Medicaid Redetermination in North Carolina

What is Medicaid Redetermination in North Carolina?

Medicaid redetermination is a process carried out by the North Carolina Department of Health and Human Services (NCDHHS) to review and confirm the continued eligibility of individuals enrolled in Medicaid. It ensures that only eligible beneficiaries receive the program’s benefits.

Why is Medicaid Redetermination important?

Medicaid redetermination is an essential process as it helps maintain the integrity of the Medicaid program. By conducting regular reviews, the NCDHHS can identify any changes in an individual’s circumstances that may affect their eligibility for Medicaid. This ensures that the program’s resources are directed towards those who genuinely need them.

When does Medicaid Redetermination occur?

Medicaid redetermination in North Carolina is typically conducted annually. The NCDHHS sends out redetermination forms to beneficiaries, which they must complete and return with the necessary documentation within a specified timeframe. It is crucial for beneficiaries to respond promptly to avoid any interruption in benefits.

What are the requirements for Medicaid Redetermination?

During the redetermination process, beneficiaries are required to provide updated information about their household and income. This includes details about employment, assets, insurance, and any changes in living arrangements. Failure to provide accurate and updated information may result in a loss of Medicaid benefits.

What happens after Medicaid Redetermination?

Once the NCDHHS receives the completed redetermination forms and supporting documents, they review the information provided. If everything is in order and the beneficiary continues to meet the eligibility criteria, the Medicaid benefits are renewed. However, if there are changes that impact eligibility, the beneficiary may be required to provide additional documentation or, in some cases, may no longer qualify for Medicaid.

How to prepare for Medicaid Redetermination?

To ensure a smooth Medicaid redetermination process, it is essential to keep your records organized. This includes retaining copies of documents such as pay stubs, tax returns, proof of residency, and insurance information. Promptly notifying the NCDHHS of any changes in your circumstances, such as a change in address or income, is crucial to avoid any disruptions in your Medicaid benefits.

What if my Medicaid benefits are terminated?

If your Medicaid benefits are terminated after the redetermination process, you may have the option to appeal the decision. You can contact the NCDHHS or seek assistance from legal aid organizations or Medicaid advocates who can guide you through the appeals process and help you understand your options.


Medicaid redetermination in North Carolina is a vital process that ensures the program’s benefits are reaching the individuals who truly require them. By understanding the importance of accurate and timely reporting of changes in circumstances, beneficiaries can help maintain their eligibility for Medicaid and continue to receive the necessary healthcare services.

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