North Carolina Medicaid Income Trust Form

State:
Multi-State
Control #:
US-00327
Format:
Word; 
Rich Text
Instant download

Description

In this agreement, the grantor establishes an income trust and directs that the trustee shall receive unto to the trust all income due to grantor and the trustee will accept such property as the initial trust estate. Other provisions of the agreement include: additions to the trust, the management and disposition of the trust estate, trustee powers, and trust termination.

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FAQ

You or a family member might be eligible if you: Live in North Carolina and are a U.S. citizen or documented non-U.S. citizen. Meet income and resource guidelines. Are in one of these groups: Pregnant women. Children under age 21. Low-income individuals and families. Adults age 65 or older. Individuals with disabilities.

North Carolina is expanding who can get Medicaid starting December 1, 2023. Adults ages 19 through 64 earning up to 138% of the federal poverty line (e.g., singles earning about $20,000/year or families of three earning about $34,000/year) may be eligible.

The application processing time standard for Medicaid Assistance to the Disabled (MAD) is 90 calendar days. Application processing time standard is 45 calendar days for all other Medicaid programs, including NCHC. Medicaid applications may be submitted: In-person.

Submitting Requests for Prior Approval The preferred method to submit prior approval requests is online using the NCTracks Provider Portal. However, providers can also submit paper forms via mail or fax. PA forms are available on NCTracks.

Who is eligible for North Carolina Medicaid Program? Household Size*Maximum Income Level (Per Year)5$46,7376$53,5737$60,4098$67,2454 more rows

For Medicaid eligibility, there are also many assets that are considered non-countable (exempt). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts up to $15,000, and generally one's primary home.

When applying for Medicaid, provide the following information: Birth certificate. Social Security card. Valid photo ID. Proof of citizenship or immigration status (valid US passport, USCIS green card, employment authorization card)

A valid North Carolina drivers' license or other identification card issued by the North Carolina Division of Motor Vehicles. b. A current North Carolina rent, lease, or mortgage payment receipt, or current utility bill in the name of the applicant or the applicant's legal spouse, showing a North Carolina address.

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North Carolina Medicaid Income Trust Form