How to Apply for North Carolina Medicaid: ePASS, DSS, Mail, Appeals

North Carolina Medicaid applications, including nursing-home applications families file for a parent, go in online through ePASS, by phone, or through your local social services office.1 For an aged, blind, or disabled applicant, the first number to know is the countable asset limit: $2,000 for one person and $3,000 for a couple.1

In This Guide

• Key Facts
• Apply Online Through ePASS
• Apply at Your County DSS or by Mail
• What Happens After You Apply
• Documents to Gather
• If You're Denied: Appeals
• Frequently Asked Questions
• Learn More

For program details and policy updates, see medicaid.ncdhhs.gov.

How to Apply for North Carolina Medicaid Online Through ePASS

ePASS, at epass.nc.gov, is the secure website NC Medicaid points applicants to for applying online.1 Before you start, pull together the records listed under Documents to Gather, since the income, asset, and identity questions are the ones those records answer.

Filing online doesn't skip the long-term-care paperwork. If the application is for nursing-home or other long-term care, the applicant still needs a completed FL-2 (or MR-2) where required, the form step covered under What Happens After You Apply.1 For what comes after approval, see our guide to renewing North Carolina Medicaid.

How to Apply for North Carolina Medicaid at Your County DSS or by Mail

Offline, you can go to your local Department of Social Services (DSS), apply over the phone, or send a paper application by mail, email, fax, or drop-off at your local DSS.1

In person. Find the office for your county in the state's local DSS directory, and bring copies of the records listed under Documents to Gather.

By mail. Complete a paper application and mail it to your local DSS along with copies of your supporting documents. Keep the originals and send copies. If you're helping a parent or spouse apply, ask your local DSS what it needs from you to sign or submit on their behalf, such as a power of attorney or guardianship papers.

What Happens After You Apply

Two separate reviews decide a nursing-facility case: the local DSS in the county where your eligibility is maintained determines financial eligibility, and the state's utilization review contractor determines medical necessity.3

Your Finances Are Reviewed

Your countable assets and income are measured against the MAABD limits in Key Facts: $2,000 in assets for one person, and on the MA-2252 income chart an MAABD-N limit of $1,330 for one person alongside the lower $242 medically needy limit.1 If you live in someone else's household, the county decides whether to use that full limit or the chart's one-third reduced level, which is $887 for one person on the MAABD-N row.1 Adults ages 19 through 64 can also qualify through North Carolina's Medicaid expansion group, which has its own limit on NCDHHS's MA-3321 chart: $1,769 a month for one person.4 Our North Carolina eligibility and income limits guide lays out every group.

For a nursing-home application, income is also tested against the facility's own costs, starting with its Medicaid reimbursement rate and then its private rate, and a person only has to qualify under one of the methods.5 Our North Carolina long-term-care guide walks through that test and the $70 monthly personal needs allowance.1

Nursing-Home Care Also Needs an FL-2

If you're applying for Medicaid to help pay for long-term care, you also need a completed FL-2 (or, for mental health services, an MR-2) where required, with at least telephone prior approval. The FL-2 is the Long-Term Care Services prior approval form, a summary of the patient's medical requirements.1 For a nursing facility, the provider submits the FL-2 (form DMA 372-124) electronically through the website of the state's utilization review contractor, with a valid PASRR screening number entered on it.3 Prior approval is required for every new Medicaid admission and also for current residents who have been paying privately or through other insurance and now seek Medicaid; it does not guarantee financial eligibility or Medicaid payment.3

If the goal is care at home instead, ask about North Carolina's CAP/DA waiver; NC Medicaid announced in March 2024 that, effective February 16, 2024, people requesting its services may be placed on a statewide waitlist, so ask whether that waitlist is still in effect.6 Our North Carolina home- and community-based waivers guide covers it.

Your Health Plan

North Carolina delivers Medicaid through several plan types: Standard Plans, Tailored Plans, the EBCI Tribal Option, the Children and Families Specialty Plan, and NC Medicaid Direct.7 Tailored Plans serve people with a serious mental illness, a serious emotional disturbance, a severe substance use disorder, an intellectual or developmental disability, or a traumatic brain injury, and anyone on the NC Innovations Waiver must be on one.7

How Long a Decision Can Take

Federal rules set the outer limits on how long a state can take to decide a Medicaid application. Under 42 CFR 435.912, the determination may not exceed 45 days for most applicants, and 90 days when you apply on the basis of disability.8 You're entitled to a decision within those limits except in unusual circumstances, for example when the applicant or an examining physician delays a required step, or an emergency beyond the agency's control. If a decision does run late, the agency must record the reasons in your case file, and it can't use the time limit as a reason to deny you.8 Federal rules also require each state to set its own processing standards and tell applicants what they are, so ask your local DSS for North Carolina's. Respond quickly to any request your local DSS sends, and keep copies of everything.

