How NC Medicaid Eligibility Recertification Works
What is Medicaid Redetermination?
Medicaid redetermination is the way your information is reviewed to make sure you are still eligible for Medicaid health coverage. It is also called eligibility recertification, renewal, ex-parté review or case review (all mean the same thing).
Redetermination takes place every 6 or 12 months based on your Medicaid program. Your Medicaid caseworker will try to complete your recertification using information from electronic resources – without contacting you.
If your Medicaid caseworker needs more information from you to finish your redetermination, they will mail you a letter.
What You Need to Know
Make sure your local Department of Social Services (DSS) has your up-to-date contact information. They may need to reach you by mail, phone, email, or text message about your redetermination.
Take 5 minutes today to make sure NC Medicaid can reach you with important benefit updates. It’s as easy as 1, 2, 3!
Find your local DSS office here: ncdhhs.nc.gov/localdss
Call or visit your local DSS office.
Update your information (Mailing and residence address, phone number, email, household size, income, job)
Sign-up for an Enhanced ePASS account online to make changes to your information at any time without visiting your local DSS. To create an ePASS account, logon to epass.nc.gov. For more information about ePASS and how to create an account, see the ePASS fact sheet.
NOTE: If there have been no changes to your personal information, no action is needed.
Check Your Mail
Check your mail for information from your local DSS. If DSS needs information from you to finish your recertification, you will get a Medical Assistance Renewal Notice in the mail.
In some cases, your local DSS will send a Request for Information form for you to fill out. Add your information and return the form to your local DSS within 30 days.
View a sample letter and form (PDF).
Be careful and aware of scams. If you are not sure about information or mail you get asking for information from you, contact your local DSS.
If your health coverage is renewed – You do not need to do anything. You will get a letter telling you your NC Medicaid benefits will stay the same or have changed.
Did Your Health Coverage Change or End?
If your health coverage changes to a different Medicaid program – You do not need to do anything unless you do not agree or have concerns with your new Medicaid program. Contact your local DSS to learn more about your new benefit program.
If your coverage is terminated (ended) – You can apply for health care coverage on the federal Health Insurance Marketplace at healthcare.gov. You can appeal the decision or reapply at any time.