North Carolina Medicaid Income Limits (2026)

North Carolina Medicaid is administered by the NC Division of Medical Assistance (NC DMA), a division of NCDHHS, and covers approximately 2.9 million state residents as of 2026. North Carolina's December 1, 2023 Medicaid expansion was the culmination of years of legislative debate; the state legislature passed Senate Bill 420 in March 2023, and enrollment began immediately on the expansion effective date. More than 600,000 previously uninsured adults ages 19 to 64 gained coverage in the first two years. The 2026 Federal Poverty Level, $15,960 for a single person and $33,000 for a family of four in the 48 contiguous states, is the anchor for every income threshold on this page. North Carolina updates its Medicaid income limits each April 1 when new federal poverty guidelines take effect, so the 2026 figures on this page reflect the April 1, 2026 update.

North Carolina Medicaid eligibility splits across five main population groups. Expansion adults ages 19 to 64 qualify at 138% FPL with no asset test, whether or not they have dependent children. Pregnant women qualify at 201% FPL, with full Medicaid benefits through the end of the month 60 days after delivery (12-month postpartum coverage as of April 2022). Children ages 0 to 5 qualify at 216% FPL, and children ages 6 to 18 qualify at 138% FPL for full Medicaid; children in households above those thresholds may access NC Health Choice (North Carolina's CHIP program) up to approximately 211% FPL for children 6 to 18. Aged, blind, and disabled adults qualify under SSI-linked rules with a separate asset test of $2,000 for an individual. Adults who qualify for both North Carolina Medicaid and Medicare are considered dual-eligible and can access D-SNP plans that coordinate both programs.

The household-size table below shows the 2026 North Carolina Medicaid income limits across all three covered MAGI populations. Adults earning above the 138% FPL expansion threshold but below 400% FPL almost certainly qualify for ACA marketplace subsidies at healthcare.gov. Note that the ACA subsidy cliff returned in 2026 because the enhanced premium tax credits from the American Rescue Plan Act and Inflation Reduction Act expired on January 1, 2026, so adults just above Medicaid income limits may face higher marketplace costs in 2026 than in recent prior years. If your child's household income is above the children's Medicaid threshold, see the NC Health Choice callout below. If you are 65 or older with limited income, see the Medicare Savings Programs section.

North Carolina Medicaid (NC Medicaid) income limits by household size (2026)

The 2026 North Carolina Medicaid income guidelines below are based on the 2026 Federal Poverty Level for the 48 contiguous states, updated April 1, 2026. Adult column = expansion-group NC Medicaid (138% FPL, covers adults ages 19 to 64 with or without dependent children). Children column = highest children's Medicaid threshold in North Carolina (216% FPL, applies to children ages 0 to 5; children ages 6 to 18 qualify at 138% FPL Medicaid or up to approximately 211% FPL via NC Health Choice CHIP). Pregnancy column = NC Medicaid for Pregnant Women at 201% FPL. Add roughly $5,680 of annual income per additional household member.

North Carolina Medicaid (NC Medicaid) eligibility requirements (non-income)

North Carolina Medicaid eligibility rests on six core criteria beyond income. Applicants must meet all applicable requirements, though the specific rules vary by eligibility group. MAGI-based categories (expansion adults, pregnant women, children, parents) use a streamlined set of rules with no asset test. SSI-related categories (aged 65+, blind, disabled) carry additional asset and income rules.

