NC Medicaid for a Grandchild Without Custody: How to Get Health Coverage
You Don't Need a Court Order
One of the most common fears grandparents have is that they can't get Medicaid for a grandchild without legal custody. In North Carolina, that's not how it works.
Medicaid eligibility for children uses Modified Adjusted Gross Income (MAGI) rules. When a child lives with a non-parent relative who doesn't claim them as a tax dependent, the Medicaid household is just the child — with the child's own income. Your pension, Social Security, wages, and savings are not part of the calculation.
The county DSS compares the child's income with the age-specific Medicaid limit.
Income Limits by Age
NC Medicaid covers children at these MAGI income thresholds (as a percentage of the Federal Poverty Level):
| Age Group | Income Limit |
|---|---|
| Under 1 year | Up to 210% FPL |
| Ages 1–5 | Up to 143% FPL |
| Ages 6–18 | Up to 133% FPL |
For ages 6–18, the ceiling is 133% FPL.
What You Need to Prove
Without a court order, DSS needs evidence that the child is actually living with you and that you're providing care. Acceptable proof includes a written statement from the child's parent acknowledging the arrangement, school records showing your address, utility bills with your name and address, a letter from the child's school or pediatrician, or a sworn caregiver statement.
You don't need all of these. One or two documents establishing that the child lives at your address and you're the responsible adult is typically enough.
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The Children and Families Specialty Plan
Children in foster care or kinship care with child welfare involvement are automatically enrolled in the Children and Families Specialty Plan (CFSP), operated by Healthy Blue Care Together under Blue Cross NC. This plan integrates physical health, behavioral health, and developmental services with a dedicated care manager.
Children in informal kinship arrangements — where there's no DSS involvement — enroll in regular NC Medicaid Direct or a standard managed care plan. They still receive full EPSDT benefits (Early and Periodic Screening, Diagnostic, and Treatment), which requires Medicaid to cover all medically necessary services for children, including dental, vision, hearing, mental health, and transportation to appointments.
How to Apply
Apply through ePASS (epass.nc.gov) or at your county DSS office. Medicaid is on the same application as Work First and food stamps — check the box when the form lists available programs.
Medicaid applications have a 45-calendar-day processing period. Check the decision notice for the coverage effective date.
Keeping Coverage: The 12-Month Rule
NC Medicaid provides 12 months of continuous eligibility for children. Once approved, the child stays covered for a full year regardless of income changes during that period. Before the year ends, DSS attempts an automatic renewal by checking databases. If they can't verify everything automatically, they'll send a pre-populated renewal form with 30 days to return it.
Keep your address current with DSS. If you can't return a renewal form by the 30-day deadline, contact DSS promptly and ask what you need to do to keep the renewal moving.
Our North Carolina Kinship Financial Help Guide covers the full Medicaid application process, what to do if the child was previously on NC Health Choice, and how to handle prescription and specialist referrals under EPSDT.
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