In this lawsuit, the Plaintiffs allege that the N.C. Medicaid agency, along with county Departments of Social Services (DSS), was terminating and reducing Medicaid benefits without considering eligibility under all Medicaid categories and without first providing timely and adequate written notice, in violation of federal Medicaid statute and the U.S. Constitution. The Defendant denied those allegations.
The Court has ordered that class members be notified of the proposed Settlement Agreement. This notice contains important information regarding details of the Settlement Agreement:
Where the full Settlement Agreement can be found for review
Beneficiary rights to object the lawsuit dismissal.
Starting July 1, 2021, most Medicaid beneficiaries began receiving the same Medicaid services in a new way. Called "NC Medicaid Managed Care," beneficiaries choose a health plan and get care through a health plan's network of doctors. Some beneficiaries are remaining in traditional Medicaid, which is called NC Medicaid Direct.
The Medicaid program was established to provide medical assistance to low-income individuals and families. The Medicaid program covers groups of people based on certain categorical requirements. To be eligible, the individual or family must make an application and must meet certain financial and non-financial criteria. If eligible, Medicaid provides coverage for the aged, blind, and disabled, including Health Care Coverage for workers with disabilities. This program provides full coverage for persons who are:
Age 65 or older, or
Blind, as defined by the Social Security Administration, or
Disabled, as defined by the Social Security Administration, and
Who meet all other financial and non-financial eligibility requirements
Medicare Savings Programs
These Medicaid programs provide limited assistance in paying Medicare premiums, deductibles, and co-payments for individuals receiving Medicare. If eligible, what Medicaid will pay is based on the applicant’s income. (The Social Security Administration agency is responsible for determining eligibility for Medicare – not the Department of Social Services.)
These programs provide full coverage to eligible children under age 21, caretaker relatives of children under age 19, pregnant women, and women enrolled, screened, and diagnosed with breast or cervical cancer including pre-cancerous conditions and early stage cancer. Family Planning Waiver Medicaid provides limited Medicaid coverage in order to assist in the reduction of the number of unplanned pregnancies. Women and men over the age of 19 and with income up to 185% of the federal poverty may qualify.
North Carolina Health Choice
This program provides health insurance coverage for eligible children age 6 through age 18 who are ineligible for Medicaid and who have family incomes equal to or less than 200% of the federal poverty level. Children are evaluated for and enrolled in North Carolina Health Choice only after they are determined to be ineligible for Medicaid.
Community Care of North Carolina (CCNC)
Community Care of North Carolina (CCNC) is a primary care case management (PCCM) health care plan for a majority of Medicaid beneficiaries in North Carolina. Learn more about CCNC/CA.
The Medicaid program aid category determines if a beneficiary is mandatory, optional or ineligible for CCNC enrollment.