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North Carolina Medicaid and the new work rules
NC Medicaid is run by NC Department of Health and Human Services, Division of Health Benefits. North Carolina expanded Medicaid on December 1, 2023, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.
From January 1, 2027, most adults have to show 80 hours a month
The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 685,000 people in North Carolina. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.
If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.
That is the state's own estimate of how many will lose coverage.
The state's own estimate of how many North Carolinians will lose coverage — many for administrative reasons rather than actual ineligibility.
Most of that is expected to be paperwork rather than people becoming ineligible. Which is the whole reason to sort out your address and your proof now rather than at the last minute.
You do not have to prove anything if any of these describe you
Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.
What you can earn and still qualify
Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.
Adults 19 to 64133% of the poverty line
- 1 person
- $1,769
- 2 people
- $2,399
- 3 people
- $3,028
Parents and caretakers195% of the poverty line
- 1 person
- $2,594
- 2 people
- $3,517
Pregnant196% of the poverty line
- 1 person
- $2,607
- 2 people
- $3,535
Source: NC DHHS policy MA-3321 MAGI income limits, effective April 1, 2026.
Two other changes land on the same day
Renewals get more frequent, and back-dated coverage gets shorter.
P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.
North Carolina has a law that would end expansion automatically
Coverage here is tied by statute to how much the federal government pays.
G.S. 108A-54.3C. If the federal medical assistance percentage for the expansion population falls below 90%, Medicaid coverage for the expansion population shall be discontinued as expeditiously as possible.
This puts coverage for 685,000+ people on a statutory hair-trigger tied to a federal funding percentage. H.R. 1 is projected to cut roughly $50bn from NC Medicaid over ten years and contains FMAP penalty provisions.
Trigger remains on the books unfixed. NC also faces a $319m Medicaid shortfall in SFY2026.
This is not a reason to delay applying. It is a reason to keep your contact details current, open everything the state sends, and not assume coverage renews itself.
Do this now
Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.
Deaf, hard of hearing or speech-impaired: 711 (RelayNC).
Free interpreter line: 1-866-719-0141.
ePASS offers printable applications in 15 languages beyond English. Free interpreter line 1-866-719-0141. Hmong, Khmer and Lao reflect specific NC communities.
Most people who lose coverage lose it over paperwork, not eligibility
85.1% of the coverage losses recorded in North Carolina were procedural — a form, a deadline, or an address, rather than a real change in whether someone qualified. From January 1, 2027 that matters more, not less.
NOTICE OF ELIGIBILITY DETERMINATION
Case number: ███████
Date of this notice: 1January 12, 2027
Our records do not show that you met the community engagement requirement for the reporting period.
2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.
3Coverage for other members of your household is not affected by this notice.
What the federal data says about coverage here
Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.
Of people who lost coverage here, this share lost it over paperwork rather than eligibility. That is among the highest rates in the country.
Open every letter. Keep your address current with the agency.
Records here are relatively accurate, so treat a notice as real rather than assuming a mistake.
Quintile 3 of 5.
Provider supply here is around the national middle. Nurse practitioners also need physician supervision in this state, which narrows your options further.
Book an appointment before you need one, not when you do.
Questions people ask about this
Do the new Medicaid work rules apply to me in North Carolina?
How many hours a month do I have to work?
Who is exempt from the work requirement in North Carolina?
When do the North Carolina work rules start?
What is the income limit for North Carolina Medicaid?
How do I apply for NC Medicaid?
How often do I have to renew North Carolina Medicaid?
Guides for neighboring states
The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.
Expansion only arrived in December 2023, so many of the 685,000 people who joined through it have never done a renewal — and from January they'll renew every six months instead of once a year.
The state expects 255,000 people to lose coverage, mostly to paperwork.
Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.
Go to ePASS (epass.nc.gov) →