North Carolina expanded Medicaid under the Affordable Care Act on December 1, 2023, becoming one of the last states to do so. Since then, more than 650,000 people have enrolled in coverage through the expansion, surpassing the state's original projections in roughly half the expected time. If you are an adult in North Carolina between the ages of 19 and 64, you may now qualify for free or low-cost health coverage through NC Medicaid, regardless of whether you have children.
This guide covers who qualifies, current income limits, how to apply, and what federal changes in 2026 mean for current and future enrollees.
What NC Medicaid Expansion Covers
NC Medicaid expansion extends full Medicaid coverage to low-income adults ages 19 through 64 who previously fell in a coverage gap. Before December 2023, adults without dependent children generally could not access Medicaid in North Carolina unless they had a qualifying disability.
Expansion coverage includes:
- Doctor visits and preventive care
- Emergency services
- Mental health and substance use disorder treatment
- Prescription drugs
- Hospitalization
- Maternity care
- Vision and dental services
There is no premium for most expansion enrollees and no asset test. You can own a home, a car, and savings and still qualify.
NC Medicaid Expansion Enrollment Status in 2026
As of April 2025, North Carolina had enrolled approximately 650,000 newly eligible residents since the program launched. That milestone was reached in fewer than 18 months, well ahead of the state's initial forecast of 600,000 enrollees by end of year one.
Enrollment continues to be open year-round. Unlike ACA Marketplace plans, there is no open enrollment window for Medicaid. You can apply any time of year.
2026 Income Limits for NC Medicaid Expansion
To qualify for expansion Medicaid in North Carolina, your household income must be at or below 138% of the Federal Poverty Level (FPL). The table below reflects income limits based on 2025 FPL guidelines, which were in use at the start of 2026. Updated 2026 FPL figures were expected to take effect around April 1, 2026, with roughly a 2% increase.
NC Medicaid Expansion Income Limits (Adults 19-64)
| Household Size | Monthly Income Limit | Annual 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 |
Income is counted as Modified Adjusted Gross Income (MAGI), which includes wages, salaries, self-employment income, Social Security benefits (most types), and other taxable income. Irregular or seasonal work is averaged over the year.
Other NC Medicaid Income Limits
Different Medicaid categories cover children, pregnant individuals, and seniors at different thresholds.
| Population Group | Income Limit (% FPL) | Approximate Annual Limit (Family of 4) |
|---|
| Adults ages 19-64 (expansion) | 138% FPL | $44,376 |
| Children ages 0-18 | Up to 216% FPL | approximately $69,400 |
| Pregnant individuals | Up to 201% FPL | approximately $64,600 |
| Seniors and adults with disabilities | Varies, often 100% FPL | approximately $15,650 (single) |
For long-term care Medicaid (nursing home coverage), different rules apply, including asset limits and spend-down provisions.
Who Qualifies for NC Medicaid Expansion
To be eligible for expansion Medicaid in North Carolina, you must meet all of the following:
- Be between 19 and 64 years old
- Be a U.S. citizen or qualifying immigration status
- Be a North Carolina resident
- Have household income at or below 138% FPL
You do not need to have children or a disability to qualify under expansion. You also do not need to be employed. The program covers adults whether they are working, unemployed, self-employed, or in school.
Who Does Not Qualify
- Adults 65 and older (they may qualify for Medicare or other Medicaid pathways)
- Individuals already enrolled in Medicare
- Adults with incomes above 138% FPL (they may qualify for subsidized ACA Marketplace plans)
- Undocumented immigrants (federal law bars them from Medicaid, with narrow exceptions such as emergency Medicaid)
How to Apply for NC Medicaid Expansion
You can apply online, by phone, in person, or by mail. Online is the fastest method.
Step-by-Step Online Application via ePASS
- Go to epass.nc.gov
- Create a free NCID account. You will need an email address to register.
- Select "Apply for Benefits" and choose Medical Assistance (NC Medicaid).
- Complete the application with information about your household, income sources, and immigration status if applicable.
- Submit the application. Most take 30 to 45 minutes to complete.
- A caseworker will review your application. You should receive a decision within 45 days.
If approved, coverage can be retroactive to the first day of the month you applied.
Other Ways to Apply
- Phone: Call the NC Medicaid Contact Center at 1-888-245-0179, Monday through Friday, 8 AM to 5 PM
- In person: Visit your local Department of Social Services (DSS) office. Find your county office at ncdhhs.gov/localDSS
- Mail: Download a paper application from medicaid.ncdhhs.gov and mail it to your local DSS office
Documents You May Need
- Proof of identity (driver's license, state ID, or passport)
- Proof of North Carolina residency (utility bill, lease, or mail)
- Proof of income (recent pay stubs, tax return, or self-employment records)
- Social Security numbers for household members applying for coverage
If you cannot gather all documents immediately, you can still submit your application. The county DSS will typically allow time to provide verification.
What Happens After You Apply
Once NC Medicaid approves your application, you will receive a letter with your Medicaid ID number. You will then be enrolled in an NC Medicaid managed care plan. As of 2024, most expansion enrollees in North Carolina are served through one of five managed care organizations: Aetna Better Health, AmeriHealth Caritas, Carolina Complete Health, Healthy Blue, or WellCare.
