Section 108A-54.3A - Eligibility categories and income thresholds(a) The Department shall provide Medicaid coverage for individuals in accordance with federal statutes and regulations and specifically shall provide coverage for the following populations: (1) Families, children under the age of 21, pregnant women, and individuals who are aged, blind, or disabled, who are medically needy, subject to the following annual income levels after meeting the applicable deductible: Family Size | Income Level |
1 | $2,904 |
2 | 3,804 |
3 | 4,404 |
4 | 4,800 |
5 | 5,196 |
6 | 5,604 |
7 | 6,000 |
8 | 6,300 |
9 | 6,504 |
10 | 6,900 |
11 | 7,200 |
12 | 7,596 |
13 | 8,004 |
14 | 8,400 |
each additional family member | add $396 |
(2) Families and children under the age of 21, subject to the following annual income levels: Family Size | Income Level |
1 | $5,208 |
2 | 6,828 |
3 | 8,004 |
4 | 8,928 |
5 | 9,888 |
6 | 10,812 |
7 | 11,700 |
8 | 12,432 |
9 | 13,152 |
10 | 14,028 |
each additional family member | add $936 |
(2a)(Repealed retroactively to July 1, 2022)(3) Children through the age of 18 with family incomes equal to or less than two hundred eleven percent (211%) of the federal poverty guidelines. (5) Children under the age of 21 who are receiving foster care or adoption assistance under Title IV-E of the Social Security Act, without regard to income.(6) Children in the legal custody of State-sponsored foster care who are under the age of 21 and ineligible for Title IV-E assistance, without regard to income. (7) Independent foster care adolescents ages 18, 19, and 20, as defined in 42 U.S.C. § 1396d (w)(1), without regard to income.(8) Former foster care children under the age of 26 in accordance with 42 U.S.C. § 1396a (a)(10)(A)(i)(IX), without regard to income.(9) Adoptive children with special or rehabilitative needs, regardless of the adoptive family's income. (10) Pregnant women with incomes equal to or less than one hundred ninety-six percent (196%) of the federal poverty guidelines. Pregnant women shall remain eligible for coverage for 12 months postpartum. (11) Men and women of childbearing age with family incomes equal to or less than one hundred ninety-five percent (195%) of the federal poverty guidelines. Coverage for the individuals described in this subdivision shall be limited to coverage for family planning services. (12) Women who need treatment for breast or cervical cancer and who are defined in 42 U.S.C. § 1396a (a)(10)(A)(ii)(XVIII). (13) Aged, blind, or disabled individuals, as defined in Subpart F of Part 435 of Subchapter C of Chapter IV of Title 42 of the Code of Federal Regulations, with incomes equal to or less than one hundred percent (100%) of the federal poverty guidelines. (14) Beneficiaries receiving supplemental security income under Title XVI of the Social Security Act. (15) Workers with disabilities, as provided in G.S. 108A-66.1. (16) Qualified working disabled individuals, as provided in G.S. 108A-67. (17) Qualified Medicare beneficiaries with incomes equal to or less than one hundred percent (100%) of the federal poverty guidelines. Coverage for the individuals described in this subdivision shall be limited to payment of Medicare premiums and deductibles and coinsurance for Medicare-covered services. (18) Specified low-income Medicare beneficiaries with incomes equal to or less than one hundred twenty percent (120%) of the federal poverty guidelines. Coverage for the individuals described in this subdivision shall be limited to payment of Medicare Part B premiums. (19) Qualifying individuals who are Medicare beneficiaries and who have incomes equal to or less than one hundred thirty-five percent (135%) of the federal poverty guidelines may be covered within funds available for the Limited Medicare-Aid Capped Enrollment program. Coverage for the individuals described in this subdivision shall be limited to payment of Medicare Part B premiums. (20) Recipients of an optional State supplementation program provided in accordance with 42 U.S.C. § 1382e. (21) Individuals who meet eligibility criteria under a Medicaid waiver approved by the Centers for Medicare and Medicaid Services and authorized by an act of the General Assembly, within funds available for the waiver.