North Carolina Medicaid now covers more people than ever before, thanks to its December 2023 expansion. In 2025, a single adult may qualify if their income is below $21,597 per year, while a family of four may qualify if their income is under $44,367.
This expansion is projected to bring coverage to over 600,000 additional adults across the state. Children and pregnant women also qualify at higher income thresholds, supported by NC Health Choice (CHIP) and extended postpartum care.
Key Takeaways
- Single adult limit: $21,597/year (138% FPL).
- Family of four limit: $44,367/year.
- Expansion took effect in December 2023, greatly expanding coverage.
- Children qualify through NC Health Choice at higher levels.
- Pregnant women qualify up to 200% FPL or more, with 12 months postpartum coverage.
- Seniors and disabled residents qualify under income and resource rules.
- Applications are processed through NC ePASS.
North Carolina Medicaid Income Limits 2025 by Household Size
| Household Size | 100% FPL (Annual) | 138% FPL (Adults) | 200%+ FPL (Pregnancy/Children) |
| 1 | $15,650 | $21,597 | ~$31,300+ |
| 2 | $21,150 | $29,187 | ~$42,300+ |
| 3 | $26,650 | $36,777 | ~$53,300+ |
| 4 | $32,150 | $44,367 | ~$64,300+ |
| 5 | $37,650 | $51,957 | ~$75,300+ |
| 6 | $43,150 | $59,547 | ~$86,300+ |
Source: HHS 2025 Poverty Guidelines
Explanation:
- Adults qualify up to 138% FPL in 2025.
- Pregnant women and children qualify at higher thresholds, often 200% FPL or above.
- Larger families qualify at higher income caps due to greater household expenses.
- Example: A single adult earning $21,000 may qualify; a family of four earning $44,000 could also qualify.
NC Health Choice (CHIP) Income Limits 2025
North Carolina’s NC Health Choice covers children in families above Medicaid limits. It functions as the state’s CHIP program.
| Family Size | Monthly Income Limit (approx.) | Annual Income Limit (approx.) |
| 1 | ~$2,750 | ~$33,000 |
| 2 | ~$3,718 | ~$44,600 |
| 3 | ~$4,685 | ~$56,200 |
| 4 | ~$5,653 | ~$67,800 |
Source: NC Medicaid Division
Explanation:
- Children qualify at higher limits than adults, ensuring most are covered.
- Families pay little to no premiums for children’s coverage.
- Coverage includes doctor visits, hospital care, prescriptions, and preventive care.
Expansion and How NC Medicaid Works
North Carolina’s decision to expand Medicaid under the ACA was historic. Adults aged 19–64 with income up to 138% FPL are now covered, including childless adults who were previously excluded.
The program operates under two systems:
- Medicaid Managed Care: Most residents are enrolled here, choosing or being assigned a health plan that coordinates their care.
- Medicaid Direct: Certain groups with complex health needs, such as those requiring long-term care, remain in this program.
Expansion has not only increased coverage but also improved access to preventive care, behavioral health services, and postpartum support for low-income families.
Who Qualifies for NC Medicaid?
- Adults (19–64, Expansion Group): Covered up to 138% FPL.
- Children (Medicaid & NC Health Choice): Qualify at higher income thresholds, often up to 200% FPL or more.
- Pregnant Women: Covered up to higher income levels, with 12 months postpartum coverage.
- Parents & Caregivers: Eligible under adult expansion rules when income fits.
- Seniors & Disabled Individuals: Income and resource rules apply, often including long-term care pathways.
How to Apply for Medicaid in North Carolina (2025)
- Start online at NC ePASS.
- Complete the screening tool to see if you qualify.
- Gather documents:
- Proof of income (pay stubs, tax returns).
- Proof of NC residency (ID, lease, or utility bill).
- Social Security numbers for household members.
- Immigration documents if applicable.
- Submit your application online, by mail, or at your county DSS office.
- Choose a managed care plan or remain in Medicaid Direct, depending on eligibility.
- Renew coverage annually by updating household and income information.
Alternatives If You Don’t Qualify
- NC Health Choice (CHIP): For children in families above Medicaid limits.
- Marketplace Plans (HealthCare.gov): Subsidized coverage with tax credits lowering monthly premiums.
- Community Health Centers: Offer sliding-scale fees for uninsured families.
- Hospital Assistance Programs: Financial help for low-income patients not eligible for Medicaid.
FAQs
Q1: What’s the income limit for adults in NC in 2025?
A: About $21,597 per year for a single adult, or 138% FPL.
Q2: Does NC Medicaid now cover childless adults?
A: Yes. Since the December 2023 expansion, childless adults qualify up to 138% FPL.
Q3: How do children qualify if parents don’t?
A: Through NC Health Choice (CHIP), which covers kids at higher income thresholds.
Q4: How long does postpartum coverage last?
A: Pregnant women are covered for 12 months after delivery.
Q5: What is the difference between Managed Care and Direct?
A: Managed Care covers most residents in health plans; Direct serves those with complex needs.
Q6: Where do I apply?
A: Apply online through NC ePASS or at your local DSS office.
Conclusion
North Carolina Medicaid expansion has changed the landscape of healthcare in the state. Adults earning up to 138% FPL are now covered, while children and pregnant women benefit from even higher thresholds. Seniors and disabled individuals continue to qualify through long-standing pathways.
Applications are simple through NC ePASS, and for those who don’t qualify, options like NC Health Choice, marketplace subsidies, and community clinics ensure coverage remains within reach.
