a nursing home, you must apply at your local DSS. MQB-Q covers only the Medicare co-payment for Medicare approved skilled nursing home care. After the first 20 days, nursing home care is not covered by Medicare Aid.
Q. What is a deductible?
A. A deductible in Medicaid works much like a deductible for private insurance. A person is responsible for a certain amount of medical bills before insurance pays. The difference is that a Medicaid deductible is not a set dollar amount (such as $100 or $250). It is based upon the person's income. If income is more than a limit set by law there must be a deductible. The deductible is the amount of income over the income limit. A deductible can be for 1, 2 or 3 months before the month of application or for a period of 6 months beginning with the month you apply.
Q. How do I meet the deductible?
A. A Medicaid deductible is met by adding up medical costs on a day by day basis. When a Medicaid applicant pays or is billed for medical care, supplies and prescriptions, he has incurred these costs and may have them applied to his deductible. Only the portion of the bill that the person must pay can be applied to the deductible. (For example, a person with health insurance may only be responsible for 10% or $50 of a $500 bill. Fifty dollars is the amount that can be applied to meet the Medicaid deductible.) You can be authorized for Medicaid on the date that the bills add up to the amount of the deductible.
Q. Whose Income/Medical Bills are counted toward the Deductible?
A. In Medicaid, your spouse's income must be counted in determining eligibility. Likewise, a parent's income must be counted when determining eligibility for a child. Because these individuals' income is counted, their medical bills may be applied to the Medicaid deductible. For additional information about deductibles, refer to the Medicaid Deductible Fact Sheet.
Q. How do I apply for Medicaid?
A. Contact your local Department of Social Services (DSS). You will find them in the phone book under government agencies. If you are unable to go to Social Services, you may request a home visit. If you cannot locate the phone number for your local DSS or if you have further questions regarding Medicaid eligibility after contacting the local department, call the Office of Citizen Services CARE-LINE Information and Referral Service toll-free at 1-800-662-7030 (Voice and Spanish) and someone will assist you. For local calls or calls from outside of North Carolina, dial (919) 733-4261. The Office of Citizen Services also has a dedicated TTY line at 1-877-452-2514 or for local TTY or TTY calls from outside of North Carolina, dial (919) 733-4851 for deaf and hearing impaired.
The Office of Citizen Services can also provide you with information and referrals on other Department of Health and Human Services programs along with other government and non-profit agencies that may be helpful, as well as tell you about prescription assistance programs available through drug manufacturers. (Office of Citizen Services 1-800-662-7030 (Voice and Spanish); (919) 733-4261 (local or out of state calls); 1-877-452-2514 (TTY Dedicated) and (919) 733-4851 (TTY Dedicated for local or out of state calls). You can also visit their website Office of Citizen Services
If you have questions about Medicaid eligibility, the CARE-LINE operator can connect you with the Medicaid Eligibility Unit in the North Carolina Division of Medical Assistance.