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Adult Medicaid

Adult Medicaid

Adult Medicaid

 

Private Living Arrangement (PLA)

  • Medical Assistance for the Aged (MAA)—Must be aged 65 or older and meet all income and resource limits.
  • Medical Assistance for the Disabled (MAD)—Must meet the Social Security definition of disability, which is have a mental or physical impairment that has lasted for at least 1 year or is expected to last that long or result in death.  Must meet income and resource limits.
  • Medical Assistance for the Blind (MAB)—Must meet the Social Security definition of blindness-vision is 20 degrees or less in the better eye, even with a corrective lens or you vision cannot be corrected to better than 20/200 in that eye.  Must meet income & resource limits.

 

Long Term Care Medicaid (LTC)

 Helps pay for medically necessary nursing home care for a Medicaid-eligible person in a nursing home or an intermediate care facility for those with intellectual disabilities.

The beneficiaries must use their income to pay for nursing home care. Medicaid pays the difference between the recipient's income and the nursing home rate. The beneficiary retains $30 per month for personal needs not provided by the nursing home. Also, an additional amount may be set aside for a spouse or a dependent living at home; or for special needs such as health insurance premiums and charges not covered by Medicaid.

 

Community Alternatives Program (CAP)

The Community Alternatives Program (CAP) allows North Carolina Medicaid funds to be used to provide home and community-based services to Medicaid beneficiaries. These services provide both medical and non-medical home and community-based services to prevent or delay institutionalization.

 

CAP RESOURCES: North Carolina has different CAP waivers tailored to individuals. For more information, contact any of the following organizations. Keep in mind there could be a waiting list.

  • CAP for Disabled Adults (CAP/DA) Harnett County Department of Aging (910) 893-7596
  • CAP for Children (CAP/C) Holland Case Management (919) 482-3595 / RHA Health Services (888) 207-7828 / XCV Jordan Management Group (877) 768-1901
  • CAP Innovations Intellectually/Developmentally Disabled Children or Adults (CAP/IN) Sandhills Center (800) 256-2452                               

 

Program of All-Inclusive Care for the Elderly (PACE)

Assist elders to live safely at home or with their loved ones with the help of a team of healthcare professionals. The beneficiary must reside in the PACE organization's service area (some areas of Harnett Co aren’t serviced).

Life St. Joseph of the Pines / PACE (919) 429-7222

 

Special Assistance (SA)

State/County Special Assistance (SA) (Rest Home)

The SA program provides financial assistance to individuals or couples who wish to reside in a state licensed adult care home, assisted living facility, and other domiciliary facilities.   Eligibility is for persons 18 years or older and individuals under the age of 65 must be determined disabled based on Social Security’s definition of disability.

Special Assistance (SA) In-Home

The SA In-Home program provides financial assistance for eligible recipients so they may remain in their own home or in a private living setting instead of placement in a facility.  The SA In-Home program provides cash payments and requires an assessment by a Social Worker.  Eligibility is limited to individuals 18 and older and individuals under 65 must be determined disabled on Social Security’s definition of disability.

Individuals must apply in person at the local county DSS in the county where they live or where they lived prior to entering a facility.  A Power of Attorney or an Authorized Representative may apply for the applicant on their behalf.

Apply in person at:

Harnett County Department of Social Services 

311 West Cornelius Harnett Blvd

Lillington, NC  27546

                                                                                                                                                                                     

 

North Carolina Medicaid Eligibility Criteria NCDHHS Policy

How do I apply?

To apply online now, click Here

Apply In-Person at Harnett County Department of Social Services 311 West Cornelius Harnett Blvd., Lillington, NC  27546

To print paper application, English / Spanish

Authorized Representative Form Authorized Representative Form

Phone 910-814-6585 or Fax 910-912-1518 

 

FAQ's

Private Living Arrangement (PLA)

What does PLA mean?

PLA stands for Private Living Arrangement, Medicaid that covers individuals or couples living in their own home or apartment or in the homes of relatives or friends. 

What requirements do I have to meet in order to be eligible for Adult Medicaid?

Aged (65 or older), Deemed disabled by SSA, or legally blind.

What is the definition of disability?

The Social Security Administration defines disability as a physical or mental impairment, that prevents an individual from engaging in any substantial gainful activity, such as holding a job, and which has lasted or is expected to last for at least 12 months OR result in death.

What is the income limit for PLA?

The income limit for a single person for full Medicaid is $1215, a couple is $1644.

What is the reserve limit for PLA?

The reserve limit for a single person for full Medicaid is $2000, a couple is $3000.

How can I apply for PLA Medicaid?

You can come to the office to apply in person, we can mail you an application, apply online with Epass (Epass.nc.gov), or do a phone application.

What is the processing time for an application?

A disability application is up to 90 days, An Aged or MQB application is 45 days.

What does MQB stand for?

Medicare Qualified Beneficiaries

What does MQBQ cover?

This program overs Medicare Part B premiums, Medicare deductibles and copays.  Beneficiaries DO NOT receive a Medicaid card.

How do I report changes to my caseworker?

You can contact your caseworker via telephone, email, intake line intake line 910-814-6585 of come into the office and speak with them.  Your caseworker contact information is listed below. 

 

Long Term Care (LTC)

What is the income limit for LTC?

Income must be less than the cost of care in the facility at the Medicaid rate.

What are the reserve limits for LTC?

The reserve limits are $2000 for one household composition. For a married couple the resource limits change yearly.

