Get the free Eligibility Review Document – Medicaid / NC Health Choice

This document is used for reviewing eligibility for Medicaid and NC Health Choice, detailing requirements for citizenship, state residence, health insurance coverage, disability verification, and

How to fill out eligibility review document medicaid

How to fill out Eligibility Review Document – Medicaid / NC Health Choice

1. Gather all necessary personal information, including your name, address, and Social Security number.
2. Collect financial documentation such as income statements, bank statements, and tax returns.
3. Provide information about household members, including their names and any relevant identification numbers.
4. Fill in the Medicaid/NC Health Choice Eligibility Review Document with the gathered information, following the formatting and instructions provided.
5. Double-check all entries for accuracy and completeness before submission.
6. Submit the completed Eligibility Review Document to the designated agency either online or through mail.

Who needs Eligibility Review Document – Medicaid / NC Health Choice?

1. Individuals or families seeking access to Medicaid or NC Health Choice programs.
2. People experiencing financial hardships or changes in household income.
3. New applicants or current recipients needing to renew their eligibility status.
4. Caregivers applying on behalf of children or dependents.

People Also Ask about

What is the income limit to qualify for NC Medicaid?

An adult ages 19-64 may be eligible if the family income is $2,351/month or less. An adult ages 65+ may be eligible for full Medicaid if the family income is $1,704/month or less, and for other programs if the family income is $2,300/month or less. Additional requirements apply.

How do you qualify for personal care services in NC?

To qualify for PCS, an individual must have a medical condition, disability or cognitive impairment, and demonstrates unmet needs for: Three of the five ADLs with limited hands-on assistance. Two ADLs, one of which requires extensive assistance. Two ADLs, one of which requires assistance at the full dependence level.

What are the eligibility criteria for the NC Health Choice?

NC Health Choice is a free or reduced cost health insurance program for uninsured children birth through age 18. Who is it for? Children who have family incomes that are too high for Medicaid coverage, but equal to or less than 200% of the federal poverty guidelines.

What is the highest income to be eligible for Medicaid?

Parents of Dependent Children: Income limits for 2025 are reported as a percentage of the federal poverty level (FPL). The 2025 FPL for a family of three is $26,650. Other Adults: Eligibility limits for other adults are presented as a percentage of the 2025 FPL for an individual is $15,650.

Who is eligible for NC Healthy Opportunity Pilot?

To be eligible for and receive Pilot services, NC Medicaid Managed Care members must live in a Pilot region (in one of the counties listed above) and have at least one qualifying physical or behavioral health condition and one qualifying social risk factor, as defined by the Department and CMS.

What documents are needed for Medicaid in NC?

Prepare the following documents below for each person applying to help complete your application: Full legal name. Date of birth. Social Security number (or immigration documents) North Carolina residency. Income information (from paystubs, W-2 forms, tax returns or business records)

What is the income eligibility for Medicaid in NC?

An adult ages 19-64 may be eligible if the family income is $2,351/month or less. An adult ages 65+ may be eligible for full Medicaid if the family income is $1,704/month or less, and for other programs if the family income is $2,300/month or less. Additional requirements apply.

How do I verify my Medicaid provider eligibility in NC?

Providers still must confirm that the recipient's eligibility information is in NCTracks before submitting the claim or the claim may be denied. To contact the NCTracks Call Center to inquire on recipient eligibility in NC FAST, dial 1-800-688-6696.

For pdfFiller’s FAQs

What is Eligibility Review Document – Medicaid / NC Health Choice?

The Eligibility Review Document for Medicaid / NC Health Choice is a form used to assess and verify the ongoing eligibility of individuals for health coverage under these programs in North Carolina.

Who is required to file Eligibility Review Document – Medicaid / NC Health Choice?

Individuals enrolled in Medicaid or NC Health Choice are required to file the Eligibility Review Document to ensure they continue to meet the eligibility criteria for these programs.

How to fill out Eligibility Review Document – Medicaid / NC Health Choice?

To fill out the Eligibility Review Document, individuals must provide accurate personal information, income details, household composition, and any other relevant information requested on the form.

What is the purpose of Eligibility Review Document – Medicaid / NC Health Choice?

The purpose of the Eligibility Review Document is to verify the eligibility of recipients for Medicaid or NC Health Choice, ensuring that assistance is provided to those who qualify based on current income and other criteria.

What information must be reported on Eligibility Review Document – Medicaid / NC Health Choice?

The document requires reporting of information including household income, number of household members, changes in employment status, and any other relevant personal details that may affect eligibility.