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Adult Medicaid Questions

Note: Changes in Medicaid policy can and do occur. Therefore, please do not base your eligibility solely upon the information in this web site. To obtain the latest policy information, please call Customer Connection at 704-336-3000 or come to the office to have an interview.

Additional Questions and Answers related to Medicaid are available on the North Carolina Division of Medical Assistance website.

  1. What is the difference between Medicare and Medicaid?
    Medicare is an assistance program administered by the Federal Government.  Medicare is the national health insurance program for: People age 65 or older, some people under age 65 with disabilities, People with End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant
    To learn more about Medicare, visit the following site:

    Medicaid, administered by each State, is health insurance that helps many people who can't afford medical care pay for some or all of their medical bills.  Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services.

  2. How do I quality for Adult Medicaid?
    An Adult Medicaid Benefit's Analyst will complete your application and discuss eligibility requirements. Applications are also taken in some area hospitals.  Please go to the Adult Medicaid information page for more information.

  3. What is the definition of disability?
    As defined by Social Security, it is a physical or mental impairment which prevents an individual from engaging in any substantial, gainful activity, and which has lasted or is expected to last for at least 12  months, or is expected to result in death.

  4. Who determines disability?
    Disability is determined by the Disability Determination Section of the North Carolina Division of Social Services. They use the same definition that Social Security uses for disability.

  5. What is the income limit for a single person or a couple?
    Eligibility is not based solely upon income.  Please call Centralized Intake or visit our office to discuss your particular situation.
    The income limit for full Medicaid is $798 for a single person and $1070 for a couple. If income exceeds these limits, the individual or couple must meet a medical deductible before he is eligible for full Medicaid. The deductible is the amount of income over the income limit. A deductible can be for 1, 2 or 3 months before the month of application or for a period of 6 months beginning with the month of application.

  6. What assets does Medicaid consider to determine Medicaid eligibility?
    Medicaid investigates all liquid assets including bank accounts, stocks, bonds, mutual funds, retirement accounts, notes, and trusts; personal property including motor vehicles and mobile homes; life insurance, burial contracts and annuities, and real estate.

  7. What is the reserve limit for Medicaid?
    The reserve limit for full Medicaid for an individual in $2,000 and $3,000 for a couple. The reserve limit for MQB is $4,000 for an individual and $6,000 for a couple.

  8. What is MQB?
    MQB is a limited Medicaid program for Medicare beneficiaries. The eligibility requirements are less stringent, however, Medicaid coverage is limited to payment of Medicare premiums, deductibles and coinsurance for charges covered by Medicare. MQB-Q does not pay toward any services not covered by Medicare, such as prescriptions, eyeglasses and dental care.

  9. Am I allowed to keep my home?
    Equity of the home site is excluded in determining the applicant's countable resources if it is currently used by the applicant, a legal spouse or  the applicant's dependent children.

  10. Am I allowed to keep my car?
    One licensed motor vehicle is excluded for the individual or couple.

  11. What does Medicaid pay for?
    Medicaid pays medical bills for people who meet certain eligibility requirements (such as income, age, or disability) which are based on Federal regulations and State law. Medical benefits may be authorized for services such as hospitalizations, physician services, medications and different levels of care in nursing and residential facilities. Specific or more detailed information about covered services can be found on page 23 of the North Carolina Consumer Guide or by calling the Care-Line at 1-800-662-7030.

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