North Carolina Medicaid 2026: Income Limits, Expansion & How to Apply

Quick answer: North Carolina expanded Medicaid on December 1, 2023, so most adults ages 19–64 now qualify with income up to 138% of the Federal Poverty Level — about $1,800 per month for one person (rising to approximately $1,835 on April 1, 2026) or roughly $3,697 per month for a family of four — with no asset test for working-age adults. If you were denied Medicaid before December 2023 because you didn’t have children or earned too much under the old rules, you should reapply — you may qualify now. Apply through ePASS at epass.nc.gov.

Who This Is For

This guide is for North Carolinians trying to understand their Medicaid options in 2026. NC Medicaid currently covers approximately 2.9 million residents, with more than 600,000 newly enrolled since the state expanded Medicaid on December 1, 2023. If you looked into Medicaid before December 2023 and were told you didn’t qualify because you didn’t have children or a disability, the rules have changed significantly — you should recheck your eligibility today.

North Carolina was historically one of the most restrictive states for Medicaid eligibility, limiting coverage primarily to children, pregnant women, parents with very low income, seniors, and people with disabilities. The December 2023 expansion was the most significant change to health coverage in the state in at least a decade. Adults who were previously in a coverage gap — earning too little for ACA marketplace subsidies but too much or the wrong category for the old Medicaid rules — now have access to comprehensive coverage at no monthly premium with copays that never exceed $4 per visit.

This guide explains who qualifies, what the income limits are for each group, how to apply through ePASS, and what changes are coming in late 2026 and into 2027. For a state-by-state comparison, see our guide on Medicaid income limits by state. For a national overview, see our Medicaid overview.

North Carolina Expanded Medicaid — What Changed on December 1, 2023

On December 1, 2023, North Carolina became the 40th state to adopt ACA Medicaid expansion, after nearly a decade of legislative deadlock. The change was historic: for the first time, adults ages 19–64 in North Carolina could qualify for Medicaid based solely on income — without needing to be a parent, pregnant, disabled, or over 65.

More than 600,000 North Carolinians enrolled in the first year following expansion, making it one of the largest enrollment surges of any state’s Medicaid program in recent history. Coverage is comprehensive: doctor and specialist visits, hospital care, prescriptions, mental health and substance use services, dental care (limited), vision, lab work, and preventive services — all with copays that never exceed $4 and no monthly premium. There are no enrollment periods: you can apply any time of year.

This is not a future plan or a proposal. Coverage has been available and actively enrolling since December 1, 2023. If you have been telling yourself you’ll check on Medicaid eligibility “when things change,” the change happened — now is the time to apply. If you applied before December 2023 and were told you didn’t qualify, the guidance from NCDHHS is explicit: reapply, because expansion may have made you eligible.

The single most important thing many North Carolinians need to know: coverage is available now, it requires no premium, copays are never more than $4, and the income limit is approximately $1,800 per month for a single adult (rising to approximately $1,835 on April 1, 2026).

Income Limits by Group (2026)

North Carolina’s Medicaid income thresholds vary by population. An important NC-specific note: unlike most states that update FPL-based income limits on January 1, North Carolina updates its income limits on April 1 each year. The figures below reflect the current and upcoming thresholds (all gross monthly income, MAGI-based):

• Adults 19–64 (Medicaid expansion): 138% FPL — approximately $1,800 per month for one person currently, rising to approximately $1,835 on April 1, 2026. Approximately $3,697 per month for a family of four. No asset test. No premium. Copays capped at $4.
• Children (Medicaid and NC Health Choice/CHIP): Up to approximately 211–216% FPL. No asset test. NC Health Choice is the state’s CHIP program and covers children whose family income is too high for straight Medicaid but still within the program limit. Children can qualify even if their parents are ineligible for Medicaid.
• Pregnant women: Up to approximately 196–201% FPL, with 12 months of full postpartum coverage following the birth. Presumptive eligibility is available — qualifying providers can grant temporary Medicaid coverage while a full application is processed, so prenatal care doesn’t need to wait.
• Family Planning Medicaid: North Carolina offers Family Planning Medicaid — coverage for reproductive health services only — to adults up to 195% FPL. This program covers contraception, STI testing, cancer screenings, and related services regardless of gender.
• Aged, Blind and Disabled (ABD): Asset limit of $2,000 for a single individual. SSI recipients automatically qualify for NC Medicaid.
• Long-term care (nursing home and HCBS): Income limit approximately $1,305 per month (100% FPL). North Carolina uses a Medically Needy spend-down for individuals whose income exceeds this cap — there are no Qualified Income Trusts (QITs) / Miller Trusts in North Carolina. Community Spouse Resource Allowance (CSRA) ranges from approximately $32,532 to $162,660 depending on total countable assets.

