Medicaid Expansion

NC Medicaid Now Covers More People in North Carolina.

WNCCHS takes all plans and is accepting new patients!

Thanks to Medicaid Expansion, NC Medicaid now covers people ages 19 through 64 with higher incomes, closing the coverage gap for North Carolinians. NC Medicaid pays for doctor visits, yearly check-ups, emergency care and more at little or no cost to participants.

Learn everything you need below, or visit Medicaid.ncdhhs.gov.

NC Medicaid Covers Most Health Services, Including:

  • Primary care so you can go to a doctor for a check-up or when you don't feel well

  • Hospital services

  • Maternity and postpartum care if you are pregnant and after giving birth

  • Vision and hearing services

  • Prescription drug benefits to pay for medications

  • Dental and behavioral health services

  • Preventive and wellness services

  • Medical devices and other therapies

There is no monthly fee and copays are never more than $4.

WNCCHS Medicaid Patients Are Eligible for Even More Benefits!

Including referrals for food boxes, transportation + car repairs, home weathering & renovations, home goods, utility assistance, and legal assistance.

Who is Eligible?

Most people will be able to get health care coverage through Medicaid if they meet the criteria below. And if you were eligible before, you still are!

  • You live in North Carolina

  • Age 19-64

  • You are a citizen. (Some non-US citizens can also get Medicaid health care coverage — more info here (English) and here (Spanish).

  • And if your household income fits within the chart to the right:

To determine whether you are eligible for Medicaid expansion, compare your household size to the 138% Federal Poverty Level for 2023. 

How Do I Apply?

Review the eligibility guidelines. If you are not sure if you are eligible, we suggest you apply anyway.

There are many ways to apply. You can apply online, by phone, email, mail, fax, or in person. See below for more details.

You can apply at any time of the year. It can take up to 45 calendar days (or up to 90 calendar days for disability applications) for your local Department of Social Services (DSS) to make a decision on your application. It can take longer if your application is missing information.

Do not wait — apply now. You may be eligible for Medicaid health care coverage for the last three months of medical bills starting from the date you apply.

Need help? If you need help applying, don’t worry! WNCCHS now has a Medicaid Navigator on our team who can help answer questions and assist with the application. Please call 828-285-0622 Ext.2141 to make an appointment with the WNCCHS Medicaid Navigator

What you must have to apply:

Full legal name and date of birth for at least one person applying

  • Mailing address for at least one person applying

  • Your signature (digital, voice, or written, depending on how you apply)

What you may need have to apply:

You can save time if you also give the following information:

  • Identity documents, such as driver’s license or school ID

  • Social Security number (SSN) for people applying who have them, or proof they have applied for one

  • Immigration documents for non-U.S. citizens who are applying

  • Proof you live in North Carolina, such as a photo ID with your address, a utility bill, a lease, or documentation of employment

  • Employer and income information for you and everyone in your household, such as paystubs, W-2 forms, tax returns or business records

  • Copies of all medical or life insurance policies

  • List of all cars, trucks, motorcycles, boats, etc. you or anyone in your household own, including the year, make, model and vehicle identification number (VIN) for each item

  • Most recent bank statements

  • List of all real property you own (this includes land, homes and buildings)

  • Current financial statements/award letters from other sources of income, such as Social Security, retirement benefits, pensions, veterans benefits and child support

Ways to Apply

For complete details on how to apply, please visit the NCDHHS Medicaid website. 

 WNCCHS patients, make sure WNCCHS is listed as your health care provider (or “PCP”) when applying!

  • Online

    Apply online through NCDHHS's secure website, ePASS. On the application, NC Medicaid is referred to as “Medical Assistance.”

    Download ePASS Fact Sheet

  • In Person

    Apply in person at your local Department of Social Services (DSS). Walk-ins are available at all local DSS. You can also schedule an in-person or phone interview.

    You can complete an application at your local DSS. Or, you can fill out a printable application (DMA-5200) ahead of time. If you are a single adult without health care coverage from your employer, use the “short form” application (DMA-5201).

  • Call

    Call your local Department of Social Services (DSS) to apply over the phone.