• North Carolina residency: Applicants must live in North Carolina and intend to remain. A physical address is required (post office boxes are not sufficient on their own). Homeless individuals may use a shelter address or a statement of homelessness.
• U.S. citizenship or qualifying immigration status: Most Medicaid categories require U.S. citizenship, lawful permanent residency, or another qualifying non-citizen status. Lawful permanent residents who arrived after August 22, 1996 must generally wait five years before qualifying for most Medicaid categories (the federal 5-year bar). Emergency Medicaid is available to non-citizens in immediate medical need regardless of immigration status.
• Social Security Number: All applicants for Medicaid must provide or apply for a Social Security Number. The requirement can be waived for individuals who object for established religious reasons, and for undocumented individuals applying only for Emergency Medicaid.
• Age and category membership: Expansion adults must be ages 19 to 64. Children must be under age 19. Pregnant women qualify at any age with a confirmed pregnancy. Aged, blind, or disabled adults (ABD) must meet SSI-linked disability or age criteria. Some family planning-only Medicaid coverage extends to individuals who do not meet other category criteria.
• Asset test (SSI-related categories only): MAGI-based North Carolina Medicaid categories (expansion adults, children, pregnant women) have NO asset test. For aged, blind, and disabled adults in SSI-related categories, an asset limit of $2,000 for an individual ($3,000 for a couple) applies. Exempt assets include the applicant's primary home, one vehicle, household goods, and burial funds up to $1,500.
• Other health coverage: Having other health insurance does not automatically disqualify an applicant from North Carolina Medicaid. Medicaid typically becomes the payer of last resort when other coverage exists, meaning other insurance pays first. Applicants must disclose other coverage but are not required to drop it.

What income counts for North Carolina Medicaid (NC Medicaid)

North Carolina Medicaid uses the federal Modified Adjusted Gross Income (MAGI) definition for all MAGI-based eligibility categories, including expansion adults, pregnant women, children, and parents. MAGI closely tracks federal taxable income but with several key additions and exclusions. The 2026 North Carolina income limits reflect gross MAGI income before the federal 5% disregard that is applied at the end of the eligibility calculation. North Carolina does not apply additional state-specific income disregards for MAGI categories beyond the standard federal 5% disregard.

Income sources included

• Wages, salaries, and tips (W-2 income): All gross earned income from employment is counted, including overtime, bonuses, and commissions.
• Self-employment net earnings (1099 income): Net profit from self-employment (gross receipts minus ordinary business expenses) is counted as MAGI income. Gig economy income, freelance income, and farm income all count.
• Social Security benefits (SSDI and retirement): Social Security Disability Insurance (SSDI) and Social Security retirement benefits are counted in MAGI. The taxable portion of Social Security is included even if not fully taxed at the federal level. Note: SSI (Supplemental Security Income) is NOT counted.
• Interest, dividends, and capital gains: All investment income including taxable interest, qualified and ordinary dividends, and net capital gain distributions from brokerage accounts, savings accounts, and retirement account withdrawals is counted.
• Unemployment compensation: State unemployment insurance benefits from North Carolina's Division of Employment Security are fully counted as MAGI income in the year received.
• Pensions and retirement distributions: Traditional IRA and 401(k) distributions, annuity payments, and pension income from prior employment are counted as MAGI income when received.
• Rental income and royalties: Net rental income (rent received minus mortgage interest, depreciation, repairs, and other allowable expenses) and royalty income are counted. If rental expenses exceed rental income, the net loss is generally not deductible against other MAGI income.
• Alimony from pre-2019 divorce decrees: Alimony payments received under divorce or separation agreements finalized before January 1, 2019 are counted as MAGI income. Alimony from agreements finalized on or after January 1, 2019 is NOT counted (per the Tax Cuts and Jobs Act).

Income sources excluded

• Supplemental Security Income (SSI): SSI is not counted as MAGI income. SSI recipients may qualify for North Carolina Medicaid automatically through the SSI pathway with no separate income calculation required.
• Child support received: Child support payments received for a child in the household are excluded from MAGI income entirely. Child support paid to someone outside the household may be deductible under certain circumstances.
• Veterans' benefits: VA disability compensation, VA pension, and educational benefits (GI Bill housing and tuition allowances) are excluded from MAGI income. Veterans' benefits are generally non-taxable and do not count.
• Workers' compensation: Payments received under a workers' compensation claim (wage replacement or lump sum) are not counted as MAGI income.
• TANF and most cash assistance: Temporary Assistance for Needy Families (TANF) payments, general assistance, and most other means-tested cash assistance programs are excluded from MAGI income.
• Gifts, inheritances, and loan proceeds: Lump-sum gifts, inherited money or property, and proceeds from personal or business loans are not MAGI income and are not counted in the monthly income calculation.

