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GROUP BENEFITS BASIC MEDICIAD ELIGIBILITY REQUIREMENTS ** Notes BASIC ELIGIBILITY REQUIREMENT WHOSE INCOME and RESOURCES COUNT MONTHLY INCOME LIMIT Updated 04/2026 RESOURCE LIMIT Updated 04/2026 DEDUCTIBLE/SPEND DOWN Families & Children MAF

Full Medicaid Coverage Parents/Caretaker Relatives, and the spouse must be living with and caring for a child to whom they are related who is under age 18. Children must be under age 21. MAGI Methodology.

1 - $434 2 - $569 3 - $667 4 - $744 5 - $824 NO YES If income exceeds income limit and the indicator is “yes” the individual or family may be able to be eligible for Medicaid if they can meet a deductible

Medicaid Deductible: When an individual/family is ineligible for Medicaid due to income over the income limit, they may become eligible by meeting a Medicaid deductible. The deductible is determined by subtracting the Medically Needy Income Limit (MNIL) (see limits below) from the countable monthly income to determine the monthly excess income. Medicaid deductibles are generally determined for 6 months, so the monthly excess income is multiplied by 6 to determine the 6-mo. deductible. Once medical bills for which they are responsible totaling the amount of the deductible are incurred, they are authorized for the rest of the 6-mo. period. Medicaid cannot pay for any of the bills applied to the deductible.

Pregnant Women MPW

Full Medicaid A self-attestation of pregnancy and due date can be accepted as proof of pregnancy unless the county has information that contradicts the attestation. MAGI Methodology 196% of Poverty Level 1 - $2,607 2 - $3,535 3 - $4,463 4 - $5,390 5 - $6,318 NO NO When determining the family size for the pregnant woman the unborn child is included. For example, the family size for a single pregnant woman would be 2. Children age 0 thru 18 MIC Full Medicaid Coverage Must be age 0 thru age 18. MAGI Methodology 211% of Poverty Level 1 - $2,807 2 - $3,806 3 - $4,804 4 - $5,803 5 - $6,802 NO NO

Title IV-E Children IAS Full Medicaid Coverage IV-E Adoption Subsidy and Foster Care for a child residing in NC and receiving IV-E Foster Care regardless of the state providing assistance. There is no income.

NO NO MNIL: 1 - $242 2 - $317 3 - $367 4 - $400 5 - $433 Resource limit: All deductible cases have a resource limit: $3,000 for families and children and $2,000 (1) and $3,000 (2) for aged, blind and disabled.

State Foster Care Children Full Medicaid Coverage A child under 21 and currently in the legal custody of the state sponsored foster care and ineligible for Title IV-E. MAGI Methodology 1. MAGI 2. MAF-M

$3,000 (MAF-M) YES

Expanded Foster Care Full Medicaid Coverage Be 18-20 and had been in Foster Care at age 18 and enrolled in Medicaid program. MAGI Methodology 1. MAGI 2. MAF-M $3,000 (MAF-M) YES