    Use the DSS directory or call the NC Medicaid Contact Center at 1-888-245-0179 to find the location closest to you.

  • Mail

    Download and fill out a printable application (DMA-5200, called the “Application for Health Coverage & Help Paying Costs”).

    Remember, you must sign your application.

    Then mail, email, fax or bring your application to your local Department of Social Services (DSS). Use the DSS directory or call the NC Medicaid Contact Center at 1-888-245-0179 to find the location closest to you.

Need Help Applying for Medicaid?

There are several ways you can get help applying for Medicaid. Here are some options:

  • WNCCHS now has a Medicaid Navigator on our team who can help answer questions and assist with the application. Please call 828-285-0622 Ext. 2141 to make an appointment with the WNCCHS Medicaid Navigator

  • Call WNCCHS's medical legal partner, Pisgah Legal Services, for help with enrollment: (828) 210-3404.

Medicaid Plans

When enrolling Medicaid, you must enroll in a health plan. All plans are required to have the same type of Medicaid services you get now. These include:

Doctor visits | Medical supplies | Hospital visits | Lab tests and X-rays | Behavioral health care | Therapies | Prescriptions | Hospice | Eye care

WNCCHS accepts all Medicaid health plans.

NCMedicaidPlans.gov

To see the full list of NC Medicaid covered services provided by the health plans, go to ncmedicaidplans.gov. WNCCHS accepts all Medicaid health plans.

We recommend you check your account to see which plan and Primary Care Provider is listed for you, since they can be automatically assigned – but you can change either for any reason. 

If you want to change your health plan, you have 90 days after Medicaid enrollment to pick a new one. To do so, visit ncmedicaidplans.gov, use the NC Medicaid Managed Care mobile app, or call 1-833-870-5500. 

WNC Family Planning Program Update

Those who are eligible for full Medicaid benefits will

  • Get a letter from their local Department of Social Services letting them know they will start getting full Medicaid coverage

  • Be assigned a health plan

  • Receive a packet from their health plan in the mail that includes a new Medicaid ID card 

Additionally, anyone with health coverage through HealthCare.gov will need to cancel their plan once they are enrolled in NC Medicaid.  

Many people who were previously enrolled in Medicaid’s limited Family Planning program were automatically enrolled for full NC Medicaid benefits starting December 1, 2023.

Not everyone with limited Family Planning Program benefits will be automatically enrolled in full coverage through NC Medicaid. Some people may have income that exceeds the new Medicaid eligibility levels, even though qualifying income levels are higher than the past. If your income has recently changed and you think you may be eligible, update your information in ePASS (ePASS.nc.gov) or by contacting your local Department of Social Services (DSS). Also, please use ePASS or contact your local DSS office to make sure your contact information is up to date so that you do not miss important information about your benefits.   

Frequently Asked Questions

Download NCDHHS's FAQ Document HERE

  • Yes, for as long as you choose to be! WNCCHS serves patients who are both uninsured and insured, which includes Medicaid. You can enroll in Medicaid and continue to see your WNCCHS provider per usual -- in fact, you become eligible for even more assistance/services!

  • Current beneficiaries with full Medicaid coverage will not see any changes.

  • You can apply now. The best way to apply is online through ePASS; you can also apply in-person, by phone or mailed applications. The processing time for applications can be up to 45 days. Applications submitted online may be processed faster.

    If you need help applying, don’t worry! WNCCHS now has a Medicaid Navigator on our team who can help answer questions and assist with the application. Please call 828-285-0622 Ext.2141 to make an appointment with the WNCCHS Medicaid Navigator

  • When Medicaid Expansion passed, some folks were automatically enrolled in a health plan and assigned a Primary Care Provider or “PCP.”

    However, you may change your PCP for any reason through Aug. 31, 2024, and we encourage you to do so. To change your PCP to your WNCCHS PCP, you need to call your health plan and request the change. You can find the phone number for your plan on your Medicaid ID Card.

