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Medicaid For Families & Children  

Medicaid For Families & Children

  • Medicaid for Infants and Children through age 5: The family income limit is equal to 200% of the poverty level. There is no limit on resources.
  • Medicaid for Children from age 6 through age 18: The family income limit is equal to 100% of the poverty level, which is lower than the income limit for younger children. There is no resource limit.
  • Medicaid for Caretakers and Children age 19 and 20: The income limit is lower than the income limit for children under age 18. There is a limit on resources.
  • Medicaid for Medically Needy coverage for parents and children whose incomes are higher than those allowed in other coverage groups: Families must meet a deductible based on the amount by which their income exceeds the MAF-MN income limit. There is a limit on resources
  • Family Planning Waiver Program: A program for men age 19-60 and women age 19 – 55 with income below 185% of the poverty level. Coverage is limited to Family Planning Services only.

What are the income limits for children?

Monthly income limits for children vary with the age of the child, with the type coverage the child is eligible for, and the number of people in the child’s family. The chart below gives examples by age, category and family size. If income is greater than these amounts children ages 6-18 may be eligible for NC Health Choice for Children.

  • Medicaid Health Insurance For Infants and Children (Effective 04/2007). Covers children under age 19
Family size 1 2 3 4
Monthly Income Limit
Under age 1
$1,476 $1,978 $2,481 $2,984
Monthly Income Limit
Age 1 through age 5
$1061 $1,422 $1,784 $2,145
Monthly Income Limit
Age 6 through age 18
$798 $1070 $1,341 $1,613

Special Note: Please remember that deductions can be taken from gross income for work-related expenses, child-care costs, and court-ordered child support or alimony. If your income is over the limit and your children have high medical bills, your children may still qualify for Medicaid and have a deductible.

  • Medicaid Health Insurance For Families
    Covers Children under age 21 and their Parents/Caretakers
Family size 1 2 3 4
Monthly Income Limit $362 $472 $544 $594

If monthly income exceeds these amounts the family must meet a deductible based upon the Medically Needy income limits below:

Family size 1 2 3 4
Monthly Income Limit $242 $317 $367 $400

What is a deductible?

A deductible in Medicaid works much like a deductible for private insurance. A person is responsible for a certain amount of medical bills before insurance pays. The difference is that a Medicaid deductible is not a set dollar amount (such as $100 or $250). It is based upon the person or family's income. If income is more than a limit set by law there must be a deductible. The deductible is the amount of income over the income limit. A deductible can be for 1, 2 or 3 months before the month of application or for a period of 6 months beginning with the month you apply.

How do I meet the deductible?

A Medicaid deductible is met by adding up medical costs on a day by day basis. When a Medicaid applicant pays or is billed for medical care, supplies or prescriptions, he has incurred these costs and may have them applied to his deductible. Only the portion of the bill that the person must pay can be applied to the deductible. (For example, a person with health insurance may only be responsible for 10% ($50) of a $500 hospital bill. Fifty dollars is the amount that can be applied to meet the Medicaid deductible.) You can be approved for Medicaid on the date that the bills add up to the amount of the deductible.

Whose Income/Medical Bills are Counted Toward the Deductible?

In Medicaid, your spouse's income must be counted in determining eligibility. Likewise, a parent's income must be counted when determining eligibility for a child. Because these individuals’ income is counted, their medical bills may be applied to the Medicaid deductible.

Example: A family of 4 has monthly income of $800. The income limit for this family is $400. The deductible is calculated as follows:

$800 family income - 400 income limit = $400 excess x 6 = $2,400 deductible

The family cannot receive Medicaid until medical bills totaling $2,400 have been incurred or paid. Once that amount has been incurred or spent, the family may receive Medicaid for the remainder of the 6-month period. For additional information about deductibles, refer to the Medicaid deductible Fact Sheet.

How do I apply for Medicaid?

You may visit the Social Work Services office at:

40 Coxe Avenue
Asheville NC 28802
(828) 250-5500

to apply or ask them to send you an application in the mail. Applications are also available at the local Health Department. You may complete the application yourself and return it in person or mail it to the Social Work Services.

What do I need to take to apply for Medicaid?

You are not required to take anything with you when you apply for Medicaid. However, it is helpful if you have your Social Security Number, proof of your income and information about your resources (such as your bank account number and your insurance policy number.) If you are self-employed, your business records and/or tax records would be helpful.

Do we have a list of doctors who accept Medicaid?

The Social Work Services should be able to help your family find a physician who accepts Medicaid. In addition, some individuals who receive Medicaid must select a primary physician under a Managed Care program known as Carolina Access. Some individuals may also enroll in a Health Maintenance Organization (HMO). Your Social Work Services representative can provide more information about these programs.