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.
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
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