NC Medicaid Rules Have Changed
Everyone must renew their coverage this year.
Your local department of social services (DSS) has begun checking to see if you are still eligible for Medicaid. DSS will cancel Medicaid for those who do not return the information needed to determine their eligibility. Follow the steps below to make sure your information is up to date.
1. Update your contact information.
Visit epass.nc.gov or call your local DSS to make sure they have your current mailing address, phone number, email, and other contact information. It only takes 10 minutes to update your information online!
Watch the video below to see how to set up an ePASS account.
- Click here for step-by-step instructions on how to set up an ePASS account.
- Click here to find your local DSS office’s phone number.
2. Look out for notices from DSS.
If you think you received a letter that was not from your local DSS and it may be a scam, contact your local DSS. Find their phone number here.
3. Reply as soon as possible.
Respond right away with updated information. Submit forms by the due date listed on your notice.
You have the right to appeal.
You have 60 days from the date you receive a notice of cancellation or reduction of coverage to ask for an appeal. If you think your Medicaid was wrongfully reduced or canceled, call 1-800-936-4971 or email firstname.lastname@example.org.
Free legal assistance may be available from the following organizations:
Legal Aid of North Carolina
Charlotte Center for Legal Advocacy
Pisgah Legal Services
You may qualify for Medicare or Marketplace coverage.
If you are no longer eligible for Medicaid, you may be eligible to enroll in Medicare or Marketplace coverage during a special enrollment period. Get help enrolling in the Marketplace or Medicare by contacting the following:
- Health Insurance Navigators
Health Insurance Navigators offer free, unbiased help enrolling in the Marketplace.
- NC Seniors’ Health Insurance Information Program (SHIIP)
SHIIP counselors offer free, unbiased information regarding Medicare health care products and eligibility.
You may qualify for a different Medicaid program—as long as you complete the request for information from DSS.
In some cases, enrollees will qualify for a different Medicaid program called Family Planning Medicaid which is a limited benefit plan. Although this is a limited benefit program, many people in Family Planning Medicaid will become eligible for comprehensive benefits after North Carolina implements Medicaid expansion—also called NC Health Works. By being in the Family Planning Medicaid plan now, people who are eligible for expansion will automatically be enrolled in NC Health Works once the program goes live (there is currently no concrete start date for Medicaid expansion enrollment).
It is important that you do not cancel Family Planning coverage to ensure you are auto-enrolled into Medicaid expansion.
You Have Rights
Under a federal lawsuit, you have the right to:
- Reach DSS by phone during the redetermination process. This includes the right to leave a message instead of remaining on hold and to have your call returned within a reasonable time.
- Request and receive help from DSS to obtain the information needed to redetermine your eligibility.
- Have DSS accept your detailed statement about your income, assets, and most other facts needed to verify your eligibility, in writing or verbally, without providing supporting documents.
- Not be asked to verify information DSS can obtain through electronic sources or to verify information that is not needed to redetermine your eligibility.
- Have your Medicaid eligibility considered under all categories, including an alleged disability, before your Medicaid can be terminated or reduced.
- Receive written notice that tells you what action has been taken and the reason it has been taken before your Medicaid is stopped or reduced.
- Have your Medicaid reopened by DSS if it was terminated due to failure to provide information and you can provide the missing information within 90 days of when your Medicaid was terminated.
If you think your rights were violated by DSS, call 1-800-936-4971 or email email@example.com.
- NCDHHS Medicaid Services Portal
- Get Legal Services
- NC Medicaid Ombudsman
- Did You Get a Message from NC Medicaid?
- Staying covered if you lose Medicaid or CHIP
- How NC Medicaid Eligibility Recertification Works