(22) Refugees, in accordance with 8 U.S.C. § 1522. (23) Qualified aliens subject to the five-year bar for means tested public assistance under 8 U.S.C. § 1613 and undocumented aliens, only for emergency services under 8 U.S.C. § 1611. (24) Individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act who are in compliance with any work requirements established in the State Plan and in rule. Coverage for individuals under this subdivision is available through an Alternative Benefit Plan that is established by the Department consistent with federal requirements, unless that individual is exempt from mandatory enrollment in an Alternative Benefit Plan under 42 C.F.R. § 440.315. (24)(Contingent effective date - See Note) Individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act who are in compliance with any federally approved work requirements established in the State Plan and in rule. Coverage for individuals under this subdivision is available through an Alternative Benefit Plan that is established by the Department consistent with federal requirements, unless that individual is exempt from mandatory enrollment in an Alternative Benefit Plan under 42 C.F.R. § 440.315.(b)(Effective retroactively to June 26, 2020)The applicable federal poverty guidelines for the eligibility categories in subsection (a) of this section shall be updated annually on April 1 immediately following publication of the federal poverty guidelines.N.C. Gen. Stat. § 108A-54.3A
Amended by 2024 N.C. Sess. Laws 1,s. 3.3-c, eff. 5/15/2024, repealing subsection (a)(2a) effective retroactively to July 1, 2022.Amended by 2023 N.C. Sess. Laws 134,s. 9E.23-e1, eff. on the later of the following dates: (1) The date approved by the Centers for Medicare and Medicaid Services for Medicaid coverage to begin in North Carolina for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act. (2) The date this act becomes law.Amended by 2023 N.C. Sess. Laws 134,s. 9E.23-c1, eff. 9/22/2023,effective retroactively to June 26, 2020..Amended by 2023 N.C. Sess. Laws 11, s. 3.2-c, eff. 4/1/2023.Amended by 2023 N.C. Sess. Laws 7, s. 1.7-n, eff. 3/27/2023. 2023 N.C. Sess. Laws 7, s. 1.1-d, provides: The Secretary of the Department of Health and Human Services shall notify the Fiscal Research Division and the Revisor of Statutes of the date approved by CMS for Medicaid coverage to begin in North Carolina for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act.Amended by 2023 N.C. Sess. Laws 7, s. 1.1-b, eff. 3/27/2023, op. 3/27/2023.Amended by 2022 N.C. Sess. Laws 74, s. 9D.15-c, eff. 4/1/2023, due to occurrence of contingency in 2022 N.C. Sess. Laws 74, s. 9D.15-cc.Amended by 2022 N.C. Sess. Laws 74, s. 9D.14-e, eff. 7/1/2022.Amended by 2021 N.C. Sess. Laws 180, s. 9D.13-a, eff. 4/1/2022.Amended by 2021 N.C. Sess. Laws 180, s. 9D.14-b, eff. 7/1/2021.Amended by 2021 N.C. Sess. Laws 62, s. 4.3, eff. 6/29/2021.Added by 2020 N.C. Sess. Laws 78, s. 4D.1, eff. 7/1/2020.Contingent Effective Date - Contingent Expiration: Section 9D.14.(c) of 2021 N.C. Sess. Laws 180 provides: "Subsection (b) of this section is effective upon the approval by the Centers for Medicare and Medicaid Services (CMS) of the request submitted in accordance with Section 9A of S.L. 2015-245, as amended by Section 2(e1) of S.L. 2016-121 and subsection (a) of this section, and on the effective date of the coverage allowed by CMS. The Secretary of the Department of Health and Human Services shall notify the Revisor of Statutes of the effective date allowed by CMS upon receipt of this approval. If the approval is not granted by CMS prior to June 30, 2023, then this section shall expire on that date."