MEDICAID ELIGIBILITY

BASIC REQUIREMENTS **
MONTHLY RESOURCE SPECIAL PROVISIONS
GROUP BENEFITS BASIC ELIGIBILITY WHOSE INCOME and INCOME LIMIT LIMIT DEDUCTIBLE/SPEND DOWN Updated 07/16
REQUIREMENT RESOURCES COUNT Updated 04/16 Updated
04/16
 Beneficiaries receiving Supplemental Security Income (SSI) -Federal cash assistance program for the aged, blind, and
disabled, are automatically entitled to Medicaid. No separate application or Medicaid determination is required.
Full Medicaid coverage
S-ABD,  Beneficiaries receiving State/County Special Assistance (SA) - program for aged and disabled individuals who are
only if a Medicaid
SSI cases primarily in adult care facilities- includes Medicaid eligibility.
application is submitted
 Beneficiaries receiving Special Assistance In-Home- the individual must be determined Medicaid categorically needy
eligible.
Age 65 or older Spouse’s income and 100% of Poverty Level SSI Limits If income exceeds Protection of income for spouse
Aged Full Medicaid at home: When an individual is in
resources if live together 1 – $ 990 1 - $2,000 YES income limit and the
MAA Coverage indicator is “yes,” the a nursing facility and has a spouse
2 – $1,335 2 - $3,000
individual or family may living at home, a portion of the
Blind by Social Spouse’s income and
100% of Poverty Level SSI Limits be able to be eligible for income of the spouse in the facility
Security Standards resources if live together.
Blind Full Medicaid may be protected to bring the
Parents’ income and 1 – $ 990 1 - $2,000 YES Medicaid if they can
MAB Coverage meet a deductible. See income of the spouse at home up
resources if under age 18 2 – $1,335 2 - $3,000 to a level specified by federal law.
and live with parents. discussion of Medical
Deductible on page 2 of Currently, that amount is
Disabled by Social Spouse’s income and $2,003/mo and can be as much as
100% of Poverty Level SSI Limits this same column.
Security Standards resources if live together. $2,981 depending upon at-home
Disabled Full Medicaid
Parents’ income and 1 – $ 990 1 - $2,000 YES spouse’s cost for housing. The
MAD Coverage
resources if under age 18 2 – $1,335 2 - $3,000 amount protected for the at-home
Individuals in nursing
and live with parents. spouse is not counted in
facilities generally do
Health Care Spouse’s income and not have to meet a determining the eligibility of the
150% of Poverty Level
for Working resources if live together. Min. CSRP deductible to be eligible spouse in the nursing facility.
Full Medicaid Parents’ income and 1- $1,485
Disabled * See Footnote limit NO for Medicaid. However,
Coverage resources if under age 18 2- $2,003
(HCWD) $23,844 they must pay all of their Protection of resources for
MAD and live with parents. monthly income, less a spouse at home: Additionally, the
Payment of Medicare Entitled to Medicare Spouse’s income and $30 personal needs countable resources of the couple
Qualified premiums and Parts resources if live together. allowance and the cost are combined and a portion is
100% of Poverty Level protected for the spouse at home.
Medicare deductibles and co- A&B Parents’ income and 1 - $7,280 of medical expenses not
1 – $ 990 NO covered by Medicaid or That portion is ½ the total value of
Beneficiaries insurance charges for resources if under age 18 2 - $10,930
Medicare covered and live with parents. 2 – $1,335 other insurance to the the countable resources, but
MQB-Q
services nursing facility. currently not less than $23,844 or
Medicaid pays the more than $119,220. The amount
Specified Entitled to free Spouse’s income and 120% of Poverty Level remainder of their cost protected for the at-home spouse
Low Income Medicare Part A resources if live together.
Payment of Medicare 1 - $1,188 1 - $7,280 of care. is not countable in determining the
Medicare Parents’ income and NO
Part B premium 2 - $1,602 2 - $10,930 eligibility of the spouse in the
Beneficiaries resources if under age 18
facility.
MQB-B and live with parents.
Entitled to free Spouse’s income and Transfer of resources: When a
Medicare Part A resources if live together. person gives away resources and
Qualifying Payment of Medicare 135% of Poverty Level
Parents’ income and 1 - $7,280 does not receive compensation
Individual Part B Premiums 1 - $1,337 NO
resources if under age 18 2 - $10,930 with a value at least equal to that
MQB-E and live with parents. 2 - $1,803
of the resources given away, he
NOTE: Total number of eligible individuals is limited to available funds. may be penalized. Medicaid will
Lost entitlement to Spouse’s income and not pay for care in a nursing facility
free Medicare A due resources if live together. or care provided under the
Payment of Medicare 200% of Poverty Level Community Alternative Program
Working
Part A premiums to earnings but still Parents’ income and 1 - $1,980
2X SSI Limits
Disabled has disabling resources if under age 18 1 - $4,000 NO (CAP) or other in-home health
2 - $2,670 services & supplies for a period of
MWD impairment. and live with parents. 2 - $6,000
time that depends on the value of
the transferred resource.

