Written by a parent, not a doctor. Nothing here is medical advice.

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North Carolina program

Medicaid after a deductible

Another way into Medicaid when income is too high: medical bills meet a Medicaid deductible.

What it is

Another way into Medicaid when income is too high: medical bills meet a Medicaid deductible.

The county subtracts a fixed monthly standard from the income it counts, then multiplies the difference by six. Eligible medical bills can meet that deductible. Medicaid then covers the rest of the period.

Eligibility rules
  • Children must be under 21. The family-and-child route has a $3,000 countable-resource limit. The county checks ownership and exclusions before comparing your resources with it.
  • The county takes your monthly income, subtracts a small standard ($367 for three people, $400 for four, more for a bigger family) and multiplies what is left by six. That is the deductible your medical bills have to meet in a six-month period.
What you get
  • Full Medicaid after eligible bills meet the deductible.
  • Unpaid bills from the previous 24 months can help.
What the help covers
  • For a qualifying inpatient admission without Medicare Part A, special rules can establish when Medicaid starts. An assigned deductible amount may still be yours to pay. Observation does not meet this inpatient rule.
  • Bills already used for an earlier deductible cannot be reused.
If you decide to apply
  1. Ask the county Department of Social Services for a family-and-child Medicaid deductible review through ePASS or its office.
  2. Have itemized unpaid bills and savings records ready.
  3. Ask the hospital whether any stay was inpatient or observation.

The county Department of Social Services: 888-245-0179 · Official page ↗

If you decide to apply
  • The county calculates the period and which bills qualify. Unpaid bills from the prior 24 months can count on the period’s first day.
Good to know

The bills you use to meet the deductible stay yours to pay; Medicaid covers what comes after. A hospital admission can set the start date, but a stay booked as "observation" does not count, so ask billing which it was.

Other details
  • There is no premium. Meeting the deductible with bills does not mean paying that amount to the state.
  • The county uses qualifying medical expenses, not a cash payment to buy coverage. Bills used to meet the deductible can remain yours to pay, including liability assigned during an inpatient stay. Ask the social worker and county which charges remain your responsibility before agreeing to a payment plan.

Federal background: Medically needy Medicaid.

Official sources
Ask your social worker

“Could the bills we owe meet a Medicaid deductible, and what would remain ours to pay? Would you recommend this route and help us document the bills and any inpatient stay?”

Why I’m asking: I want to understand whether medical bills can open coverage when income is above the ordinary child limit.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask for it by name, hand over the itemised bills you still owe, and say when the child was admitted.

Your social worker

The hospital financial counsellor pulls the itemised bills and confirms inpatient status.

The care team

Records and letters when the application asks for them.

Who decides
The county Department of Social Services works out the six-month figure.
Ask the billing office
“Can you give me itemised bills we still owe from the last two years, and confirm in writing whether the stay was inpatient or observation?”

How to apply

First step: Apply on ePASS and write "family and child Medicaid deductible" on the form.

  1. Apply on ePASS and write "family and child Medicaid deductible" on the application.
  2. Ask the hospital billing office for itemised bills from the last 24 months that are still owed.
  3. Check whether the stay was billed as inpatient or as observation.

Official application / program page ↗

Where it starts: Apply on ePASS or at the county office and ask in writing for a family and child Medicaid deductible evaluation.

What to gather

  • Itemised hospital bills you still owe, going back two years
  • The admission date and whether it was inpatient
  • This month’s income
  • Savings balances

How long: Up to 45 days for the decision. The deductible period runs six months.

What a yes looks like

A notice giving a deductible figure and the date Medicaid starts once bills reach it.

What a no looks like, and the next move

Check whether the no was on savings or on the figure. If on savings, ask what counts before spending anything down.

Watch out

  • Savings over $3,000 stop this route for a family and child case.
  • A stay for observation is outpatient and does not count as an admission.
  • Bills already used to meet an earlier deductible cannot be used again.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Medicaid after qualifying bills meet the county-calculated deductible. An inpatient coverage date does not erase any assigned deductible liability.

  • $367/month — Monthly standard, family of 3
  • $400/month — Monthly standard, family of 4
  • $433/month — Monthly standard, family of 5
  • $3,000 — Savings limit on a family and child deductible case
  • $6 — Months of excess income the deductible is worked out over
  • $24 — How far back an unpaid bill can be counted

Covers: Full North Carolina Medicaid for the rest of the six-month period once the deductible is met

Legal protection: Unpaid bills from the previous 24 months can be applied on the first day of the period

What it costs the family: No premium. Qualifying incurred expenses meet the deductible; an assigned amount may still be owed to the hospital. County DSS confirms the budget and whether any payment option applies.

The eligibility facts, as published

Age
children must be under 21
Income
net countable income above the MAF-M standard; the excess over six months is the deductible
Assets
$3,000 for a family and child case
Note
For a qualifying inpatient admission without Medicare Part A, special rules can establish the Medicaid start date. Observation is outpatient. An assigned deductible can still be payable by the family.

Decisions this site cannot make: County six-month deductible calculation

Expect friction on: There is a $3,000 savings limit on deductible cases · The county has to be asked for it by name

The trap: Observation is not an admission. The manual says a stay for observation is an outpatient service and does not count as inpatient. Ask the hospital which one it billed.

Where I read this

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