Medicaid North Carolina: Eligibility, Application & Benefits Guide for 2026

After years of legislative opposition, Medicaid in North Carolina experienced its biggest change in decades when the state finally expanded Medicaid under the Affordable Care Act (ACA) on December 1, 2023. Around 600,000 new, newly eligible North Carolinians are now eligible for coverage, and enrollment has surged to more than 450,000 by May 2024. The program is administered by the Division of Health Benefits (DHB) of the North Carolina Department of Health and Human Services (NCDHHS). The 2026 income thresholds are $1,800/month for an expansion adult (138% FPL); pregnant women (196% FPL for 1 month) up to $5,654/month (combined Medicaid and NC Health Choice for children); and $1,305/month for seniors and disabled adults (100% FPL). Medicaid programs in North Carolina also have significant differences in coverage, including: Tailored Plans, which are Medicaid plans for people with serious behavioral health needs, intellectual/developmental disabilities, or substance use disorders, and offer integrated physical and behavioral health coverage (launched in 2023). NC also has the nation's highest ex parte renewal rate (99%), or the percentage of Medicaid beneficiaries who are automatically retained without any paperwork. Changes are coming under the One Big Beautiful Bill Act (OBBBA) to major 2026: expansion adults move to 6-month renewals from December 2026; 80-hours-per-month work requirement, January 2027.

This brochure provides information about North Carolina Medicaid programs, income eligibility, assets considerations and how to apply. Data source: NCDHHS, Medicaid.gov, and KFF. 

North Carolina Medicaid programs at a glance

Under the structure of the Medicaid expansion, North Carolina has multiple Medicaid programs addressing various populations.

NC Medicaid Expansion (launched 12/1/23) provides coverage for adults ages 19-64 and has a 138% FPL eligibility limit ($1,800/month for a single adult in 2026). Has no asset test for expansion adults. As of 2026, some 600,000+ North Carolinians are covered by expansion.

Children are eligible for Medicaid for Children if their family's income is below 216% FPL (family of 4, $5,654/month). No asset test, no premiums and full coverage including vision, dental and mental health services.

North Carolina's CHIP is designed for children in families with slightly higher income than Medicaid eligibility—called NC Health Choice. Offers a similar extensive coverage but at a low cost.

The difference is that Pregnant women with income up to 196% FPL ($2,557/month single woman in 2026) will be eligible for Pregnancy Medicaid coverage. Covers prenatal, delivery and 12 months after delivery.

Aged, Blind, and Disabled (ABD) Medicaid is a benefit for seniors and those who are disabled who fall short of the income (100% FPL, which is about $1,305/single) and asset limits ($2,000 single).

Nursing Home Medicaid is an entitlement program (no waitlist) for persons who require nursing facility level of care. 2026 income cap: Single person income of around $1305/month. Asset limit: $2,000.

The CAP/DA Waiver (Community Alternatives Program for Disabled Adults) is North Carolina's main HCBS waiver for the elderly & physically disabled adults who need nursing home level care, but would rather live in the community. Limited enrolments with waiting lists.

Tailored Plans (trial will be expanded in 2023) are integrated physical and behavioral health coverage with a particular managed care organization (MCO) for people with serious mental illness, substance use disorders, or intellectual/developmental disabilities. When behavioral health was changed from a Local Management Entity/Managed Care Organization (LME/MCO) system, it was replaced by Tailored Plans.

Through the MCOs statewide, Standard Plans are managed care plans for the majority of other Medicaid beneficiaries.

Women with breast or cervical cancer that are diagnosed, whether or not they meet the standard income limits in the NC Breast and Cervical Cancer Medicaid program, are covered by the program.

See our Medicaid coverage guide for more information about Medicaid coverage. 

2026 North Carolina Medicaid income limits

The federal poverty guidelines change every spring (usually in April) and North Carolina will also recalculate income levels.

For two-parent, two-child households: $3,697/month.For NC Medicaid Expansion (adults ages 19-64): $2,442/month for couple, $3,697/month family of four.For single adult (ages 19-64), $1,800/month; for two-parent, two-child household, $2,442/month; for family of four, $3,697/month. This is 138% of FPL.

For Medicaid for Children (under 19): Up to $5,654/month for family of four. This is 216% of FPL. If you are a pregnant woman, up to $2,557/month for a single woman and $3,460/month family of three. This is 196% FPL. Approximately $1,305/month for one applicant for ABD Medicaid (seniors and disabled): This is 100% FPL.

