Yes. North Carolina has a Medicaid program, run by the North Carolina Department of Health and Human Services (NCDHHS) and funded jointly by the state and federal governments.1North Carolina General Assembly. North Carolina Code 108A-54 – Authorization of Medical Assistance Since December 1, 2023, the program has covered adults aged 19 through 64 under Medicaid expansion, in addition to the longstanding groups: children, pregnant women, seniors, and people with disabilities.2NC Medicaid. North Carolina Expands Medicaid
Who Qualifies
Every applicant, regardless of category, must be a North Carolina resident, a U.S. citizen or hold an eligible immigration status, and have a Social Security number or proof of having applied for one.3NC Medicaid. NC Medicaid Eligibility Beyond those basics, the income rules and resource rules depend on which group you fall into.
Adults 19 Through 64 (Expansion Group)
The expansion group covers adults 19 through 64 whose household income is at or below 138 percent of the Federal Poverty Level.2NC Medicaid. North Carolina Expands Medicaid For 2026, the FPL for a single person is $15,960 per year, which puts the 138 percent threshold at roughly $1,800 per month for one person.4HHS ASPE. 2026 Poverty Guidelines The limit rises with household size, to about $2,433 per month for two people and $3,065 for a family of three.3NC Medicaid. NC Medicaid Eligibility Figures update each spring with the new federal guidelines.
Eligibility for this group uses Modified Adjusted Gross Income (MAGI), which counts total household income before taxes. There is no asset test. Your savings balance or the value of your car does not affect eligibility.
Children and Pregnant Women
Income limits for children and pregnant women run considerably higher. A child from birth through age 18 can qualify in a single-person household earning up to $2,752 per month, and in a four-person household earning up to $5,645 per month.3NC Medicaid. NC Medicaid Eligibility Children whose families earn too much for Medicaid may still qualify for NC Health Choice, the state’s Children’s Health Insurance Program.
A pregnant person in a single-person household (counting the unborn child) can qualify with family income up to $3,455 per month. Coverage includes prenatal care, labor and delivery, and postpartum services.
Seniors and People With Disabilities
Adults 65 and older, people who are blind, and people with qualifying disabilities fall under a different set of rules with lower income limits and an asset test. A single person 65 or older can qualify for full Medicaid with income at or below $1,305 per month, and for other Medicaid programs if income is $1,761 per month or less.3NC Medicaid. NC Medicaid Eligibility People with certain conditions, including physical or cognitive disabilities, traumatic brain injuries, and breast or cervical cancer, may qualify for specialized coverage.
Countable assets for a single person in this group generally cannot exceed $2,000. Bank accounts, stocks, and bonds count. A primary home (up to a certain equity value), one vehicle, personal belongings, and qualifying burial funds typically do not. A lot of applicants assume everything they own counts against the limit; usually it does not.
What NC Medicaid Covers
NC Medicaid pays for doctor visits, inpatient and outpatient hospital care, prescription drugs, vision care, dental care, mental health treatment, and nursing home care.5North Carolina Department of Health and Human Services. Medicaid It also covers home health services, personal care services, durable medical equipment, and in-home care through the Community Alternatives Program (CAP) for people who would otherwise need a nursing facility. Children under 21 receive the broadest package, which covers essentially all medically necessary services.
One point surprises many new beneficiaries: Medicaid is the payer of last resort. If you have private insurance, Medicare, or any other coverage, those pay first, and Medicaid picks up remaining eligible costs. When you apply, you must disclose any other health insurance, and as a condition of eligibility you assign the state your right to pursue payment from any third party that should have covered a service.6eCFR. 42 CFR Part 433 Subpart D – Third Party Liability
Most beneficiaries receive care through managed care, meaning you enroll in a health plan that coordinates services through a network of doctors, hospitals, and specialists. You can compare plans at ncmedicaidplans.gov. Beneficiaries who cannot enroll in a managed care plan receive coverage through NC Medicaid Direct, which operates more like traditional fee-for-service Medicaid.
How to Apply
Gather your documents before you start. You will need:
- Social Security numbers for every household member seeking coverage.7NC DHHS Policies. Notice on the Use of Social Security Numbers
- Proof of North Carolina residency, such as a utility bill, lease agreement, or state driver’s license.
- Income verification, typically the most recent 30 days of pay stubs, or your most recent federal tax return if self-employed.
- Citizenship or immigration documentation, such as a birth certificate, passport, or immigration paperwork.8North Carolina Department of Health and Human Services. Aged, Blind and Disabled Medicaid Manual MA-2506 – US Citizenship Requirements
- Medical records if you are applying based on a disability or specific health condition, along with contact information for your providers.
List every person in the household on the form, even those not applying, because household size affects income calculations. Report all gross monthly income: wages, Social Security benefits, unemployment compensation, alimony, and any other recurring payments. Gross means the total before taxes or deductions. Math errors here are the most common cause of processing delays.
You can submit the application through the ePASS online portal, which also lets you upload documents and check status.9NC Medicaid. Enhanced ePASS Accounts for NC Medicaid Beneficiaries You can also deliver a completed paper application to your local Department of Social Services (DSS) office or mail it in.
Federal rules give the state 45 calendar days to make an eligibility decision in most cases, and 90 calendar days for disability-based applications that require medical evaluation.10eCFR. 42 CFR 435.912 – Timely Determination and Redetermination of Eligibility You will get a written notice telling you whether you have been approved, denied, or whether the agency needs more information.
Coverage for Bills You Already Owe
Federal rules let the state cover medical expenses you incurred during the three months before your application date, as long as you would have been eligible at the time of care. If you put off applying while bills piled up, those charges can still be paid once your application is approved. The three-month lookback applies automatically. Keep records of medical bills from that window so they can be submitted.
Keeping Your Coverage Each Year
Medicaid eligibility is not permanent. Federal rules require the state to renew your eligibility once every 12 months.11eCFR. 42 CFR 435.916 – Regularly Scheduled Renewals of Medicaid Eligibility Sometimes the state can verify continued eligibility using data it already has, such as tax records, and you simply get a notice confirming coverage. Other times, the state mails a pre-populated renewal form that you must complete and return within at least 30 days of the mailing date.
If coverage ends because you did not respond, you have 90 days after the termination date to submit the renewal paperwork. During that window, the state treats your submission like an application and reconsiders eligibility without making you start over.12eCFR. 42 CFR 435.916 – Regularly Scheduled Renewals of Medicaid Eligibility Miss the 90 days and you file a brand new application. People lose coverage over paperwork far more often than because they actually became ineligible, so keep your address current with DSS and watch the mail.
A Note on Estate Recovery
One rule most applicants do not think about at sign-up matters later for families with real property. North Carolina is required by federal and state law to seek repayment of certain Medicaid costs from the estates of deceased beneficiaries. Recovery targets two groups: recipients of any age who received care in a nursing facility or similar institution and were not expected to return home, and recipients who were 55 or older when they received covered services, including nursing facility care, home and community-based services, hospital care, prescriptions, and personal care services.13North Carolina General Assembly. North Carolina Code 108A-70.5 – Medicaid Estate Recovery Plan
Recovery cannot begin until after the death of both the beneficiary and any surviving spouse, and is further postponed if the beneficiary has a surviving child who is under 21, blind, or permanently disabled.14Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets The state must also waive recovery when it would create an undue hardship or would not be cost-effective.13North Carolina General Assembly. North Carolina Code 108A-70.5 – Medicaid Estate Recovery Plan Families should know about this rule before a loved one enters long-term care.