Medicaid Expansion Information from North Carolina

Medicaid expansion will allow more North Carolinians to get health coverage through NC Medicaid. It will cover people aged 19 through 64 years with higher incomes. Many North Carolinians who did not qualify for health coverage through Medicaid before, may soon qualify. If you currently have full Medicaid coverage, nothing will change for you.

Medicaid expansion is for people who have limited benefits or who were not previously eligible for full Medicaid. If you are currently on a limited benefit program, then you might receive full Medicaid. If you qualify for Medicaid expansion, you will receive a letter explaining the coverage. If you have full Medicaid, your services will not change.

You can apply for Medicaid at any time, but the new eligibility requirements will take effect on December 1, 2023.

The best way is to apply online through ePASS – a secure, self-service website at ePASS.nc.gov. When you apply online, you can avoid having to go in person to your local Department of Social Services (DSS) office. It’s also faster and you can access the site at any time.

If you can’t apply online, you can apply in person at your local DSS office, by calling your local DSS office or by mailing in a paper application available at ncgov.servicenowservices.com. To find your local DSS office, go to ncdhhs.gov/divisions/social-services/local-dss-directory.

If you currently have full Medicaid coverage, nothing will change for you.

It may take up to 45 days after you apply. Incomplete applications take longer. If your application is incomplete or we need more information, you will hear from your local DSS office requesting additional information. You may be contacted by mail, phone, email and/or text message, so it is important to make sure your contact information is up to date and complete to make sure that your caseworker can reach you.

Some non-US citizens are eligible for Medicaid. Some non-US citizens with documents must wait a period of five years before they are eligible for Medicaid coverage. Residents without documents are not eligible for Medicaid unless they have an emergency condition as defined under federal law.

Health coverage through Medicaid is comprehensive. Because these services are covered by Medicaid, they are provided at no cost or low cost to you. Services include, but are not limited to:

• Primary care so you go to a doctor for a check-up or when you are not feeling well
• Hospital services when you need to stay overnight (inpatient) or when can go home the same day (outpatient)
• Maternity and postpartum care if you are pregnant and after giving birth
• Vision and hearing services
• Prescription drug benefits
• Behavioral health services
• Dental and oral health services
• Medical-related devices and other therapies

You do not have to pay any monthly premiums. Medicaid pays for the cost for most health care services. The highest copay is $4 and that is only required on some visits.

Everyone who qualifies under the new rules will get their health coverage through a Standard Plan, NC Medicaid Direct, Tribal Option, or through Tailored Plans in the future, depending upon their individual needs, just like other Medicaid beneficiaries.

No. Some people who have Medicare coverage may be eligible for other existing Medicaid programs. For example, people who are disabled and are age 64 and under may be eligible for Medicaid through disability coverage.

Yes. You may qualify for subsidized health coverage offered on HealthCare.gov. Contact a North Carolina health insurance navigator for enrollment assistance. Community health centers also provide low-cost care through a sliding scale based on one’s income and insurance status.

Yes, people already enrolled in Medicaid’s limited Family Planning program who are eligible will be automatically moved to full Medicaid expansion benefits. Those who are eligible for full Medicaid benefits will receive communication in the mail from the state informing them that they enrolled in full Medicaid benefits and a new Medicaid insurance card that they can use to access health care services.

If eligible for full Medicaid benefits, you will receive a letter in the mail from the state informing you that you were enrolled in full Medicaid benefits and a new Medicaid insurance card that you can use to access health care services.

You will get a letter from your local DSS letting you know that you will start getting full Medicaid coverage. You will then be assigned a health plan. If you want to change your health plan, you have 90 days to pick a new one. Your health plan will send you a packet in the mail. It will include a new Medicaid ID card. Your ID card also has the name of your primary care doctor. You can change your doctor through your health plan.

You may have income that exceeds the Medicaid eligibility levels, if your income has recently changed and you believe you may be eligible, update your information by updating your contact information in ePASS or contacting your local DSS.

Research shows that expanding Medicaid coverage increases access to health care, improves health outcomes, creates jobs, and strengthens the economy. It means that people with low incomes can work, earn more and keep themselves healthy. Expansion is also good for the state. Other states that have expanded Medicaid have increased state revenues, created jobs, and saved state funding. It also has helped prevent rural hospitals from closing. Most people who qualify for Medicaid under these new rules are working adults in important service industries across the state. Keeping them healthy keeps them on the job.

Everyone benefits when more people have access to affordable health care and can live healthier lives. Taxpayers will also benefit because federal funds will help the state cover more people, keep our health systems strong and reduce the cost of care.

Yes. In states that have expanded Medicaid, suicide rates decreased and access to substance use disorder treatment increased. About two million North Carolinians will experience a mental illness and substance use disorder. In 2019, more than 55% of people who needed treatment did not receive it because of cost. Untreated mental illness can lead to homelessness, involvement in the justice system, and trauma to children.

Many hard-working people can finally afford to take care of their health while providing for their families. Most of those who don’t have insurance are working people with low incomes in important service industries and small businesses. By raising income limits so more people are eligible for Medicaid, more people can work without losing their healthcare coverage. Medicaid expansion also helps more people with disabilities enter the workforce because without it, many people with disabilities must live in poverty to maintain their Medicaid eligibility.

Medicaid expansion can build a healthier workforce for businesses like childcare, restaurants and the service industry by helping more employees have access to affordable health insurance.

For more information, visit medicaid.ncdhhs.gov/. You may also call Partners Health Management at 1-888-235-4673.