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Details for Service Ambulance
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Service Name
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Ambulance
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Program Name
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At-Risk Family Health and Safety Benefits
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Goal
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Provide outreach, support and services to individuals and families identified as being at risk of compromised health and safety to eliminate or reduce those risks.
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Objective
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Assure that families at risk of economic challenges receive health and safety benefits to mitigate those risks.
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Division
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Division of Health Benefits
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Service Description
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Ambulance includes transportation provided for emergency situations. Ground and air transportation are both covered services. Air transportation refers to fixed wing crafts and helicopters.
Under some conditions, a patient will be provided with non-emergency ambulance transportation. Situations when this is a covered service include when a recipient is bed-confined and has debilitating physical condition(s) that require travel by stretcher only and require ground transportation to receive medical services. The recipient’s condition must meet the definition of medical necessity and he/she must require medical services that cannot be provided in the place of residence.
Most Medicaid recipients are eligible for ambulance services, but there may be restrictions depending on the person’s type of Medicaid eligibility.
Ambulance services are optional. Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) program requires that states offer these services, if medically necessary, to children up to age 21.
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Web Site
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http://www.ncdhhs.gov/dma/
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Year First Initiated
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1975
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Available State Wide
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Yes
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Geographic Area Served
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Grants Provided
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No
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Competitive Bidding
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No
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Competitive Bidding Details
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Waiting List
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No
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Waiting List Start Date
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Number Waiting
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Waiting List Details
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Income Eligibility
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Yes
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Income Eligibility Method
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Eligibility for Medicaid is determined by the county departments of social services (DSS) and the Social Security Administration (SSA) for Supplemental Security Income (SSI) recipients.
200% FPL - MIC children under age 6
185% FPL - MPW
133% FPL - MIC children age 1-5
100% FPL - MIC children 6-18, MAD, MAA, MAB
150% FPL -HCWD
MAF-CN, HSF Categorically Needy:
1 person - $362
2 - $472
3 - $544
4 - $594
5 - $648
MAF, MAD, MAA, MAB Medically Needy:
1 person - $242
2 - $317
3 - $367
4 - $400
5 - $433
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Income Eligibility Type
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Earned income such as: wages, self-employment
Unearned income such as: RSDI, unemployment, VA, retirement, child/spousal support, worker's compensation, etc.
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Whose Income Eligibility
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Individual on the Medicaid case + financially responsible individuals in the home - (Parent for child under age 21 or spouse).
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Income Disregard
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Yes
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Income Disregard Desc
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Earned Income Disregards:
MAA, MAD, MAB: $65 + 1/2 remainder
MAF-C - 27-1/2%
MAF-N/M, MIC, MPW, HSF: $90 + child/adult care up to $175/200
Unearned income disregards:
MAA, MAD, MAB: $20 general exclusion, 1/3 child support
MAF, MIC, MPW, HSF: $50 of child/spousal support
Work expense exclusion for the blind: MAB, HCWD
Impairment related work expense for the disabled - MAD, MAB, HCWD
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Income Verified
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Yes
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Income Verified Method
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Electronic match with ESC, SSA, wage stubs, verification from source of income, such as VA, employer, award letter, self-employment records
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Income Criteria
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Federal and State
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Income Eligibility Change
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1/1/2006
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Income Eligibility Method Prior To Change
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185% MIC children less than 1
133% MIC children 1-5
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Income Eligibility Other
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Age Range Start
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Age Range End
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0
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100+
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Authorization Level
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Authorization Type
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Citation
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Federal
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Code of Federal Regulations
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42 CFR 414 Subpart H
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State
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Administrative Rules
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10A NCAC 13P .0102, .0207, .0208, .0209, .0210, .0301, .0302, .0305, .0502 and 10A 22O .0110
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State
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Statute
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NCGS§ 131E 155.1, 156, 157, 158, 159
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Budget Information
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State Fiscal Year (SFY)
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As of the month of
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Authorized Budget Fiscal Year 2024
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SFY 2023-2024 Year To Date Expenditures
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Balance
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Salary and Fringes (1X)
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0
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0
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0
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Salary Other (1X)
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0
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0
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0
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Operating (2X-5X)
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0
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0
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0
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Contracts/Allocations (6X)
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0
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0
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0
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Reserves (7X)
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0
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0
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0
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Transfers (8X)
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0
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0
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0
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Total Requirements
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0
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0
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0
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Receipts-Federal
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0
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0
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0
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Receipts- Local receipts
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0
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0
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0
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Receipts- Other receipts
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0
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0
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0
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Total Receipts
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0
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0
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0
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General Fund Appropriations
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0
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0
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0
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Match
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State
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Local
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Other
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0
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0
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0
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