Understanding Medicaid

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Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors, and people with disabilities.   Medicaid pays for extended nursing home care and even for assisted living care. There is no limit on the length of stay (the number of days or years in the facility). Although Medicaid pays for extended nursing home care it does so only for people who require such care and who meet very tight income and asset requirements. In other words, a person must apply for Medicaid and meet eligibility requirements. Medicaid may help pay for nursing homes and intermediate care facilities, as well as long-term care in the home. There are income and resource limits and transfer of asset requirements. You do not have to sell your house. The home, a vehicle and all personal possessions are not countable resources.  

Your income must be less than the cost of care in the facility at the Medicaid rate. Medicaid must approve the need for the level of care. You must use some of your income to help pay for the cost of care. This is called the “patient monthly liability.” Medicaid will pay the rest to the facility.

If you or your representative give away assets (cash, bank accounts, life insurance policies, vehicles, property, anything that can be converted to cash, etc.) or sell them for less than market value, you may be ineligible to receive Medicaid for 3 to 5 years to pay for these services.  The sanction period is based upon the value of the assets transferred out of your name.

When a Medicaid recipient receiving any of the above long-term care services dies, Medicaid seeks to recover certain expenses. There will be a claim filed against the estate. Under certain circumstances, estate recovery may not apply.

How to Apply for Medicaid

If you wish to apply for Medicaid, you may either visit the local Department of Social Services or you may mail in an application (form DMA 5000 for Medicaid for the Disabled or form DMA 5063 for Family & Children). You may print the application or you may call the local DSS and ask that an application be mailed to you. Once the mail-in application is completed, mail it to Martin County Dept. of Social Services, PO Box 809, Williamston, NC 27892.  The date the mail-in application is received in the agency is the date of application. Faxed applications and applications received over the internet are not acceptable.   If you have an ongoing Medicaid case and you move into a skilled nursing facility, you do not need to reapply for benefits.  You must, however, contact your caseworker within ten days and report the change.  If you move from into an assisted living facility, you must visit the local DSS and complete a new application

If possible, take the items listed below with you when you go to the DSS office to apply.   

  • Certified birth certificates or other proof of citizenship/alien status for each individual applying for Medicaid/NCHC
  • Identity documents for each individual applying for Medicaid/NCHC
  • Social security cards, social security numbers, or proof that you have made an application for a number from the Social Security Office, for each individual applying for Medicaid or NCHC
  • A copy of all pay stubs for the last 3 months
  • Copies of all medical or life insurance policies
  • A list of all cars, trucks, motorcycles, boats, etc. you or anyone in your household own, including the year, make, model, and vehicle identification number (VIN) for each item
  • Most recent bank statements
  • A list of all real property you own
  • Current financial statements/award letters from other sources of income, such as social security, retirement benefits, pensions, veteran benefits, and child support.
If you are unable to go to a DSS office, you may also print and mail completed Medicaid Applications to your local DSS office, or you may call and ask that an application be mailed to you.  Faxed applications and applications received over the internet are not acceptable.  Some health centers and hospitals have application forms available and may be able to assist you in completing them. 

For more information regarding this article, please contact Martin County Department of Social Services at (252) 789-4400 and ask for someone in Adult Medicaid.

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