Medicaid in North Carolina does not stop at a single age. Coverage runs from birth through old age, but the rules that decide who qualifies change at a handful of key thresholds: 19 for children, 26 for young adults who were in foster care, 65 when adult rules shift to the Aged, Blind, and Disabled category, and separately during pregnancy. What usually ends at a specific age is a particular category of Medicaid, not Medicaid itself. The question for most families is which category you move into next, and whether your income and assets still fit.
Children’s Medicaid Ends at Age 19
Children from birth through age 18 qualify at roughly 211% of the federal poverty level, with no asset or resource test. For a family of four, that works out to about $5,645 a month in gross income; smaller and larger households scale from there.1NC Medicaid. NC Medicaid Eligibility
When a child turns 19, they lose eligibility for children’s Medicaid and have to requalify under adult rules, which carry much lower income limits.2DB101 North Carolina. Parent Focus: Turning 18: NC Medicaid Rules That Change This catches a lot of families off guard. A 19-year-old’s income is also evaluated separately if they are no longer claimed as a tax dependent, which can change the picture quickly.
If Your Child Earns Too Much for Medicaid
Families whose income exceeds the children’s Medicaid ceiling may still qualify for NC Health Choice, the state’s version of the federal Children’s Health Insurance Program. It covers kids whose family income is above Medicaid’s limit but below a higher ceiling, with low or no premiums depending on the bracket.3Centers for Medicare & Medicaid Services. North Carolina Health Choice for Children NC Health Choice also ends at 19. Applications go through your county Department of Social Services.
Former Foster Care Youth Keep Coverage Until 26
If you aged out of foster care in North Carolina at 18 and were enrolled in Medicaid at that time, you keep coverage until you turn 26, with no income or resource test.4NCDHHS Policies. Family and Children’s Medicaid Manual – Former Foster Care Since January 1, 2023, this also covers people who were in foster care and receiving Medicaid in any other state, not just North Carolina.5NCDHHS Policies. Basic Medicaid Eligibility Requirements
If you fall into this group and are not enrolled, coverage is essentially automatic once you document your foster care history with DSS. The cutoff is your 26th birthday.
Adults 19 Through 64: Medicaid Expansion
North Carolina launched Medicaid expansion on December 1, 2023, opening coverage to adults 19 through 64 who were previously shut out.6NCDHHS. NC Medicaid Expansion Will Launch on Dec. 1, 2023 The income ceiling for this group is 138% of the federal poverty level, which for 2026 comes out to roughly $22,025 a year for a single person, or about $1,800 a month.1NC Medicaid. NC Medicaid Eligibility For a family of four, the limit is about $3,698 a month.
Expansion Medicaid uses modified adjusted gross income and does not impose an asset test, so savings and property do not count against you. If your income later rises above the limit, you lose eligibility and would need to look at Marketplace or employer coverage.
Pregnancy Coverage
Pregnant women qualify at substantially higher income thresholds than other adults, around 196% of the federal poverty level. The state counts the unborn child as a household member, so a single pregnant person is evaluated as a family of two.1NC Medicaid. NC Medicaid Eligibility Coverage continues through 60 days postpartum, after which eligibility is reassessed under the regular adult rules.
At 65, the Rules Change Again
Medicaid does not end at 65. What changes is the framework. Adults 65 and older, along with people who are blind or have qualifying disabilities, fall under the Aged, Blind, and Disabled (ABD) category, which uses different eligibility rules than the expansion population.7NCDHHS Policies. MAABD Eligibility Overview Chart
The income limits are tighter. Full Medicaid coverage under ABD caps monthly income at $1,305 for a single person and $1,763 for a married couple.1NC Medicaid. NC Medicaid Eligibility ABD also imposes an asset test that expansion Medicaid does not: as of April 2026, a single applicant cannot hold more than $2,000 in countable assets, and a married couple cannot exceed $3,000.7NCDHHS Policies. MAABD Eligibility Overview Chart Your primary home (within equity limits), one vehicle, personal belongings, and burial funds up to set limits are exempt from the asset count. Receiving Supplemental Security Income triggers automatic Medicaid enrollment in North Carolina.
So the practical answer at 65 is that your Medicaid does not stop, but it may be recategorized, and the income and asset tests you now face look nothing like the ones that applied the day before your birthday.
Help With Medicare Costs
If you are 65 or older or receive Social Security disability and are enrolled in Medicare, North Carolina Medicaid can also help pay your Medicare costs through the Medicare Savings Programs, even if you do not qualify for full Medicaid. The Qualified Medicare Beneficiary program covers Part A and Part B premiums, deductibles, and copays for people with monthly income up to $1,350 for an individual or $1,824 for a couple. The Specified Low-Income Medicare Beneficiary program pays Part B premiums for those with income up to $1,616 for an individual or $2,184 for a couple. Both carry a resource limit of $9,950 for an individual and $14,910 for a couple.8Medicare. Medicare Savings Programs Many people who miss out on full Medicaid still qualify here and never apply.
The PACE Program at 55
Separate from the age-65 line, the Program of All-Inclusive Care for the Elderly (PACE) is available starting at 55 for people who need a nursing-facility level of care but can live safely at home. PACE bundles medical care, social services, and daily support through a single organization, and it is only available in parts of the state.9NC Medicaid. Program of All-Inclusive Care for the Elderly (PACE)
What to Do When You’re About to Age Out
A few months before a child turns 19, or before a former foster youth turns 26, contact your county Department of Social Services and ask what category you’ll move into and what documentation they need. If a 19-year-old’s income is above the expansion limit, the Health Insurance Marketplace is usually the next stop. For someone approaching 65 who already has Medicaid under expansion, the agency reassesses eligibility under ABD rules, which is where the asset test suddenly matters.
Keep up with annual recertification regardless of age. North Carolina requires renewal every 12 months, and DSS sends a notice when it’s due; losing coverage for failing to respond is common even when the person still qualifies.1NC Medicaid. NC Medicaid Eligibility Report income changes, household changes, and moves promptly rather than waiting. You must live in North Carolina and be either a U.S. citizen or hold a qualifying immigration status to receive any form of state Medicaid.10NC Medicaid. Immigration Status and Eligibility for NC Medicaid