If You Were Denied Before December 2023 — Reapply Now

This section is specifically for North Carolinians who applied for Medicaid in the past and were turned away as “ineligible adults.” If that happened to you — at any point before December 1, 2023 — you should reapply today.

Before expansion, North Carolina Medicaid for adults was essentially limited to parents with very low income, pregnant women, seniors 65 and older, and people with qualifying disabilities. A single adult earning $900 per month with no children and no disability had no Medicaid pathway. A childless couple earning $1,500 combined had no pathway. Tens of thousands of North Carolinians were denied coverage for exactly these reasons.

That changed on December 1, 2023. NCDHHS’s official guidance is that anyone who was previously denied as an ineligible adult should reapply, because expansion opened a new eligibility category — the ACA Adult expansion group — that did not previously exist. Reapplying doesn’t count against you. There is no penalty for a prior denial, and the previous denial does not affect your current application. Simply go to ePASS (epass.nc.gov) and submit a new application based on your current circumstances.

If you know family members, friends, or neighbors who were turned away from NC Medicaid in the past and may not know about the expansion, pass this information along. NCDHHS estimates that hundreds of thousands of North Carolinians who would now qualify may still not know coverage is available.

Who Qualifies — Residency, Citizenship, and Special Pathways

To qualify for North Carolina Medicaid, you must meet these baseline requirements in addition to the income limits:

• North Carolina residency: You must live in North Carolina. You do not need a fixed address — if you are experiencing homelessness, you can use a county DSS office address or a shelter address. Residency documentation (such as a utility bill or lease dated within the past 60 days) is required, but there are accommodations for those without standard documentation.
• U.S. citizenship or qualified immigrant status: U.S. citizens and many lawfully-present immigrants qualify. Federal rules on immigrant eligibility apply. Children may be covered regardless of a parent’s immigration status in certain circumstances — contact your county DSS for specifics.
• Social Security Number: Required for each person applying. If you have applied for an SSN but don’t have it yet, you can provide proof that you’ve applied.

Several special pathways exist beyond standard income-based Medicaid:

• SSI recipients automatically qualify for North Carolina Medicaid — no separate application required.
• Disability Medicaid: Individuals with qualifying disabilities can access Medicaid through the ABD program with standard asset test rules ($2,000 for a single individual).
• Traumatic Brain Injury (TBI) Waiver: A specific waiver program for individuals who have experienced a TBI and need home and community-based services.
• Breast and Cervical Cancer Medicaid: Women who are diagnosed with breast or cervical cancer through the NC BreastCheck or BreastCervicalCancer Control Program may qualify for full Medicaid coverage regardless of income.
• Former foster youth: Young adults who were in foster care in North Carolina can remain on Medicaid up to age 26, regardless of income.

How to Apply for North Carolina Medicaid (Step by Step)

Applying for North Carolina Medicaid is free. Here is the step-by-step process for 2026:

1. Apply online at ePASS — Go to epass.nc.gov. You’ll need to create an NCID (a state online account) or sign in with an existing one. ePASS is the fastest application method and also screens you for SNAP food benefits and other programs. Complete the application and submit; upload required documents directly through the portal to avoid delays.
2. Apply through HealthCare.gov — The federal marketplace will screen for Medicaid eligibility and route you to NC Medicaid if you appear potentially eligible. This is a good option if you’re unsure whether you qualify for Medicaid or a subsidized marketplace plan.
3. Call 1-888-245-0179 — NCDHHS’s Medicaid line can assist with questions, walk you through the application, and connect you with local assistance.
4. Visit your county Department of Social Services (DSS) — Paper applications are available at county DSS offices, and staff can assist with in-person applications. You can also mail a paper application to your county DSS.
5. Decision timeline: North Carolina must process most Medicaid applications within 45 days. Disability-related (ABD) applications may take up to 90 days. Online applications through ePASS may be processed faster than paper applications. If your application hasn’t been processed within the required timeframe, contact your county DSS or call 1-888-245-0179.
6. Retroactive coverage: North Carolina Medicaid can cover eligible medical expenses incurred up to 3 months before the month of application, if you were eligible during that period. If you had medical bills in the 3 months before you applied, tell your DSS or note it in your application so retroactive coverage can be considered.
7. Managed care plan selection: Once approved for full Medicaid, you will select a managed care plan. North Carolina uses five standard managed care organizations: AmeriHealth Caritas NC, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan, and WellCare of NC. For individuals with serious behavioral health needs or intellectual/developmental disabilities (I/DD), Behavioral Health and Intellectual/Developmental Disability Tailored Plans may serve your needs better — discuss this with your county DSS or NCDHHS.
8. If denied: Your denial notice must explain the reason and include instructions for appealing. You typically have 30 days to request an administrative appeal.