Coverage for Bills From Before You Applied

Federal law sets a default of retroactive coverage for qualifying medical bills from up to three months before the month you applied, as long as you would have been eligible when the care was furnished. A state can run a shorter window under an approved federal demonstration, and the exact start date inside the window is set by the state plan, so confirm North Carolina's current retroactive period with your local DSS.9 If a parent entered a nursing facility weeks before the application went in, that earlier care may still be covered. (For applications filed on or after January 1, 2027, a federal change shortens this window to two months for most enrollees and one month for the Medicaid expansion adult group.)9

Documents to Gather

These are the kinds of records that back up the income, asset, and identity checks. If your local DSS asks for something specific after you apply, follow that request:

Identity and residency:

• Photo ID or driver's license
• Proof of North Carolina residency, such as a lease, utility bill, or mortgage statement
• Social Security number for each person applying

Citizenship or immigration status:

• U.S. passport, birth certificate, or naturalization certificate
• Eligible immigration documents, if applicable

Income:

• Social Security Administration award letter or SSA-1099
• Pension and retirement income statements
• Recent pay stubs, if anyone in the household is working

Assets:

• Bank statements for all checking and savings accounts
• Statements for retirement accounts, CDs, stocks, and bonds
• Life insurance policies showing face value and cash surrender value
• Vehicle titles or registration
• Property deeds and prepaid burial or funeral contracts

For long-term-care applications, the federal look-back period reaches asset transfers made in the 60 months before you apply.10 Gifts or below-market transfers made during those 60 months can create a penalty period during which Medicaid won't pay for nursing-facility care or home- and community-based waiver services, though the penalty doesn't withdraw the rest of your Medicaid coverage.10 Prepare account records covering the full five years. Separately from the application, North Carolina can later recover Medicaid costs from the estates of some recipients age 55 and older; our North Carolina estate recovery guide explains who is affected.1

If your assets are over the limit, don't transfer them on your own to qualify; the look-back rule can penalize gifts. See Medicaid planning strategies and consider talking to an elder law attorney first.

If You're Denied: Appeals

A denial doesn't have to be the end. If your North Carolina Medicaid application is denied or you disagree with the decision, you have the right to appeal.

Work from your denial notice. The deadline that applies to you is the one your state sets, which may be well short of the federal maximum.11 If the notice explains why you were denied, read that closely, since it may point to a fix, such as a missing document, an exempt item counted as an asset, or income the spend-down route could address.

Federal rules give you a reasonable time to ask for a hearing, and they cap how long that window can be: under 42 CFR 431.221, a state Medicaid agency may allow no more than 90 days from the date the notice is mailed.11 Ninety days is the outer limit a state may offer, not a floor you are entitled to, and a state may set a shorter deadline as long as it is reasonable.11

In North Carolina, an eligibility decision by your local DSS, such as a denied application, is appealed through the local agency. You must request a hearing within 60 calendar days from the date the notice was mailed or given, or no later than 90 calendar days if you can show good cause. A local hearing is held at the local DSS, except that appeals involving a disability determination go to a state hearing. If you disagree with the local hearing decision, you can ask for a state hearing before a State Hearing Officer, but you must request it within 15 calendar days of the date that decision was mailed.11

A different route applies once you're covered and a specific Medicaid service is denied, reduced, suspended, or stopped. Those appeals go to the North Carolina Office of Administrative Hearings on the hearing request form included with the decision, and if you're in a managed care plan, you appeal to the plan first and go to the Office of Administrative Hearings only after the plan's reconsideration review.11 Our guide to North Carolina Medicaid appeals and fair hearings walks through both routes. Not every service appeal follows the same procedure, so the Office of Administrative Hearings says to check the paperwork you received with the hearing request form for your filing deadline and where to send the form.11

You don't have to handle a hearing alone: you can represent yourself or use a lawyer, a relative, a friend, or another spokesperson.12 If the denial turned on missing paperwork, ask your local DSS whether supplying it now can resolve the case.

For help with an application or an appeal, start with the resources below.

Learn More

Find personalized help applying for North Carolina Medicaid at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.