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Details for Service Financing - Group Health Plans
Service Name Financing - Group Health Plans Program Name At-Risk Family Health and Safety Benefits
Goal 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.
Objective Assure that families at risk of economic challenges receive health and safety benefits to mitigate those risks.
Division Division of Health Benefits
Service Description

Medicaid pays premiums to some private insurance companies for some people who are also eligible for Medicaid.  The people for whom Medicaid makes premium payments have diseases or conditions which are serious, complex and have a high treatment cost.  By paying these claims, the person retains the third party insurance as the primary payor and Medicaid is the secondary payor. 

 

This program is administered by Medicaid’s Program Integrity section, which helps enroll the people who are qualified for these premium payments.

Group Health Plan premium payments are optional for states
Web Site http://www.ncdhhs.gov/dma/ Year First Initiated 1992
Available State Wide Yes Geographic Area Served
Grants Provided No Competitive Bidding No
Competitive Bidding Details
Waiting List No Waiting List Start Date
Number Waiting
Waiting List Details

Income Eligibility
Income Eligibility Yes
Income Eligibility Method 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
Income Eligibility Type Earned income such as: wages, self-employment Unearned income such as: RSDI, unemployment, VA, retirement, child/spousal support, worker's compensation, etc.
Whose Income Eligibility Individual on the Medicaid case + financially responsible individuals in the home - (Parent for child under age 21 or spouse).
Income Disregard Yes
Income Disregard Desc 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
Income Verified Yes
Income Verified Method Electronic match with ESC, SSA, wage stubs, verification from source of income, such as VA, employer, award letter, self-employment records
Income Criteria Federal and State Statutes are used as a base for setting income levels.
Income Eligibility Change 1/1/2006
Income Eligibility Method Prior To Change 185% MIC children less than 1 133% MIC children 1-5
Income Eligibility Other

Target Population
Age Range Start Age Range End
0 100+

Legal Authority
Authorization Level Authorization Type Citation
Federal Public Law 42 U.S.C. Section 1396e Section 1906 of the Social Security Act

Budget Information
State Fiscal Year (SFY)
As of the month of
Authorized Budget Fiscal Year 2024 SFY 2023-2024 Year To Date Expenditures Balance
Salary and Fringes (1X) 0 0 0
Salary Other (1X) 0 0 0
Operating (2X-5X) 0 0 0
Contracts/Allocations (6X) 0 0 0
Reserves (7X) 0 0 0
Transfers (8X) 0 0 0
Total Requirements 0 0 0
Receipts-Federal 0 0 0
Receipts- Local receipts 0 0 0
Receipts- Other receipts 0 0 0
Total Receipts 0 0 0
General Fund Appropriations 0 0 0
Match
State Local Other
0 0 0
 
MOE
State Local
0 0
 
FTEs
0.00
Please be advised that data is updated frequently. It is recommended to return to this site to get the most recent information.