NC CHIP Eligibility: Income Limits, Coverage, and Enrollment

A child qualifies for North Carolina CHIP eligibility if the family’s income is at or below 211 percent of the federal poverty level and the child is under 19, lives in North Carolina, and is a U.S. citizen or has an eligible immigration status.¹ Since April 1, 2023, the state has delivered this coverage through NC Medicaid rather than the former NC Health Choice program, which means no enrollment fees, no copays, and a broader set of benefits than the old CHIP plan offered.²

Income Limits for 2025–2026

Eligibility is based on Modified Adjusted Gross Income (MAGI) measured against the federal poverty level. The 211 percent threshold already includes a mandatory five-percentage-point income disregard built into federal MAGI rules, so a family whose income lands just above the posted limit may still qualify once that disregard is applied.¹

NC Medicaid lists the following monthly pre-tax income limits for children ages 0 through 18, valid through April 1, 2026:³

Family of one: $2,752
Family of two: $3,719
Family of three: $4,686
Family of four: $5,645
Family of five: $6,621

The state treats these numbers as a guide and encourages families to apply even if they appear slightly over the limit, because certain deductions can change the final determination.³ The old tiered structure that split eligibility between infants, young children, and school-age children no longer applies; all children from birth through 18 are now covered under a single Medicaid threshold.¹

Other Requirements Beyond Income

A child must be under 19, live in North Carolina, be a U.S. citizen or have an eligible immigration status, and have (or have applied for) a Social Security number.³ North Carolina does not impose a waiting period that requires children to go uninsured for a set stretch of time before enrolling, so a child losing other coverage can apply right away.⁴

Immigrant Children

North Carolina uses the federal CHIPRA 214 option, which lets lawfully residing children under 19 enroll without the five-year waiting period that normally applies to many non-citizen categories. Any form of lawful immigration status qualifies except DACA. Children with DACA status are not eligible for Medicaid but may find coverage through the Health Insurance Marketplace or care at federally qualified health centers.⁵

Undocumented children do not qualify for full Medicaid, though they may receive Emergency Medicaid for severe medical emergencies if they otherwise meet income and residency rules. An undocumented parent can apply on behalf of a child who independently qualifies.⁵

One change is worth flagging. Beginning October 1, 2026, the federal budget reconciliation law known as H.R.1 will end federally funded Medicaid eligibility for several categories of lawfully residing non-citizens, including refugees, asylees, victims of trafficking, and humanitarian parolees. Lawful permanent residents (green card holders) keep their coverage. Those losing coverage may still qualify for Emergency Medicaid.⁶

What the Coverage Includes

Because children’s CHIP-funded coverage is now delivered through NC Medicaid, there are no premiums and no copays. The former Health Choice program charged $50 to $100 annual premiums and copays for office visits and prescriptions for families above 159 percent of FPL; those charges are gone.²⁴

Children now receive the full federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit, along with non-emergency medical transportation to appointments and enhanced behavioral health services that the old program did not cover.⁷ Covered services include:⁸

Inpatient and outpatient hospital care, ambulance services, and inpatient psychiatric care for individuals under 21
Prescription drugs through the NC Medicaid Preferred Drug List
Mental and behavioral health care, including crisis services, peer support, and research-based treatment for autism spectrum disorder
Vision care, including eye exams and prescription lenses
Dental care through NC Medicaid Direct, as long as the provider accepts NC Medicaid⁹
Preventive care including well-child visits, immunizations, and screenings

Some services require prior authorization or a showing of medical necessity.

How to Apply

Families can apply four ways:¹⁰

Online through the ePASS portal at epass.nc.gov (an NCID account is required) or through HealthCare.gov
In person at a local Department of Social Services office
By phone through the local DSS office or the NC Medicaid Contact Center at 1-888-245-0179
By mail, fax, or email, using a paper application sent to the local DSS office

At a minimum, an application needs a full legal name and date of birth for at least one applicant, a mailing address, and a signature. Supporting documents speed up processing: a photo ID or utility bill for residency, pay stubs or tax returns for income, a birth certificate or passport for citizenship, and a Social Security card or document showing the number.¹⁰ Free interpreter services are available at 866-719-0141.¹¹

Keeping Coverage After Approval

North Carolina provides 12-month continuous eligibility for children. Once a child qualifies, coverage lasts a full year even if family income rises during that period.¹² The state has also sought federal waivers to extend continuous coverage for children from birth through kindergarten and to allow two-year recertification periods for children ages six and older.¹³

At recertification time, the local DSS office sends forms that can be returned through ePASS, by mail, phone, fax, email, or in person.¹⁴ Many renewals happen automatically through an ex parte process that uses existing government data to confirm eligibility without any paperwork from the family. Missing a renewal deadline is the most common way children lose coverage they still qualify for, so watch the mail for anything from DSS and respond promptly.

1
Medicaid.gov. Medicaid, CHIP, and BHP Eligibility Levels
2
NC DHHS. NC Health Choice Move to Medicaid
3
NC DHHS. Eligibility
4
NASHP. North Carolina CHIP Fact Sheet
5
NC DHHS. Immigration Status and Eligibility for NC Medicaid
6
NC DHHS. Medicaid Is Changing
7
NC DHHS. Children in NC Health Choice Program Moving to NC Medicaid April 1
8
NC Medicaid Plans. Benefits and Services
9
NC DHHS. Dental Home Initiative
10
NC DHHS. Apply for NC Medicaid
11
NC DHHS. ePASS Portal
12
NC DHHS. NC Plan for Prioritizing and Distributing Renewals
13
Georgetown CCF. North Carolina and Hawaii Make 10 States Advancing Medicaid/CHIP Multi-Year Continuous Eligibility for Young Children
14
NC DHHS. Medicaid Recertification