NC Medicaid Expansion eligibility and enrollment
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Describes North Carolina's Medicaid expansion effective December 1, 2023, including who is eligible, how to apply, benefits and costs, automatic enrollment for some Family Planning beneficiaries, and enrollment timelines.
Beginning December 1, 2023, more North Carolinians will be able to get health coverage through NC Medicaid.
People enrolled in the limited Family Planning program who are eligible will be automatically moved to full Medicaid expansion benefits and will receive notice and a new Medicaid card.
There are no monthly premiums and copays are limited (highest copay $4 for some visits).
Eligibility, Benefits, and Enrollment Rules
inv-01: Eligibility criteria — coverage scope for NC Medicaid expansion
Covered when ALL of the following are met:
ALL of the following
- Residency: Must live in North Carolina
- Age: 19 through 64
- Citizenship: U.S. citizens and some non-U.S. citizens are eligible; some non-U.S. citizens with documentation must wait five years; residents without documents are only eligible for emergency services
- Income: Household income must be within the listed thresholds by household size (examples provided: single adult $20,120 or less; family of 4 $41,400 or less)
Notes
- If an individual was eligible before expansion, that eligibility continues under the new rules
inv-02: Benefits and cost sharing — covered benefits and cost-sharing limits
Covered benefits and cost-sharing
ALL of the following
- Covered services: Primary care; Hospital inpatient and outpatient services; Maternity and postpartum care; Vision and hearing services; Prescription drugs; Behavioral health services; Dental and oral health services; Medical-related devices and other therapies
- Cost sharing: No monthly premiums
- Copays: Copays are limited; the highest copay is $4 for some visits
Scope
- Coverage is comprehensive and services are provided at no cost or low cost as applicable under Medicaid
inv-03: Automatic enrollment process — mechanics for Family Planning enrollees moving to full Medicaid
Enrollment mechanics for Family Planning enrollees
ALL of the following
- Family Planning enrollees who are eligible will be automatically enrolled into full Medicaid expansion benefits
- The state will mail notice informing the enrollee they have been enrolled in full Medicaid benefits
- Enrollee will be assigned a health plan; the enrollee has 90 days from assignment to choose a different plan
- Assigned health plan will send a packet by mail that includes a new Medicaid ID card and primary care provider information; the enrollee can change their primary care doctor through the health plan
Operational note
- Automatic movement applies to people already enrolled in the limited Family Planning program who meet full Medicaid eligibility
Covered Services, Income Thresholds, and Coding Notes
| Primary care | Primary care so you go to a doctor for a check-up or when you are not feeling well |
| Hospital services - inpatient | Hospital services when you need to stay overnight (inpatient) |
| Hospital services - outpatient | Hospital services when you can go home the same day (outpatient) |
| Maternity and postpartum care | Maternity and postpartum care if you are pregnant and after giving birth |
| Vision services | Vision services |
| Hearing services | Hearing services |
| Prescription drugs | Prescription drug benefits |
| Behavioral health services | Behavioral health services |
| Dental and oral health services | Dental and oral health services |
| Medical-related devices and other therapies | Medical-related devices and other therapies |
What Providers and Enrollees Must Do
Plan assignment: health plan packet, new Medicaid ID, 90-day plan choice
When an enrollee is automatically moved to full Medicaid, the enrollee will be assigned a health plan and the health plan will mail a packet that includes a new Medicaid ID card; the enrollee has 90 days to select a different health plan and may change their primary care doctor through the health plan.
- Enrollee will receive a letter from local DSS notifying them of full Medicaid coverage.
- Assigned health plan mails a packet that includes the new Medicaid ID card and the name of the primary care doctor.
- Enrollee has a 90-day window to choose a different health plan; doctor changes are handled through the health plan.
How to apply: ePASS preferred; in-person, phone, or mail alternatives
Applicants should apply online using ePASS at ePASS.nc.gov as the preferred and faster method; if unable to apply online, applicants may apply in person at their local DSS office, by phone to their local DSS, or by mailing a paper application.
- Online: ePASS.nc.gov (preferred — secure, self-service, available anytime).
- In person: local Department of Social Services (DSS) office.
- By phone: call your local DSS office.
- By mail: submit a paper application (available at ncgov.servicenowservices.com).
Information and contact: website and Partners Health Management phone
For additional information about Medicaid expansion and benefits, visit the North Carolina Medicaid website or call Partners Health Management at the provided toll-free number.
- Website: medicaid.ncdhhs.gov/
- Phone: Partners Health Management 1-888-235-4673
Key Terms and Definitions
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