North Carolina Medicaid covers millions of residents across different eligibility categories, each with its own income threshold. If you are trying to figure out whether you qualify, the number that matters most is the Federal Poverty Level (FPL) percentage assigned to your situation. This guide breaks down every major eligibility group, shows exact monthly and annual income limits for 2026, and walks through how to apply.
North Carolina expanded Medicaid on December 1, 2023, which opened coverage to adults ages 19 to 64 who previously fell into a coverage gap. If you checked your eligibility before that date and were told you did not qualify, it is worth checking again.
Who Qualifies for NC Medicaid in 2026?
NC Medicaid covers several distinct groups. Income limits differ by group, so find the category that applies to your household:
- Adults ages 19 to 64 (Medicaid Expansion): Up to 138% FPL
- Children ages 0 to 18: Up to approximately 211% FPL through Medicaid; up to 216% FPL through NC Health Choice (CHIP)
- Pregnant women: Up to 196% FPL, with 12 months of postpartum coverage
- Parents and caretaker relatives: Up to 45% FPL
- Adults with disabilities: Determined under SSI-related rules; income and asset limits apply
- Seniors (65 and older): Coverage available for long-term care at 100% FPL; asset and income caps apply
For most working-age adults without children, Medicaid Expansion is the relevant program. It has no asset test, meaning savings, a car, and a home do not count against you.
NC Medicaid Income Limits 2026: Adults Ages 19 to 64
These figures are based on 138% of the Federal Poverty Level and apply to the Medicaid Expansion category. Limits reflect gross monthly income before taxes.
| 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 |
| 6 | $4,973 | $59,676 |
These limits are set by the federal poverty guidelines updated each January. NC Medicaid applies its own income thresholds effective April 1 each year, so the amounts above reflect figures current through mid-2026.
There is no asset test for expansion adults. You can own a home, vehicle, and savings account without it affecting eligibility.
NC Medicaid Income Limits 2026: Children and Pregnant Women
Children qualify at higher income thresholds than adults. NC Health Choice (the state's CHIP program) extends coverage further for children ages 6 to 18.
| Group | Income Limit | Notes |
|---|
| Children (Medicaid) | ~211% FPL | Covers ages 0 to 18 |
| NC Health Choice (CHIP) | 211% to 216% FPL | Ages 6 to 18; small premiums may apply |
| Pregnant women | 196% FPL | Approximately $2,557/month for a single person |
| Infants under age 1 | 196% FPL | Income based on household |
Pregnant women who qualify receive full Medicaid coverage through the pregnancy and for 12 months after delivery, regardless of income changes during that period.
NC Medicaid Income Limits 2026: Long-Term Care and Seniors
Medicaid for nursing home care, home and community-based services (HCBS), and other long-term care programs works differently. These programs use 100% FPL as the income cap and apply asset limits.
| Group | Monthly Income Limit | Asset Limit (Individual) |
|---|
| Nursing home care | ~$1,305/month | $2,000 |
| HCBS Waiver | ~$1,305/month | $2,000 |
| Community Medicaid (aged/disabled) | ~$1,305/month | $2,000 |
Married couples have a higher combined asset limit. A spouse who remains in the community (not receiving institutional care) is permitted to keep significantly more assets under spousal impoverishment protections.
What Counts as Income for NC Medicaid?
NC Medicaid uses Modified Adjusted Gross Income (MAGI) rules for most applicants, including expansion adults, children, and pregnant women. MAGI includes:
- Wages and salaries
- Self-employment income
- Unemployment compensation
- Social Security benefits (in most cases)
- Alimony received (for divorces finalized before 2019)
MAGI does not count: child support received, gifts, veterans' non-service-connected pension (in most cases), or Supplemental Security Income (SSI).
For seniors and people with disabilities, the state may use different income rules tied to SSI methodology rather than MAGI.
How to Apply for NC Medicaid in 2026
There are four ways to apply. The online option through ePASS is generally the fastest.
Option 1: Apply Online Through ePASS
- Go to epass.nc.gov and create an NCID account if you do not have one.
- Log in and select "Medical Assistance" from the list of programs.
- Fill out the application with accurate household and income information. Answer every question you can.
- Upload supporting documents if possible. This speeds up processing.
- Submit the application and save your confirmation number.
Option 2: Apply In Person at Your Local DSS
Every county in North Carolina has a Department of Social Services (DSS) office that accepts Medicaid applications. You can find your local office at the NCDHHS DSS directory.
