What is North Carolina Medicaid and how does it work in North Carolina?
When you’re shopping for health insurance, it’s important to understand the difference between Medicaid and the Marketplace to determine which one is right for you. In this section, we’ll go over the North Carolina Medicaid program, how it differs from the Marketplace, what’s available for children, and eligibility for each one.
What is Medicaid?
Medicaid is a jointly funded, Federal-State health insurance program, providing free or low-cost health insurance for eligible low-income adults, children, pregnant women, seniors, and people with disabilities. In 2014, the Medicaid program significantly expanded due to the Affordable Care Act — and states individually decided to opt-in or out of the expansion. Currently, over 30 states and the District of Columbia have expanded their Medicaid programs
Before the Affordable Care Act, many uninsured, low-income individuals were not eligible for Medicaid. At that time, the Medicaid program only covered low-income parents with dependent children, qualifying children and pregnant women, individuals with specific disabilities, and qualifying people over 65 years old.
Once the Affordable Care Act was signed into law, anyone with a household income of less than 138 percent of the
Federal Poverty Level became eligible for Medicaid. This expanded the program so you would no longer have to fall under one of the qualifying categories; you could now qualify for Medicaid based on your income.
Optional services may vary state-to-state but every program has to cover costs for mandatory benefits like physician services, family planning services, inpatient and outpatient hospital services, laboratory and x-ray diagnostic services, home healthcare,
plus more.Enrollment is year-round, so you can apply for North Carolina Medicaid at any time.
Fill out an application here to confirm whether you qualify.
Medicaid vs. the Marketplace
If you’re eligible for Medicaid, you can still enroll in health insurance through the Marketplace. However, you won’t qualify for one or both of the subsidies offered under the Affordable Care Act:
cost-sharing reductions and
premium tax credits. Therefore, Medicaid will be the more affordable option.
If you’re enrolled in Medicaid and then become ineligible due to your household income increasing, now is the time to enroll in a Marketplace health insurance plan. Plus, there’s a good chance you’ll qualify for one or both of the ACA subsidies.
Find out how much you can save here.What is the Medicaid gap?
The Medicaid coverage gap refers to a group of uninsured individuals in states that did not expand their Medicaid programs. They are not eligible for Medicaid, yet at the same time not eligible for subsidies offered by the Affordable Care Act. Therefore, making both forms of affordable health insurance inaccessible. There are approximately
2.4 million Americans in this coverage gap, according to the Kaiser Family Foundation.
If you live in a state without the Medicaid expansion, you could fall within this gap. The exact factors depend on your state but for Medicaid the median income limit for parents in these states is just
44% of poverty, or an annual income of $8,985 a year for a family of three. Medicaid is generally not available at all to childless adults in states that did not expand Medicaid. ACA premium subsidies are only available for people with a household income of at least 100 percent of the FPL, up to 400 percent of FPL. (This
chart shows the income limits for Medicaid in each state.)
If you do not qualify for Medicaid or ACA subsidies, you are in the Medicaid gap. To get health insurance, you can pay full price for an ACA Marketplace plan or purchase a private health insurance plan. Both options can be expensive and lack the protections that come with the ACA plans. An often more affordable option is to get low-cost care through a community health center. These health centers generally provide health care services on a sliding scale based on your income. To find a community health center near you, use this tool from the
U.S. Department of Health and Human Services.
What is CHIP and how does it relate to Medicaid, the ACA, and your family
CHIP (Children’s Health Insurance Program) was created to help fund health coverage for children at the state level. Each state has put their own program in place, primarily working to serve low-income households. Most of the time, these households aren’t eligible for Medicaid or may have employer-sponsored health insurance that does not cover their kids. CHIP helps fill these gaps, helping more children get insured.
CHIP eligibility differs by state, with the majority of states covering children with household incomes up to at least 200% of the Federal Poverty Level (FPL). In California, more than 1.2 million children under 19, have access to health insurance through the Children’s Health Insurance Program.
Fill out an application here to determine if your household meets the state income requirements. Like Medicaid, CHIP does not have a set enrollment period and can be applied for year-round.