WHERE TO START CHART: E-PASS VS. MARKETPLACE?
** START HERE **
Is consumer a US citizen or
“qualified immigrant”?
YES NO
Do one of the following apply?
If NO, proceed to the
marketplace. If YES, follow flow
chart to see if you should start
with e-pass.

Blind or disabled?

Under age 19

Age 19 - 20

Primary Caretaker of a
child under age 18

Over age 65?

Pregnant?

Have breast or cervical
cancer?

In foster care
when turned age 18?
Can get Medicaid coverage up
to age 26 regardless of assets
and income. Apply at DSS or
via e-pass.
To Qualify for Medicaid for Disabled (MAD), must be under 100
FPL unless medically needy (very large unpaid bills) or in nursing
home. No earned income limit for working disabled (HCWD).
Consumer will not qualify for
Medicaid (unless experience a
medical emergency).
If consumer has another legal
status, proceed to marketplace.
Does consumer have an YES
application or appeal
pending for Social
Security Disability or SSI? NO
Is HH income below
211 FPL?
Is HH income below
100 FPL?
Is HH income
below 196 FPL?
 Note 1: May be under 100 FPL for MAD but over 100 FPL for APTC.
Over ½ earned income disregarded for this Medicaid category.
 Note 2: There is an asset test for this category of Medicaid. $2k for
an individual, $3k for a couple. Up to $23k if working disabled.
Advise consumer that they must have a current disability or SSI
application on file with Social Security before they can be approved
for Medicaid as a disabled individual. Proceed with Medicaid
and/or Marketplace application as indicated in box above.
YES
NO –
Box A
Is HH income below
approximately 50 FPL
or medically needy
(very large unpaid bills)?
If income over 100 FPL, do both marketplace application and epass. Can get Marketplace coverage while Medicaid decision
pending (can take up to 90 days).
YES
NO –
Box A
May qualify for Medicaid or
NC Health Choice. Apply at DSS or
via e-pass.
Note: Parents may need Marketplace
May qualify for Family Medicaid
(MAF). Apply at DSS or via e-pass.
YES
NO
YES
NO –
Box A
Was cancer diagnosed at
NC Breast and Cervical
Cancer Program?
BOX A: Will not
qualify for Medicaid
under this category.
If not eligible in other
categories, proceed
to Marketplace
application.
May qualify for Medicaid.


Note 1: There is an asset test for this category of Medicaid
Note 2: Over ½ earned income disregarded for this Medicaid
category.
Will not qualify for full Medicaid under this category
NO –
Box A
YES
If client is uninsured, between ages 18-64,
and income is below 250 FPL, may qualify
for the BCCM program. Apply at DSS.
 Note 1: Can’t qualify for Marketplace if eligible for Medicare
 Note 2: Medicare recipients under 135 FPL may be dual eligible
for Medicare and Medicaid affordability programs (MQB/LIS)
May qualify for Medicaid for pregnant women

Note 1: For Medicaid, include pregnant woman and unborn
children when calculating HH size
 Note 2: If 100 - 196 FPL, pregnant women can enroll in
Medicaid and also qualify for subsidies in Marketplace