Medicaid/NC

About

Medicaid in North Carolina is supervised by the North Carolina Department of Health and Human Services Division of Medical Assistance (NC DHHS DMA); the NC DHHS DMA home page appears to also be the focal point for information about both Medicaid in NC and another program called NC Health Choice for Children (NCHC, NC's version of SCHIP) which "provides funding to extend health care coverage to roughly 115,000 children each month whose family income exceeds Medicaid financial eligibility criteria".

Eligibility - EIS

There does not appear to be any human-readable manual or official rules for determining eligibility for NC Medicaid; rather, eligibility is determined through entering the potential client's information into a mainframe-based computer program called the Eligibility Information System (EIS).

There is a single-page "desk reference" covering basic eligibility requirements, but it does not handle all cases (e.g. maximum qualifying income for more than 2 children).

Local Contacts

Medicaid applications and hearings are administered by each county's Department of Social Services. The directory sometimes has outdated links.

• Durham County: Durham County Department of Social Services
  • Medicaid (durhamcountync.gov seems to be down as of 2015-07-14)

Stories

• Josh: a tale of first being denied for having filled out the wrong form, and then being denied for not having turned in documentation even though they never told us they were missing it and wouldn't respond to phone calls. As of this writing, we're being told we have to apply for a third time, and we still don't know what documentation is missing. --Woozle 17:05, 7 August 2008 (EDT)

Notes

Apparently children always go through NC Health Choice for Children, or perhaps only if the parents' income is too high to qualify for regular Medicaid. In any case, the questions on the Adult Medicaid form simply don't make sense when applying on behalf of a disabled child. --Woozle 07:32, 11 June 2008 (EDT)

Confirmed: Josh ultimately got Medicaid by applying using a Health Choice/Health Check application. --Woozle 16:07, 29 December 2009 (UTC)

Links

Official

• Information for Medicaid Consumers: links to related pages and documents
• Medicaid Eligibility Summary: different ways to be eligible; includes NCHC eligibility
• How to Apply for North Carolina Medicaid and/or Health Choice for Children
  • application forms
• Adult Medicaid Manual
• Family and Children's Medicaid Manual (does not apply for Aged, Blind and Disabled; those are under Adult, as explained here)
• Adult Medicaid Manual MA-200: DEFINITIONS: extensive list of acronyms and program names

News

• North Carolina Medicaid
  • 2017-01-04 New governor vows to expand Medicaid unilaterally; Republican lawmakers fighting him
• 2016-12-07 NC health plan to cover sex changes, if medically necessary, in 2017 (archive)