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ADULT MEDICAID

Begin the Application Process On Line Through E-Pass
 
 
ePASS is a tool that lets you check on the Internet to see if you may be eligible for several North Carolina benefits and services. ePASS shows you the benefits for which you may be eligible. It can also help you decide if you want to apply for assistance. It may also make it easier to apply for benefits. You can complete and print off an application for Food and Nutrition Services and Medicaid and mail it or bring it to DSS.
 
Click here to go to ePASS
 
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, blind, or disabled. Income and resource limits apply. No money is paid to the client. The eligible client receives an annual Medicaid identification card in the mail to show the health care provider. The provider bills Medicaid for the service. Medicaid can also cover medical expenses from up to 3 months prior to the month of application, if there was medical need during that time. 
 
Some individuals are only eligible for the Medicare-Aid program. In this program Medicaid only pays for services that Medicare covers. If it is a Medicare covered service, Medicaid will pay the coinsurance and/or the deductible. If Medicare denies the service, Medicaid will also deny. 
 
Some individuals are only eligible for Medicaid which pays their part B Medicare premium that would normally be taken out of the individual’s Social Security check each month.
 
Special Assistance
 
Special Assistance is a program that helps pay for care in a Rest Home or Family Care Home. This program is for individuals that are aged, blind, and/or disabled. The Special Assistance program helps pay the cost of rest home care. Medicaid is also authorized for all recipients who are eligible for Special Assistance. The individual must meet income and resource guidelines to be eligible for Special
Assistance.
 
A Special Assistance check is issued to the eligible recipient to supplement their income in order to pay for the cost of care in the facility. A Medicaid card is also issued to pay medical expenses.
 
The funding for the Special Assistance program comes from State and County funds.
 
For additional information on the web, manuals are on line at http://www.dhhs.state.nc.
 
Community Alternatives Program
 
North Carolina operates four programs to provide home and community care as a cost-effective alternative to institutionalization. These are known as "waiver" programs because standard program requirements are waived to allow the program to operate. The waiver programs provide some services that otherwise are not covered under Medicaid.
 
CAP/DA Program:
The Community Alternatives Program for Disabled Adults (CAPIDA) provides a package of services which allow adults (age 18 and older) who qualify for nursing facility care to remain in their private residence. The program is available in all North Carolina counties. The program contributed to the quality of the participants and their families/caregivers while providing care that was cost-effective in comparison to the Medicaid cost for nursing facilities.
 
CAP-MR/DD:
The Community Alternatives Program for Persons with Mental Retardation or Developmental Disabilities (CAP-MRIDD) provides community services to individuals of any age who qualify for an intermediate care facility for the mentally retarded (ICF-MR). The Division of Mental Health, Developmental Disabilities and Substance Abuse Services manages the daily operation of the program under an agreement with DMA. The program is available statewide through local area mental health, developmental disabilities and substance abuse programs. CAP-MR/DD offers an alternative to institutionalization.
 
CAP/Choice:
The CAP/Choice program is similar to CAP/DA. CAP/Choice uses a non-traditional case management service. CAP/Choice has four addition services to the usual CAP/DA services: 1)A care advisor replaces the case manager; 2) A financial manager bills Medicaid ; 3) a personal assistant provides help with personal and home maintenance tasks and is hired by the client and may be a family member; 4) there are consumer-designated goods and services that can be purchased to increase client’s independence for daily tasks that are not usually provided.
 
CAP/AIDS:
The Community Alternatives Program for Persons with AlDS (CAPIAIDS) offers a home care assistant to nursing facility care for persons with AlDS as well as children who are HIV-positive with other qualifying conditions. CAP/AIDS is a cooperative effort with the Division of Public Health's AIDS Unit. The AIDS Care Unit administers the program with DMA providing oversight. The program paid for services to 36 people in SFY 2001.
 
Information needed when applying for Adult Medicaid
 
  • Social Security Numbers
  • Medicare Card
  • Verification of any Income
  • Verification of any bank accounts, certificates of deposit, retirement benefits, IRA'S, stocks, bonds, etc.
  • Life Insurance Policies
  • Pre-Need Burial contracts
  • Verification of vehicles you own
  • In some cases medical bills will be needed
If there are other things needed to complete the applications, you will be given a list of these and will be able to provide them later.