North Carolina expanded Medicaid in December 2023, opening the door to free or low cost health coverage for hundreds of thousands of residents who previously did not qualify. In 2026, adults ages 19 through 64 with incomes up to 138% of the Federal Poverty Level can now get NC Medicaid coverage, including adults without children. If you live in North Carolina and are wondering whether you or your family might be eligible, this guide covers everything you need to know about income limits, basic requirements, how to apply, and what services are covered.
Not sure where to start? Check your eligibility in minutes with our free screener to see which benefits programs you may qualify for.
What Is NC Medicaid?
NC Medicaid is North Carolina's public health insurance program for people with lower incomes. It is administered by the NC Department of Health and Human Services (NCDHHS) and covers a wide range of medical services at little or no cost to enrollees. Since the state expanded Medicaid under the Affordable Care Act, more North Carolinians than ever before can access this coverage.
NC Medicaid is not just for families with children. Thanks to expansion, single adults, childless adults, and parents alike can qualify based on their income. The program covers doctor visits, hospital stays, prescriptions, mental health services, preventive care, and much more.
For a broader look at all assistance programs available in the state, visit our North Carolina Benefits Overview.
NC Medicaid Income Limits for 2026
Eligibility for NC Medicaid is primarily based on your household income and family size. The income limits below are the monthly gross income thresholds (before taxes) and are current until April 1, 2026.
Adults Ages 19 to 64 (Medicaid Expansion)
| Family Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $1,800 | $21,597 |
| 2 | $2,433 | $29,194 |
| 3 | $3,065 | $36,781 |
| 4 | $3,698 | $44,368 |
| 5 | $4,340 | $52,073 |
These limits are set at 138% of the Federal Poverty Level (FPL). If your income falls at or below these amounts, you may qualify for full NC Medicaid coverage.
Children Ages 0 to 18
Children in North Carolina qualify at higher income levels than adults. The limit for children is approximately 216% of the FPL.
| Family Size | Monthly Income Limit |
|---|---|
| 1 | $2,752 |
| 2 | $3,719 |
| 3 | $4,686 |
| 4 | $5,645 |
| 5 | $6,621 |
Pregnant Individuals
Pregnant individuals qualify at even higher income thresholds, approximately 196% to 201% of FPL. The unborn child counts as a family member when calculating income eligibility.
| Family Size (Including Unborn Child) | Monthly Income Limit |
|---|---|
| 1 (pregnant, counting unborn) | $3,455 |
| 2 | $4,353 |
| 3 | $5,252 |
| 4 | $6,150 |
| 5 | $7,048 |
Adults Ages 65 and Older
Seniors have different eligibility pathways:
| Family Size | Full Medicaid | Other Medicaid Programs |
|---|---|---|
| 1 | $1,305/month | $1,761/month |
| 2 | $1,763/month | $2,380/month |
Seniors ages 65 and older may also qualify through disability based Medicaid or other specialized programs. Contact your local Department of Social Services (DSS) office for more information.
Family Planning Services
Anyone may qualify for family planning services, including screening and treatment for certain sexually transmitted infections, at higher income limits:
| Family Size | Monthly Income Limit |
|---|---|
| 1 | $2,544 |
| 2 | $3,437 |
| 3 | $4,331 |
| 4 | $5,225 |
Basic Eligibility Requirements
To qualify for NC Medicaid in 2026, you must meet these basic requirements:
- Live in North Carolina. You must be a current resident of the state.
- Be a U.S. citizen or have an eligible immigration status. Families that include non citizens can still apply. Your children may qualify even if you do not. Applying will not affect your immigration status or your chances of becoming a permanent resident or citizen.
- Have a Social Security number or provide proof that you have applied for one.
- Meet the income requirements for your age group and family size (see the tables above).
- For expansion coverage (ages 19 to 64): You must not be eligible for Medicare.
It is important to note that NC Medicaid does not have an asset or resource test for most applicants. Your eligibility is determined primarily by your income and household size.
How to Determine Your Family Size
Correctly counting your family size is essential for determining your income limit. Include the following people in your household count:
- Yourself
- Your spouse
- Your children under age 21, including stepchildren
- Any other person listed on the same federal income tax return (including children over 21 claimed as dependents)
Do not include:
- Parents who live with you but file their own tax return (if you are over age 21)
- Other adult relatives who file their own tax return
- Unborn children (for determining family size on the income chart, though they are counted separately for pregnant individuals)
You do not need to file taxes to apply for health coverage.
How to Apply for NC Medicaid in 2026
Applying for NC Medicaid is free and can be done in several ways. Follow these steps to get started:
Step 1: Gather Your Information
Before you apply, have the following ready for each person in your household:
- Social Security numbers
- Dates of birth
- Proof of income (pay stubs, tax returns, or a letter from your employer)
- Proof of North Carolina residency (utility bill, lease, or mail with your address)
- Immigration documents (if applicable)
Step 2: Choose Your Application Method
You can apply through any of the following options:
- Online: Visit ePASS (epass.nc.gov) to submit your application electronically. NC Medicaid is listed as "Medical Assistance" on the ePASS website.
