Who Qualifies for Medicaid in NC: Expansion, Income, and Assets

Who qualifies for Medicaid in NC depends on which eligibility group you fall into. Since North Carolina expanded Medicaid on December 1, 2023, adults ages 19 through 64 can qualify based on income alone — up to 138% of the federal poverty level, roughly $22,025 a year for a single person in 2026. Children, pregnant women, seniors, and people with disabilities follow different rules, and several of those groups qualify at substantially higher income levels. More than 650,000 previously uninsured North Carolinians enrolled through expansion in its first 18 months.¹

Residency and Citizenship

You must live in North Carolina and intend to stay. Under N.C.G.S. § 108A-54, an applicant must be a current resident with documented intent to remain permanently or indefinitely.² Someone visiting without intent to stay is ineligible, and someone who has moved to another state no longer qualifies here.³ A utility bill, lease, or mortgage statement tied to a North Carolina address usually satisfies the proof.

U.S. citizens and nationals meet the citizenship test. Certain lawfully present non-citizens classified as qualified aliens under federal law can also qualify, though many face a five-year waiting period from the date they received that status. Refugees and asylees are generally exempt from the five-year bar.

Adults Ages 19 Through 64 Under Expansion

Before December 2023, a non-disabled adult without a dependent child had almost no path to Medicaid here, regardless of income. Expansion changed that. If you are between 19 and 64, do not qualify for Medicare, and your household income (measured as Modified Adjusted Gross Income, or MAGI) sits at or below 138% of the federal poverty level, you qualify.⁴

In 2026 dollars, that works out to:⁵

Individual: about $22,025 per year
Household of 2: about $29,863 per year
Household of 3: about $37,702 per year
Household of 4: about $45,540 per year

MAGI includes wages, salaries, tips, self-employment earnings, and most taxable income, including certain Social Security benefits. There is no asset or resource test for this group, so the determination is straightforward: you either fall under the income ceiling or you don’t. Thresholds adjust each year when the federal poverty guidelines are updated, usually in January.

Children and Pregnant Women

Children get the most generous income ceiling. From birth through age 18, a child qualifies when household income is at or below 211% of the federal poverty level — a single threshold that applies at every age, with no lower limit for teenagers.⁶⁷

In 2026 dollars:⁵

Family of 3: about $57,645 per year
Family of 4: about $69,630 per year

Pregnant women qualify under a separate program at 196% of the federal poverty level.⁷ One detail trips people up: the unborn child counts as a current household member. A single pregnant woman is counted as a household of two, which puts her income limit at roughly $42,414 per year in 2026. Coverage includes prenatal visits, delivery, and postpartum care.

Seniors and People With Disabilities

Residents age 65 and older, along with people who are blind or have a qualifying disability, fall under the Aged, Blind, and Disabled (ABD) category. The rules are tighter here because ABD applicants must pass both an income test and an asset test.

Monthly income limits for full ABD coverage, current through April 2026:⁸

Individual: $1,305 per month (about $15,660 per year)
Couple: $1,763 per month (about $21,156 per year)

Countable resources cannot exceed $2,000 for an individual or $3,000 for a couple.⁹ Cash, bank accounts, stocks, and real property beyond your primary home all count. Your home, one vehicle, household goods, and certain burial funds are generally excluded.

If You Earn Slightly Too Much: The Medically Needy Program

North Carolina’s Medically Needy program offers a path for people whose income sits just above the ABD ceiling. It works like a deductible. You must first accumulate medical expenses equal to the gap between your monthly income and the Medically Needy income limit. Once your bills reach that threshold, Medicaid covers the rest of your care for the remainder of a six-month period.⁷

Hospital charges, pharmacy bills, and other medical expenses all count toward your share of cost. Medicaid will not reimburse the amount used to meet the deductible, only services after you clear it. The deductible resets every six months, so a change in income or expenses gets picked up at the next redetermination. The program matters most for people with chronic conditions or high prescription costs.

Long-Term Care Medicaid and the Five-Year Look-Back

Nursing home coverage adds another layer of financial scrutiny on top of the standard income and asset tests. North Carolina reviews your financial history for the 60 months before you apply, looking for assets you gave away or sold below fair market value. The look-back period exists to stop applicants from transferring wealth to family and then qualifying for taxpayer-funded long-term care.

When the state finds improper transfers, it calculates a penalty period during which Medicaid will not pay for your nursing home care. The penalty equals the total value of the transfers divided by the average monthly cost of nursing home care in North Carolina, roughly $7,110 under recent state figures. A $71,100 gift made within the look-back window produces about 10 months of ineligibility. There is no cap on the penalty period, so large transfers can mean years without coverage.

Your primary home is generally excluded from the asset count up to an equity value of approximately $752,000 in 2026. If a spouse, a child under 21, or a blind or disabled child of any age lives in the home, the equity limit is waived entirely. Anyone approaching the need for long-term care should know these rules well in advance; restructuring finances inside the look-back window almost always backfires.

Estate Recovery After Death

One thing families often don’t see coming: federal law requires North Carolina to seek repayment of certain Medicaid costs from the estates of deceased beneficiaries.¹⁰ Under N.C.G.S. § 108A-70.5, the state can recover amounts it paid for nursing facility care, home and community-based services, hospital stays, prescription drugs, and personal care services provided to recipients age 55 and older, or to recipients of any age who were institutionalized and not expected to be discharged.¹¹

The state cannot pursue estate recovery if the deceased is survived by a spouse, a child under 21, or a blind or disabled child of any age.¹⁰ North Carolina law also directs DHHS to establish rules for waiving recovery when it would cause undue hardship.¹¹ The recovery amount is limited to what Medicaid actually paid.

How to Apply

North Carolina accepts applications three ways:¹²

Online through the ePASS portal (you will need to create an NCID login first)
In person at your county Department of Social Services office
By mail, fax, or email, using the application form from the NCDHHS website

Have these ready before you start:¹³

Social Security numbers for each household member applying
Proof of residency, such as a utility bill, lease, or mortgage statement
Income documentation: recent pay stubs, W-2s, or tax returns, plus profit and loss statements if self-employed
Current insurance details, including policy numbers and premium amounts for anyone in the household who already has coverage

Report gross income before taxes or deductions. List every person in the household accurately, because the income limit shifts with each member added. Household composition is where most applications hit delays.

1
NC DHHS. NC Medicaid Expansion Reaches 650,000 North Carolinians Enrolled
2
North Carolina General Assembly. North Carolina Code 108A-54 – Authorization of Medical Assistance
3
North Carolina Office of Administrative Hearings. Title 10A Health and Human Services, Chapter 23E
4
NC Medicaid. Questions and Answers About Medicaid Expansion
5
HHS ASPE. 2026 Poverty Guidelines: 48 Contiguous States
6
Centers for Medicare and Medicaid Services. Medicaid, CHIP, and BHP Eligibility Levels
7
NCDHHS Policies and Manuals. Basic Medicaid Eligibility Requirements
8
NC Medicaid. NC Medicaid Eligibility
9
Medicaid.gov. January 2026 SSI and Spousal Impoverishment Standards
10
Medicaid.gov. Estate Recovery
11
North Carolina General Assembly. North Carolina Code 108A-70.5 – Medicaid Estate Recovery Plan
12
NC Medicaid. How To Apply for NC Medicaid
13
North Carolina Department of Health and Human Services. Application for Health Coverage and Help Paying Costs