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Medicaid Eligibility In North Carolina

Federal and local governments provide a variety of resources for residents to ensure their basic needs are met. One of these resources is Medicaid, a program aimed at ensuring that certain low-income and needy populations are covered by health insurance. In order to qualify, however, individuals must meet certain Medicaid eligibility requirements

Read on to better understand what and who is covered by Medicaid in North Carolina and how a Medicaid planning lawyer can help you secure the coverage you deserve.

What is Medicaid?

Medicaid is federal and state-funding health insurance for low-income individuals of all ages that fall into certain eligibility groups. Medicaid is available to low-income, North Carolina residents that fall into one of the following groups:

  • Pregnant women
  • Individuals responsible for a child 18 years of age or younger
  • Blind individuals
  • Individuals with a disability or who have a family member in their household with a disability
  • Individuals 65 years of age or older

Medicaid Eligibility Limits in North Carolina

Your ability to receive Medicaid will depend on the total income of your household. The threshold that constitutes low-income depends on the Medicaid program needed based on age and health. Examples of income limits include:

  • Individuals 65 and Older: For full Medicaid covered, the household monthly income at or below poverty level meaning a family of one must have an income at or below $1,064 a month and a household of two must have an income at or below $1,437 a month.
  • Pregnant Women: The income limits are higher for pregnant women, but the covered care is limited to treatment for conditions that affect the pregnancy. The household income must be at or below 196% of the poverty level.
  • Disabled Individuals: Disabled individuals are eligible for full Medicaid coverage if the monthly household income is at or below 100% of the poverty level.
  • Social Security Income (SSI) Recipients: Individuals who receive SSI due to age, blindness, or disability are automatically entitled to Medicaid without an additional application. SSI is a federal program that provides basic monthly payments to meet basic needs for food, clothing, and shelter. A tool is available to determine if you qualify for SSI payments.

The above are examples of the different eligibility requirements and limits for receiving Medicaid in North Carolina. A skilled Medicaid planning attorney can assess your situation and advise on your options.

When Should I Start Medicaid Planning?

Medicaid is an important resource for any eligible individual, but it becomes increasingly important for the aging population who must consider long-term care. Long-term care is necessary but very expensive, with the average monthly cost of a private room in a nursing home in North Carolina at $8,060.

North Carolina Medicaid will only cover the costs of a nursing home if it is medically necessary — meaning that the individual needs the type of care that can only be provided at a nursing home. If your needs meet this requirement, you can only secure Medicaid if:

  • You receive SSI
  • You meet the income limits
  • Your income is over the income limit, but you have medical expenses that meet or exceed your extra income. You will be required to meet a deductible before you qualify for Medicaid coverage, and you can have no more than $2,000 in resources.

The above calculations are further complicated if you have a spouse who will continue to live independently. Because nursing home care is so expensive and Medicaid coverage is complicated, it is important to plan ahead for Medicaid coverage.

The sooner you begin to plan for Medicaid coverage, the more able you will be to protect your assets. You should not wait until you need to access Medicaid benefits. At the latest, it is advised to start planning for Medicaid five years before you anticipate requiring coverage because Medicaid financial review can go back up to five years. It is difficult to predict the age you will require nursing home care, but you should assume it could be necessary within ten years of retirement.

How Can A Lawyer Help Me Meet The Medicaid Eligibility Limits?

An experienced Medicaid planning attorney can help you manage your assets in a way that maximizes your ability to secure Medicaid coverage when you need it. A lawyer can advise on the type of assets that will be counted when assessing your eligibility. A few examples of these complexities include:

  • Equity in a home is not counted for Medicaid purposes, but it is susceptible to Medicaid Estate Recovery after your death, meaning it could be sold to recover payments for Medicaid services.
  • A single individual can retain $2,000 in countable assets and still qualify for Medicaid, but you must understand what qualifies as a countable asset to make smart choices about what to accrue towards this limit.
  • If the individual who requires care has an independent spouse, a spousal allowance will be determined based on the marital assets in the 30 days prior to entering a nursing home. The couple should plan strategically to ensure the snapshot captures the maximum possible amount so that the spouse receives the maximum compensation.

The above are just examples of the type of strategic planning a Medicaid attorney in North Carolina can provide.

Contact us today to discuss your options when it comes to Medicaid eligibility in North Carolina.

Frequently Asked Questions

How much money can you make to qualify for Medicaid?

The Medicaid income limits will depend on the particulars of an individual’s situation. In general, in North Carolina, an individual must make below $1,064 per month in order to qualify.

Can I qualify for Medicaid if I have savings?

In order to meet the Medicaid eligibility requirements for assets, you must have less than $2,000 in assets (including your savings account).

Can you own a house and be on Medicaid?

Yes. In most situations, a primary home would not be included in the calculation of a person’s assets for the purposes of qualifying for Medicaid.