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experience with Medicaid in NC?

post #1 of 7
Thread Starter 

Hi all,

My name's Sadie and I'm new here!


Anyone have experience using Medicaid for your pregnancy in NC? I read that your eligibility is based on one month's income. But I'm wondering which month that is - the month of your interview? the previous month? the month you conceived? other?  My income varies wildly and I don't know how to tell if it's even worth my while to apply!


I'm also curious to hear about any other experiences, thoughts, info about Medicaid!



post #2 of 7
Congrats and welcome to NC!
It's been awhile (2011), but for us they wanted five months of DH's income (self employed) and six weeks of my paystubs because ours varies widely too. I think they worked out an average from that. I wasn't pregnant when I applied, though, so you might have an easier time. I know the income cap is higher for pregnancy so it might be worth your while to at least do the math & compare. Are you planning on getting it for yourself too or just for baby?
post #3 of 7

We will be applying too(for our 3 children) so I'd be curious how they do it too.  We are relocating though from LA and they already have it here so I hope it is a smooth transition.  I won't even get paid until 3 weeks until August(start a new job end of the month) so I don't know what to expect!

post #4 of 7

If you are receiving paystubs, it's the last completed month (so right now on July 14, I'd have to turn in June's).  I am self-employeed, so they usually want 5 or 6 months or my tax filing print-out.

post #5 of 7
Thread Starter 

Hi all,

Thanks for the info!  FYI, I did some further investigating on my own and found out some helpful info.  Right now, for a pregnant woman, the income limit is 185% of the FPL (federal poverty line) and (for maternity medicaid only) they do not look at your "resources" (savings, property, etc).  If you are not married, they only look at your income - not your partner's, roommate's. 


Unfortunately, however, a bill just passed the state Senate that would lower the limit to 133% - more info here: http://www.newsobserver.com/2013/05/29/2925430/nc-senate-budget-plan-pushes-pregnant.html  It still has to pass the House, but it probably will, sometime in 2014.  :-(  I'm not sure if women between 133% and 185% would be kicked off or grandfathered in at that point.


However, at the same time, by then the new "no closed door" policy will have been enacted (part of healthcare reform), meaning that if you don't qualify for Medicaid, instead of being turned away, you will instead be directed to a BYO healthcare plan. And since pregnancy will no longer be considered a pre-existing condition, you can purchase your own insurance, and you will be able to get financial assistance from the federal government in paying premiums, copays, etc - more info here: https://www.healthcare.gov/.  Unlike now, in which if you get turned down by Medicaid, it is too late to buy insurance. Ugh.


Whew!!  So complicated!


- Sadie

post #6 of 7
Thread Starter 

Oh yes, and a few more resources:


Here is a link to the DHHS manual on Medicaid coverage on pregnant women. It is not very user-friendly, but does cover the process and policy rules in detail: http://info.dhhs.state.nc.us/olm/manuals/dma/fcm/man/MA3240.htm#TopOfPage.


For questions on specifically what coverage is available under Medicaid for children (MIC) and Medicaid for Pregnant women (MPW): http://www.ncdhhs.gov/dma/medicaid/famchld.pdf.


To find local providers who accept Medicaid, a search tool: http://www.ccpgm.org/body.cfm?id=110.




- Sadie

post #7 of 7
I just got pregnancy Medicaid. I'm self-employed and so had to turn in my taxes from last year, plus an itemized list of business expenses vs. Income. I'm unmarried, but living with my partner. I qualified bc my income was less than the limit of I think about $1,800 a month. Also had to explain my current income, which is a part time job plus self employed. It took like a month and a half for them to sort through it. For a family of five, it would be different.
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