NC Medicaid Expansion FAQ

We know you have questions, and we’ve got answers to some of the most common ones associated with North Carolina expanding access to Medicaid. Medicaid expansion will provide access to essential healthcare services for thousands of low-income individuals and families, improving overall public health and well-being in the state. Find out who will be eligible, when it starts, how to apply, and more.

North Carolina is expanding Medicaid eligibility starting December 1, 2023. This means that more people will be able to get health care coverage through Medicaid, including people aged 19 through 64 with higher incomes.

What health services are covered?

Medicaid offers comprehensive healthcare coverage, and under North Carolina’s Medicaid program, these services are available at little to no cost. These services encompass primary care for check-ups and when feeling unwell, hospital services for both inpatient and outpatient needs, maternity and postpartum care for pregnant individuals, vision and hearing services, prescription drug benefits, behavioral health support, preventive and wellness services, dental and oral health care, as well as medical-related devices and various therapies.

When will I be able to get coverage through NC Medicaid?

Beginning December 1, 2023, more North Carolinians will be able to receive health coverage through NC Medicaid if you live in North Carolina and are between the ages of 19-64, and if you are a citizen (some non-US citizens can also get coverage through Medicaid), and if your household income falls within the chart below:

How do I apply for Medicaid?

You can go to ePASS online. Applying online is the fastest way to get your application processed. If you cannot apply online, you can apply in person at your local DSS office, by calling your local DSS office, or by mailing in a paper application. To find your local DSS office HERE.

Can I apply before December 1 (pre-qualify)?

Although you can apply for Medicaid at any time, “pre-qualifying” is not an option right now. Eligibility and program evaluation will be conducted at the time of your application, based on the eligibility criteria in effect. Please exercise caution regarding scams, as there is no legitimate process for “pre-qualifying” for Medicaid.

When will I know if I’m eligible for Medicaid after I apply?

The processing of your application may require up to 45 days, and incomplete applications may take longer to review. If your application lacks the necessary information, your local DSS office will reach out to you to request the missing details. They may contact you through various means such as mail, phone, email, and text messages. Therefore, it’s crucial to ensure that your contact information is current and complete to facilitate communication with your caseworker. Approval or denial notifications will be sent to you via mail, and authorized representatives will also receive the same notifications.

When does the Medicaid coverage begin?

The effective start date of your Medicaid coverage hinges on when you submit your application. Here are a couple of scenarios to illustrate this:

• If you apply for Medicaid in December but your application isn’t processed until January or later, yet you require medical care in December, your Medicaid coverage can be retroactively applied to December 1. Consequently, if you received care in December, your provider can bill Medicaid for the covered services, and you should not need to make out-of-pocket payments, except for any applicable copays.
• In the event that you apply for Medicaid in January 2024 or a later date, but have outstanding medical bills from services received in December 2023, it’s important to answer questions about prior months’ medical bills when applying for Medicaid. You have the option to request retroactive Medicaid coverage for up to three months before the month of your application. For instance, if you apply in March and meet the eligibility criteria, Medicaid can cover bills for services rendered in December, January, and February. It’s worth noting that coverage under the expansion program can only be retroactive to December 2023.

What if I’m a non-U.S. citizen? Am I eligible for coverage through NC Medicaid?

Certain non-U.S. citizens may be eligible for Medicaid coverage in North Carolina. To qualify, you must meet the following criteria:

• Reside in North Carolina.
• Hold “qualified non-citizen” status for a minimum of five years. This means that individuals must wait five years after obtaining “qualified” immigration status before they can access Medicaid.

There are exceptions to this waiting period, including refugees, asylees, or lawful permanent residents who were formerly refugees or asylees. They do not need to wait five years.

It’s important to note that individuals without proper immigration documents are generally not eligible for Medicaid, except in cases of emergency conditions as defined by federal law, such as someone involved in a car accident and requiring immediate care at the emergency room.

What information will I need to apply for NC Medicaid?

The application process requires some time to complete. When applying for each individual, you will be required to furnish the following information:

• Full legal name
• Date of birth
• Social Security number (or immigration documents)
• Proof of North Carolina residency
• Income details (derived from paystubs, W-2 forms, tax returns, or business records)

North Carolina employs external resources to authenticate the information you provide. In the event that additional information is necessary, you will receive a notification by mail from your local DSS.

What if DSS asks for more information? What documents will I need?

What if I already have Medicaid? Will my benefits change at all?

