Medicaid benefits and eligibility vary according to a person's circumstances. Following is a brief explanation of eligibility for Medicaid, Medicare-Aid, and NC Health Choice for Children.
There are several different groups of individuals who qualify for Medicaid benefits. All have income limits and some have resource limits. Individuals who are eligible for full Medicaid benefits receive an annual Medicaid card. Medicaid may also be retroactive to cover medical bills from the 3 months prior to the month of application.
- Medicaid for Aged (65 and older), Blind and Disabled Persons. The income limit is equal to 100% of the poverty level. There is a limit on resources.
- Medicaid for Long Term Care. Medicaid pays for medically necessary nursing home care for patients in skilled or intermediate care nursing homes or in intermediate care facilities for the mentally retarded. The patient's income must be less than the cost of care in the facility at the Medicaid rate, and there is a limit on resources. If the patient or his representative gives away assets or sells them for less than market value, he may be ineligible for payment of the cost of care. The sanction period is based upon the value of the assets transferred away.
- Medicaid for Pregnant Women. The family income limit is equal to 185% of the poverty level. There is no limit on resources. If a pregnant woman is covered by Medicaid, her newborn child is automatically eligible for Medicaid up to age 1. This benefit is available even if the pregnant woman has no other children.
- Medicaid for Infants up to age 1. The family income limit is equal to 185% of the poverty level. There is no limit on resources.
- Medicaid for Children from age 1 through age 5. The family income limit is equal to 133% of the poverty level. There is no resource limit.
- Medicaid for Children from age 6 through age 18. The family income limit is equal to 100% of the poverty level, which is lower than the income limit for younger children. There is no resource limit.
- Medicaid for Caretakers and Children age 19 and 20. The income limit is lower than the income limit for children through the age of 18. There is a limit on resources.
- Medicaid for Medically Needy coverage for parents and children whose incomes are higher than those allowed in other coverage groups. Families must meet a deductible based on the amount by which their income exceeds the MAF-MN income limit. There is a limit on resources.
- Work First Family Assistance for families with children Supplemental Security Income (SSI) for elderly, blind and disabled individuals
- State/county Special Assistance (SA) assistance for payment of rest home expenses for elderly, blind and disabled individuals
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