North Carolina expanded Medicaid in December 2023, and the impact on working adults has been significant. More than 600,000 North Carolinians became newly eligible, including part-time workers, gig workers, self-employed adults, and low-wage full-time employees who previously fell into a coverage gap. In 2026, most adults ages 19 to 64 can qualify based on income alone, at or below 138% of the Federal Poverty Level (FPL). No asset test, no disability requirement, no dependent children required.
If you work but your job does not offer affordable health insurance, or your income is too low to make Marketplace premiums work, NC Medicaid expansion may cover you at no monthly premium cost.
What 138% FPL Actually Means for Your Income
The 138% FPL threshold is recalculated each year when the federal government updates poverty guidelines. The figures below reflect the limits in effect through approximately April 1, 2026, based on the 2025 federal poverty level. Updated limits typically take effect each April.
NC Medicaid Expansion Income Limits 2026 (Adults 19 to 64)
| Household Size | Monthly Gross Income Limit | Annual Gross Income Limit |
|---|
| 1 | $1,800 | $21,597 |
| 2 | $2,433 | $29,196 |
| 3 | $3,065 | $36,780 |
| 4 | $3,698 | $44,376 |
| 5 | $4,340 | $52,080 |
| Each additional person | +$643 | +$7,716 |
These limits are based on gross income (before taxes are taken out). If your income falls at or below the limit for your household size, you likely qualify for expansion Medicaid.
Income counted includes wages, salaries, tips, net self-employment income, unemployment compensation, Social Security benefits (excluding SSI), and most other taxable income. It does not include child support received, SNAP benefits, veterans' disability payments, or most cash gifts.
Who Qualifies as a Working Adult
NC Medicaid expansion targets the "childless adult" population that previously could not access Medicaid regardless of income. Today, the eligibility rules are straightforward:
- Adults ages 19 to 64
- NC resident
- U.S. citizen or qualifying immigration status
- Income at or below 138% FPL
You do not need to be unemployed to qualify. The program is specifically designed to serve working adults who cannot afford private coverage. Part-time workers, seasonal workers, freelancers, and people with irregular income all qualify on the same terms.
There is no asset test for expansion adults. Owning a home, car, or savings account does not affect eligibility.
Groups That Were Already Covered Before Expansion
NC Medicaid covered certain populations before the 2023 expansion at different income thresholds:
| Population | Income Limit (% FPL) |
|---|
| Children under 19 | Up to 216% FPL |
| Pregnant women | Up to 201% FPL |
| Parents and caretaker relatives | Up to 47% FPL (pre-expansion) |
| Adults with disabilities (SSI-linked) | Asset-based rules apply |
| Adults ages 65 and older | Separate long-term care rules |
If you are a parent or caretaker with income above 47% FPL but below 138% FPL, expansion now covers you as an adult even if your children already had Medicaid separately.
What NC Medicaid Covers
Expansion adults receive comprehensive Medicaid coverage, the same benefit set required for ACA expansion populations under federal law. There are no monthly premiums. Copays are minimal, with a maximum of $4 for some services.
Covered services include:
- Doctor visits and primary care
- Specialist visits
- Inpatient hospital stays
- Outpatient hospital care and same-day surgery
- Emergency room visits
- Prescription drugs
- Mental health and behavioral health services
- Substance use disorder treatment
- Preventive care and screenings
- Lab tests and imaging
- Maternity and postpartum care
- Vision and dental services (varies by plan)
Most NC Medicaid expansion members are enrolled in managed care and assigned to one of several health plans, including Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan, WellCare of North Carolina, or AmeriHealth Caritas. You can choose a plan when you apply or be auto-assigned.
Upcoming Change: Work Requirement Starting January 2027
A federal requirement included in legislation signed in 2025 will require some expansion adults to meet a community engagement or work requirement beginning January 1, 2027. Under the current rule, adults ages 19 to 64 without a disability will need to work, participate in job training, attend school at least half-time, or volunteer for at least 80 hours per month to maintain coverage.
Exempt populations include people receiving SSI or SSDI, people with documented medical conditions that prevent work, primary caregivers, and others defined by exemption criteria yet to be finalized.
As of May 2026, NC DHHS is developing its implementation roadmap. The requirement does not apply in 2026. If you qualify today and enroll, you will not be affected until early 2027 at the earliest, and outreach will be required before any action is taken on your case.
How to Apply for NC Medicaid in 2026
The fastest way to apply is through the NC ePASS portal at epass.nc.gov. You can also apply by phone, in person, or by mail.
Step-by-Step Application Through ePASS
Step 1: Create or log in to your ePASS account
Go to epass.nc.gov and create a free account. You will need a valid email address. If you already have an account from a previous application, log in with your existing credentials.
Step 2: Start a new application
Select "Apply for Benefits" and choose Medicaid (NC Health Coverage). The same application also lets you apply for SNAP (food assistance) if you need both.
Step 3: Complete the household and income section
List everyone in your household and enter income for each person. Include all income sources. The portal will walk you through MAGI-based income rules applicable to expansion adults.
