SPECIAL BULLETIN COVID-19 #122: NC Medicaid Will Reimburse Providers for COVID-19 Testing for Uninsured North Carolinians; Applications Available

Monday, August 17, 2020

Effective Sept. 1, 2020, NC Medicaid will begin reimbursing COVID-19 testing costs for uninsured individuals enrolled in the NC Medicaid Optional COVID-19 Testing (MCV) program. This option was made available to all states through Section 6004(a)(3) of the Families First Coronavirus Response Act (FFCRA).

A webinar for providers on the MCV process will be held in the future.

Applications

A simple online application for the MCV program will be available in September. Individuals will be able to apply using the Internet or mobile device. Until the online application is functional, NC Medicaid encourages COVID-19 testing site providers and other Medicaid-enrolled providers who perform testing to download paper applications, available in English and Spanish, and collect them for mailing to the Medicaid address on the form. Paper applications are estimated to take 2-6 weeks for processing.

MCV Program Eligibility

Individuals must be uninsured, a resident of North Carolina, and meet the citizenship and legal immigration status requirements of the Medicaid program. NC Medicaid will accept self-attestation of eligibility factors, except for citizenship and immigration status, to determine eligibility for the group. Individuals must meet eligibility qualifications at the time the test was obtained.

NOTE: Uninsured individuals currently enrolled in NC Medicaid’s limited “Family Planning Only” benefit and who have no other health insurance coverage will automatically be enrolled in the MCV program and will not need to complete an application. 

Approval of an individual’s eligibility for the MCV program is required prior to payment for testing services. Testing site providers must be enrolled in Medicaid to receive payment.

Verifying Eligibility

As there will be a delay between when the application is received and when the application is processed, providers will need to wait until the individual is determined eligible to submit claims for testing. Once an individual is determined eligible, they will remain eligible continuously throughout the federal public health emergency. Enrolled MCV beneficiaries will also be eligible for retroactive coverage of COVID-19 tests, up to three months prior to September, provided they were uninsured at the time of the test.

To determine whether an individual is enrolled in the MCV program, testing site providers can:

  • Check the NCTracks Portal to confirm Medicaid eligibility and then bill NCTracks for testing provided OR
  • Allow beneficiaries to apply online or collect paper applications at testing location; then submit applications to Medicaid and wait approximately 2-6 weeks for application processing. Finally, check the NCTracks Portal to confirm Medicaid eligibility; and then bill NCTracks for the testing provided OR
  • Bill HRSA for individuals who are not eligible for Medicaid.

Contact

NC Medicaid Contact Center: 888-245-0179