If you currently have full Medicaid coverage, there will be no changes to your benefits. However, when it’s time to prepare for the renewal process, here are the steps you should take:

• Ensure your contact information is up to date. Make sure your local DSS has your current mailing address, phone number, email, and other contact details. This enables the DSS to reach out to you regarding your Medicaid coverage. You can conveniently update your address and other information for Medicaid online through the ePASS, a secure self-service website provided by North Carolina. It allows Medicaid recipients to create an enhanced account, facilitating benefit applications, case details viewing, Medicaid renewals, and contact information updates. You can find more information on creating an enhanced ePASS account on the NC Medicaid beneficiary portal.
• Regularly check your mail. Your local DSS will send you a letter concerning your coverage. This letter will inform you whether you need to complete a renewal form or provide additional information to confirm your continued eligibility for Medicaid.
• If you receive a renewal form, promptly fill it out and return it to your local DSS to prevent any gaps in your Medicaid coverage.

What will I have to pay monthly?

Medicaid pays the cost for most health services you use. There are no monthly premiums and copays are low, at most $4 for some services.

What distinctions exist between Medicaid expansion coverage and obtaining coverage through the Standard Plan, Tailored Plan, Tribal Option, or Medicaid Direct? Are there any alterations or modifications to these plans under the new regulations?

Everyone who qualifies for Medicaid expansion coverage will be enrolled in a Standard Plan, Medicaid Direct, Tribal Option, or Tailored Plan, depending on their individual needs. This is the same system that other Medicaid beneficiaries use.

Am I eligible to have Medicare and still receive Medicaid expansion?

The short answer is, “No”. Some people with Medicare coverage may also be eligible for other Medicaid programs, such as disability coverage for people under age 65.

What about other insurance options if I don’t qualify for Medicaid under the new rules?

You may qualify for affordable health insurance through HealthCare.gov. For help enrolling, contact a North Carolina health insurance navigator. Community health centers like Compassion Health Care, Inc. also offer low-cost care based on your income and insurance status. See our Sliding Fee Scale here.

Will I be automatically enrolled in Medicaid now?

Yes, individuals who are currently enrolled in Medicaid’s limited Family Planning Program and are eligible will experience an automatic transition to full Medicaid expansion benefits. If you qualify for full Medicaid benefits, the following will occur:

• You will receive a notification from your local Department of Social Services (DSS) informing you of your upcoming full Medicaid coverage.
• A health plan will be assigned to you, but you have a 90-day window to select a different one if you prefer.
• You will receive a packet from your health plan by mail, which includes a new Medicaid ID card. This ID card will also indicate the name of your primary care physician, and you can change your assigned doctor by contacting your health plan.
• If you currently have health coverage through HealthCare.gov, you will need to cancel that plan. You can do so by either logging into your HealthCare.gov account or calling 1-800-318-2596. However, do not cancel your HealthCare.gov plan until you receive information from your new Medicaid health plan.
• It’s important to note that not all individuals with limited Family Planning Program benefits will be automatically enrolled in full Medicaid coverage. Some may have income levels that exceed Medicaid eligibility criteria. If you believe you may be eligible due to recent changes in your income, please update your information on ePASS (ePASS.nc.gov) or get in touch with your local Department of Social Services (DSS). Additionally, ensure that your contact information is current through ePASS or your local DSS office to receive important updates about your benefits.

What is limited Family Planning Medicaid and who is eligible?

Family Planning Medicaid offers comprehensive reproductive health care services free of charge to individuals with incomes up to 195% of the federal poverty line, which amounts to approximately $2,370 per month for a single person. This coverage encompasses a wide range of birth control methods, testing, and treatment for sexually transmitted infections, as well as preventive services and other related care.

I’m currently receiving Family Planning benefits and I have full coverage through NC Medicaid. When it is expanded, what happens next?

You’ll receive a notification from your local DSS confirming your eligibility for complete Medicaid coverage. Subsequently, you’ll be allocated a health plan. Should you wish to alter your health plan, you have a 90-day window to make a different selection. Your designated health plan will dispatch a package via mail, containing a new Medicaid ID card displaying your primary care physician’s name. Modifying your doctor can be done through your health plan. Medicaid covers expenses for doctor visits, annual check-ups, emergency care, mental health services, and additional benefits at minimal or zero cost to you.

Why won’t everyone with Family Planning Program benefits automatically get enrolled in full coverage through NC Medicaid?

Certain individuals might surpass the Medicaid qualification thresholds due to their income. If your income has undergone recent changes and you believe you might meet the eligibility criteria, please update your details using ePASS (ePASS.nc.gov) or get in touch with your nearby Department of Social Services (DSS). Additionally, it’s important to use ePASS or connect with your local DSS office to verify and maintain updated contact information, ensuring you receive crucial notifications regarding your benefits without any disruptions.

