Most adults in North Carolina qualify for Medicaid if their household income is at or below 138% of the Federal Poverty Level, which is roughly $22,025 a year for a single person under the 2026 poverty guidelines. That is the headline number, but the Medicaid income limits in NC actually vary by category: children, pregnant women, and older or disabled applicants each have their own thresholds, and the way the state counts your income can pull you under a limit you thought you exceeded. North Carolina opened Medicaid to this broader adult group on December 1, 2023, through Medicaid expansion.1NCDHHS. NC Medicaid Expansion Will Launch on Dec. 1, 2023
Income Limits by Category
Each Medicaid category is tied to a percentage of the Federal Poverty Level. The 2026 FPL is $15,960 for one person, $21,640 for two, and $27,320 for three.2Federal Register. Annual Update of the HHS Poverty Guidelines North Carolina refreshes its official dollar-amount tables around April 1 each year, so the figures below are close approximations.
Adults 19 Through 64 (Medicaid Expansion)
Adults who don’t qualify through another category can get full Medicaid at or below 138% of the FPL.1NCDHHS. NC Medicaid Expansion Will Launch on Dec. 1, 2023 Using the 2026 poverty guidelines, that translates to about:
- Single adult: about $22,025 per year
- Household of two: about $29,863 per year
- Household of three: about $37,702 per year
- Household of four: about $45,540 per year
Before expansion, most childless adults in North Carolina had no Medicaid pathway at all, and parents faced a much lower caretaker-relative threshold. A working parent who used to earn just a bit too much for that old category now typically qualifies under expansion.
Children Under 19
Children from birth through age 18 qualify at a single income threshold of 211% of the FPL, regardless of age within that range.3NCDHHS Policies. Basic Medicaid Eligibility Requirements For a family of three, that is roughly $57,645 a year under the 2026 guidelines. NC Medicaid publishes exact monthly dollar limits by family size on its eligibility page.4NC Medicaid. NC Medicaid Eligibility
Pregnant Women
Pregnant women qualify with household incomes up to 196% of the FPL.3NCDHHS Policies. Basic Medicaid Eligibility Requirements The unborn child counts toward household size, so a single pregnant woman is measured against the two-person poverty level, raising her dollar cutoff. Coverage continues for 12 months after the pregnancy ends even if income or household circumstances change.5NC Medicaid. Postpartum Coverage Extension
Aged, Blind, or Disabled
People who are 65 or older, blind, or disabled follow a different set of rules. The full-Medicaid income limit is generally 100% of the FPL. Effective April 1, 2026, the monthly income cap is $994 for one person and $1,491 for a couple. Anyone receiving Supplemental Security Income is automatically enrolled in Medicaid without a separate county application.6NC Department of Health and Human Services. MAABD Eligibility Overview Chart – Effective 04/01/2026 Medicare Savings Programs cover premium and cost-sharing help at higher income tiers, up to about 135% of the FPL.
How North Carolina Measures Your Income
For expansion adults, children, and pregnant women, the state uses a federal formula called Modified Adjusted Gross Income, or MAGI. MAGI starts with your adjusted gross income from your tax return and adds back items like tax-exempt interest and foreign earnings. It captures wages, self-employment income, Social Security benefits, pensions, and unemployment payments.7NC Department of Health and Human Services. MAGI Household Composition and Income Determination Training
What MAGI leaves out often surprises applicants. Child support you receive, veterans benefits, workers’ compensation, SSI payments, gifts, inheritances, and TANF cash assistance do not count. Money you defer into a 401(k) or a flexible spending account is also excluded, which can meaningfully lower your countable income.7NC Department of Health and Human Services. MAGI Household Composition and Income Determination Training
Household size drives the number just as much as income. For MAGI purposes, your household generally includes you, your spouse, and children under 21. A pregnant woman counts her unborn child, which raises the family size used to test her income.4NC Medicaid. NC Medicaid Eligibility
There is also a 5% income disregard for MAGI-based groups. If your gross income barely exceeds a category limit, the state subtracts 5% of the FPL from your countable income, which can pull you back under.7NC Department of Health and Human Services. MAGI Household Composition and Income Determination Training If your income sits just over a threshold, apply anyway and let the county run the math.
Do Savings and Property Count?
If you are applying under a MAGI category (expansion adults, children, pregnant women), there is no asset or resource test. The state cannot deny you because of a bank balance, a car, or home equity.8Medicaid.gov. Eligibility Policy
Aged, blind, or disabled applicants do face a resource test: $2,000 for an individual and $3,000 for a married couple.6NC Department of Health and Human Services. MAABD Eligibility Overview Chart – Effective 04/01/2026 Countable resources include bank accounts, stocks, and some property. A primary home is generally exempt if equity stays below $752,000, rising to $1,130,000 when a spouse or dependent lives there under 2026 federal limits.9Centers for Medicare & Medicaid Services. 2026 SSI and Spousal Impoverishment Standards One vehicle, personal belongings, and burial funds also typically do not count.
If Your Income Is Over the Limit: Medically Needy Spend-Down
If you are aged, blind, or disabled and your income is above the ABD limit, the “medically needy” pathway can still get you coverage. It works like a deductible. The state calculates how much your income exceeds the medically needy income limit, and once you incur medical bills equal to that excess amount, Medicaid takes over for the rest of the coverage period.10NC Department of Health and Human Services. MA-2120 Medically Needy Regulations
Doctor and hospital bills, prescriptions, dental charges, nursing home fees, and Medicare premiums and copayments all count toward the spend-down. Bills paid by insurance or by Medicaid itself do not. If your bills exceed the deductible in a budget period, the leftover can sometimes carry into the next.
Citizenship and Immigration
Full Medicaid requires U.S. citizenship or a qualified immigration status. Lawful permanent residents generally wait five years from the date they received their green card before they can enroll, though refugees, asylees, and certain humanitarian categories are exempt from the wait.11HealthCare.gov. Health Coverage for Lawfully Present Immigrants Undocumented immigrants generally cannot receive Medicaid, but emergency Medicaid covers acute medical emergencies regardless of immigration status.12Center for Medicaid and CHIP Services. Eligibility for Non-Citizens in Medicaid and CHIP
How to Apply
You can apply online through the ePASS portal, the state’s benefits application system. Medicaid appears as “Medical Assistance.” You’ll need an NCID login to submit through ePASS.13NC Medicaid. How To Apply for NC Medicaid You can also apply through HealthCare.gov, which forwards your information to the state, or file a paper application by mail, fax, or in person at your county Department of Social Services office.
Do not wait until you have every document to file. The county can request missing paperwork after your application is on record, and applying early protects the potential start date of your benefits.