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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 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.
Special Assistance In-Home
The Special Assistance In-Home Program (SA/IH) provides an alternative to placement in a SA facility by providing a cash supplement to individuals who desire and are able to live at home safely with additional supportive services. Individuals who wish to receive an SA/IH payment must be eligible for full Medicaid and have an FL-2 indicating a need for licensed residential facility level of care.
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.
The Community Alternatives Program for Disabled Adults (CAP/DA) 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.
The Community Alternatives Program for Persons with Mental Retardation or Developmental Disabilities (NC Innovations) 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. NC Innovations offers an alternative to institutionalization.
CAP Consumer Direction (CAP/CD)
The CAP Consumer Direction Program is similar to CAP/DA. CAP Consumer Direction has four additional 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 maybe 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 for Children (CAP-C)
CAP/C provides services and supports in the home and community to medically fragile children, whom are under age 21 and have been determined to be disabled by Disability Determination Services or the Social Security Administration, as an alternative to an institutional placement.
Information below may be needed in order for your application to be approved
- 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.