Step 4: Upload required documents
Use the ePASS Document Center to upload:
- Photo ID for each adult applicant (NC driver's license, NC ID, passport, or military ID)
- Proof of income for the most recent 30 days (pay stubs, employer letter, or most recent tax return for self-employed)
- Social Security numbers for all household members
- Proof of NC residency if not already shown on your ID (utility bill, lease agreement)
Uploading documents during the same session as your application reduces processing delays.
Step 5: Submit and wait for a decision
Standard Medicaid applications must be processed within 45 days. Most expansion adult decisions come faster. You will receive a notice by mail and can check your status in the ePASS portal at any time.
Step 6: Choose a health plan
If approved, you will select a managed care health plan. If you do not choose, one will be assigned to you. You can change plans within the first 90 days of enrollment.
Other Ways to Apply
- Phone: Call the NC Medicaid Contact Center at 1-888-245-0179 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m.
- Local DSS office: Apply in person at your county Department of Social Services. Find your local office at ncdhhs.gov.
- Paper application: Download a paper application from ncdhhs.gov and mail it to your county DSS office.
Common Reasons Applications Are Delayed
- Missing income documentation (most common delay)
- Social Security number not provided for all household members
- Residency not verifiable from documents submitted
- Income reported inconsistently across household members
Uploading complete documentation through the ePASS Document Center in your first session cuts processing time significantly. If you are missing a document, submit what you have and note what is coming, rather than waiting to apply at all.
What If Your Income Is Just Above the Limit
If your income exceeds 138% FPL, you do not qualify for NC Medicaid expansion, but you may qualify for other coverage with financial assistance.
From 138% to 400% FPL, you can enroll in an ACA Marketplace plan at HealthCare.gov with premium tax credits that reduce your monthly cost. Many people in this range pay $0 to $50 per month for a benchmark silver plan after credits.
You can check your eligibility for both Medicaid and ACA subsidies at the same time using the BenefitsUSA screener. If you apply on HealthCare.gov and your income comes in below 138% FPL, the system will route you to Medicaid automatically.
Other NC Benefits You May Also Qualify For
Working adults who qualify for NC Medicaid expansion often qualify for additional programs depending on household size and income:
- NC SNAP (Food and Nutrition Services): Gross income limit of 130% FPL for most households. Apply through ePASS at the same time as Medicaid.
- LIHEAP: Heating and cooling assistance for households with low income. Apply through your county DSS or at ncdhhs.gov.
- WIC: Available for pregnant women, postpartum women, infants, and children under 5 at or below 185% FPL.
Use the BenefitsUSA screener to check multiple programs at once based on your specific income and household.
Frequently Asked Questions
Does having a job disqualify me from NC Medicaid expansion?
No. Employment does not disqualify you. The only income test is whether your total household income falls at or below 138% FPL. Many full-time and part-time working adults qualify, especially those in lower-wage jobs or without employer-sponsored insurance.
Is there a waiting period after I apply?
There is no waiting period built into the expansion program. Once you are approved, coverage is typically effective the first day of the month you applied or the month of your approval, depending on the timing. Ask when you apply to confirm your effective date.
What if I have fluctuating income as a gig worker or freelancer?
You can use projected annual income to determine eligibility. If you expect to earn at or below the annual limit for your household size, you qualify. Report your income as accurately as possible. If your income changes during the year, report the change in ePASS so your eligibility can be reassessed.
Can I keep my employer insurance and also have Medicaid?
In most cases, Medicaid will be secondary to employer coverage. NC Medicaid can still fill in gaps for services your employer plan does not cover or for cost-sharing you cannot afford. Talk to a Medicaid eligibility worker at your county DSS for guidance on how coordination of benefits would work in your situation.
What happens to my coverage in 2027 when the work requirement starts?
You will not lose coverage without notice. NC DHHS is required to send outreach by August 31, 2026 at the latest. Most working adults will already meet the 80 hours per month requirement through their jobs. Exemptions will cover people with disabilities, caregivers, and others who cannot work. The state has not finalized all implementation details as of May 2026.
What is the difference between MAGI Medicaid and regular Medicaid?
MAGI stands for Modified Adjusted Gross Income. It is the income calculation method used for expansion adults, children, pregnant women, and parents. It is simpler than the old Medicaid income rules because it follows the same income counting rules as the ACA. No asset test applies. Traditional or non-MAGI Medicaid applies to aged, blind, and disabled individuals and uses different rules including asset limits.
Where can I check my application status?
Log in to your ePASS account at epass.nc.gov and go to "My Cases" to see your application status. You can also call the NC Medicaid Contact Center at 1-888-245-0179.
For a quick check on whether you qualify for NC Medicaid or other programs, use the free BenefitsUSA screener. It covers Medicaid, SNAP, LIHEAP, ACA subsidies, and more, and takes less than five minutes to complete. Visit our North Carolina benefits page for a full list of state programs.
