NEED HELP ENROLLING IN MEDICAID? WE’RE HERE TO HELP!
BIG NEWS, North Carolina! Medicaid has expanded – bringing better health care within reach for thousands of families.
Advance Community Health has partnered with the United Language Group (ULG) to offer FREE health insurance enrollment assistance to community members who need help enrolling in Medicaid or marketplace health insurance. ULG’s certified application counselors are here to walk you through the application process, answer any questions you may have, and ensure you obtain a health insurance plan that meets your needs!
Frequently asked questions
What is Medicaid Expansion?
North Carolina is expanding who can get Medicaid! Beginning December 1, 2023, NC Medicaid will cover people aged 19 through 64 years with higher incomes. Many North Carolinians who did not qualify for health coverage through NC Medicaid before may soon qualify.
What is the new eligibility for Medicaid?
Most people can get health care coverage through NC Medicaid if they meet the criteria below. If you were eligible before, you still are. Eligibility criteria:
- You live in North Carolina
- Age 19 through 64
- You are a citizen (some non-U.S. citizens can get health coverage through NC Medicaid).
- If your household income fits within the chart below:
|$20,120 or less
|Family of 2
|$27,214 or less
|Family of 3
|$34,307 or less
|Family of 4
|$41,400 or less
|Family of 5
|$48,493 or less
|Family of 6
|$55,586 or less
Why is expanding Medicaid good for my community?
Research shows that expanding Medicaid coverage increases access to health care, improves health outcomes, creates jobs and strengthens the economy. It means that people with low incomes can work, earn more and keep themselves healthy. Expansion is also good for the state. Other states that have expanded Medicaid have increased state revenues, created jobs and saved state funding. It has also helped prevent rural hospitals from closing. Most people who qualify for Medicaid under these new rules are working adults in important service industries across the state. Keeping them healthy keeps them on the job.
Medicaid Application Process
How do I apply for Medicaid?
You can apply online through ePASS – a secure, self-service website at ePASS.nc.gov. When you apply online, you can avoid having to go in person to your local Department of Social Services (DSS) office. If your application is complete, it may be processed faster.
If you cannot apply online, you can schedule a FREE in-person enrollment appointment at Advance Community Health by calling 919-833-3111. Our certified application counselors will help walk you through the application process.
You can also apply in person at your local DSS office, by calling your local DSS office or by mailing in a paper application available at ncgov.servicenowservices.com. To find your local DSS office, go to ncdhhs.gov/divisions/social-services/local-dss-directory.
What information do I need to apply?
It takes time to complete the application. Here is some of the information you will be asked to provide for each person applying:
- Full legal name
- Date of birth
- Social Security number (or immigration documents)
- North Carolina residency
- Income information (from paystubs, W-2 forms, tax returns or business records)
North Carolina uses external resources to verify the information you provide. If more information is needed, you will receive a letter in the mail from your local DSS.
What is ePASS?
What is NCID and why do I need it?
NCID stands for NC Identity Management. Having an NCID account helps protect your personal information. Anyone using ePASS to apply for Medicaid will need to create a NCID. You will be asked to create an account the first time you use ePASS. Instructions for creating an NCID account are online at https://info.ncdhhs.gov/dhsr/es/pdf/how-to-create-NCIDAccount.pdf.
Where do I get help with an NCID account?
If you need to reset your password or unlock your account:
- Go to ncid.nc.gov.
- Choose the link under the NCID login that you need.
- Forgot Password
- Unlock Account
- Enter your username and follow the directions.
If you need help, call the North Carolina Department of Information Technology Service Desk at 800-722-3946.
What if I do not have a physical address, mailing address or email address?
- Physical Address: You do not need a physical address to apply for Medicaid. However, you must confirm you are physically in North Carolina and plan to live here. You do not need to plan to stay permanently and do not need to have a fixed address.
- Mailing address: If you do not have a mailing address, enter an address where you can pick up mail or enter the address your local DSS office. Find a DSS office near you at ncdhhs.gov/localdss.
- Email address: You must have an email address to make an NCID and use ePASS. If you don’t have an email address, you may apply at your local DSS office, by phone or by paper application.
Do I have to provide my Social Security Number (SSN)?
No. You can apply without providing your SSN. If you have one and do not include it on your application, your local DSS will call you to ask for it. Including your SSN on your application will avoid delays in processing.
If you have applied for a SSN, you can provide documents that show you have applied.
How long will it take to find out if I’m eligible for Medicaid once I apply?
