This calculator provides an estimate for NC Medicaid eligibility based on common program guidelines.
Eligibility is complex and can depend on many factors.
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Your estimated eligibility will appear here.
Understanding NC Medicaid Eligibility
Determining eligibility for North Carolina Medicaid is a multi-faceted process that considers household income, household size, and specific circumstances such as pregnancy, disability, or age. North Carolina has expanded Medicaid, which has broadened coverage for low-income adults. However, specific program rules and income limits apply to different categories of individuals.
Key Factors in Eligibility:
Household Income: This is the gross monthly income of all individuals living in the household who are related and contribute to the expenses. Income is compared against the Federal Poverty Level (FPL) for the given household size.
Household Size: The number of people in the household directly impacts the income threshold. Larger households generally have higher income limits to qualify.
Categorical Eligibility: Certain groups are often prioritized or have different rules. These include:
Pregnant Women: Often have higher income limits or different calculation methods to ensure maternal and infant health.
Children: Medicaid and the Children's Health Insurance Program (CHIP) provide coverage for children in low-income families.
Individuals with Disabilities: May qualify under specific disability-related programs.
Elderly Individuals (Age 65+): Can qualify based on age and income, sometimes linked to Medicare Savings Programs.
Adults (Age 19-64): NC Medicaid expansion covers adults in this range with incomes at or below 138% of the FPL, provided they meet other requirements.
How This Calculator Works (Simplified):
This calculator uses simplified income limits based on common NC Medicaid categories. It checks your provided monthly household income against a benchmark percentage of the Federal Poverty Level (FPL) adjusted for household size.
Note: Actual eligibility determinations are made by the North Carolina Department of Health and Human Services (NCDHHS). This calculator is a tool for estimation purposes only and does not guarantee eligibility. Factors like assets, specific medical needs, or enrollment in other programs may influence the final decision. For accurate information, please consult the official NC Medicaid website or contact your local Department of Social Services (DSS).
function calculateEligibility() {
var householdIncome = parseFloat(document.getElementById("householdIncome").value);
var householdSize = parseInt(document.getElementById("householdSize").value);
var isPregnant = document.getElementById("isPregnant").value;
var childCount = parseInt(document.getElementById("childCount").value);
var isBlindOrDisabled = document.getElementById("isBlindOrDisabled").value;
var isOver65 = document.getElementById("isOver65").value;
var resultDiv = document.getElementById("result");
resultDiv.innerHTML = ""; // Clear previous results
resultDiv.className = ""; // Reset classes
// Basic validation
if (isNaN(householdIncome) || isNaN(householdSize) || householdSize 8
var eligible = false;
var reason = "";
// Logic simplified for demonstration. Real Medicaid is more complex.
if (isPregnant === "yes") {
var specificLimit = (fplLimits[householdSize] || (fplLimits[8] + (householdSize – 8) * (fplLimits[8] – fplLimits[7]))) * pregnantChildLimitPercentage;
if (householdIncome <= specificLimit) {
eligible = true;
reason = "Pregnant individuals often have expanded eligibility.";
}
} else if (isBlindOrDisabled === "yes" || isOver65 === "yes") {
// Simplified logic for Aged, Blind, Disabled (ABD) groups. Real limits vary.
var specificLimit = (fplLimits[householdSize] || (fplLimits[8] + (householdSize – 8) * (fplLimits[8] – fplLimits[7]))) * blindDisabledElderlyLimitPercentage;
if (householdIncome <= specificLimit) {
eligible = true;
reason = "Individuals who are blind, disabled, or over 65 may qualify under specific pathways.";
}
} else {
// General Expanded Medicaid for adults
var specificLimit = (fplLimits[householdSize] || (fplLimits[8] + (householdSize – 8) * (fplLimits[8] – fpl⑦))) * incomeLimitPercentage;
if (householdIncome <= specificLimit) {
eligible = true;
reason = "Your household income is within the estimated range for expanded Medicaid.";
}
}
if (eligible) {
resultDiv.innerHTML = "Estimated: Eligible";
resultDiv.className = "eligible";
} else {
resultDiv.innerHTML = "Estimated: Not Eligible";
resultDiv.className = "ineligible";
}
if (reason) {
resultDiv.innerHTML += "" + reason + "";
}
}
// Toggle visibility of child count input based on household size logic
document.getElementById("householdSize").addEventListener("input", function() {
var size = parseInt(this.value);
var childCountGroup = document.getElementById("childCountGroup");
if (size > 0) { // Assume children can exist in any size household > 0
childCountGroup.style.display = "flex";
} else {
childCountGroup.style.display = "none";
document.getElementById("childCount").value = ""; // Clear if hidden
}
});