    • WellCare: 1-866-799-53181 (TTY: 711) 1-866-799-53181

    • UnitedHealthcare Community Plan: 1-800-349-1855 (TTY: 711)

    • HealthyBlue: 1-844-594-5070 (TTY: 711)

    • AmeriHealth Caritas: 1-855-375-8811 (TTY: 1-866-209-6421)

    • Carolina Complete Health: 1-833-552-3876 (TTY: 711 or 1-800-735-2962)

    • How to change your PCP if you are in NC Medicaid Direct: Call the NC Medicaid Contact Center at 1-888-245-0179.

  • Medicaid recently transitioned to a managed care model and most enrollees must choose the health plan that best works for them. Click here to view health plan options available for you. Many providers accept Medicaid plans, and WNCCHS accepts them all.

    We recommend you check your account to see which plan and Primary Care Provider is listed for you, since they can be automatically assigned – but you can change either for any reason.

    If you want to change your health plan, you have 90 days after Medicaid enrollment to pick a new one. To do so, visit ncmedicaidplans.gov, use the NC Medicaid Managed Care mobile app, or call 1-833-870-5500.

  • Health care visits will be either free or low cost. You will not have pay a monthly premium to enroll in Medicaid expansion.

  • Not at this time. As of now, CMS and the Biden administration have not allowed work reporting requirements as a condition of Medicaid coverage.

  • The date coverage begins depends on when you apply for Medicaid. Here are examples of situations people may have:

    • You apply for Medicaid in December 2023. Your application is not processed until January (or later). But you need care in December. If you are eligible, your Medicaid coverage will be retroactive to December 1. That means if you get care in December, your provider can bill for services that Medicaid covers. You should not have to pay out of pocket. You may have to pay a copay.​

    • You apply for Medicaid in January 2024 (or later) but have medical bills you need to pay from services you received in December 2023. When you apply for Medicaid, make sure you answer the questions that ask about medical bills from prior months. You can request that your Medicaid coverage be retroactive for up to three months before the month you applied. So, if you apply in March and you are eligible, Medicaid can pay bills for covered services from December, January and February. Remember, coverage under expansion can only go back to December 2023.

  • Some non-U.S. citizens can get health coverage through Medicaid. To be eligible you must live in North Carolina and be a non-citizen with qualified immigration status. Many people in this category must wait five years before they can apply for Medicaid, although there are some exceptions, as explained below.

    Qualified immigration status includes:

    • Lawful Permanent Residents (LPR/Green Card Holder)

    • Asylees

    • Refugees

    • Cuban/Haitian entrants

    • Paroled into the U.S. for at least one year

    • Conditional entrant granted before 1980

    • Battered non-citizens, spouses, children or parents (“Battered” means someone who has experienced abuse from a family member.)

    • Victims of trafficking and their spouse, child, sibling or parent or individuals with a pending application for a victim of trafficking visa

    • Granted withholding of deportation (a specific situation similar to asylum)

    • Non-citizen members of a federally recognized Indian tribe or American Indian born in Canada

    • Citizens of the Marshall Islands, Micronesia and Palau who are living in one of the U.S. states or territories

    Some of the non-U.S citizens on the list above do NOT have to wait 5 years to be eligible for Medicaid, including pregnant women, children under the age of 19, asylees, refugees, victims of trafficking, Cuban-Haitian Entrants and people who now have LPR status and who were previously asylees, refugees, victims of trafficking or Cuban-Haitian entrants.

    Also, all non-citizens from the list above who are connected to the military such as veterans, active-duty military (and their spouses and children) do not have to wait five years for Medicaid eligibility.

    IF NONE OF THE QUALIFIED IMMIGRATION STATUSES LISTED ABOVE APPLY TO YOU:

    • If you are not a U.S. citizen or part of these immigration categories, but you would otherwise qualify for NC Medicaid, you may still apply to get emergency coverage that includes:

    • Payment for the costs of childbirth. Get coverage for medical costs during labor and delivery. You can apply up to three months after birth.

    • Payment for emergency services. Get coverage for the medical costs of treating an emergency, like a heart attack, stroke or serious accident. You can apply up to three months after the emergency.

    To get this emergency coverage, apply for NC Medicaid as normal — but you do not need to show documentation or answer questions about your immigration status.

  • You do not have to pay any monthly premiums. Medicaid pays the cost for most health care services. The highest copay is $4 and that is only required for some services.