Family & Children’s Medicaid
Q. What is Family and Children’s Medicaid?
A. Family & Children’s Medicaid is a program that pays medical bills and prescriptions for eligible families who cannot afford the cost of health care.
Q. What are the income guidelines for Medicaid?
A. Income requirements vary for different programs. In order to determine which programs you may be eligible for, please visit our DSS office and speak with a case worker who specializes in eligibility determination.
Medicaid Health Insurance For Infants and Children (Effective 04/2008)
Covers children under age 19
|*Monthly Income Limit -Under age 1 through age 5||*$1,634||*$2,200||*$2,767||*$3,334|
|Monthly Income Limit – Age 6 through age 18||$817||$1,100||$1,384||$1,667|
*Represents highest income allowed
Monthly income limits for children vary with the age of the child, with the type coverage the child is eligible for, and the number of people in the child’s family. The chart below gives examples by age, category and family size. If income is greater than these amounts the child may be eligible for NC Health Choice for Children.
Special Note: Please remember that deductions can be taken from gross income for work-related expenses, child-care costs, and court-ordered child support or alimony paid. Please contact us to see if your family may qualify. If your income is over the limit and your children have high medical bills, your children may still qualify for Medicaid and have a deductible.
Medicaid Health Insurance For Families
Covers Children under age 21 and their Parents/Caretakers
|Monthly Income Limit||$362||$472||$544||$594|
If monthly income exceeds these amounts the family must meet a deductible based upon the Medically Needy income limits below:
|Monthly Income Limit||$242||$317||$367||$400|
Q. Who is eligible?
A. In the Family Medicaid program, it may be a child/children and may or may not include the adult caretaker.
Q. What are the basic eligibility criteria for children?
A. For a child 18 and younger, eligibility is based solely on the income of the financially responsible adult the child lives with. There are different income levels based on the age of the child. There is no resource evaluation for children.
Q. How does the Doctor get paid for services provided?
A. The doctor or other health care provider sends his bill to the state and the state pays the provider for the services.
Q. How can I get a new Medicaid card?
A. New Medicaid cards are mailed to recipients at the beginning of each month. It may take up to the first 10 business days of the month to receive your card.
Q. Can an adult be covered in this program?
A. In order for the adult caretaker to receive in the Family Medicaid program, first of all, their child must be Medicaid eligible. Eligibility for the adult is based on the child. If there is an eligible child, then the adult can possibly receive. But, the income guidelines for an adult to receive are much lower than for the child. Also, there is a resource evaluation that must be met for the adult to receive.
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 or family’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 or 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% ($50) of a $500 hospital bill. Fifty dollars is the amount that can be applied to meet the Medicaid deductible.) You can be approved 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.
Example: A family of 4 has monthly income of $800. The income limit for this family is $400. The deductible is calculated as follows:
$800 family income – 400 income limit = $400 excess x 6 = $2,400 deductible
The family cannot receive Medicaid until medical bills totaling $2,400 have been incurred or paid. Once that amount has been incurred or spent, the family may receive Medicaid for the remainder of the 6-month period. For additional information about deductibles, refer to the Medicaid deductible Fact Sheet.
Q. What is Retroactive Medicaid?
A. Someone who has medical bills in one or all 3 months prior to application date may apply for these bills, if all other eligibility factors are met
Q. What is Carolina Access?
A. Linking Medicaid/NCHC recipients to a Primary Care Doctor for their health needs in their community.
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. Why is one of my children eligible for Medicaid but the other are not?
A. Medicaid is determined by comparing countable income to an income level for the number in the family. The income levels are different based on the child’s age. Depending on each child’s countable income and age, the children could be in different income levels.
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 each month in the mail. You must take your current card with you each time you go to the doctor, hospital, pharmacy, or any other medical provider. Your Medicaid card is proof that you have coverage. 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, they will not know Medicaid covers you and you may become responsible for paying the full cost of the medical bill or prescription.
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. Changes in your household may affect your medicaid eligibility
Q. When will I receive my Medicaid card?
A. Medicaid cards are mailed on the first day of each month provided the first day does not fall on a weekend or holiday. You should receive your Medicaid card by the 15th working day of the month.
Q. How do I change my Carolina Access doctor?
A. Contact your medicaid caseworker or call the agency at 336-570-6532 if you would like to change your Carolina Access doctor.
Q. How do I apply for Medicaid?
A. Contact Alamance County Department of Social Services. You will find them in the phone book under government agencies. You may go to the DSS to apply or ask them to send you an application in the mail. Applications are also available at the local Health Department. You may complete the application yourself and return it in person or mail it to the DSS.
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 the 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).
Q. Do we have a list of doctors who accept Medicaid?
A. We should be able to help your family find a physician who accepts Medicaid. In addition, some individuals who receive Medicaid must select a primary physician under a Managed Care program known as Carolina Access. Some individuals may also enroll in a Health Maintenance Organization (HMO). Your Social Services representative can provide more information about these programs.