Making a Difference
Matthew Reese
Economic Services Supervisor
mreese@alexandercountync.gov
828-632-1080 Ext 309
Medicaid is a program for Medical Assistance in North Carolina that pays medical bills for eligible low-income people who cannot afford the cost of medical care. Medicaid's rules and regulations are a combination of Federal and State laws. The North Carolina Division of Medical Assistance (DMA) administers the program. The program costs are paid by federal and state taxes.
Who is eligible for Medicaid?
| Program Name | Income | Group Covered | Benefits | Reserve |
|---|---|---|---|---|
| Medicaid for the Aged, Blind, & Disabled (MAABD)
(Categorically Needy) |
$ 908 (1) $1226 (2) |
Over 65, Blind or disabled: based on Social Security criteria. At or below 100% of federal poverty level | Covered services include Medical, dental, vision, prescriptions limitations on amount of RX & MD visits Dually eligible pays Medicare premiums, co-payments & deductibles |
$ 2000 (1) $ 3000 (2) |
| Medicaid-Aged, Blind, Disabled (Medically needy) | If income over $908/$1226 must meet a deductible | Over 65, Blind or disabled: based on Social Security definition of a disability *** | Covered services include Medical, dental, vision, prescriptions- limitations on amount of RX & MD visits | $ 2000 (1) $ 3000 (2) |
| Medicaid for Qualified
Beneficiaries (MQB-Program Q) |
$ 908 (1) (MQBQ) $1226 (2)(MQBQ) |
Medicare beneficiaries at or below 100% federal poverty level but assets over $2000/$3000 | Pays Medicare premiums, co-payments, and deductibles | $ 6940 (1) $10410 (2) |
| Medicaid for Qualified
Beneficiaries (MQB-Program B) (MQB-Program E) |
$1089 (1) (MQBB) $1457 (2) (MQBB) $1226 (1) (MQBE) |
Medicare beneficiaries at or below 120% federal poverty level |
Pays Medicare part B & D premiums |
$ 6940 (1) |
Medicaid- Skilled Nursing Facility |
All income except $30/mo goes to Nursing Home * | Certified by doctor and prior approval from Electronic Data Systems (EDS) | All Medicaid covered services and cost of care in a nursing facility-requires EDS prior approval | $ 2000 ** |
| Medicaid-CAP (Cat Needy) Medicaid-CAP (medically Needy) |
$908
no deductible If income >$908 must meet monthly deductible |
Certified by doctor and prior approval from Electronic Data Systems (EDS) | All Medicaid covered services and additional in-home services and supplies as drawn up by CAP Case Manager with EDS prior approval | $ 2000 ** |
*INCOME MAY BE DEEMED TO A COMMUNITY SPOUSE
*RESOURCES MY BE PROTECTED FOR A COMMUNITY SPOUSE
***The State/SSI definition of Disability is: "A physical or mental impairment which prevents an individual from engaging in any substantial gainful activity (or for a child under 18, an impairment of comparable severity) and which has lasted or is expected to last for at least 12 months or is expected to result in death."
Medicaid will pay for medically necessary nursing home care for a Medicaid eligible individual who is either a patient in a nursing home or in an Intermediate Care facility for the Mentally Retarded.
Medical need for the patient to be in a nursing home bed must be approved in Raleigh.
If an applicant/recipient, his spouse, or legal representative gives away or sells assets belonging to the applicant/recipient for less than current market value, he may not be eligible for payment of cost of care in the nursing home(lookback period currently 11/1/2007 & will be 60 months effective November 2012).
There are limits on the amount and type of real and personal property a person may have. If the applicant has a spouse, it is possible for up to one-half of the assets to be protected for the spouse at home.
The recipient must use his/her income to help pay for nursing home care. Each recipient keeps $30 per month for his personal needs; an additional amount may be set aside for the spouse at home.
This program provides Medicaid and financial assistance to those who are in a licensed Adult Care Home, Family Care Home, or an area-operated Mental Health Group Home.
The individual must be at least 18 years of age and meet the program criteria of age, blindness, or disability. The individual's income must be used to help pay the cost of care; Special Assistance supplements their income, and $66 is set aside for personal care needs, prescription co-payments, and personal costs.
This program is for Medicaid eligible individuals with incomes at or below 100% of the federal poverty level, who meet all other eligibility criteria for Special Assistance, and are financially eligible for Special Assistance payments in in-home living arrangements. The current federal poverty level is $908 and is normally adjusted in April. This income level (needs standard) is lower than the income level for individuals receiving Special Assistance in adult care homes and financial assistance is also less.
This Medicaid program covers blind or disabled workers age 16 through 64 with incomes equal to or less than 150% of the federal poverty level. This would be $1362 for a single individual and $1839 for a couple. This program provides an incentive for disabled persons to pursue employment or increase their hours of work, while protecting their Medicaid eligibility.
Medicare is a Federal health insurance program for retirees, disabled individuals, their survivors and dependents. Administered by the federal government through the Social Security Administration, it is available without regard to the individual's assets or income level. Medicare benefits may be used Nationwide, regardless of the beneficiary's state of residency.
Medicare Link (http://www.Medicare.gov)
Medicaid is a "means-based" medical assistance program, and applicants must meet income and resource criteria. Administered by the state, it is based on both federal and state regulations---each state's Medicaid programs differ to some degree and Medicaid cannot transfer from state to state. The individual must meet income and asset limits, and be aged, blind, or disabled.
Our office is located at 604 7th St. SW Taylorsville, NC 28681
Our phone number is 828-632-1080. Office hours are 8am-5pm
Mail-in applications are available at our agency and online at
Please bring the individual's Social Security number, life insurance policies, recent bank statements, medical bills, proof of residency, and birth certificate.
Alexander County
Social Services
604 7th St. SW
Taylorsville, NC 28681