For broader guidance on applying, see our page on how to apply for Medicaid. After enrollment, report changes in income, household size, or address through ePASS promptly to ensure your coverage remains accurate.

Required Documents

Missing or incomplete documentation is the top cause of delays in ePASS applications. Gather these items before you start:

• Photo ID for each adult applicant: State-issued driver’s license, ID card, U.S. passport, or other government-issued photo identification.
• Social Security Numbers: For each person in your household for whom you are applying.
• Proof of North Carolina residency: A utility bill, bank statement, lease agreement, or official government mail dated within the past 60 days and showing your NC address. This is especially important — ePASS frequently delays applications that are missing current residency documentation.
• Income verification: Pay stubs for the past 30 days, employer letters, or records of self-employment income. Award letters for Social Security, SSI, unemployment, or other benefit programs.
• For ABD and LTC applicants: Asset documentation including bank statements, property records, life insurance policies, and investment accounts. The LTC program has comprehensive asset verification requirements including a 60-month (5-year) look-back period for asset transfers.

The NC Hospital Assistance and Sustainability Program (HASP)

North Carolina’s Hospital Assistance and Sustainability Program (HASP) is a state-specific initiative that is particularly valuable for uninsured or underinsured patients. Under HASP, North Carolina hospitals are required to relieve medical debt for patients with income below 300% of the Federal Poverty Level — approximately $46,950 per year for a single adult in 2026.

This means if you receive a hospital bill and your income is below 300% FPL, you may be eligible to have some or all of the debt forgiven through HASP. This program operates independently of Medicaid eligibility — you don’t need to qualify for Medicaid to access HASP debt relief. If you have outstanding hospital bills, contact the hospital billing department and specifically ask about HASP or the hospital’s financial assistance program.

Important 2026–2027 Changes to Know

Several changes are affecting North Carolina Medicaid in 2026 and 2027 that current enrollees should prepare for:

Six-month renewals for expansion adults starting December 31, 2026: Beginning December 31, 2026, expansion adults ages 19–64 without disabilities will shift from annual to 6-month eligibility renewals. Under the new cycle, you’ll need to verify your continued eligibility twice per year rather than once. More frequent renewals mean more chances for coverage to lapse if your contact information is outdated or you don’t respond to renewal notices on time. Update your address and phone number in ePASS now, and watch for renewal packets from NCDHHS.

Work requirements scheduled for 2027 — with early reporting in late 2026: Federal work requirements for non-exempt expansion adults are scheduled to be enforced beginning in 2027. In preparation, NCDHHS may begin asking some enrollees to report their work status, volunteering, or educational enrollment in late 2026 — but as of the time of this review, this reporting is not yet a condition of coverage. When requirements are formally enforced in 2027, the standard will be 80 hours per month of qualifying activities. Exemptions will apply for pregnancy, caregiving, disability, and other circumstances. Monitor medicaid.ncdhhs.gov for official announcements on implementation timing.

Income limit update on April 1, 2026: North Carolina updates its FPL-based income limits on April 1 rather than January 1. The single-adult expansion income threshold rises from approximately $1,800 per month to approximately $1,835 per month on April 1, 2026. If you were recently income-screened as slightly over the threshold, recheck after April 1 as the limit increases.

See also our guide on North Carolina assistance programs for other benefits available alongside Medicaid.

