Will YOU be Medicaid Eligible on January 1, 2013?

Ok, Maybe not exactly on January 1, 2013. But starting January 1, 2013, new rules will be implemented from Obamacare, and, slowly, changes in Medicaid eligibility will occur.  Realistically, in may take a year for NC to adjust.

To qualify currently for the North Carolina Medicaid program, a person must be a citizen or lawful permanent immigrant in the United States for at least five years and must meet certain categorical, income and resource requirements.  The individual must also have an income below a certain income threshold and have limited resources (depending on the size of the family) or assets to qualify.

Imagine, as of now, a person working at minimum wage ($7.25/hour), 40 hours week, and 50 weeks/year and earn $14,500/year, is generally making too much money to be Medicaid eligible.  For example, a parent in a family of four would only qualify in North Carolina if his or her income was less than $7,128/year, equivalent to less than half of what a person earns on minimum wage.

The best way to illustrate who will be covered by Medicaid in the future is a chart:

                                  2011 Income Eligibility/Year              2013+ Income Eligibility/Year

Category                 % Fed Poverty        Medicaid                      % Fed Poverty        Medicaid

Child Age 0-5                   200%                   1:<$21,780               200%                      1:<$21,780

Child Age 5-18                100%                    1:<$10,890                138%                       1:<$15,028

Pregnant Woman           185%                    2:<$27,214                185%                      2:<$27,214

Parent of Dep. < 19         1:40%                    1:<$4,344                138%                    1:<$15,028

Adult, 0 children           Not eligible          Not eligible               138%                    1:<$15,028

After 2013, the income guidelines for an individual (single adult without dependent children) would be $15,028/year or $30,843/year for a family of four if based on 2011 federal poverty levels.

Obviously, this is a huge expansion. Low-income adults is the category impacted the most.

So, after the BIG CHANGE, will YOU be Medicaid eligible?


About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on December 7, 2012, in Affordable Care Act, Medicaid, Medicaid Eligibility, Medicaid Expansion, North Carolina, Obamacare and tagged , , , , , , , . Bookmark the permalink. Leave a comment.

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