You will receive a health plan card and can start using your benefits. If you have a preferred doctor, check whether that provider is in your plan's network.
Federal Policy Changes Affecting NC Medicaid in 2026
Federal legislation passed in 2025 introduced several changes that will affect NC Medicaid expansion enrollees in 2026 and beyond.
More Frequent Eligibility Redeterminations
Starting December 31, 2026, adults in the Medicaid expansion group (ages 19 to 64 without disabilities) will need to have their eligibility re-checked every 6 months, compared to the current 12-month cycle. This means expansion enrollees will need to respond to renewal notices more frequently to keep coverage.
If you receive a renewal notice, respond promptly. Failure to return the form or update your information can result in your coverage being terminated even if you still qualify.
Work Requirements Incoming
Federal rules set to take effect in late 2026 will require some Medicaid enrollees to document 80 hours per month of work, school, or community service to maintain coverage. North Carolina officials have noted that implementing this requirement will be administratively complex and costly. Individuals with disabilities and certain caregiving responsibilities may be exempt.
Details on exactly how North Carolina will implement the federal work requirement are still being finalized. Monitor updates at medicaid.ncdhhs.gov for state-specific guidance.
Immigration Eligibility Restrictions
By October 1, 2026, federal funding restrictions will remove coverage for certain immigrant groups, including many refugees, asylees, DACA recipients, and others with humanitarian immigration statuses. These individuals may lose Medicaid coverage depending on their specific status. If this could affect you or a family member, contact NC Medicaid or a local immigration legal services provider.
Provider Rate Cuts
North Carolina announced $320 million in Medicaid program cuts as a result of reduced federal matching funds. These cuts may affect provider reimbursement rates and the availability of some optional services such as dental and behavioral health.
Keeping Your NC Medicaid Coverage
Once enrolled, you need to take a few steps to keep your coverage active:
- Update your contact information with NC Medicaid and your county DSS whenever you move or change your phone number or email
- Respond to all renewal notices within the stated deadline
- Report changes in income, household size, or address within 10 days
- Starting in 2027, be prepared for 6-month renewals if you are in the expansion group
If your coverage is terminated and you believe you still qualify, you have the right to appeal. Contact your county DSS or call 1-888-245-0179.
NC Medicaid Expansion and the ACA Marketplace
If your income is above 138% FPL, you do not qualify for expansion Medicaid but may qualify for subsidized health insurance through the ACA Marketplace (healthcare.gov). Premium tax credits are available for individuals earning between 100% and 400% FPL (or higher in some years under extended provisions).
If your income fluctuates month to month, you may move between Medicaid eligibility and Marketplace eligibility. Enroll in the program that fits your current income level and update your information if your income changes significantly.
Use the free Benefits Navigator screener at benefitsusa.org/screener to check your estimated eligibility for both Medicaid and Marketplace plans in North Carolina based on your household size and income.
Frequently Asked Questions
Does North Carolina have Medicaid expansion in 2026?
Yes. North Carolina expanded Medicaid on December 1, 2023. The expansion is fully active in 2026. Adults ages 19 to 64 with household incomes up to 138% FPL can apply year-round at epass.nc.gov or medicaid.ncdhhs.gov.
How many people are enrolled in NC Medicaid expansion?
As of April 2025, approximately 650,000 people had enrolled in NC Medicaid expansion since it launched in December 2023. The state had originally estimated it would take two years to reach that number.
What is the income limit for NC Medicaid expansion in 2026?
For a single adult, the income limit is approximately $1,800 per month (138% FPL). For a family of four, the limit is approximately $3,698 per month. Updated figures based on 2026 FPL guidelines were expected around April 2026 with a roughly 2% increase.
Can adults without children get Medicaid in NC?
Yes. Before expansion, most adults without children and without a disability did not qualify for NC Medicaid. Under the expansion, adults between 19 and 64 can qualify based on income alone, with no children or disability required.
Is there an asset limit for NC Medicaid expansion?
No. The expansion group (adults 19 to 64) has no asset test. You can own a home, vehicle, savings account, or other property and still qualify as long as your income is within the limit.
Will I lose NC Medicaid coverage because of work requirements in 2026?
Federal work requirements are set to take effect in late 2026. The exact implementation process for North Carolina is still being developed. Individuals with disabilities, caregiving responsibilities, and certain other circumstances may be exempt. Check medicaid.ncdhhs.gov for updates on how NC will implement this rule.
How long does it take to get approved for NC Medicaid?
Applications are generally processed within 45 days. Some applications, especially those involving disability-related Medicaid, may take up to 90 days. Applying online through ePASS tends to be faster than paper applications.
What if I was denied NC Medicaid expansion?
If your application was denied and you believe the decision was wrong, you have the right to request a fair hearing. Contact your county DSS office or call NC Medicaid at 1-888-245-0179. You generally have 90 days from the date of the denial notice to file an appeal.
For a personalized eligibility check across Medicaid, SNAP, and other North Carolina benefits programs, use the free Benefits Navigator screener or visit the North Carolina benefits guide for a full overview of programs available in your state.
