Adult Medicaid


The purpose Adult Medicaid is to determine eligibility for those individuals who meet the income and reserve criteria as set forth by state and federal guidelines. Medicaid helps pay medical bills for some people who have low income and cannot afford health care. These incomes and reserve limits can range anywhere from 100% to 135% of the federal poverty level, depending on the particular Medicaid program.

Adult Medicaid helps provide medical care for the elderly, people who are blind or disabled, and people who need help with rest home costs and nursing home costs. Note: Medicaid pays for medical services only, and can be used in conjunction with other health insurance (including Medicare). Eligibility guidelines are determined by federal and state government standards and are monitored by the North Carolina Division of Medical Assistance.

For more information, please visit the website for the Department of Health and Human Services for North Carolina.

What Do You Need to Apply for Adult Medicaid?

The process of making an application for Medicaid can be complex and require a considerable amount of information. Here is a list of information that may be needed in making an application:

  • Recent Medical Bills
    • Canceled checks to medical providers
    • Health insurance receipts
    • Proof of medical transportation costs
    • Statements and payments made to medical providers
  • Proof of Income for the Last Several Months
    • Copy of checks
    • Record of payments received
    • Self-employed records
    • Statement from employer
  • Bank Statements and Account Numbers
    • Bankbooks. Current savings statements
    • Checking account statements for the last several months
    • Copies of stock certificates
    • Security account statements
  • Life Insurance Policies and Policy Numbers
  • Social Security Card or Number for Client and Family Members
  • Health Insurance Information
    • Coverage
    • Payments
    • Policy Cost
    • Statements
  • Proof of Legal Alien Status (If Applicable)

Medical Treatment Facility (MTF)

This includes nursing homes, hospice care, hospital stays of 30 days of more, and Community Care Services. The income limit for MTFs is adjusted annually.

Supplemental Security Income (SSI)

This is a financial assistance program administered by Social Security. If an individual is eligible for SSI, he or she qualifies for Medicaid automatically. Any person who may be potentially eligible for SSI will be referred to Social Security before a Medicaid application will be taken. The income maximum for SSI is adjusted annually.

Qualified Medicare Beneficiaries (QMB)

This coverage pays an individual's Medicare CO-insurance and deductibles. It does not pay prescription drugs. The income maximum for QMB is adjusted periodically.

Adult Medically Needy

This is the one Medicaid program that has no income maximum. An individual can qualify for Medicaid if his or her medical bills exceed a certain percentage of their monthly income, which is known as the spend down. Medically Needy is limited to one month, and it only pays for bills incurred after the spend down is met.

Important Requirements

  • Age 65 or older, or be totally disabled, or be blind
  • A citizen of the U.S or a qualified alien
  • A resident of North Carolina(there is no time limit for establishing residency, only the intent to live in North Carolina)
  • Residing in a Medicaid approved nursing home