Medicaid in North Carolina

 

Medicaid is a state and federally funded medical assistance program for people with low incomes. The North Carolina Medicaid Program is handled by the North Carolina Division of Medical Assistance.

 

NC Medicaid

 

 

General Information

Medicaid information for North Carolina is available on the website of the North Carolina Division of Medical Assistance.

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Medicaid for Long-Term Care Residents

The North Carolina Division of Medical Assistance offers guidance on Financial Rules For Long-Term Care Recipients as well. "Medicaid pays for medically necessary nursing home care for patients in skilled or intermediate care nursing homes or in intermediate care facilities for the mentally retarded. The patient's income must be less than the cost of care in the facility at the Medicaid rate, and there is a limit on resources. If the patient or his representative gives away assets or sells them for less than market value, he may be ineligible for payment of the cost of care. The sanction period is based upon the value of the assets transferred away." Therefore, it is very important to know the requirements and/or consult with an attorney before deciding to change your financial situation to qualify for Medicaid for long-term care.

 

Long-Term Care Summary:

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Medicaid Recipients and Managed Care

Managed care for Medicaid recipients is available in all 100 counties. Options include Community Care of NC (Carolina ACCESS and ACCESS II) and Risk Contracting with a state-licensed HMO, which operates in Mecklenburg County only. Eligibility to participate in a managed care plan is mandatory for a majority of Medicaid recipients in North Carolina.

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Medicaid Waiver Programs in North Carolina

North Carolina operates three programs to provide home and community care as a cost-effective alternative to institutionalization. These are known as "waiver" programs because standard program requirements are waived to allow the program to operate. The waiver programs provide some services that otherwise are not covered under Medicaid.

  • CAP/DA Program
    The Community Alternatives Program for Disabled Adults (CAP/DA) provides a package of services to allow adults (age 18 and older) who qualify for nursing facility care to remain in their private residences. The program is available in all North Carolina counties. The program provides care that is cost-effective in comparison to the Medicaid cost for nursing facility care.

  • CAP-MR/DD
    The Community Alternatives Program for Persons with Mental Retardation or Developmental Disabilities (CAP-MR/DD) provides community services to individuals of any age who qualify for care in an intermediate care facility for the mentally retarded (ICF-MR). The Division of Mental Health, Developmental Disabilities and Substance Abuse Services manages the daily operation of the program under an agreement with the Division of Medical Assistance. The program is available statewide through local area mental health, developmental disabilities and substance abuse programs. CAP-MR/DD offers an alternative to institutionalization.

  • CAP/C
    The Community Alternatives Program for Children (CAP/C) provides cost-effective home care for medically fragile children (through age 18) who would otherwise require long-term hospital care or nursing facility care. This service might be useful for grandparents raising grandchildren.

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Personalized Assistance for Medicaid in North Carolina

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The CareLine is the North Carolina Department of Health and Human Services’ toll-free Information and Referral telephone service. Call to find information and referrals regarding human services in government and non-profit agencies in North Carolina.
Email Them!
1-800-662-7030

 

Please do note that the confidentiality of e-mail correspondence is maintained to the extent that e-mail is confidential. If you have a serious concern about confidentiality (beyond knowing that your information will not be shared without your consent), call the CareLine and talk to them directly.

If you would like to apply for Medicaid, the NC Division of Medical Assistance website can provide general information and your local Department of Social Services will take your application and discuss your eligibility.

 

 

 

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