Join our Newsletter    Events    Shop    Contact Us
advocates-for-medically-fragile-kids-nc-logo
Search
Close this search box.
Welcome to our new website! If you have any suggestions, please email info@fragilekidsnc.org

Home  •  Waiver & Medicaid Services  •  Medicaid  •  Introduction

Medicaid for Waiver
& Non-Waiver Recipients

growing-plant-showing-growth-and-life

Introduction

No matter how your child qualifies for Medicaid (i.e., through a HCBS waiver or through financial eligibility), there are what’s known as Medicaid State Plan Services that are available to anyone with Medicaid. In addition to covering things like medical appointments, hospitalizations, and prescription drugs, Medicaid also covers vision and dental services for kids and adults. Below are some additional State Plan Services that many medically fragile children utilize. The clinical coverage policies for all of these can be found here: Program Specific Clinical Coverage Policies | NC Medicaid.

If you also have private insurance, Medicaid will always be the payor of last resort, meaning that your private insurance will be billed first and then any remaining balance (including claims against the deductible or claims requiring co-pay/co-insurance) will be billed to Medicaid. If a provider accepts NC Medicaid, they are not allowed to bill you for any remaining portion after NC Medicaid has been billed.