North Carolina Medicaid Eligibility 2026: New Guidelines

Last Updated: February 2026 | Source: NC DHHS / medicaid.ncdhhs.gov

In 2026, North Carolina Medicaid covers most low-income adults, children, seniors, and people with disabilities.

A single adult earning up to $1,800 per month can qualify for free health coverage with no premiums and no asset test.

Thanks to Medicaid expansion, more North Carolinians qualify today than ever before.

Quick Summary — What You’ll Learn:

• Who qualifies for NC Medicaid in 2026
• Income limits by household size and group
• Asset rules for seniors and people with disabilities
• Important 2026 policy changes you need to know
• How to apply online, by phone, or in person
• Answers to the most common NC Medicaid questions

Quick Answer: In 2026, a single adult in North Carolina can qualify for free Medicaid coverage with income up to $1,800/month. A family of four qualifies with up to $3,697/month. There is no asset test for most adults, children, and pregnant women. Seniors and disabled individuals follow separate income and asset rules. You can apply today at the NC ePASS portal in minutes.

By Akash

Who Qualifies for NC Medicaid in 2026?

North Carolina expanded Medicaid in December 2023 under the Affordable Care Act (ACA). That expansion is still in effect in 2026. Most adults ages 19–64 now qualify based on income alone — no disability or dependent children required.

To be eligible, you must generally:

• Live in North Carolina
• Be a U.S. citizen or have a qualifying immigration status
• Have a Social Security number (or proof you applied for one)
• Meet income limits for your household size and category

Qualifying Groups in 2026

NC Medicaid covers several groups of people. Each group has its own income rules.

• Expansion Adults (ages 19–64): Low-income adults who don’t qualify through other categories
• Children (under 19): Covered up to 216% of the Federal Poverty Level (FPL)
• Pregnant Women: Covered up to 201% FPL, including 12 months of postpartum care
• Seniors (65+) and People with Disabilities: Covered under stricter income and asset rules
• Parents and Caretakers: Covered at lower income thresholds

Note: Families with non-citizen members can still apply. You can apply for your child even if you are not eligible yourself. Applying will not affect your immigration status.

NC Medicaid Income Limits 2026

Understanding the North Carolina Medicaid Income Limits in 2026 is the fastest way to know if you qualify. The table below shows current monthly and annual income limits by household size and program group.

These figures are based on 2025 Federal Poverty Levels and are effective until April 1, 2026. The 2026 FPL (base: $15,960/year) was released in late January 2026. Updated limits are expected to take effect in April 2026.

2026 NC Medicaid Income Limits Table

Group	Monthly Limit	Annual Estimate	Asset Limit
Single Adult (Expansion, ages 19–64)	$1,800	~$21,600	None
Family of 2	$2,430	~$29,160	None
Family of 4	$3,697	~$44,360	None
Pregnant Women (household of 2)*	$3,455	—	None
Senior (65+) / Person with Disability	$1,305	~$15,660	$2,000

*Pregnant women limits count the unborn child as part of the household.

All dollar amounts are gross income before taxes. There is no asset test for expansion adults, children, or pregnant women.

💡 Tip: Even if your income is slightly above the limit, you should still apply. A caseworker may find deductions that bring you under the threshold.

For a state-by-state comparison, see Medicaid income limits by state in 2026.

Eligibility Rules for Seniors and People with Disabilities

Seniors (65+), blind individuals, and people with disabilities follow different rules than the Medicaid expansion group. These applicants are subject to both income limits AND asset (resource) limits.

Asset Limits for Seniors and Disabled Applicants

Category	Asset Limit
Individual	$2,000
Married Couple	$3,000

Exempt assets (these do NOT count toward the limit):

• Primary home (primary residence)
• One vehicle
• Personal belongings and household furnishings
• Term life insurance

Medically Needy Program (Spend-Down)

If your income is above the limit, you may still qualify through the Medically Needy program. This is sometimes called a “spend-down.”

Here’s how it works: You pay a deductible equal to the difference between your income and the Medically Needy limit. Once you meet that deductible through medical bills, Medicaid coverage kicks in.

• Medically Needy Limit (Single): $242/month
• Medically Needy Limit (Couple): $317/month

Example: If you earn $500/month as a single senior, your spend-down deductible is $258/month ($500 – $242). Once your medical bills reach $258, Medicaid covers the rest.

Important NC Medicaid Updates for 2026

Several key changes are taking effect this year. These changes come from new federal legislation (H.R.1) passed by Congress. Knowing about them now can help you stay covered.

1. More Frequent Eligibility Checks Starting Late 2026

Beginning December 31, 2026, some low-income adults ages 19 through 64 without disabilities must have their Medicaid eligibility redetermined every 6 months instead of the traditional 12 months. This applies to expansion adults when renewing coverage.

What to do: Keep your contact information up to date in NC ePASS. Respond quickly to any renewal notices you receive.

2. Work Reporting Requirements Coming in 2027

Strictly enforced work requirements as a condition of eligibility are scheduled to begin in 2027. However, in late 2026, some beneficiaries may be asked to start reporting work status — including employment, volunteering, or education. This is a preparation step, not yet a requirement to keep coverage.

3. Medical Debt Relief Through HASP

As part of the Hospital Assistance for Patients (HASP) program, North Carolina hospitals are now required to relieve medical debt for patients with income below 300% of the Federal Poverty Level. This means millions of NC residents may be eligible to have existing hospital bills forgiven or reduced.

What Does NC Medicaid Cover?

NC Medicaid provides comprehensive health coverage at no monthly premium for most members. Covered services include:

• Doctor visits and preventive care
• Hospital stays and emergency care
• Prescription drugs
• Mental health and substance use treatment
• Dental and vision (for children; limited for adults)
• Pregnancy and postpartum care (12 months)
• Long-term care and nursing home services (for eligible seniors)

Providers are reimbursed based on the Medicaid Fee Schedule 2026, which sets standard rates for covered services across North Carolina.

How to Apply for NC Medicaid in 2026

Applying is free and can be done in three ways. Most people find the online portal to be the fastest option.

Option 1: Apply Online (Recommended)

Use the NC ePASS Portal to apply, check your status, upload documents, and manage your account — all in one place. Available 24/7.

Option 2: Apply by Phone

Call the NC Medicaid Contact Center at: 📞 1-888-245-0179 (TTY: 711)

Representatives are available to help with applications and general questions. Help is available in multiple languages.

Option 3: Apply In Person

Visit your county’s Department of Social Services (DSS) office. Bring the following documents:

• Proof of identity (ID, birth certificate)
• Proof of North Carolina residency
• Proof of income (pay stubs, tax returns)
• Social Security number

What Happens After You Apply?

• Standard applications are processed within 45 days
• Disability-based applications may take up to 90 days
• If approved, benefits may be retroactive up to 3 months
• You will receive a renewal notice each year (or every 6 months starting late 2026 for some adults)

Frequently Asked Questions (FAQs)

Official Sources and Resources

• 🔗 NC Medicaid Eligibility – Official Site (medicaid.ncdhhs.gov)
• 🔗 NC ePASS Application Portal (epass.nc.gov)
• 🔗 Find Your Local DSS Office (ncdhhs.gov)
• 📞 NC Medicaid Contact Center: 1-888-245-0179

This article is for informational purposes only and is based on official NC DHHS guidelines as of February 2026. Income limits are current until April 1, 2026. Always verify your eligibility directly with NC Medicaid or your local DSS office.