Eligibility & Enrollment

Eligibility and Enrollment staff (E&E) enroll consumers in the State Benefit Plan through Provider Enrollment Request; update member information through Provider Update Requests; process discharges for state members; and verify Medicaid, State and COB coverage for providers and other Vaya Health departments. E&E staff also verify, add and update Medicaid C eligibility in AlphaMCS.

The Eligibility and Enrollment Team can answer the following questions:

  • How do I enroll a consumer into state mental health services? (enrollments)
  • How do I update information in a consumer’s record? (consumer updates)
  • Why can’t I pull up a consumer in Alpha?
  • What is an explanation of Medicaid’s categories of eligibility?
  • How can I get a Common Name Data Service (CNDS) number for a consumer? (This includes looking it up in Alpha or creating one in NCTracks.)
  • How can I activate Medicaid C insurance layer for the month in Alpha?
  • How can I verify if Medicaid B is active?
  • How can I verify if State insurance is active?
  • What if I have questions about the claim denial “no coverage on date of service”?
  • Why does an individual see something different in NCTracks from what we have in Alpha? (GEF)
  • What if I have questions about 3rd party insurance and dual eligibility

 

Medicaid Categories of Aid and the 1915(b)(c) Waiver

Although Vaya is responsible for the administration of Medicaid waivers, we are not responsible for all Medicaid categories of aid. Review the information below to learn more about covered populations and Medicaid categories of aid for which Vaya is responsible as a payer under the 1915(b)(c) Waiver.

General categories of aid:

  • Aid to Families with Dependent Children (AFDC)
  • Foster children, ages 3 and older
  • Aged, age 65 and older
  • Blind and disabled, ages 3 to 20
  • Blind and disabled, age 21 and older
  • Innovations, all ages

Specific eligibility codes for each general category of aid:

  • AFDC (Aid to Families with Dependent Children, 3 and older): AAFCN, MAFCN, MAFMN, MAFNN, MAFWN, MICNN, MIC1N, MPWNN
  • Foster children (age 3 and older): HSFCY, HSFMN, HSFNN, HSFNY, IASCN, MCINN (new, March 2015)
  • Aged (age 65 and older): MAABN, MAACY, MAAMN, MAANN, MAAMY, MAAQN, MAAQY, SAACN, SAACY, SAAQN, SAAQY
  • Blind and disabled (ages 3 to 20 and ages 21 and older): MABBN, MABCY, MABMN, MABNN, MABQN, MABQY, MADBN, MADCY, MADMN, MADNN, MADQN, MADQY, MSBBN, MSBBY, MSBCN, MSBQN, MSBQY, SADCN, SADCY, SADQN, SADQY
  • Innovations (all ages): 1915(c) Waiver recipients as identified by an Innovations waiver code (IN) in the state’s eligibility file

The eligibility status of Medicaid recipients who qualify for a category of aid covered by the waiver is downloaded into AlphaMCS through the Global Eligibility File (GEF), which is generated by NCTracks and updated daily.

The following Medicaid populations remain “Fee for Service” and are not covered by MCOs under the 1915 (b)(c) waivers:

  • Infants under age 3, except those who are eligible for Innovations
  • Qualified Medicare beneficiaries
  • Specified low-income beneficiaries
  • Children enrolled in the N.C. Health Choice (NCHC) Health Insurance Program for Children
  • Legal and Illegal aliens
  • Refugees
  • Individuals eligible for the Program of All-Inclusive Care for the Elderly

Call 1-800-849-6127 toll free 24/7 to obtain services and support for mental health, developmental disabilities and substance abuse. Members can request materials in Spanish or English.

Llamar al número gratuito 1-800-849-6127 24/7 para obtener servicios y apoyo a la salud mental, discapacidades de desarrollo y abuso de sustancias. Los miembros pueden solicitar materiales en español o Inglés.