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Medicaid Programs for Long-Term Care Services

Medicaid Programs for Long-Term Care Services

Medicaid is a federal government program that provides health insurance to low-income individuals and families who cannot afford healthcare costs. 

Medicaid may help pay for certain medical expenses, such as medical bills, prescriptions, vision and dental care, nursing home care, personal care services, and more.

Who is eligible?

There are unique guidelines for different Medicaid programs. You can see these additional requirements in the description of the programs. To be eligible for general Medicaid, you must:

  • Meet income guidelines

  • Be a US citizen or give proof of eligible immigration status
  • Live in North Carolina and provide proof of residency
  • Have a Social Security number or have applied for one

To receive Medicaid, you do not have to go through a physical or other type of exam, unless you are applying because you are disabled and do not currently receive Social Security Disability Insurance. If you are applying for Medicaid because you are pregnant, proof of pregnancy is needed.

How can I apply? What should I bring with me?

You can apply for Medicaid online or visit your local Department of Social Services (DSS) office. You can also complete a paper application and drop it off or mail it to your local DSS.

When applying for Medicaid, provide the following information:

  • Birth certificate

  • Social Security card

  • Photo ID

  • Proof of citizenship or immigration status (passport, green card, employment authorization card)

  • Paycheck stubs from the last month, a written letter from your employer with wage amounts, or tax records for the previous year

  • Proof of all income from sources like Social Security, Veterans Benefits (VA), and retirement benefits - Bank statements are NOT an acceptable proof of income - MUST provide an award letter

  • Bank statements from the last month for ALL accounts

  • Copies of all life insurance policies

  • Proof of any property that you own (home, land, vehicle, etc)

  • Proof of residency (rent receipt, mortgage, lease, or written statement from landlord)

  • Insurance benefit card, if you have any other health insurance

  • Medicare card, if you have Medicare

Medicaid for Long-Term Care (LTC)

This program helps pay for long-term care in a nursing facility.

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. Your spouse can keep all of the income he/she receive. He or she may be able to receive some of your income as well.

People applying for long-term care Medicaid must provide five years of bank statements and an FL-2 form from their doctor that shows the need for nursing facility level of care, in addition to the regular Medicaid application requirements.

 

Additional Long-Term Care Requirements:

  • Transfer of Assets: If you give away assets or sell them for less than market value, you may be ineligible to receive Medicaid for 3-5 years. The sanction period is based upon the value of the assets transferred out of your name. There are certain circumstances where assets may be given away without penalty. Contact your local Department of Social Services office for more information.

  • Estate Recovery: When a person receiving long-term care Medicaid dies, Medicaid seeks to recover certain expenses. There will be a claim filed against the estate. Under certain circumstances, estate recovery may not apply. Contact your local Department of Social Services office for more information.

Program of All-Inclusive Care for the Elderly (PACE)

This program provides a PACE Center that includes a primary care clinic, therapy services, personal care, and dining services.

Who is eligible?

  • Age 55 or older

  • Need a nursing facility level of care

  • Live in a PACE organization's service area

Find a list of PACE centers.

People applying for PACE must provide an FL-2 form from their doctor that shows the need for nursing facility level of care and a signed application from their PACE center, in addition to the regular Medicaid application requirements.

To find help in the NC 2-1-1 database, search by:

Medicaid

PACE Programs

Long Term Care Options Counseling

Long Term Care Resident Subsidies

Need more information?

If you didn't find what you need on this page or need more information on local resources, dial 2-1-1 or 888-892-1162. Our call specialists are available 24 hours a day, 7 days a week.

 

Prepared by: NC 2-1-1/LP

Date Updated: May 23, 2018

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