Family & Children's Medicaid

Medicaid is a health insurance program for families and individuals whose income makes it difficult for them to afford health care. It is a publicly funded program governed by federal and state laws.

In order to be eligible to receive Medicaid individuals must:

• Be a U.S. Citizen or qualified alien
• Live in North Carolina and have a social security number or have applied for one

Have income that meets program requirements for one of the following categories:

• Families with children under age 19
• Children under age 21
• Single or married pregnant women
• Children receiving adoption or foster care assistance

OR

• Be currently receiving a check for Supplemental Security Income (SSI), Work First Family Assistance (WFFA), or Special Assistance for the Aged, Disabled or Blind (SAA, SAD or SAB)

This is just a guide. An eligibility specialist at the Department of Social Services will assess your individual situation and inform you.

Your family's income, the number of people in your family, and the age of your children determine if you or your children qualify.
When you apply for Medicaid, your family's monthly income is calculated by subtracting certain deductions from your gross income. Certain deductions are given for work-related expenses, child care costs, and court-ordered child support or alimony. The deductions vary with each Medicaid program. An eligibility specialist will calculate your monthly family income.
For more information please go to http://www.ncdhhs.gov/dma/medicaid/index.htm

Medicaid for children provides medical coverage for children under age 19. The income limits are determined by the size of the family and the age of the child(ren) for whom you are applying. There is no limit on resources.

North Carolina Health Choice (NCHC) is North Carolinas health insurance program for children under age 19 who have no health insurance and whose family's income prevents them from affording health care, but who are ineligible for Medicaid. The income limits are determined by the size of the family and the age of the child(ren) for whom you are applying. There is no limit on resources.

Medicaid for Families with Dependent Children provides medical coverage for parent(s) or other caretakers with child(ren) under age 19 in the home and for children under age 21. The income limit is determined by the size of the family. You cannot have more than $3,000 in resources, such as savings, in the bank.

Medicaid for Pregnant Women only covers services related to pregnancy:

• Prenatal care, delivery and 60 days postpartum care
• Services to treat medical conditions which may complicate the pregnancy
• Childbirth classes
• Family planning services

A pregnant woman may apply for this program before or after she delivers. A woman who has experienced a recent pregnancy loss may also be eligible. The income limit is determined by the size of the family. There is no limit on resources.

The Be Smart Family Planning Program is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina. The program provides free family planning and birth control services. It is voluntary and confidential. Women ages 19 through 55 and men ages 19 through 60 are eligible to apply. In order to receive services, applicants cannot be pregnant, sterile, or incarcerated.

You may apply at Alexander County Social Services
located at 604 7th St SW Taylorsville, NC 28681

If possible, please bring the items listed below with you when you go to apply. If you do not have some or all of these items, please apply anyway because it is very important to protect your application date. The Eligibility Specialist can assist you in obtaining these items and information.

• Certified birth certificates or other proof of citizenship/alien status for each individual applying for Medicaid/NCHC
• Documents to verify identity for each individual applying for Medicaid/NCHC
• Social security cards, social security numbers, or proof that you have applied for a social security number for each individual applying for Medicaid or NCHC
• A copy of all pay stubs for last month
• Copies of all medical policies
• Most recent bank statement

If you are unable to apply in person, you may also download an application at http://info.dhhs.state.nc.us/olm/forms/dma/dma-5063.pdf. Please print, complete, and mail the application to the Department of Social Services at 604 7th St SW Taylorsville, NC 28681. Or you may call and ask that an application form be mailed to you. If you are disabled, an eligibility specialist may be able to make a home visit to assist you with the application process. Faxed applications and applications received over the internet are not acceptable.

What does Medicaid cover?

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. Additional information concerning Medicaid is available at http://www.ncdhhs.gov/dma/medicaid/index.htm.

Why is one of my children eligible for Medicaid but the other isn't?

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.

How do I let my doctor know that I have Medicaid?

When you are approved for Medicaid, you will receive a Medicaid ID card 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.

What do I do if I lose my Medicaid card?

You may notify your caseworker if you lose your Medicaid card and request a replacement card. Your Medicaid card is your proof that you have coverage. It is very important to keep up with your Medicaid card!

How long can I receive Medicaid after I am approved?

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.

What does North Carolina Health Choice cover?

If you are eligible for North Carolina Health Choice, you will receive a Health Choice of Children Handbook, which contains listing 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 Customer Services at 1-800-422-4658.

How do I let my doctor know that I have North Carolina Health Choice?

When you are approved for North Carolina Health Choice, you will receive one Identification (ID) card in the mail. You must always show your ID card each time you go to the doctor, hospital, pharmacy or any other medical provider. Your ID card is proof that you have coverage. It is very important to keep up with your ID card! It is your health insurance card. If you do not show your card to the medical provider, they will not know you are covered by NCHC and you may become responsible for paying the full cost of the medical bill or prescription. Each child covered by NCHC receives his or her own ID card.

What do I do if I lose my child's North Carolina Health Choice ID card?

In the event you lose your child's North Carolina Health Choice ID card, you must call your local DSS caseworker & request a replacement card.

How long can I receive North Carolina Health Choice after I am approved?

You may receive NCHC as long as you continue to meet the requirements. Your caseworker will review your situation 12 months. You must report all changes in situation to your caseworker within 10 days. You cannot receive North Carolina Health Choice if you begin receiving coverage through another health insurance program.

Community Care of North Carolina/ Carolina Access (CCNC/CA) is North Carolina's Medicaid managed care program. It provides you with a medical home and a primary care provider (PCP) who will coordinate your medical care.

As a CCNC/CA member, you are eligible for all the services that Medicaid covers. Being a member also has the following advantages:

• You can choose a medical home with a primary doctor for each family member.
• You can call your primary doctor day or night for medical advice. Your Medicaid ID card will have your doctor's daytime and after-hours phone number listed on it.
• You may have a care manager who can help you understand and manage your health care.
• You receive regular sick care and well care at your medical home. These services include: yearly physical check-ups, immunizations, pap smears, and prescriptions when necessary.
• Your primary doctor will make referrals to other doctors if you need special care not provided in your primary doctor's office. Medicaid recipients may choose to change their PCP and may do so at any time. The change is usually reflected on the following month's Medicaid card, depending on when the request is made.

If you wish to change your PCP or if you have questions regarding Carolina Access, contact your caseworker at 828-632-1080.

• Medicaid Manual and Carolina Access
• Medicaid/NC Health Choice Application - English
• Medicaid/NC Health Choice Application - Espanol