Medicaid is the government-mandated national health plan that helps needy seniors, children and adults with disabilities access primary, emergency, acute and long-term health care. The program is administered at the state level, and in North Carolina, Medicaid is managed by the Division of Health Benefits.
Because Medicaid is designed to help those who are unable to afford basic health care, the eligibility requirements include income and asset limits. In North Carolina, seniors who already receive Supplemental Security Income benefits or are registered in the State-County Special Assistance for the Aged or Disabled program are automatically eligible for Medicaid.
To qualify for NC Medicaid, seniors must:
- Have a monthly income of $1,041 or less for individuals and $1,409 or less for couples
- Own no more than $2,000 in countable assets (per person), or
- Own no more than $3,000 in countable assets when applying with a spouse
- Have a valid Social Security number
- Provide proof of permanent North Carolina residency
- Be a US citizen or have an eligible immigration status
Under the community spouse resource allowance the non-applicant spouse can keep up to $126,420 of a couples’ joint assets, an owner occupied home worth up to $585,000 and up to $3,160.50 as a monthly maintenance needs allowance. These allowance amounts are disregarded on the applicant spouse’s Medicaid application.
If the applicant has income that exceeds Medicaid limits, they may be able to qualify for coverage under the
medically needy pathway. This program is similar to private insurance in that participants must spend a predetermined amount of their excess income on medical expenses. Once they’ve reached their MN spending limit, Medicaid coverage begins.
Personal Care Services Personal Care Services is a NC Medicaid entitlement program that provides up to 3.5 hours of personal care daily, or 60 hours per month, for seniors who live in an adult care home, also known as assisted living. PCS services let seniors who need help with two or more activities of daily living remain in the community rather than be placed in a nursing facility.
ADLs covered under this program include dressing, bathing, toileting, eating and mobility.
To qualify for PCS, a NC Medicaid assessor must identify that the senior has a physical or cognitive impairment that results in unmet needs as follows:
- Requires some help to perform three out of five ADLs, or
- Requires extensive help with one ADL and some help with another, or
- Is completely dependent on another person to perform one ADL and needs some help with another
PCS services may be increased to 80 hours per month under the PCS Plus program with a written recommendation from a physician.
For NC Medicaid and PCS application assistance, contact the
Pender County Department of Social Services at (910) 259-1240.