What is ePASS?

ePASS serves as an online platform accessible to North Carolina residents seeking services such as Medicaid. To initiate a Medicaid application online, simply visit ePASS.nc.gov. For further insights into ePASS, check out this fact sheet to gain a better understanding of its functionalities and benefits.

What is NCID? Why do I need it?

NCID represents NC Identity Management, serving as a safeguard for your personal information. Utilizing an NCID account is necessary for individuals applying for Medicaid through ePASS. Upon your initial use of ePASS, you’ll be prompted to establish an NCID account. Detailed instructions for creating an NCID account can be found online HERE.

How can I get help with an NCID account?

To reset your password or unlock your account, follow these steps:

• Visit ncid.nc.gov.
• Select the appropriate link under the NCID login:
  • » Forgot Password
  • » Unlock Account
• Enter your username and proceed according to the instructions provided.

For assistance, contact the North Carolina Department of Information Technology Service Desk at 800-722-3946.

Do I have to answer every question in ePASS?

While it’s not mandatory, try to respond to as many questions as possible. An incomplete application might prolong the processing time. If there are missing elements in your application, DSS will contact you for the necessary information. Therefore, ensure prompt responses to mail or phone inquiries to facilitate the application completion.

I don’t have a physical address, mailing address, or email address. What do I do?

• Physical Address: While a physical address isn’t mandatory for a Medicaid application, confirming your physical presence in North Carolina and your intent to reside here is necessary. Permanency isn’t required, nor is a fixed address.
• Mailing Address: If you don’t have a mailing address, enter an address where you can collect mail or use the address of your nearby DSS office. Locate a DSS office close to you at ncdhhs.gov/localdss.
• Email Address: Having an email address is essential for creating an NCID and accessing ePASS. If you don’t possess an email address, alternative application methods are available at your local DSS office, via phone, or through a paper application.

Do I need to give my Social Security Number (SSN)?

No, it’s not mandatory to provide your Social Security Number (SSN) when applying. However, if you have an SSN and choose not to include it, your local DSS will contact you to request it. Including your SSN on the application helps prevent processing delays. If you’ve applied for an SSN, you can submit documentation indicating your application status.

How will more people get health coverage through NC Medicaid?

Federal legislation permits states to broaden the scope of health coverage under Medicaid, a move commonly referred to as Medicaid expansion. Since 2014, 40 states along with Washington, DC, have adopted Medicaid expansion, expanding eligibility criteria for health coverage.

Why is Medicaid expansion in North Carolina a good thing for my community?

Studies indicate that broadening Medicaid coverage enhances healthcare accessibility, betters health outcomes, stimulates job creation, and bolsters the economy. This expansion enables individuals with lower incomes to remain productive, earn higher wages, and maintain good health. Moreover, Medicaid expansion benefits the state by amplifying state revenues, fostering job growth, and conserving state funds. Additionally, it serves as a safeguard against the closure of rural hospitals. The majority of individuals qualifying for Medicaid under these updated regulations are employed adults contributing to vital service sectors statewide. Sustaining their health ensures their sustained employment.

What about North Carolinians who already have insurance? Will they benefit from expansion?

Society as a whole gains when a larger population can access cost-effective healthcare, fostering healthier lifestyles. Taxpayers stand to benefit too, as federal funds assist states in extending coverage to more individuals, thereby fortifying our healthcare systems and diminishing overall care expenses.

Will this expansion improve access to mental health services or substance abuse treatment?

Yes. Within states that have implemented Medicaid expansion, there has been a decrease in suicide rates and an improvement in access to treatment for substance use disorders. Approximately two million residents of North Carolina are anticipated to encounter mental health issues and substance use disorders. In 2019, over 55% of individuals in need of treatment were unable to access it due to financial constraints. Untreated mental health conditions may result in homelessness, entanglement within the justice system, and adverse effects on children, leading to trauma.

What about workers without health insurance? How will they benefit from the new Medicaid expansion rules?

Many hard-working individuals can now manage their healthcare expenses while supporting their families. A significant proportion of those lacking insurance are individuals with modest incomes working in crucial service sectors and small-scale enterprises. By elevating income thresholds to expand Medicaid eligibility, a larger number of individuals can sustain their employment without the risk of losing their healthcare coverage. Moreover, Medicaid expansion facilitates greater participation in the workforce for individuals with disabilities; lacking it often forces many individuals with disabilities into poverty to maintain Medicaid eligibility. This expansion holds the potential to cultivate a healthier workforce, benefitting businesses such as childcare, restaurants, and service industries by ensuring more employees have access to affordable health insurance.