Community Care of North Carolina
Prior authorization is required for certain drugs prescribed to N.C. Medicaid and Health Choice recipients. Providers may submit requests for approval via fax, phone or the NCTracks secure prior authorization portal.
Division of Health Benefits
Who is eligible for NC Medicaid/Health Choice?
| Family Size | NC Medicaid (Children under 6) | NC Health Choice (CHIP) (6-18 years old) |
|---|
| 2 | $2,960 | $2,974 |
| 3 | $3,733 | $3,751 |
| 4 | $4,507 | $4,528 |
| 5 | $5,280 | $5,305 |
Within the State of North Carolina, there are actually several different types or categories of Medicaid as well, including: Families with dependent children; infants and children; pregnant women; and aged, blind, and disabled. The eligibility guidelines vary somewhat within the programs.
Does NC Medicaid cover eye exams and glasses for adults? Starting January 1st of 2019, NC Medicaid covers eye exams and glasses for adults. If you're 21 years of age or older, and have NC Medicaid, you can also be seen by Medicaid eye care providers for medical eye exams.
NC Health Choice is a comprehensive health insurance plan which covers not only hospitalization but also outpatient care. Preventive dental, vision and hearing benefits are available.
The North Carolina Health Choice (NCHC) Health Insurance Program for Children is a comprehensive health coverage program for low-income children. If you do not qualify for Medicaid, but cannot to afford private or employer-sponsored health insurance, your children may qualify for NCHC.
Medicaid and the Children's Health Insurance Program (CHIP) provide no-cost or low-cost health coverage for eligible children in North Carolina. These programs provide health coverage for children so that they can get routine check-ups, immunizations and dental care to keep them healthy.
There are currently six
health insurance companies on the
North Carolina exchange.
The insurers available in North Carolina are:
- Blue Cross and Blue Shield of NC.
- Bright Health.
- Cigna Healthcare.
- Ambetter of North Carolina.
- UnitedHealthcare.
- Oscar Health Plan of North Carolina, Inc.
Click the one called "Medicaid" for Medicaid providers and the one called "Health Choice" for NC Health Choice providers. You need a referral from your Primary Care Provider (PCP) to see a specialist. Only your PCP can refer you to another doctor.
10. How Long Will My Medicaid Benefits Last? Your benefits will last as long as you remain eligible.
North Carolina Medicaid DefinitionMedicaid is a wide-ranging, jointly funded state and federal health care program for low-income people of all ages, including pregnant women, children, families, disabled, and the elderly.
Generally, nothing. A woman who was previously eligible and enrolled in full-scope Medicaid who becomes pregnant continues to be eligible, and will be able to access pregnancy services. A woman who becomes pregnant while enrolled in Medicaid Expansion can stay in that coverage, at least until redetermination.
How is poverty defined? In 2018, the federal poverty income threshold was $25,465 for a family of four with two children, and $17,308 for a single parent of one child.
Medicaid is the program that provides health coverage to eligible low-income adults, children, pregnant women, seniors and people with disabilities. The program is jointly funded by North Carolina and the federal government. NC Health Choice is our state's name for the Children's Health Insurance Program (CHIP).
Luckily, for residents of North Carolina, Medicaid insurance can help cover some dental needs. Dental care that is deemed “medically necessary” is covered by Medicaid. This includes routine checkups for both adults and children. However, care that is deemed “experimental” is not covered by this policy.
All types of Social Security income, whether taxable or not, received by a tax filer counts toward household income for eligibility purposes for both Medicaid and Marketplace financial assistance.
If you receive SSI and live in an assisted living facility, you may qualify for a benefit called Special Assistance (SA) that will pay for room and board expenses, up to $1,182/month, at adult care homes (also known as assisted living facilities).
NCTracks also offers a Secure Recipient Portal where you can check your eligibility status with Medicaid, Health Choice, Public Health, and the Office of Rural Health and Community Care.
?Applying for Medicaid online is the most convenient and efficient way to apply. You can apply via the NC ePASS Online Application Site from any device that has is connected to the Internet. ePASS is an easy-to-use, online website will allow you to apply for Medicaid and Food Assistance.
Medicaid Dental Providers
- General Dentists – Provide exams, X-rays, preventive services, fillings, complete and partial dentures, and simple extractions to patients of a wide age range.
- Pediatric Dentists – Provide exams, X-rays, preventive services, fillings and simple extractions for children.
Out-of-state providers, including border-area providers, must be enrolled in Medicare or their home-state Medicaid program to enroll in NC Medicaid and Health Choice programs. States can rely on the results of other states' screenings, eliminating additional costs and burdens to state Medicaid programs and providers.
North Carolina's Transformation to Medicaid Managed CareStandand Plans are scheduled to go live July 1, 2021, while Behavioral Health I/DD Tailored Plans are scheduled to launch July 1, 2022. Until that time, NC Medicaid will continue to operate under the current fee-for-service model administered by the Department.
Contact
- NC Medicaid Contact Center - Provider and beneficiary information on Medicaid and NC Health Choice policies and procedures. Phone: 888-245-0179.
- NCTracks Contact Center - Provider information for claims and billing. Phone: 800-688-6696.
- Dave Richard. Phone: 919-855-4100.
- Jay Ludlam.
- Patrick Doyle, Director.
- John E.
Medically necessary care and services provided within 40 miles of the NC border in the contiguous states of Georgia, South Carolina, Tennessee, and Virginia are covered to the same extent and under the same conditions as medical care and services provided in NC, with the exception of the services found in Subsection
The difference between Medicaid and Medicare is that Medicaid is managed by states and is based on income. Medicare is managed by the federal government and is mainly based on age. But there are special circumstances, like certain disabilities, that may allow younger people to get Medicare.