Option 3: Apply by Phone
Call the NC Medicaid Contact Center at 1-888-245-0179, Monday through Friday, 8 AM to 5 PM.
Option 4: Mail, Email, or Fax
Download the application from the NCDHHS website, complete it, and mail, email, or fax it to your local DSS office.
Documents You May Need
Gathering these before you start will help avoid delays:
- Photo ID (driver's license, state ID, or passport)
- Proof of North Carolina residency (utility bill, lease agreement)
- Social Security numbers for all household members
- Proof of income (recent pay stubs, tax return, employer letter)
- Proof of citizenship or immigration status
- If applying for disability-based Medicaid: medical records or documentation of the disability
Processing Time
DSS has up to 45 days to process a standard Medicaid application. Disability-based applications can take up to 90 days. You can check your status at any time through ePASS or by calling 1-888-245-0179.
Free Help Applying
If you need help completing your application, NC Navigators offer free, unbiased assistance. They can help you understand your options and submit your application correctly. Call 1-855-733-3711 to schedule a free appointment.
What NC Medicaid Covers
Once approved, NC Medicaid provides comprehensive coverage with no premiums for most members. Covered services include:
- Doctor visits and preventive care
- Hospital stays (inpatient and outpatient)
- Emergency care
- Mental health and substance use services
- Prescription drugs
- Vision and dental care
- Maternity care
- Long-term care and home health services
Most NC Medicaid recipients are enrolled in a managed care plan. You will select a plan and a primary care provider after approval.
NC Medicaid and the ACA Marketplace
If your income is above 138% FPL, you will not qualify for expansion Medicaid. However, you may qualify for subsidized health insurance through the ACA Marketplace. Subsidies are available for households with income from 100% FPL up to 400% FPL, and in some cases higher.
If your income falls between 100% and 138% FPL and you are not eligible for Medicaid for another reason (such as immigration status), you can still use the Marketplace and receive premium tax credits.
Use our free eligibility screener to see which programs you qualify for based on your actual income and household size.
Check If You Qualify Today
Income limits change every April 1 when NC Medicaid updates its figures. If you are near the threshold, it is worth checking your eligibility now and again after that date. The ePASS portal is available 24 hours a day, and applications can be submitted any time.
You can also use the Benefits Navigator screener to check eligibility for Medicaid, SNAP, ACA subsidies, and other programs in one place, for free, without creating an account. For state-specific information, visit our North Carolina benefits guide.
Frequently Asked Questions
What is the income limit for Medicaid in North Carolina in 2026?
For adults ages 19 to 64 under Medicaid Expansion, the limit is 138% of the Federal Poverty Level. That works out to approximately $1,800 per month for a single person or $3,698 per month for a household of four.
Did North Carolina expand Medicaid?
Yes. North Carolina expanded Medicaid under the Affordable Care Act effective December 1, 2023. Adults ages 19 to 64 with income at or below 138% FPL are now eligible, regardless of whether they have children or a disability.
Does NC Medicaid have an asset test in 2026?
No, for Medicaid Expansion adults. There is no asset test, so savings, a vehicle, and home ownership do not affect eligibility. Asset tests do apply for long-term care Medicaid programs for seniors and people with disabilities.
How long does it take to get approved for NC Medicaid?
Standard applications take up to 45 days. Disability-based Medicaid applications can take up to 90 days. You can check your status through ePASS at epass.nc.gov or by calling 1-888-245-0179.
Can I apply for NC Medicaid if I am self-employed?
Yes. Self-employment income counts toward the income limit, but you can deduct business expenses to arrive at your net self-employment income before it is compared to the Medicaid threshold.
What is NC Health Choice?
NC Health Choice is North Carolina's Children's Health Insurance Program (CHIP). It covers children ages 6 to 18 in households with income between 211% and 216% FPL who earn too much for full Medicaid but still need affordable coverage. Small monthly premiums may apply.
What happens if my income goes over the limit mid-year?
You must report income changes to your local DSS. If your income rises above the limit, you may lose Medicaid coverage but could qualify for subsidized Marketplace insurance instead. Changes in income should be reported within 30 days.
Is there a phone number to call for NC Medicaid questions?
Yes. The NC Medicaid Contact Center can be reached at 1-888-245-0179, Monday through Friday from 8 AM to 5 PM Eastern Time.
