Medicaid Eligibility in North Carolina 2026: Income Limits and Who Qualifies

Yes—many North Carolina residents qualify for Medicaid in 2026, even if they work.

Thanks to Medicaid expansion, most adults ages 19–64 can get NC Medicaid if their household income is at or below 138% of the Federal Poverty Level.

For a single adult, that’s about $1,800 per month, and for a family of four, about $3,697 per month.

Children, pregnant women, seniors, and people with disabilities may qualify at higher income levels or under different rules, and asset limits only apply to seniors and disability-based Medicaid, not expansion adults.

Medicaid in North Carolina covers:

• Doctor visits and hospital care
• Prescriptions and preventive services
• Dental and vision care for children
• Maternity, postpartum, and long-term care services

Eligibility in 2026 depends on income, household size, age, and program category, with final income limits updated once federal poverty guidelines are released early in the year by the North Carolina Department of Health and Human Services.

This guide breaks down who qualifies, current income limits, how household size affects eligibility, and what rules apply in 2026, so you can quickly determine whether you or your family can get coverage—and how to apply without delays.

Medicaid Eligibility in North Carolina (2026): Income Rules, Program Limits, and Key Exceptions

In 2026, Medicaid eligibility in North Carolina is largely shaped by the Medicaid expansion implemented in late 2023, which remains in effect. This expansion significantly widened access by allowing most adults ages 19–64 to qualify based solely on income, without requirements related to disability, pregnancy, or dependent children.

Medicaid eligibility is administered by the North Carolina Department of Health and Human Services and follows federal income guidelines tied to the Federal Poverty Level (FPL). While final 2026 FPL numbers are released early in the year, projected limits are used at the beginning of 2026 to determine eligibility.

Core Income Rule for Expansion Adults (Ages 19–64)

If you are an adult between 19 and 64 years old, you may qualify for Medicaid if your household income is at or below 138% of the Federal Poverty Level (FPL).

• Single adult: about $1,800 per month
• Family of four: about $3,697 per month

This group includes working adults, part-time employees, gig workers, and adults without children. Employment alone does not disqualify you.

2026 Medicaid Income Guidelines by Eligibility Group

Different Medicaid groups have different income thresholds. Children and pregnant women qualify at much higher income levels, while seniors and people with disabilities follow more traditional Medicaid rules.

Estimated Monthly Income Limits (Projected 2025–2026 Guidelines)

Important: These figures are projections based on current federal guidelines. The official 2026 Federal Poverty Level amounts are typically released in late January or early February, and income limits may increase slightly at that time.

Asset Limits and Non-Financial Eligibility Rules

Income is not the only factor for some Medicaid programs. Asset rules and residency requirements still apply to certain groups.

Asset Limits by Program Type

• Expansion Adults (19–64):
  No asset limit. You may own a home, a vehicle, and have savings without affecting eligibility.
• Seniors (65+) & Individuals with Disabilities (ABD Medicaid):
  • $2,000 asset limit for individuals
  • $3,000 for married couples
  • Countable assets include cash, bank accounts, investments, and additional vehicles
  • Your primary home and one vehicle are usually exempt

Residency & Citizenship Rules

To qualify for North Carolina Medicaid, you must:

• Be a resident of North Carolina
• Be a U.S. citizen or an eligible non-citizen, such as:
  • Lawful Permanent Residents (generally after 5 years)
  • Refugees or asylees
  • Certain humanitarian or protected status holders

How Medicaid Works in North Carolina in 2026

NC Medicaid is the state’s health program for low-income people. It works with federal rules but adds state touches. The Department of Health and Human Services runs it.

It covers basic care like doctor visits and hospital stays. Prescriptions and check-ups are included. Kids get dental and vision. Adults get emergency dental.

Coverage depends on your group. Expansion in 2023 opened it to more adults. In 2026, this continues.

Adults without kids can qualify if income is low. This helps working folks too. The program aims to keep people healthy without big bills.

Who Qualifies for Medicaid in North Carolina in 2026?

Anyone can apply for NC Medicaid. Approval depends on your group and income. Expansion makes it easier for many.

Low-income adults qualify under expansion. This includes ages 19 to 64. You don’t need kids or disability. Income is the main check.

Children get coverage through NC Medicaid or Health Choice. This helps kids up to age 18. Families with low income qualify.

Pregnant women get help during pregnancy and after. Income limits are higher here. This covers prenatal care and more.

Parents and caretakers of kids may qualify. You must live with dependent children. Income matters.

Seniors age 65 and older often get coverage. Income and assets are reviewed. This helps with long-term care.