Common Mistakes to Avoid

These are the most frequent errors North Carolinians make when navigating Medicaid eligibility:

• Assuming NC still doesn’t cover childless adults: This was true before December 1, 2023. It is no longer true. North Carolina expanded Medicaid and adults without children now qualify on income alone. Do not let outdated information prevent you from applying.
• Not reapplying after a pre-December 2023 denial: If you were denied for being an “ineligible adult,” that denial was made under a different set of rules. NCDHHS’s official guidance is to reapply. The prior denial does not affect your current application.
• Assuming savings disqualify you: There is no asset test for expansion adults (ages 19–64), children, or pregnant women applying under MAGI rules. You can have a savings account, own a car, or have other assets and still qualify. Assets only matter for ABD (aged, blind, disabled) applicants, who face a $2,000 asset limit.
• Submitting ePASS applications without residency documentation: Missing current residency proof (dated within 60 days) is the single most common cause of ePASS application delays. Gather this document before you start the application, not after.
• Missing the new 6-month renewal cycle starting December 31, 2026: Under the new renewal frequency, you’ll need to respond to Medicaid renewal notices twice per year. If your mailing address or phone number is outdated, notices won’t reach you. Update your contact information in ePASS now.
• Not knowing about HASP for hospital bills: Many North Carolinians don’t know that hospitals must relieve medical debt for patients under 300% FPL through HASP. If you have outstanding hospital bills, ask the billing department about HASP financial assistance before assuming you must pay in full.

Frequently Asked Questions

Did North Carolina expand Medicaid?

Yes. North Carolina expanded Medicaid on December 1, 2023, becoming the 40th state to do so. Adults ages 19–64 now qualify with income up to 138% FPL — no disability, pregnancy, or children required. Coverage is available now.

What is the income limit for NC Medicaid in 2026?

Adults ages 19–64 qualify up to 138% FPL — approximately $1,800 per month for one person currently, rising to approximately $1,835 per month on April 1, 2026 (NC updates limits April 1, not January 1). For a family of four, the threshold is approximately $3,697 per month. There is no asset test for expansion adults.

I was denied NC Medicaid before — should I reapply?

Yes. If you were denied before December 2023 as an ineligible adult, expansion created a new eligibility category that may cover you now. NCDHHS’s official guidance is to reapply through ePASS. The prior denial does not affect your new application.

Can I get NC Medicaid if I work?

Yes. Eligibility for expansion Medicaid is based on income (up to 138% FPL), not employment status. Part-time, gig, and low-wage full-time workers commonly qualify. Having a job does not disqualify you.

How do I apply for North Carolina Medicaid?

Apply online at ePASS (epass.nc.gov), through HealthCare.gov, call 1-888-245-0179, or visit your county Department of Social Services. Have your photo ID, Social Security Number, recent residency documentation, and income proof ready. Most decisions come within 45 days.

What managed care plans are available in NC Medicaid?

After approval, you choose from five standard managed care plans: AmeriHealth Caritas NC, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan, and WellCare of NC. For individuals with serious behavioral health needs or I/DD, Behavioral Health and IDD Tailored Plans are also available. Plan availability may vary by county.

What is Family Planning Medicaid in NC?

Family Planning Medicaid is a limited-benefit program that covers reproductive health services — contraception, STI testing, cancer screenings, and related services — for adults with income up to 195% FPL. It is available regardless of gender and does not require full Medicaid eligibility.

What is HASP?

The NC Hospital Assistance and Sustainability Program (HASP) requires North Carolina hospitals to relieve medical debt for patients with income below 300% FPL (approximately $46,950 per year for a single adult in 2026). This is separate from Medicaid — you don’t need to qualify for Medicaid to access HASP. Ask your hospital’s billing department about HASP if you have outstanding medical bills.

Does NC Medicaid use Miller Trusts / QITs for long-term care?

No. North Carolina does not use Qualified Income Trusts (QITs) or Miller Trusts. For long-term care applicants whose income exceeds the approximately $1,305 per month cap, NC uses a Medically Needy spend-down approach. Consult a North Carolina elder law attorney for LTC planning.

What other assistance is available in North Carolina?

SNAP food benefits have separate eligibility rules from Medicaid. See our guide on North Carolina food stamps for 2026 income limits. For other NC state benefit programs, see our North Carolina assistance programs guide.

Official Sources

• NC Medicaid (NCDHHS Division of Health Benefits) — medicaid.ncdhhs.gov
• ePASS (apply online) — epass.nc.gov
• NC Medicaid customer service: 1-888-245-0179
• HealthCare.gov — alternative application entry point
• Medicaid.gov — North Carolina

Last reviewed: July 2026. Not affiliated with any government agency. Medicaid rules and figures change — confirm your situation with NC Medicaid / NCDHHS at medicaid.ncdhhs.gov or call 1-888-245-0179.