* For Basic Coverage, the beneficiary does not have to meet the Social Security SGA requirement to be disabled. For Medically Improved coverage, the beneficiary does not have to meet the Social Security medical requirements for disability.
 BASIC REQUIREMENTS **
MONTHLY RESOURCE
SPECIAL PROVISIONS
GROUP BENEFITS BASIC ELIGIBILITY WHOSE INCOME and LIMIT
INCOME LIMIT DEDUCTIBLE/SPEND DOWN Updated 07/16
REQUIREMENT RESOURCES COUNT Updated
Updated 04/16 04/16
Parents/Caretaker 1 - $434 If income exceeds income
relatives must be living 2 - $569 limit and the indicator is
Families & with and caring for a “yes” the individual or
Children 3 - $667 family may be able to be
child to whom they are
Full Medicaid coverage related who is under age MAGI Methodology. 4 - $744 $3,000 YES eligible for Medicaid if they
MAF
19. 5 - $824 he can meet a deductible
Children must be under Medicaid Deductible:
age 21. When an individual/family is
A self-attestation of 196% of Poverty Level ineligible for Medicaid due to
pregnancy and due income over the income When determining the family
Pregnant Coverage is limited to date can be accepted 1 - $1,941 limit, they may become size for the pregnant woman the
Women treatment for conditions as proof of pregnancy 2 - $2,617 eligible by meeting a unborn child is included. For
MAGI Methodology NO NO example the family size for a
MPW that affect the unless the county has 3 - $3,293 Medicaid deductible. The
pregnancy. information that deductible is determined by single pregnant woman would
4 - $3,969
contradicts the subtracting the Medically be 2.
attestation 5 - $4,646 Needy Income Limit (MNIL)
210% of Poverty Level (see limits below) from the
Children countable monthly income to
1- $2,079 determine the monthly
under
Full Medicaid 2 - $2,804 excess income. Medicaid
age 6 Must be under age 6. MAGI Methodology NO NO
Coverage 3 - $3,528 deductibles are generally
MIC determined for 6 months, so
4 - $4,253
the monthly excess income
5 - $4,977 is multiplied by 6 to
determine the 6-mo.
133% of Poverty Level deductible. Once medical
Children bills for which they are
1 - $1,317 responsible totaling the
age
Full Medicaid Must be age 6 thru age 2 - $1,776 amount of the deductible are
6 thru 18 MAGI Methodology NO NO
Coverage 18 3 - $2,235 incurred, they are authorized
MIC for the rest of the 6-mo.
4 - $2,694
period. Medicaid cannot pay
5 - $3,153 for any of the bills applied to
the deductible.
Resource Adoptive Parents income of
limit: special needs children adopted
Title IV-E
Full Medicaid Be an Title IV-E Medicaid eligibility is automatic. There is no income or resource All deductible under state adoption
Children NO
Coverage adoptive or foster child determination. cases have a agreements is not counted
IAS resource when determining Medicaid
limit: $3000 eligibility.
State MNIL: for families
If not eligible for HSF, then evaluate for other children’s programs. and children
Foster Care Full Medicaid 1 - $242
NO and $2,000
Children Coverage
(HSF) 2 - $317 (1) and
3 - $367 $3000 (2) for
4 - $400 aged, blind
and disabled.
5 - $433
Be 18-20 and had been
Expanded
Full Medicaid a Title IV-E or State There is no income
Foster Care None NO NO
Coverage foster child on 18th determination
HSF, IAS
birthday
 BASIC REQUIREMENTS **
MONTHLY RESOURCE
BASIC ELIGIBILITY WHOSE INCOME and LIMIT SPECIAL PROVISIONS
GROUP BENEFITS INCOME LIMIT DEDUCTIBLE/SPEND DOWN
REQUIREMENT RESOURCES COUNT Updated Updated 07/16
Updated 04/16 04/16
MFC-
Medicaid Be age 18-25 and was
for Former Full Medicaid in NC foster care prior There is no income
Foster Care None NO NO
Coverage to age 18 and enrolled determination
in NC Medicaid

Must be a woman aged

Breast & 18 to 64 who has been To be eligible under the Breast
Cervical screened and enrolled and Cervical cancer Medicaid
Cancer Full Medicaid in the NC Breast & There is no income NO program, the woman cannot
NO NO NO
Medicaid Coverage Cervical Cancer control determination. have any type of medical
Program and is insurance including Medicare
MAF-W otherwise ineligible for
Medicaid.
195% of Poverty Level
Family Family Planning exams 1 - $1,931 If a beneficiaries income
Planning & services. Screening & 2 - $2,604 increases to more than 195%,
treatment for STI. NO AGE LIMIT MAGI Methodology NO NO NO he/she will be ineligible for
MAF-D Screenings for HIV. 3 - $3,276
family planning coverage
Sterilizations. 4 - $3,949
5 - $4,622
Beneficiaries with household
Be age 6 through 18, 211% of Poverty Level income over 159% of poverty
Medicaid-equivalent
ineligible for Medicaid, level must pay enrollment fee.
NC Health coverage with four 1 - $2,089
Medicare, or other
Choice exceptions: no long-term 2 - $2,817 NO 1- $1,575.01
federal government-
(NCHC) care, no EPSDT, no non- MAGI Methodology NO NO 2- $2,123.01
sponsored health 3 - $3,545
emergency medical
insurance, be 4 - $4,273 3- $2,672.01
transportation, and
uninsured, a NC 4- $3,220.01
restricted dental. 5 - $5,001
resident
5- $3,769.01

**This chart addresses benefits and basic eligibility requirements. Other requirements (such as citizenship/alien status, incarceration, & state residence) which can also affect eligibility or the level of benefits are not
reflected on this chart.