What Is Medicaid?
Simply put, Medicaid is healthcare coverage for people with low incomes, including children, seniors and individuals with disabilities. It’s a federal program administered by the states.
In North Carolina, Medicaid also includes NC Health Choice (NCHC) for Children. NCHC is our state’s name for the federal Children’s Health Insurance Program (CHIP), which is also administered by the states, and provides free or low-cost comprehensive health coverage to children whose families make too much money to qualify for Medicaid.
In recent years, an estimated 1.5 to 2 million North Carolinians have been enrolled in Medicaid (roughly one out of every five people in the state), with children making up more than half of that number.
Maybe because many enrollees are elderly, Medicaid is sometimes confused with Medicare, the federal health-insurance program that pays for hospital and medical care for elderly patients, and for certain disabled Americans. To complicate this picture a little more, close to 10 million people in the United States are actually covered by both Medicaid and Medicare. These “dual-eligibles,” typically low-income seniors and younger people with disabilities, generally have more complex, and costly, healthcare needs.
The federal government provides at least half the funding for state Medicaid programs, but does require that states provide a minimum set of services in order to receive that money.
What Services Does Medicaid Offer?
NC Medicaid adds some services to those benefits that the federal government requires of all states, though in general, Medicaid covers the following:
- Doctors, OB/GYNs, health departments, and rural health clinics
- Laboratory and radiology
- Hospitals, anesthesia, and ambulatory surgical centers
- Outpatient specialized therapy
- Prescriptions (except prescriptions for Medicare beneficiaries)
- Vision and hearing
- Dental services
- Children’s orthodontia
- Nursing-home care
- Personal care and other home-health services
- Medical equipment, such as wheelchairs
- Orthotics and prosthetics
- Mental and behavioral healthcare
- Transition from facilities to home-based and community care
- Most medically necessary services for children under age 21
- Medicare premiums, copayments, and deductibles
What Services Does NCHC Offer for Children?
North Carolina Health Choice, a health-insurance program for children of families who make too much to qualify for Medicaid but too little to afford private insurance, covers:
- Case-management and care-coordination services
- Limited dental services
- Durable medical equipment and disposable medical supplies
- Emergency services
- Family-planning services
- Hospice care
- Home-health care
- Immunizations (shots)
- Inpatient services
- Laboratory and radiology services
- Mental health services, both inpatient and outpatient
- Physician and clinic services, both well-child and sick visits
- Physical therapy
- Occupational therapy
- Therapy for children with speech, hearing and language disorders
- Prescription drugs
- Substance-abuse services, both inpatient and outpatient
- Surgical services
Types of Medicaid
N.C. has several different Medicaid programs; Access East works directly with the two most common:
- Medicaid Managed Care: The largest NC Medicaid program. People join one of several available standard health plans, officially known as prepaid health plans, or PHPs. Four PHPs are available in all the N.C. counties (with one additional plan also available in a few of the southernmost counties that Access East serves).
All plans are required to provide the same Medicaid services, such as doctor’s office visits and hospital services, blood tests and X-rays, and care management like Access East provides. Some plans also offer additional health services, like helping people to quit smoking or to eat a better diet. Each plan has its own network of doctors and support staff.
People applying for Medicaid should talk with their current medical practice to figure out which plan may be best for them, or call the NC Medicaid office at (833) 870-5500 for advice on how to decide.
- Medicaid Direct: Our state’s healthcare program for people on Medicaid who are not enrolled in one of the standard health plans. People with more complex healthcare needs often are better suited to this program; Medicaid patients should ask their doctor’s offices, or call the NC Medicaid office at (833) 870-5500, for help figuring out if Medicaid Direct is a better fit for them.