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new expanded Medicaid program


Medicaid – Will you be eligible for health care under the new expanded Medicaid program?

new expanded Medicaid programStarting December 1, 2023, North Carolina will expand health insurance coverage under Medicaid to people up to 138% of the federal poverty guidelines. This means more people will qualify including people who were not eligible previously.  

NC Medicaid covers most health services. It includes doctor visits, check-ups, emergency care, hospital services, maternity and postpartum care, vision and hearing services, prescription drugs, behavioral health, preventive and wellness services, dental/oral health care, devices, and more including some services that address developmental supports, including those for autism. There is no monthly fee and copays are never more than $4.  

You don’t need to have a disability or even a diagnosis of any kind to qualify for this expanded coverage – eligibility is based on income levels, age, and other criteria. More facts and answers to questions about the new program can be found here.  More info about the new Medicaid benefit can be found here.


Am I eligible?

Only NC Medicaid/Department of Social Services can decide if you are eligible as there are several Medicaid programs, each with different criteria. You can review general eligibility guidelines online. If you are low-income and need help paying for health care costs, including services for developmental disability services or behavioral health, you may want to consider Medicaid.  


When should I apply?  

You can apply for Medicaid at any time, however, the new eligibility guidelines for expanded Medicaid begin December 1st.  If you apply now, you might be found eligible for other Medicaid programs including “regular” Medicaid for people up to 100% of the federal poverty guidelines or the limited Family Planning health benefit that is available to people up to 195% of the Federal poverty levels. We can’t tell you exactly when it is best to apply but know that the NEW guidelines allowing people up to 138% of the Federal poverty level to qualify for Medicaid coverage will not begin until December 1st 


Where do I apply? What do I need to show to apply? 

You can apply online, through the mail, in person, or by phone. To get started, the information found here shows the ways you can apply, what types of documents are needed, as well as links to local DSS offices if you prefer to apply in person or by phone. 

Other News – LME MCO Consolidation and Tailored Plan Update 

The North Carolina Department of Health and Human Services, acting on new authority and directives outlined in the state budget bill to reduce the number of Local Management Entities (LME MCOs), announced further consolidation of LMEs which would be reduced from 6 to 4. LME MCOs are responsible for managing access to regional mental health, developmental disability, and substance use services under both Medicaid and other government-funded health and disability programs. Under the consolidation: 

  • The Sandhills Center and Eastpointe LME/MCOs will merge and the surviving entity, Eastpointe, will consolidate with Trillium Health Resources to serve a new 46-county region covering Eastern and some Central regions of the state.  
  • Davidson County will re-align with Partners Health Management 
  • Harnett County will re-align with Alliance Health  
  • Rockingham County will re-align with Vaya Health 


These changes are already underway, and consolidation plans were due to NC DHHS the week of November 13th. NC DHHS expects the public to see what the new east/central LME MCO made up of the former Eastpointe, Sandhills, and Trillium service regions will look like in early January, and as long as things go to plan, participants in those areas would be getting update Medicaid cards February 1. The three counties that are realigning with other LME/MCOs, Davidson, Harnett, and Rockingham, may move on a faster timeline as those consolidations are expected to take place “immediately.”   

More details about the consolidations can be found in this announcement from DHHS Sec Kody Kinsley.   

The state budget also set a new timeline for Tailored Plans to start: July 1, 2024. Once consolidations are complete, LME MCOs and NC DHHS will continue the process where individuals with developmental disabilities, as well as those with serious mental health and substance use disorders, who have Medicaid coverage, will be enrolled in specialized whole health plans that integrate physical, behavioral and developmental services under LME MCO control. ASNC has written more about Tailored Plans and how they might affect you on our Medicaid Transformation page


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