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Autism: Life After Diagnosis | Part Three – How to Qualify and Apply for Medicaid for Autism in North Carolina

About the Series “Autism: Life After Diagnosis – A Road to Service”

ShineLight was created with the distinct purpose of providing a brighter life and future for individuals with autism. As you can imagine, life with services can dramatically improve the quality of life for individuals with autism, which is why early intervention is key. My name is Nikki Giovanni Creecy and I am the Founder and CEO of ShineLight. I have created a blog series entitled “Autism: Life After Diagnosis – A Road to Service” to help individuals with autism as they navigate life after diagnosis and to provide autism treatment near Robeson and throughout North Carolina.

If you have not yet read the introduction to “Autism: Life After Diagnosis – A Road to Service”, I encourage you to do so before proceeding.

This six-part series will cover the following topics:

A Little Bit About Me | Nikki Giovanni Creecy

I am a local, born and raised in Fayetteville, NC, and I have more than two decades of experience in serving individuals with autism. In 2006, after eight years of working with the Autism Society of North Carolina, my vision and leadership led me to create ShineLight, Services and Support for People with Autism. As Founder and CEO of ShineLight, I am committed to hiring and employing cutting-edge methodologies and uniquely qualified staff to provide the very best residential, community, and employment support for individuals with autism. When I’m not involved in my work, I can be found singing in my church choir, teaching Sunday school, and making music as Nikki Giovanni Worship.

Part Three: How to Qualify and Apply for Medicaid for Autism in  North Carolina


Qualifications: Determining Eligibility for Medicaid

Eligibility for the Medicare Savings Programs, through which Medicaid pays for autism treatment near Robeson and throughout North Carolina, including premiums, deductibles, and/or coinsurance costs for beneficiaries, is normally determined by assessing a person’s financial eligibility. The Affordable Care Act established a new way to determine income eligibility for Medicaid and it is based on Modified Adjusted Gross Income (MAGI).

However, people with autism are exempt from the MAGI-based income counting rules in the state of North Carolina. Instead, their eligibility is determined using the same qualifications used for the Supplemental Security Income (SSI) program that we discussed in our previous blog post, which you can view here. If a person with autism in North Carolina is already enrolled in the SSI program, they are automatically entitled to Medicaid and no separate application or Medicaid determination is required.

The Supplemental Security Income (SSI) program is a crucial component of receiving Medicaid in the state of North Carolina for autism. In order to receive Medicaid as an individual with autism, SSI serves as a gateway to health insurance under Medicaid.

Upon approval for the SSI program, the Social Security Administration (SSA) promptly notifies the state of North Carolina’s Medicaid agency of an individual’s eligibility for Medicaid upon award of SSI payments using an electronic transmission process. Put simply, Medicaid enrollment is automatic after being approved for the SSI program.1

How to Apply for Medicaid

Since enrollment in Medicaid is automatic after a person with autism has been approved for Supplemental Security Income, you must first apply for SSI.

You must complete the SSA BEST Questionnaire to find the benefits you may be eligible to receive. If you are eligible, at the end of the questionnaire, you will be directed to the agency in order to apply. You can begin the SSA BEST Questionnaire here.

If you’re interested in learning more about SSI and the application process, we invite you to read our previous blog post How To Qualify and Apply for Supplemental Security Income (SSI) for Autism in North Carolina.

Effective Date of Coverage

Since a person with autism’s Medicaid eligibility is determined by their SSI benefits, their Medicaid will begin the first day of the month that they became eligible for SSI benefits.

ShineLight Provides Autism Treatment Near Robeson & Beyond

ShineLight was created with the distinct purpose of providing a brighter life and future for individuals with autism. ShineLight serves as a guiding light for individuals and their families by leading the way in residential, employment support services, and community advocacy. Our service areas include: Fayetteville, Wake, Sampson, Scotland, Duplin, Wayne, Lenoir, Greene, Wilson, Edgecombe, Durham, Johnston, Cumberland, Hoke, Robeson, and Bladen Counties. Contact us today.

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