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Medicaid Eligibility: Understanding the Income Criteria

Although Medicaid is a federal program, it is actually state-run. That means that the program varies slightly from state to state. In North Carolina, the NC Medicaid Division of Health Benefits and your county Division of Social Services (DSS) caseworkers work together to ensure that the Medicaid program runs smoothly.

Whether you are eligible for Medicaid will depend on a number of factors, including your age, income, and health needs. This blog focuses on the income requirements for North Carolina citizens.

The Basics of the Medicaid Income Requirements

The purpose of Medicaid is to help older, disabled, or low-income individuals have healthcare options when they cannot afford that care themselves. Because of that goal, Medicaid is only available to those who fall under certain income limitations.

There are income limitations for each “set” of circumstances that trigger Medicaid eligibility. That is, your unique life situation will put you into a different category of income limitations. It is important to note, however, that if you are already receiving Supplemental Security Income, you are automatically eligible for Medicaid, and you do not need to apply.

Medicaid for Elderly, Blind, and Individuals with Disabilities

You must have less than $2,000 of “countable” resources. These resources include things like:

  • Money in your bank accounts
  • Retirement accounts
  • Stocks and bonds
  • Life insurance policies (cash value)
  • Cash

“Non-countable” resources include the value of your home, one car, home furnishings, clothing, and jewelry.

Medicaid Availability for Infants and Children

If you are requesting Medicaid for your children, there are separate limitations that depend on your family size and the age of your children. For example, if you have an infant to a child of age 5, a four-person home cannot have monthly income above $4,393 to qualify for Medicaid. If the child is older than age 5, that income level drops to $2,782.

Keep in mind, however, that even if your income is over the limit, you may still be able to get assistance with healthcare with a Medicaid deductible.

Medicaid for Families with Dependent Children

Medical coverage is available for families who have dependent children. However, these income limitations are much lower. A family size of one, for example, has to make below $434 per month to qualify. A family size of 4 must fall below $744 per month.

Medicaid for Pregnant Women

There is also a separate program for pregnant mothers. Women may be able to apply for this program while they are pregnant or even after they deliver their child. This program only addresses services related to pregnancy, but it can be extremely helpful for a new mom. It also offers things like family planning classes and childbirth classes. The income limitations are much higher for this service – $1,983 for a family of one.

Income limitations are somewhat complicated. DSS is an excellent resource for those who want to learn more about eligibility requirements and whether they qualify.