Tools and Information

NC Medicaid’s new “1915(i) services” help you live more independently in your home and community, and give your caregivers the support they need. These services are for people with serious mental illness, severe substance use disorders, traumatic brain injuries or intellectual/developmental disabilities.

Las exenciones de Medicaid "eximen" ciertos requisitos federales de Medicaid, como los requisitos de ingresos familiares, para permitir que las personas con discapacidades calificadas tengan acceso a servicios y apoyos especializados que están cubiertos por Medicaid.

Medicaid recertification (renewal) is the way your information is reviewed to make sure you are still eligible for Medicaid health coverage. It is also called eligibility redetermination, renewal, ex-parté review or case review (all mean the same thing).

NC Medicaid now covers people ages 19 through 64 with higher incomes. You may be able to get health care coverage through Medicaid even if you did not qualify before. Medicaid pays for doctor visits, yearly check-ups, emergency care, dental care, mental health and more – at little or no cost to you.

Call your Tailored Plan to make sure your doctors and specialists are in your network. Tailored Plans are a new kind of Medicaid health plan. If you got a welcome packet and new health plan ID card from Alliance, Partners, Trillium or Vaya, you have a Tailored Plan

With NC Medicaid Managed Care comes the introduction of new points of contact for beneficiaries, such as the NC Medicaid Enrollment Broker and health plans

Medicaid waivers allow states to “waive” certain federal Medicaid rules, such as income requirements, so that individuals with qualifying disabilities can access specialized services and supports covered by Medicaid. These waivers are designed to help individuals receive care at home rather than in a hospital or institutional setting.

A Medicaid Home and Community-Based Service. Private Duty Nursing (PDN) is substantial, complex and continuous skilled nursing care that is authorized to supplement the care provided by a beneficiary’s trained, informal caregiver. Eligible beneficiaries must live in a private primary residence with at least one trained, informal caregiver who may provide direct care to the beneficiary during planned and unplanned absences of PDN staff. PDN services must be medically appropriate and medically necessary.

This service is for people with NC Medicaid to help them get to their medical and mental health appointments. This includes people on the Tailored Plan, a kind of Medicaid health plan. Accessible rides are also available

This factsheet explains the federal rules for Medicaid fair hearings (also referred to as an “appeal”) related to eligibility determinations that apply to all states and identifies areas where state practices may vary.