It may take up to 45 days after you apply. Incomplete applications may take longer. If your application is incomplete or we need more information, you will hear from your local DSS office requesting additional information. You may be contacted by mail, phone, email and/or text message, so it is important to make sure your contact information is up-to-date and complete to make sure that your caseworker can reach you.
You will receive a letter in the mail that will tell you if you are approved or denied. Authorized Representatives will receive the same communication.
Are non-US citizens eligible for health care coverage through NC Medicaid?
Some non-U.S. citizens can get health coverage through Medicaid. To be eligible you must be:
- A person living in North Carolina
- A qualified non-citizen for at least five years
- This means a person must wait five years after receiving “qualified” immigration status before they can get Medicaid.
- There are exceptions. For example, refugees, asylees or lawful permanent residents who used to be refugees or asylees do not have to wait five years.
Individuals without documents are not eligible for Medicaid unless they have an emergency condition as defined under federal law – such as someone in a car accident who is taken to the emergency room.
What documents can be used if DSS asks for more information?
North Carolina Residency
|Date of Birth
|Social Security Number
COVERAGE AND COSTS
What health services will North Carolina cover?
Health coverage through Medicaid is comprehensive. Because these services are covered by NC Medicaid, they are provided at no cost or low cost to you. Services include, but are not limited to:
- primary care so you can go to a doctor for a check-up or when you are not feeling well
- hospital services when you need to stay overnight (inpatient) or when you can go home the same day (outpatient)
- maternity and postpartum care if you are pregnant and after giving birth
- vision and hearing services
- prescription drug benefits
- behavioral health
- preventive and wellness services
- dental and oral health services
- medical-related devices and other therapies
How much will I have to pay in monthly premiums and copays?
You do not have to pay any monthly premiums. Medicaid pays the cost for most health care services. The highest copay is $4 and that is only required for some services.
What are the differences between Medicaid expansion coverage and getting coverage through Standard Plan, Tailored Plan, Tribal Option or Medicaid Direct members? Does anything change under these new rules?
Everyone who qualifies under the new rules will get their health coverage through a Standard Plan, Medicaid Direct, Tribal Option or through Tailored Plans in the future, depending upon their individual needs, just like other Medicaid beneficiaries.
Can I have Medicare and receive Medicaid expansion?
No. Some people who have Medicare coverage may be eligible for other existing Medicaid programs. For example, people who are disabled and are age 64 and under may be eligible for Medicaid through disability coverage.
Are there other insurance options if I still do not qualify for Medicaid?
Will anyone be automatically enrolled in Medicaid under the new rules?
Yes, people already enrolled in Medicaid’s limited Family Planning Program who are eligible will be automatically moved to full Medicaid expansion benefits. Those who are eligible for full Medicaid benefits will:
- get a letter from your local Department of Social Services (DSS) letting you know that you will start getting full Medicaid coverage.
- be assigned a health plan. If you want to change your health plan, you have 90 days to pick a new one.
- receive a packet from your health plan in the mail. It will include a new Medicaid ID card. Your ID card also has the name of your primary care doctor. You can change the doctor that was assigned to you by contacting your health plan.
- need to cancel your plan if you have health coverage through HealthCare.gov. You can do that by logging into your HealthCare.gov account or calling 1-800-318-2596. Do not cancel your plan until you receive information from your new health plan through Medicaid.
Not everyone with limited Family Planning Program benefits will be automatically enrolled in full coverage through Medicaid. Some people may have income that exceeds the Medicaid eligibility levels. If your income has recently changed and you think you may be eligible, update your information in ePASS (ePASS.nc.gov) or by contacting your local Department of Social Services (DSS). Also, please use ePASS or contact your local DSS office to make sure your contact information is up-to-date so that you do not miss important information about your benefits.
What is limited Family Planning Medicaid and who is eligible?
Family Planning Medicaid provides reproductive health care at no cost to people with incomes up to 195% of the federal poverty line – that’s about $2,370 a month for a single person. It covers almost all methods of birth control, testing and treatment for sexually transmitted infections, preventive services and more.
If I am currently receiving Family Planning benefits and am enrolled in full coverage through NC Medicaid when it is expanded, what will happen?
You will get a letter from your local DSS letting you know that you will start getting full Medicaid coverage. You will then be assigned a health plan. If you want to change your health plan, you have 90 days to pick a new one. Your health plan will send you a packet in the mail. It will include a new Medicaid ID card. Your ID card also has the name of your primary care doctor. You can change your doctor through your health plan. Medicaid will pay for doctor visits, yearly check-ups, emergency care, mental health services and more – at little or no cost to you.