Difference Between Carolina Access & Regular Medicaid

Medicaid is a health insurance program for those without the financial means to pay for medical care and is funded by both federal and state governments. While federal guidelines for Medicaid eligibility are broad, the states set more specific rules for providing and funding medical services. Thus, North Carolina offers an option for comprehensive managed care that directs Medicaid recipients to primary-care doctors or clinics that can best serve all their needs. The program is called Carolina Access.

Medicaid Benefits

• Medicaid partially funds care for poor individuals, families with children, the elderly and disabled, some of whom are completely dependent on social service benefits and others who are low- income workers. The program covers doctor and dental visits, prescription drugs, hospital stays, emergency treatment, mental health services, nursing home stays, in-home care and medical equipment, and long-term disabilities. However, federal rules do not provide guidance to patients for choosing health-care providers or a long-term treatment plan.

Carolina Access Benefits

• Carolina Access provides social service counseling that encourages Medicaid recipients to choose a "medical home'' where a primary care physician is assigned and an individual medical record of routine visits, tests and treatments is established. Counselors help patients develop a routine for preventive care. Under the CA managed-care system, recipients also have 24-hour-a-day access to medical advice and emergency treatment.

Eligibility

• To be eligible for Medicaid, you must have a social security number and provide proof of U.S. citizenship or legal immigration status. In North Carolina, applicants for Carolina Access also must prove state residency. Eligible residents include those receiving Social Security disability, state or county assistance for the blind and elderly, state Work First Family benefits, foster children, those adopted under state programs, and pregnant women and dependent children living in low-income households within specific wage ranges.