Medicaid is the national health coverage program that’s jointly funded by state and federal governments and administered by each state. It provides low-income seniors, adults with disabilities, parents and children with access to a broad range of health services, including emergency, primary and long-term care.
In North Carolina, seniors who receive Supplemental Security Income benefits automatically qualify for NC Medicaid Aged, Blind and Disabled coverage. All other seniors must complete an application process that includes verifying income and resources (assets).
Current income limits are $1,041 per month for individuals ($1,410 per couple) and includes all wages, pension payments and alimony. The asset limit is $2,000 per applicant and $3,000 per married couple if both spouses are seeking NC Medicaid coverage. Countable assets include all cash on hand, bank account balances, investments and real estate except for an owner-occupied home valued at or below $585,000.
If only one spouse in a married couple applies, the non-applicant spouse is entitled to $3,160.50 per month under the minimum monthly maintenance needs allowance, which can be deducted from the applicant’s income. A non-applicant spouse can also keep up to $126,420 worth of shared assets under the community spouse resource allowance.
Seniors with excess monthly income and high ongoing medical expenses may be eligible for coverage under the Medically Needy pathway. Also known as Medicaid spend-down, this program lets seniors deduct qualified medical costs from their monthly income to reach Medicaid limits every six months.
Personal Care Services
Seniors who reside in an assisted living setting, have Medicaid coverage and need help with two or more activities of daily living may be eligible for assistance up to 3.5 hours per day and 60 hours per month through the Personal Care Services program. As a Medicaid entitlement program, all seniors who meet program criteria receive services.
ADLs include toileting, eating, dressing, bathing and mobility.
To qualify, seniors must meet one of the following criteria:
- Need limited help to perform three out of the five qualifying ADLs
- Need extensive help performing one ADL and limited help performing another
- Be entirely reliant on assistance from another person to perform one ADL and need some help performing another ADL
PCS assessments are performed by NC Medicaid employees or designated Medicaid agents, and program services are assigned according to an individualized service plan.
Seniors who need additional services may qualify for up to 80 hours of care per month under the PCS-Plus program with approval from a physician.
For more information on NC Medicaid, the Medically Needy pathway and the PCS program, contact
Haywood County, Health and Human Services at (828) 452-6620 or apply in person at 157 Paragon Parkway in Clyde.