People with disabilities qualify if health limits work. This includes physical or mental issues. Medical proof is needed.

Eligibility ties to household size and income. U.S. citizens or qualified immigrants can apply. Arkansas residents only. Expansion helps more adults without kids.

North Carolina Medicaid Income Limits (2025 — Current Limits Used for 2026 Eligibility)

Income limits depend on your eligibility group and household size. North Carolina has not released official Medicaid income limits for 2026 yet.

Until new figures are published, the most recent confirmed 2025 income limits remain in use. These limits are used when checking eligibility at the start of 2026.

Expansion adults qualify mainly based on income. Children and pregnant women have higher limits. Parents, seniors, and people with disabilities follow different rules.

Household size matters. Bigger households qualify at higher income levels. Use ePASS for a quick check, but apply to get a final decision.

How Household Size Affects Medicaid Eligibility in North Carolina

Household size includes everyone living together. This counts you, spouse, and dependents. Size raises income limits.

Dependents like kids or elderly parents matter. They increase the household number. This allows higher income.

For adults alone, size is one. With a child, it’s two. This changes the limit.

Expansion looks at tax household. It includes who you claim on returns. Get this right to avoid errors.

Bigger households qualify at higher incomes. Use state tools to count yours.

Medicaid Expansion in North Carolina: What It Means in 2026

Medicaid expansion lets more adults get coverage. North Carolina started this in 2023. It covers adults 19 to 64 with low income.

This means working adults can qualify. You don’t need kids or disability. Income is key.

Expansion simplifies rules. It fills gaps for those too poor for marketplace plans but not poor enough before.

In 2026, this continues. It helps reduce uninsured rates. More people get check-ups and care without big bills.

Can Working Adults Qualify for Medicaid in North Carolina?

Yes, many working adults qualify. NC Medicaid is income-based. Jobs don’t disqualify you.

Part-time or low-wage workers often get coverage. Hourly jobs with varying pay still count.

Expansion helps those with steady work but low pay. Income after deductions matters. Apply to see if you fit.

Asset Limits for North Carolina Medicaid Programs

No asset limits for expansion adults, children, and pregnant women. This makes it easier.

For seniors and disability Medicaid, assets count. Savings and property have limits.

What counts as assets. Bank accounts, stocks, and extra cars. Homes and one car often don’t.

Check rules for your group. This avoids surprises.

North Carolina Medicaid Long-Term Care Eligibility (2026 Updates)

Long-term care Medicaid helps with nursing homes or home care. It’s for those needing ongoing help.

Financial rules include income and assets. Medical needs must show daily aid required.

North Carolina is reviewing long-term care Medicaid eligibility rules for 2026, and income or asset limits may be updated during the year.

Apply through county offices. Proof of needs is key. This covers services like meals or bathing help.

North Carolina Medicaid Income Limits (2025 — Used for 2026 Eligibility)

Note: North Carolina has not released official Medicaid income limits for 2026 yet. The 2025 income limits remain in effect and are used to determine eligibility at the start of 2026. Updated limits are expected in January 2026, and this page will be updated once they are confirmed.

How to Apply for Medicaid in North Carolina

Apply online through ePASS. This is fast. Go to epass.nc.gov. Create an account and fill forms.

Apply in person at county DSS offices. Find yours on ncdhhs.gov. Bring papers.

Mail or fax forms too. Download from the site. Include copies of docs.

Provide ID, income proof, and residency. Staff help if needed. Apply anytime.

How Long Does Medicaid Approval Take in North Carolina?

Most cases take up to 45 days. Disability or long-term care can take 90 days.

Delays happen with missing papers. Busy offices slow things.

Check status online or call. Respond fast to requests.

Common Reasons Medicaid Applications Are Delayed or Denied

Missing documents cause delays. Always send ID and income proof. Income too high leads to denials. Check limits first. Household size errors happen. Count everyone right. Not responding to notices delays. Open mail quick. Incomplete forms get sent back. Fill all parts.

Medicaid vs Marketplace Insurance in North Carolina (2026)

Medicaid fits low-income groups. It has no premiums. Marketplace plans suit higher incomes with subsidies.

Medicaid covers more for kids and pregnant women. Marketplace has deductibles.

Expansion reduced gaps. If over Medicaid limit, check marketplace at healthcare.gov.

Key Takeaways 

Expansion lets more adults qualify in 2026. Income limits base on household size.

Dependents raise limits for families. Seniors and disabled have asset rules.

North Carolina updates limits in January 2026. Long-term care rules may change.

Apply early to avoid waits. This gets you covered sooner.

North Carolina Medicaid Eligibility 2026;  FAQs