Adult Medicaid

Adult Medicaid 

PLA (Private Living Arrangement) Medicaid 

In order to qualify for Adult Medicaid, client must be blind, aged 65 or older or considered disabled by the Social Security Definition of disability.  That 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 at least 12 months or result in death.”

  • Income limits: Individual - $1041 Couple - $1410
  • If you are working, and are deemed disabled, you may possibly qualify for HCWD (Healthcare for Working Disabled).  That income limit is $1508 or $2010 (this one comes with a yearly as well as monthly payment depending on income). 
  • If you do not qualify income wise, you could possibly meet a deductible if you have outstanding medical bills incurred in the last 2 years. 
  • Resource (Reserve) limits: $2000 for individual/$3000 for couple/$25,284 HCWD

MQB (Medicaid for Qualified Beneficiaries) Program is a limited program for Medicare recipients that only pays for the Part B Medicare Premium.

  • Income limits: MQBB is $1249 for individual/$1691 for couple and MQBE is $1406 for individual and $1903 for couple
  • Resource limit is $7730 for individual/$11,600 for couple

All resources are evaluated, including but not limited to:  Bank accounts, 401K’s, stocks, bonds, mutual funds, etc.  Cash Value of life insurance policies that are more than $10,000 and any burial contracts.  Equity value in vehicles (we will exclude one vehicle, but if you have more than one it will be counted in reserve), real estate (we will exclude one home site, any other properties will be counted in reserve), boats, etc. 

Medicaid applications may be submitted: in-person, by mail/fax/email, or online.

If you choose to apply online, you may do so at:
https://www.nc.gov/services/e-passOpens in New Window. 


Long Term Care

Long Term Care (LTC) is a program designed to assist in Cost of Care for those in need of extended care such as Hospitalization for over 30 days, Skilled Nursing Homes/Rehab and State-run Mental Health facilities. Applicants must meet all other eligibility requirements including resource limits, resource protection, transfer of assets and income limits.

To be eligible for LTC:

  • Individual must be over 65 or under 65 and deemed disabled or blind by the definition set by SSA.
  • Individual must meet state residency & citizenship requirements
  • Gross total income for the individual being “institutionalized” must be less than the facility’s assigned Medicaid reimbursement rate for 31 days (average monthly rate $5708.) Client statement in not acceptable verification.
  • Meet resource limit of $2000 for an individual (after spousal protection allowance applied if there is a spouse)
  • Cannot have any Transfer of Assets within the last 5 years
  • STATE Approved FL2/MR2
  • 30 consecutive days in a medical facility or combination of two or more medical facilities. A medical facility could be: A Medicare-Medicaid certified nursing facility, Skilled nursing care in a general hospital, Psychiatric unit in a state mental hospital (Dix, Broughton, Umstead, and Cherry).

Medicaid applications may be submitted: in-person, by mail/fax/email, or online.

If you choose to apply online, you may do so at:
https://www.nc.gov/services/e-passOpens in New Window. 


SA

State/County Special Assistance (SA) is a Supplemental Security Income (SSI) state supplement that pays cash benefits to eligible beneficiaries who reside in licensed facilities authorized to receive SA payments (Assisted Living facility, group home or Family Care homes, Secure care Assisted Living facilities).  Special assistance income limits for basic Assisted $1228.00 and for Secure care (lock down unit) is $1561.00.

To be eligible for SA, an individual must be eligible for SSI, or ineligible for SSI solely due to income. Each applicant/beneficiary (a/b) for State/County Special Assistance must apply for all benefits to which he/she may be entitled, including receiving the maximum benefit for which the applicant is eligible. This includes but is not limited to SSI. If the a/b’s income is less than the Federal Benefit Rate (FBR) for SSI.

General eligibility requirements:

  • Be an individual who is age 65 or older; or is 18-64 and disabled or legally blind; or an individual who is under 18 and is legally blind.
  • Reside in North Carolina for at least 90 days with the intent to remain and meet residency requirements
  • Reside in a licensed facility authorized to receive SA payments, except for temporary absence not expected to exceed 30 days.
  • Require the level of care provided in licensed adult care homes or supervised living and have a valid FL-2 that is signed and dated by a physician, physician assistant, or nurse practitioner.
  • Not be an inmate in a jail or prison.
  • Receive SSI or is financially ineligible for SSI solely due to income;
  • Be a U.S. citizen or qualified alien.

Special Assistance applications must be done in person.  Please visit your local agency during regular business hours

CAP

CAP Waiver programs provide an alternative to Institutionalization for individuals described as needing a “Nursing Home Level of Care”. Under the CAP Medicaid Waivers, individuals may remain in their home and receive products and services such as: Personal Care Aide, Personal Emergency Alert Systems, Nutritional Supplements, Meal delivery/preparation, Medical Supplies, Home Adaptation, Case Management and more.

  • Individuals’ total countable income must be at, or below the Medicaid “Categorically Needy” income limit of $1041 to qualify without a Deductible. Individuals with income that exceeds the income limit are subject to a monthly deductible.
  • The CAP Medicaid Waiver programs are subject to resource limits, asset transfer evaluations and Estate Recovery.
  • Onslow County currently has three CAP Waiver programs, which include CAP-Disabled Adults (DA), CAP- Children (C) and CAP- Innovations (IN) .

   • The CAP-DA Waiver program includes an option for a consumer driven program         called CAP-Choice. Participants in CAP-Choice may “employ” a caregiver of their        choosing.

Medicaid applications may be submitted: in-person, by mail/fax/email, or online.

If you choose to apply online, you may do so at:
https://www.nc.gov/services/e-passOpens in New Window.