- 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 DSS office at ncdhhs.gov/localDSS.
- By mail: Download an application from the NC Medicaid website and mail it to your local DSS office.
- Through HealthCare.gov: You can also apply at HealthCare.gov, and the system will route you to NC Medicaid if you appear to qualify.
Step 3: Submit Your Application
Complete the application with accurate information about your household, income, and any other details requested. Double check all information before submitting.
Step 4: Wait for a Decision
After submitting your application, a caseworker will review it. You should receive a decision within 45 days (or 90 days for disability related Medicaid). The caseworker may contact you if additional information or documentation is needed.
Step 5: Receive Your Coverage
If approved, you will receive information about your NC Medicaid coverage, including your health plan options. North Carolina uses a managed care system, so you will typically choose a health plan and primary care provider.
Want to quickly check if you might qualify before starting the full application? Use our free eligibility screener to find out in just a few minutes.
What Does NC Medicaid Cover?
NC Medicaid provides comprehensive health care coverage, including:
- Doctor visits and specialist appointments
- Hospital stays (inpatient and outpatient)
- Prescription medications
- Preventive care such as annual checkups, vaccinations, and cancer screenings
- Mental health services and substance use disorder treatment
- Dental care (limited for adults, more comprehensive for children)
- Vision care including eye exams
- Lab tests and diagnostic imaging
- Emergency services
- Maternity and newborn care
- Transportation to medical appointments (through Medicaid transportation services)
- Home health services and durable medical equipment
Most NC Medicaid enrollees pay little to no out of pocket costs. There are no premiums for most beneficiaries, and copays are minimal or waived entirely depending on your income level.
Important 2026 Changes to Know
Federal Changes and H.R. 1
Beginning December 31, 2026, some low income adults ages 19 through 64 without disabilities (the Medicaid expansion population) must have their eligibility redetermined every 6 months instead of the traditional 12 months. This means it is more important than ever to keep your contact information and income details up to date with NC Medicaid to avoid a gap in coverage.
Medicaid Expansion Continues
North Carolina's Medicaid expansion, which began in December 2023, continues to provide coverage in 2026. If you were previously denied Medicaid because you did not have children or your income was too high under the old rules, you should apply again. The expanded income limits (138% FPL) apply to all adults ages 19 to 64.
Special Eligibility Categories
Beyond the standard income based eligibility, certain groups may qualify for NC Medicaid through specialized pathways:
- People with physical or cognitive disabilities may qualify for disability based Medicaid with different income and asset rules
- Individuals with traumatic brain injury may be eligible for specialized coverage
- Women diagnosed with breast or cervical cancer may qualify regardless of income through the NC Breast and Cervical Cancer Medicaid program
- Former foster care youth up to age 26 who were in foster care at age 18 may qualify automatically
- Medically needy individuals with high medical expenses may qualify even if their income exceeds regular limits through a "spend down" process
Frequently Asked Questions
Can I apply for NC Medicaid if I am undocumented?
Undocumented immigrants are not eligible for full NC Medicaid coverage. However, you may qualify for emergency Medicaid, which covers emergency medical situations. You can also apply for your children if they are U.S. citizens or have eligible immigration status. Applying will not affect your immigration case.
How long does it take to get approved for NC Medicaid?
Most applications are processed within 45 days. Applications involving disability may take up to 90 days. You can check your application status through ePASS or by calling 1-888-245-0179.
Do I need to reapply every year?
Yes, NC Medicaid requires periodic eligibility reviews. Currently, most enrollees are reviewed every 12 months. Starting at the end of 2026, adults in the expansion group may be reviewed every 6 months. You will receive a renewal notice before your review date. Make sure your contact information is current so you do not miss important notices.
Can I have NC Medicaid and employer insurance at the same time?
Yes, you can have both. NC Medicaid can serve as secondary insurance and may help cover costs that your employer plan does not, such as copays and deductibles.
What if my income changes during the year?
You are required to report changes in income, household size, or address within 10 days. If your income increases above the limit, you may lose Medicaid eligibility but could qualify for subsidized health insurance through HealthCare.gov. If your income decreases, you may become newly eligible.
Is there a waiting period for NC Medicaid coverage?
There is no waiting period. Once you are approved, your coverage can begin immediately. In some cases, Medicaid can even cover medical bills from up to three months before your application date if you would have been eligible during that time.
What is the difference between NC Medicaid and NC Health Choice?
NC Health Choice is a separate program for children ages 6 through 18 in families with incomes between 211% and 216% of FPL. It covers similar services as Medicaid but may have slightly different cost sharing. Children are automatically considered for both programs when you apply.
Next Steps
If you think you or your family might qualify for NC Medicaid in 2026, the best thing you can do is apply. Even if you are unsure about your eligibility, a caseworker will review your application and determine what programs are available to you.
Check your eligibility now with our free screener to see if you may qualify for NC Medicaid and other benefits programs like SNAP, LIHEAP, WIC, and more. It only takes a few minutes, and there is no cost or obligation.
You can also visit the official NC Medicaid website at medicaid.ncdhhs.gov or call 1-888-245-0179 for assistance with your application.
