North Carolina Medicaid: Ultimate Guide

In North Carolina, Medicaid covers about one out of every eight adults, two out of every five kids, 5 out of every 8 nursing home residents, 3 out of every 8 disabled persons, and 1 out of every 6 Medicare beneficiaries. That’s about 18% of the North Carolina population, and thousands more are eligible but not taking advantage of the benefits. Many people think they do not qualify because they are employed, but actually, about 57% of adult Medicaid beneficiaries in North Carolina are employed. This guide can help you discover whether or not you qualify for North Carolina Medicaid or Healthy Choice (the NC kids Medicaid program).

Keep in mind that if you have Medicare, Medicaid eligibility can help you cover your Medicare costs.

What You Should Know about NC Medicaid Includes:

• NC Medicaid Eligibility Requirements
• Find NC Medicaid Providers
• NC Medicaid Coverage and FAQ
• How to Apply for Medicaid in NC

NC Medicaid Eligibility Requirements

To qualify for NC Medicaid, you must meet the income requirements and be a legal North Carolina resident with a Social Security number. If you receive SSI (Supplemental Security Income), Work First Cash Assistance, or either State or County Special Assistance for the Aged or Disabled, you will automatically qualify for NC Medicaid (all others must apply). The chart below can help you determine whether or not you are eligible.

Find NC Medicaid Providers

Unfortunately, not all doctors, hospitals, pharmacists, and health specialists accept North Carolina Medicaid coverage. Click here to download the most up-to-date list of NC Medicaid providers, and click here for a list of specialists. You can also use a “doctor finder” website like ZocDoc or doctor.com.

NC Medicaid Coverage and FAQ

In general, NC Medicaid covers:

• Doctor wellness visits
• Rural health clinics
• OB/GYNs
• Labs
• Hospital visits
• Nursing homes
• Home health
• Anesthesia
• Ambulatory surgical centers
• Specialized therapy
• Vision
• Hearing
• Dental and orthodontics for kids
• Podiatry
• Prosthetics and orthotics
• Mental health
• Prescriptions
• Medicare costs if applicable

NC Medicaid Dental Coverage for Adults

The North Carolina Medicaid dental program covers preventative, restorative, periodontal, and orthodontic dental services as well as oral surgeries and dentures. Adults and kids alike can find dentists who accept North Carolina Medicaid here. Before you go in for your appointment, make sure to call the dentist office and verify that they will accept your plan.

Generally, you can receive exams, cleanings, fillings, sealants, x-rays, extractions, and dentures. Surgeries and periodontal services are available when medically necessary, and root canals are available for those under 21. Those under 21 can also receive crowns for baby teeth, space maintainers, fluoride treatments, sealants, and x-rays. In most cases, bridgework, implants/transplants, and prescription drugs are not included.

Does NC Medicaid Cover Glasses for Adults?

NC Medicaid only covers vision exams and glasses for those under the age of 20. Those above the age of 20 have coverage for eye-related diseases like glaucoma, cataracts, macular degeneration, eye strain and related headaches, and more.

The NC Medicaid Preferred Drug List and Formulary

The NC Medicaid program includes a comprehensive prescription drug benefit plan. There is a formulary called the “preferred drug list” that pharmacists and doctors are encouraged to use when awarding prescription to Medicaid beneficiaries. To get a prescription that is not included in the preferred list, you will need prior approval from NC Medicaid. Always be sure that your doctor or pharmacist knows that you receive Medicaid coverage to be sure that your prescriptions are compatible with your health care plan.

Click here to view the most up-to-date NC Medicaid Preferred Drug List.

While non-emergency transportation is not a nationally required Medicaid benefit, the NC Medicaid program does provide non-emergency medical transportation coverage. There are three versions of this benefit: gas cards, lift vans, and County vehicles. This coverage relates to non-emergency transportation, not ambulance rides. When possible, always call to make your arrangements at least five days in advance to be sure that you have a ride.

• If you own or have access to a vehicle, you can qualify for gas vouchers whenever you need to get to a Medicaid-covered appointment. Call 828-695-2135 for more information.
• If you cannot use a wheelchair or cannot successfully get into a vehicle, you can get a lift van to transport you to and from your Medicaid-covered appointments.  Call 828-695-55608 to schedule transportation.
• If you have the physical ability to get to a vehicle (and safely seat yourself), you can get Medicaid appointment transportation from a county vehicle. Call 828-695-5608 to schedule transportation

How to Apply for Medicaid in NC

You can apply for Medicaid in NC either online, in person, by phone, or by mail. To apply in person, visit your local Department of Social Services office. To apply by mail, download the NC Medicaid Application PDF. To apply by phone, call your local Department of Social Services office.

If you think you may qualify for Medicare as well, call us! A Medicare Plan Finder licensed agent can go over all of your options with you.