What Is NC Medicaid Expansion and Who Qualifies?

North Carolina’s Medicaid expansion is the state’s extension of Medicaid coverage, effective December 1, 2023, to adults ages 19 through 64 who earn up to 138% of the federal poverty level. The legislature authorized it through Session Law 2023-7, and more than 690,000 newly eligible residents had enrolled in the program’s first two years. Coverage includes doctor visits, hospital care, prescriptions, behavioral health, dental, and vision.1NC Medicaid. North Carolina Expands Medicaid

Before expansion, the program mainly covered children, pregnant women, people with disabilities, and some very low-income parents. Adults without children were almost entirely shut out regardless of how little they earned. Expansion changed that by opening eligibility to working-age adults based on income alone.

Who Qualifies

You qualify for expanded NC Medicaid if you meet all of the following:

  • You are between 19 and 64 years old
  • You are a North Carolina resident
  • Your household income is at or below 138% of the federal poverty level
  • You are a U.S. citizen or have a qualified immigration status (some non-citizens also face a five-year waiting period after obtaining that status)2NC Medicaid. Immigration Status and Eligibility for NC Medicaid

Income is measured using Modified Adjusted Gross Income. For 2026, the limits based on the federal poverty guidelines are:3HHS ASPE. 2026 Poverty Guidelines – 48 Contiguous States

  • Single adult: $22,025 per year (about $1,835 per month)
  • Household of two: $29,863 per year (about $2,489 per month)
  • Household of three: $37,702 per year (about $3,142 per month)
  • Household of four: $45,540 per year (about $3,795 per month)

Each additional person in the household adds roughly $7,838 to the annual limit. If your income rises and falls through the year, what matters is your projected annual income, not any single paycheck.

What Coverage Includes

The benefit package tracks the ACA’s essential health benefits and covers:4NC Medicaid. Questions and Answers about Medicaid Expansion

  • Primary care, including routine checkups, sick visits, and specialist referrals
  • Inpatient and outpatient hospital services
  • Emergency care
  • Prescription drugs
  • Mental health and substance use disorder treatment
  • Preventive and wellness services, including screenings and immunizations
  • Maternity and postpartum care
  • Vision and hearing services
  • Dental and oral health services
  • Durable medical equipment, prosthetics, and supplies

Dental and vision coverage are included, which is not the case under every state’s Medicaid program.

What You Pay

NC Medicaid has no monthly premiums. The most you will pay out of pocket is a $4 copay for certain services, including doctor visits, outpatient visits, optometrist visits, and prescriptions.5NC Medicaid. NC Medicaid Copays

Many services carry no copay at all:

  • All services for members under 21
  • Pregnancy-related care, including prenatal and postpartum services
  • Behavioral health, intellectual disability, and traumatic brain injury services
  • Family planning services
  • Adult vaccines
  • HIV antiretroviral medications and opioid treatment medications
  • Durable medical equipment, prosthetics, and supplies

Providers cannot deny you care because you cannot pay a copay at the time of service.

How to Apply

You can apply four ways:6NC Medicaid. How To Apply for NC Medicaid

  • Online through the ePASS portal at epass.nc.gov, where Medicaid is listed as “Medical Assistance”
  • In person at your county Department of Social Services office
  • By mail, email, or fax to your county DSS office
  • By dropping off a paper application at that same office

At minimum your application needs the full legal name and date of birth of at least one applicant, a mailing address, and your signature. Gathering supporting documents up front speeds the process. DSS looks for:

  • Proof of income: pay stubs, employer verification, or your most recent tax return (business records or a tax return if you are self-employed)
  • Proof of North Carolina residency: a photo ID with your address, a utility bill, a lease or mortgage, or vehicle registration. If you have none of these, you can check a residency declaration box on the application.
  • Proof of identity and date of birth: a photo ID or birth certificate
  • Your Social Security number, or proof you have applied for one
  • Proof of citizenship or immigration status: a birth certificate, passport, or for non-citizens, a visa or immigration card

DSS has up to 45 days to decide. Applications with complete documentation generally move faster. If more information is needed, DSS will contact you by mail, so keep the address and phone number on your application current. If you are approved, coverage can start as early as the date you applied.

Keeping Your Coverage

Approval is not permanent. North Carolina reviews eligibility every 6 or 12 months, depending on your program, through a process called recertification. Your caseworker first tries to confirm eligibility using electronic data sources without contacting you. If that works, your coverage renews automatically.7NC Medicaid. How NC Medicaid Eligibility Recertification Works – Fact Sheet

If the state cannot verify eligibility electronically, you will get a letter asking for updated information. You have 30 days to respond to the first letter. If a second letter follows, you have only 12 days. Missing those deadlines can cost you your coverage, so keep your contact information current with your county DSS office and watch your mail.

A federal change takes effect soon. Under the Working Families Tax Cut legislation (Public Law 119-21), states must redetermine eligibility for the adult expansion population every six months instead of every twelve, beginning with renewals scheduled on or after January 1, 2027.8Medicaid.gov. Implementation of Eligibility Redeterminations, Section 71107 of the Working Families Tax Cut Legislation – SMD 26-001 If you enrolled through expansion, you will confirm eligibility twice a year rather than once.

One Thing to Know If You Are 55 or Older

Federal law requires every state to seek repayment from the estates of Medicaid beneficiaries who were 55 or older when they received certain long-term care services.9Medicaid.gov. Estate Recovery In North Carolina, estate recovery applies to payments for nursing facility care, home and community-based services, personal care services, hospital care, and prescription drugs connected to those services.

North Carolina waives recovery when the estate holds less than $50,000 in assets or when Medicaid paid less than $10,000 on your behalf. Recovery is deferred while a surviving spouse is living, while a surviving child under 21 remains in the household, or while a surviving child of any age who is blind or disabled lives in the home.

Estate recovery does not reach every enrollee. If you are under 55, or if you are older but using Medicaid only for routine care, prescriptions, and preventive services, it does not apply. It only kicks in for the specific long-term care services listed above, received at age 55 or older.