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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 between now and January matters.
From January, 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.
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 rests on a federal funding rate that state law treats as a switch.
Under G.S. 108A-54.3C, if the federal government reduces how much it pays toward the expansion group, North Carolina's expansion ends — without a new vote.
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.
HB 653 (2025-26) would have softened the trigger to a comparative standard. Filed April 1, 2025, referred to House Rules April 2, never advanced. A similar Senate amendment to S257 was tabled. Trigger remains on the books unfixed. NC also faces a $319m Medicaid shortfall in SFY2026.
Nothing has changed yet, and 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 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 three of 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 middling. 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?
Guides for nearby 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.
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) →