How long will it take to approve my LTC application?

For 65 and over the timeframe is 45 days.  Under 65 the time frame is 90 days, and the client must be deemed disabled.  The time starts from the date of the application. 

Can I give my assets/resources to a family member?

When an applicant transfers assets/resources to a family member this could potentially make the applicant ineligible for LTC Medicaid.  All assets/resources are reviewed for transfers 5 years prior to the date of the application.

What is a FL2 and how do I get it?

An FL2 describes a patient's medical condition and the amount of care they need when placed in a nursing home.

If the client receives health insurance from a Prepaid health plan (PHP), the FL2 would be obtained from the PHP.

If the client received managed care Medicaid, the Doctor would complete the FL2 and submit the form to NC Tracks.

The hospital and/or the nursing home will assist in this process.

What is a PML?

Patient Monthly Liability (PML) is the amount the beneficiary is responsible for toward their monthly cost of LTC.  The PML consists of the applicant's countable income.

Do I have to be placed in a Nursing home before I can be approved for LTC Medicaid?

Yes, an applicant must be placed in a nursing home before their application can be approved.

Do I have to be placed in a Harnett County Nursing home?

No, an applicant can reside in any Nursing home in North Carolina.

Would I be able to move to another nursing home?

Yes, make sure to notify your Medicaid caseworker of the change. 

What is the difference between an Adult Care Home and a Nursing home?

An Adult Care Home assist individuals who do not need nursing care but cannot live at home independently and have their care needs safely met.

A Nursing Home is a health care facility that provides nursing or convalescent care to persons who are not sick enough to be in the hospital, but who need services provided by licensed nursing staff.

How can my spouse at home pay the bills and I'm in a nursing home?

A spouse at home will keep all of their income, potentially they can receive some or all the spouses' income that's in the nursing home.

 

Special Assistance (SA)

What is the income limit for Special Assistance?  

Special Assistance Basic Rate total countable monthly income limit is $1354.51.

Special Assistance Enhanced Rate total countable monthly income limit is $1716.51.

What is the difference in basic and enhanced rate?

Enhanced rate is a higher rate for beneficiaries diagnosed with Alzheimer or other forms of Dementia.

What is Special Assistance In-Home?

Special Assistance In-Home provides an alternative to placement in a SA Facility by providing a cash supplement to individuals who desire and are able to live at home safely with additional supportive services. 

What is the FL2 for Special Assistance?

In order to receive SA in an Adult Care Home or SA In-Home you must have a valid Adult Home FL2 with recommended level of care indicated in block 11, it must indicate the need for domiciliary care, which is a term that includes care provided in adult care homes, assisted living, supervised living, mental health group homes, hospice residential facilities, rest homes, or specialized community residential centers.

How do I choose an adult care home?

Find out as much as you can about the adult care home, such as the homes' compliance status and compliant history, talk with doctors, social workers, ombudsman, anyone who might be familiar with the home, residents and families of residents who live at the home about the care and services offered.  Visit the home at least twice unannounced, observe the resident's appearance, hygiene, interaction between residents and staff, visibility of staff, type of meals served, cleanliness of the building, noise level, lighting and building security. 

How do I apply for SA?

SA application must be done in person, face to face, at the Department of Social Services by the client, Power of Attorney, Legal Gurdian, or Authorized Representative.

 

 

Contact Us:

INTAKE PHONE NUMBER: 910-814-6585

Fax number: 910-912-1518

Email: dssmedicaid@harnett.org 

Pam Bryant / 910-814-6812 / pbryant@harnett.org 

Brenda Cameron / 910-814-6577 / bcameron@harnett.org 

Casey Cantrell / 910-814-6598 / ccantrell@harnett.org 

Michael Cardona / 910-814-6588 / mcardona@harnett.org 

Michelle Ennis / 910-814-6599 / mennis@harnett.org 

Bridgett Hagins / 910-814-6573 / bhagins@harnett.org 

Kristan Harrod / 910-814-6852 / kharrod@harnett.org 

Patricia Jennings / 910-814-6578 / pjennings@harnett.org 

Vickie Jones / 910-814-6813 / vjones@harnett.org 

Mattie Kelly / 910-814-6583 / mkelly@harnett.org 

Myra Laster / 910-814-6589 / mlaster@harnett.org 

Lanita McDougald / 910-814-6853 / lmmcdougald@harnett.org 

Dyanna Montes Febres / 910-814-6845 / dfebres@harnett.org 

Christin Murphy / 910-814-6820 / cmurphy@harnett.org 

Michelle Odom / 910-814-6587 / modom@harnett.org 

Jakese Ricks / 910-814-6146 / jricks@harnett.org 

Denise Roberts / 910-814-6828 / vroberts@harnett.org 

Petrina Smith / 910-814-6576 / pcsmith@harnett.org 

Dana Ward-Tyndall / 910-814-6676 / dward-tyndall@harnett.org 

Dedra Dingle / PLA Lead Worker / 910-814-6832 / ddingle@harnett.org 

Marcella Phillips / LTC Lead Worker / 910-814-6809 / hdevane@harnett.org

Gail Rios / SA Supervisor / 910-814-6580 / grios@harnett.org 

Kim Hathcock / PLA Supervisor / 910-814-6579 / khathcock@harnett.org 

Moneak Blue / LTC Supervisor / 910-814-6808 / lblue@harnett.org 

Tracie LeCesne / Program Manager / 910-814-6572 / tlecesne@harnett.org

 

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