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Medical Assistance Programs in North Carolina

The state of North Carolina offers a variety of health care assistance and coverage programs for legal residents who are currently without health insurance. Because the state opted out of the federal offer to expand Medicaid, a coverage gap in healthcare insurance has manifested. Due to this insurance gap, in which residents do not have coverage because they earn too much to qualify for Medicaid, but not enough to afford private health insurance, other health care programs have been established. Those who do not make enough to afford private insurance and do not qualify for Medicaid are most often the groups assisted through these health care programs. North Carolina also offers special programs for children’s health and dental services. North Carolina residents who believe they may need subsidized medical insurance, or for those who believe they would fall into the low income guidelines, are urged to read the sections below for more information.

Subsidized Health Care in North Carolina

North Carolina has opted to use the federal health insurance exchange, called the Health Care Marketplace. On that site is an area just for North Carolina residents. Applicants must supply information to populate the form, and if it is determined that the applicant is low-income, then a subsidy will be applied to the overall monthly premium which reduces the price. Many low-income families are able to afford the lower tiered health care insurance programs with the additional subsidies.

North Carolina Health Choice for Children

The North Carolina Health Choice for Children program is designed to provide healthcare coverage for the children of low-income families who have a net household income too large to meet eligibility requirements for Medicaid. The coverage offered through NC Health Choice for Children is identical to the coverage offered to NC state employees.

To be eligible for the program, the child must be a North Carolina resident under the age of 19 without any other form of health insurance. The child must also be a United States citizen or a legal resident. The child receiving benefits must be a part of a household that meets the income eligibility requirements. Benefits are expansive and include yearly checkups, behavioral counseling, free or discounted medication, dental work, irregular (non-routine) doctor’s visits, hospital and emergency services, eye exams and the purchase of glasses, hearing exams and the purchase of hearing aids.

Medicaid in North Carolina

Medicaid is a federally funded health insurance program for families with low incomes, the elderly, and the disabled. North Carolina specifically offers a branch of Medicaid called Baby Love, intended for health care assistance for women and children before and right after birth. The children’s health services offered through Medicaid is called the Health Choice program. Other branches of the North Carolina Medicaid program include Health Check, insurance for people up to 21 years of age, Carolina ACCESS, North Carolina’s PCCM (Primary Care Case Management System) which manages the primary care usage of Medicaid beneficiaries to ensure benefits are not being abused.

To qualify for Medicaid, applicants must be a resident of North Carolina and a United States citizen or legal resident without any other form of health insurance assistance and no sound financial ability to purchase private health insurance. Recipients must also be one of the following: blind, disabled or have a household member with a disability, pregnant, be legally responsible for people under the age of 19 or at least 65 years of age.

Medication Assistance in North Carolina

The state of North Carolina offers two main programs for those wishing to receive discounts on prescription medications. One, called MedAssist, offers programs for discounted and free medications and a special program specifically for senior citizens. Within MedAssist is the Free Pharmacy program, which provides pharmacy services for free. Eligible individuals must be legal residents of North Carolina, ineligible for any sort of government health insurance, or unable to afford private insurance. Applicants must live below 200 percent of the federally enforced poverty level.

MedAssist also offers the Senior Care program, a prescription medication assistance program for those who benefit from Medicare Part D and run out of benefits during the year. The service provides free pharmacist consultations and advice for free or reduced priced medications until Medicaid benefits can be renewed.

 

The second major North Carolina prescription medication program is the Medication Assistance Program (MAP). MAP is a program that provides free prescription drugs for low-income households that do not have insurance. Only certain pharmaceutical companies participate in MAP, so those wishing to benefit from MAP must contact a service center and individually discuss eligibility.

Assisted Dental Health Care in North Carolina

North Carolina offers Safety Net Dental Clinics, which are clinics run by nonprofit institutions for low-income households to receive dental services. Clinics accept private insurance, Medicaid and Health Choice for Children. For those without insurance, there is a sliding fee option available to allow affordable pricing for the dental care when taking the patient’s income into account. Eligibility requirements and applications vary from clinic to clinic, so those interested must contact the clinic of their choice. Some Safety Net Dental Clinics also operate out of private practices. There are Safety Net Dental Clinics in almost all of North Carolina’s 100 counties.

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