Nursing Home Medicaid and CAP/DA Waiver (first person): ~ $1305 per month. This is the 100% FPL (less than what would be found in some states, 300% FBR).

For those with above income limits in NC, the spend-down is a Medically Needy. The state has the lowest income floor of any state for being medically needy, at $242 per month for a single person, and extensive medical expense documentation is needed to qualify.

For broader Medicaid qualification, see our Medicaid qualification guide.

North Carolina asset rules

Asset rules vary by program:

For NC Medicaid Expansion, Medicaid for Children, NC Health Choice, and Pregnancy Medicaid: No asset test. You can own a home, vehicle, savings without affecting eligibility.

For ABD Medicaid, Nursing Home Medicaid, and CAP/DA Waiver: $2,000 asset limit for a single applicant (standard limit).

For married couples where one spouse applies for long-term care: The non-applicant spouse can keep the Community Spouse Resource Allowance (CSRA) of $162,660 in 2026. The Minimum Monthly Maintenance Needs Allowance (MMNA) for the community spouse is $2,644/month, with shelter standard at $794/month, and can reach up to $4,066.50/month with elevated shelter costs.

The home is exempt if the applicant or spouse lives there or intends to return, with equity up to $752,000 protected (higher than the federal minimum of $730,000).

Personal Needs Allowance for nursing home residents: approximately $30/month (lowest in the South among expansion states).

Life insurance face value exemption: $10,000 (matching Louisiana and Mississippi at the high end).

For Medicaid planning details, see our Medicaid planning guide.

The 5-year look-back and estate recovery in North Carolina

North Carolina applies the federal 5-year (60-month) look-back for asset transfers preceding Medicaid long-term care applications. The penalty divisor varies but is established by NCDHHS based on average private-pay nursing home costs.

Medicaid Estate Recovery (MERP) is administered by NCDHHS, recovering long-term care costs from deceased Medicaid beneficiaries' estates. Federal exemptions (surviving spouse, child under 21, blind/disabled child) apply.

The Caregiver Child Exemption (2+ years of caregiving) and Sibling Exemption (1+ year of equity interest residency) can protect the home from estate recovery.

For Medicaid planning attorney assistance, see our Medicaid planning attorney guide.

How to apply for North Carolina Medicaid

The primary application portal is ePass at epass.nc.gov, North Carolina's integrated benefits portal.

Application methods:

• Online: ePass (fastest method)

• Phone: 1-888-245-0179

• HealthCare.gov: Application gets transferred to NC Medicaid

• In person: Local County Department of Social Services (DSS) office

• Mail: P.O. Box 24309, Raleigh, NC 27611

Documents typically needed: Proof of identity, Social Security cards, citizenship/immigration documents, income documentation (pay stubs, tax returns), residency proof, household member information, and asset documentation for non-MAGI populations.

Most applications process within 45 days. Retroactive coverage may extend up to 3 months before application date (dropping to 2 months for non-expansion groups starting January 2027 under OBBBA).

NC has the highest ex parte (automated) renewal rate in the nation at 99%. This means most renewals happen automatically without enrollees needing to submit paperwork. For Medicaid renewal details, see our Medicaid renewal guide.

2026 changes for North Carolina Medicaid

The One Big Beautiful Bill Act (OBBBA), signed into law July 2025, brings significant changes:

Work Requirements: Starting January 1, 2027, NC Medicaid Expansion adults ages 19-64 must complete 80 hours/month of work, school, training, or community service. NCDHHS must begin outreach by September 30, 2026. Pregnant individuals, medically frail adults, and those receiving disability benefits are exempt.

6-Month Redeterminations: Starting December 2026, expansion adults will have eligibility redetermined every 6 months instead of annually.

Reduced Retroactive Coverage: Starting January 2027, retroactive coverage drops from 3 months to 2 months for non-expansion populations.

Federal Funding Reduction: OBBBA eliminates the enhanced federal funding rate for Medicaid expansion states. NC could lose significant federal support for expansion. The state's expansion only launched December 2023, making the funding cut especially impactful.

Note: Many North Carolina expansion enrollees have had coverage for only 1-2 years and may be less familiar with renewal processes than enrollees in long-standing expansion states. NCDHHS is conducting outreach to prepare enrollees for the December 2026 transition to 6-month renewals.

For Medicaid waiver programs, see our waiver guide.