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Economic Services |
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Economic Services |
This program helps families or individuals with medical bills such as doctor fees, prescription drugs, hospital charges, and nursing home care.
There are several different types of Medicaid. All have income limits, and some have resource limits. Your caseworker will explain these to you.
| 1. | Persons who are eligible will get a Medicaid card each month. Medicaid can also cover medical bills from the three months before the month you apply. |
| 2. | Families with children through age 20. The parent can receive Medicaid if only one parent is in the home and the child is under age 19. Both parents can receive Medicaid if both are in the home, but one of the parents is out of work or has an illness or injury; unemployment and underemployment. |
| 3. | Children through age 20 who live with both parents or other adults. |
| 4. | Individuals through age 20 who live apart from their parents or other adults. |
| 5. | Children under age 1 whose parents' income is equal to or less than 185% of the poverty limit. The limit is higher than for older children. There is no resource limit. |
| 6. | Children from age 1 through age 5 whose parents' income is equal to or less than 133% of the poverty level. This limit is higher than for children ages 6 and over. There is no resource limit. |
| 7. | Children from age six through age 18 whose parents' income is equal to or less than 100% of the poverty level. There is no resource limit. |
| 8. | Pregnant women, with or without other children. The income limit is 185% of the poverty level. There is no resource limit. |
| 9. | Newborn child of a Medicaid authorized mother - Automatic coverage of newborn (M-AF or M-IC) |
Adult Medicaid is a program that helps with medical bills such as doctor fees, prescription drugs, hospital charges, and nursing home care for eligible individuals that are aged, disabled, or blind. Income and resource limits apply. No money is paid to the client. The eligible client receives a Medicaid identification card through the mail to show the health care provider. Medicaid can also cover medical bills from up to 3 months prior to the month of application and in which there is a medical need.
The blue Medicaid identification card indicates the recipient is eligible for all Medicaid services. Each eligible family member has a specific recipient MID number; however, in some instances, not every member of the same family may be eligible for Medicaid. Family members are only eligible for Medicaid if their name and MID number appear on the card.
The buff Medicaid identification card indicates the recipient is eligible for the Medicare-Aid program. If Medicare covers the service, then Medicaid will pay the coinsurance and/or deductible. If Medicare denies the service, then Medicaid will also deny.
NC Health Choice (NCHC)
North
Carolina Health Choice is health coverage that is to be provided under the
federal Title XXI program, which was approved by the North Carolina General
Assembly, signed into law by Governor Hunt and approved by the United States
Health Care Financing Administration (HCFA). The program was implemented
in October 1998, allowing families to obtain health coverage for their children
who are otherwise ineligible for Medicaid and not covered by comprehensive
health insurance.
Eligibility Requirements
In addition to family income eligibility, children must have been uninsured for two months prior to their application, unless the child has special needs that must be verified by a health care professional. It must be determined the child or children are not qualified for Medicaid.
Income Guidelines
There are essentially two countable income levels. If the family's countable income is at or below 150% of the federal poverty level, there is no fee required. If the family's countable income is at or below 200% of the federal poverty level, there is a fee of $50.00 for one child and $100.00 for two or more children. See charts below:
Requires a Fee
Family Size Annual Income Monthly Income
1 $17,180 $1,432
2 $23,220 $1,935
3 $29,260 $2,439
4 $35,300 $2,942
5 $41,340 $3,445
*Each additional person in the family adds $504 per month. Income levels are effective April 1, 2001.
No Fee Requirement
Family Size Annual Income Monthly Income
1 $12,885 $1,074
2 $17,415 $1,452
3 $21,945 $1,829
4 $26,475 $2,207
5 $31,005 $2,584
*Each additional person in the family adds $378 per month. Income levels are effective April 1, 2001.
Services Covered
Below are some of the covered services provided to recipients of North Carolina Health Choice. A fee may be required for some services depending on the family's countable income
Hospital Care
Outpatient Care
Physician and Clinic Services
Surgical Services
Prescription Drugs
Laboratory and Radiology
Inpatient Mental Health Services
Durable Medical Equipment and Supplies
Vision
Hearing
Home Health Care
Nursing Care
Dental Care
Inpatient Substance Abuse Treatment and Outpatient Substance Abuse Treatment
Physical Therapy, Occupational Therapy and Therapy for Individuals with Speech, Hearing and Language Disorders
Hospice Care
Special Needs
How to Apply
Applications are available at the Dare County Department of Social Services and various locations throughout the county. Local health care professionals, and the Dare County Health Department have applications available to be picked up by interested families. Applications can be made in person or completed and mailed to Dare County Social Services, P O Box 669, Manteo, North Carolina 27954. For further information, please contact Dare County Social Services at (252) 475-5500.
"Let's keep our children healthy, let's keep them covered!"
NC Health Choice Covered Services
NC Health Choice Rights and Responsibilities
Work First
Family Assistance (WFFA)
Work First Family Assistance (WFFA) is a
cash assistance, employment based program. Families found
eligible will receive a monthly check, in addition to Medicaid
and Food Stamps. Eligibility is based on income and reserve.
Emphasis on employment and personal responsibility begin at the application interview and are carried throughout the process.
Individuals are required to sign a Personal Responsibility Contract during the application process. This contract states that the client agrees to:
Reserve limit: $3,000.00
Income limit is based on the number of people included in the
check.
The food stamp program is a federal program designed to help low income families supplement their purchasing power for groceries. Non food items and alcohol products can not be purchased with food stamps.
Families must meet the income and resource limits in order to be eligible to receive food stamps. All countable income is based on the gross income an individual receives. Standard work related deductions, shelter cost and, if eligible, medical deductions are some of the deductions that may be subtracted from the gross countable income. Receipts are required for these deductions. Non-relatives who live together in the same home may meet the eligibility requirement to apply separately. Children living in the home with their parents must be age 22 in order to be considered for eligibility as a separate food stamp unit.
An individual's resources are considered in the eligibility process. This may include bank accounts, excess value of vehicles, trust funds, promissory notes (if negotiable), and certificates of deposits. Real property that is not being used as a homesite may also be included as countable reserve. Each reserve item will be evaluated to determine if it is a countable reserve item.
Food stamp allotment is based on the number of individuals being included in the food stamp unit and the countable net monthly income. Certification periods vary based on individual circumstances, but are not to exceed twelve months.
This service requires investigation of suspected "welfare fraud" and ensures collection of overpayments.
Basis for investigation:
Most investigative referrals come from people other than
DCDSS staff. Sources of a referral include but are not limited to
the following:
The investigator must examine all factors, which may substantiate the existence of an erroneous payment. An overpayment occurs if someone receives public assistance and it is later determined the person was not eligible to receive that benefit, either because it was received as a result of fraud or because of a mistake in eligibility determination.
There are 3 types of over-issuance: client error, intentional program violation, or agency error.
If the decision is to initiate investigative activity, it will then be determined whether the nature of the investigation is criminal, civil, or administrative.
