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» LymeNet Flash » Questions and Discussion » General Support » North Carolina Medicaid....who knows anything about the coverage?

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Author Topic: North Carolina Medicaid....who knows anything about the coverage?
Hoosiers51
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I am probably going to be getting North Carolina Medicaid (state run health insurance for those with low income and disabled).

My Indiana Medicaid was fabulous...it covered pretty much all my meds, even the really expensive ones. But in Indiana, their system is unique in that the government outsources Medicaid to a private, for-profit insurance company. This company ran things very efficiently so there was little waste but great coverage since the gov. picked up the tab.

I'm wondering if all state Medicaid programs (once you are able to get on them) are this good....do they normally have such great prescription drug coverage, or was I spoiled? I'm wondering specifically how good the coverage for DRUGS is in North Carolina's system. Will they not pay for my Bicillin, or things like Malarone?

Thanks!

Posts: 4590 | From Midwest | Registered: Jun 2008  |  IP: Logged | Report this post to a Moderator
Keebler
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Each state handles Medicaid entirely differently. Even each county within states can differ. Find the website for your new state and also the web site for your new county - for more detail.

So, you are not on Medicare, right? If so, Medicare Part D would be your drug coverage (at least primary). In most states, medicaid no longer covers drugs for those on Medicare.

For many services, Medicaid not only varies state to state but county to county, at least regarding qualifies for some services that fall under medicaid.

Be aware that only a percentage of low income or disabled persons can actually qualify for medicaid - and that is a county decision, not a state one, as to who qualifies for any part of their coverage. For any kind of personal assistance through medicaid, in my county, if one can "toilet" themselves they do not qualify for any help.

There are different tiers for insurance coverage, though. For instance, if monthly income is determined to be too high to qualify (and that could be even just $800 a month as "too high"), one might still quality for the QMB program to cover the deductible and copays. QMB is qualified medical beneficiary. But, in actuality, QMB tells doctors so "just write it off" and they often just don't get paid for the first appointments of the year or co-pays.

You can find the web site for the state and county and that offers more detail. But, be aware, some of this sounds great on paper but the reality can be very different. You should call the COUNTY offices for Adult and Family services for more detail - without getting into specifics. You should not discuss diagnoses or prescriptions.

They can tell you if you will qualify for coverage - or how long the wait may be, or even if they are currently taking applications.

If you will qualify, they can direct you to a FORMULARY list for approved drugs. You may be able to find that on the web for your state - it's just that you have to qualify and enroll through your county.

It can fee a bit unsettling, however, I hope this all works out so that you can find what you need to get better.
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[ 03-14-2010, 07:12 PM: Message edited by: Keebler ]

Posts: 48021 | From Tree House | Registered: Jul 2007  |  IP: Logged | Report this post to a Moderator
Hoosiers51
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Thanks, Keebler.

It would be Medicaid, and I know for SURE (100%) that I qualify.

I am just reluctant to leave my old state's system if I find out the NC one doesn't cover what I need.

So this "formulary"...never heard that word....this is some kind of list that would tell me if my Bicillin (for example) is covered?

I don't want to sign up, then find out my stuff is not covered. We are still paying the apartment lease in my old state, so I don't want to get off my old state's Medicaid and onto the NC Medicaid YET if it is gonna be worse.

So I'd like to know what it will cover before I switch. So since I know I qualify, can they just give me the formulary list? Do I just call the county and ask for such a list?

I just don't want them to tell me, "well just sign up" because I'm not comfortable doing that yet. Thanks.

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MariaA
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call them and tell them that you're researching moving to NC and are partially basing the decision on what happens to your healthcare. I hate lying but sometimes you have to for things like this.

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Hoosiers51
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that's a good idea, thanks. I hate lying too, but it's def. worth it in this case.
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Hoosiers51
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Luckily there are other ways of getting Bicillin too. But I'd rather refill a few more times in the old home state than get it overseas.
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Keebler
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http://www.lymenet.org/SupportGroups/UnitedStates/NorthCarolina/

North Carolina Lyme Support Groups

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From a search at Google:
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www.dhhs.state.nc.us/dma/

Home page for the North Carolina Division of Medical Assistance

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http://www.dhhs.state.nc.us/dma/medicaid/index.htm

NC Medicaid index

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http://www.dhhs.state.nc.us/dma/plan/index.htm

Medicaid State Plan - contact phone number listed

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http://www.ncafp.com/advocacy/nc-medicaid-program-plans-implement-preferred-drug-list-pdl

Feb 16, 2010

N.C. Medicaid Program Plans to Implement a Preferred Drug List (PDL)

The N.C. Medicaid Program has announced plans to implement a Preferred Drug List (PDL) beginning March 15.
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Posts: 48021 | From Tree House | Registered: Jul 2007  |  IP: Logged | Report this post to a Moderator
Hoosiers51
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Thanks, Keebler!

Wow, that is a great list of links. Thank you so much.

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