How to apply for North Carolina Medicaid (NC Medicaid) in North Carolina

North Carolina Medicaid applications are accepted year-round with no enrollment window. The Division of Medical Assistance processes most applications within 45 days, or within 15 days for pregnant women under federal expedited-processing rules. The primary online portal is ePASS at epass.nc.gov, the statewide self-service portal that accepts applications for Medicaid, NC Health Choice (CHIP), Food and Nutrition Services (FNS/SNAP), Work First, Energy Assistance, and other state benefits on a single combined application. Applicants may also apply in person at their county Department of Social Services, by calling the NC Medicaid Contact Center at 1-888-245-0179, or by submitting a paper application mailed to their county DSS.

1. 1. Gather your documents: photo ID for each adult applicant, Social Security Numbers for everyone applying for coverage, proof of North Carolina residency (utility bill, lease, mortgage statement, or government letter dated within the last 60 days), and the last 30 days of income documentation (pay stubs, employer letter, or self-employment records).
2. 2. Create an account at epass.nc.gov (or call 1-888-245-0179 if you prefer a phone application). ePASS lets you apply for multiple programs at once, check your application status, upload documents, renew coverage, and update contact information after approval.
3. 3. Complete the application by listing every household member, reporting all income sources for the past 30 days, and disclosing any other health insurance. For pregnant women, include the expected due date; the unborn child is counted as a household member for income-limit purposes.
4. 4. Upload or submit supporting documents through ePASS. You can scan or photograph documents with your smartphone. Missing documents are the most common reason for processing delays; submitting all required documents with your application significantly speeds up the decision.
5. 5. Respond promptly to any additional information requests from the county DSS. North Carolina requires applicants to respond to requests for verification within 10 days. Failure to respond within the deadline is a leading cause of application denial.
6. 6. Await the eligibility determination notice. Standard applications are decided within 45 days. Pregnancy applications are decided within 15 days under federal rules. Disability-based applications can take 60 to 90 days because they require a medical disability determination. Check status anytime at epass.nc.gov.

Official portal: epass.nc.gov

Documents needed

• Photo ID for each adult applicant: North Carolina driver's license, NC state ID card, U.S. passport, or military identification card.
• Social Security Numbers for all household members applying for Medicaid or NC Health Choice (children's coverage). Individuals without SSNs may apply but must explain the reason.
• Proof of North Carolina residency: utility bill, rental or lease agreement, mortgage statement, or government mail addressed to you at your NC address dated within the last 60 days.
• Proof of U.S. citizenship or qualifying immigration status: U.S. birth certificate, U.S. passport, Naturalization Certificate, Permanent Resident Card (Green Card), or other qualifying immigration documentation.
• Last 30 days of income documentation: recent pay stubs (for employees), profit and loss statement or last year's tax return (for self-employed individuals), Social Security or SSDI award letter, pension statements, unemployment determination letter, child support order or award documentation.
• For pregnant women: documentation of pregnancy from a healthcare provider (prenatal visit record, letter from OB-GYN, or hospital confirmation), and the expected due date. The county DSS can sometimes verify pregnancy directly.

Processing timeline: Standard North Carolina Medicaid applications are decided within 45 days of a complete application. Applications for pregnant women are decided within 15 days under federal expedited-processing rules. Applications for aged, blind, or disabled adults may take 60 to 90 days because they require a medical disability determination by the NC Division of Medical Assistance. If you are not notified within 45 days (or 15 days for pregnancy), contact your county DSS or call 1-888-245-0179. If approved, coverage may be backdated to the first day of the month your application was received.

Common reasons applications get denied

• Income above the eligibility threshold: household income exceeding the limit for the applicant's population group (most commonly 138% FPL for expansion adults or 201% FPL for pregnant women). Verify your household income calculation carefully, including all required inclusions and exclusions.
• Failure to respond to a 10-day verification request: county DSS may request additional documents or information. Not responding within the 10-day window results in denial. If you miss the deadline, reapply promptly; prior application information may still be used.
• Residency issues: inability to document North Carolina residency with an address-verified utility bill, lease, or government correspondence. Individuals staying with friends or family should ask for a letter from the householder confirming residency.
• Immigration status ineligibility: applicants who arrived in the United States after August 22, 1996 as lawful permanent residents and have not yet met the 5-year bar, or who hold non-qualifying visa categories, may be denied non-emergency Medicaid coverage.
• Age or category mismatch: applying under the expansion-adult category as someone over age 64 (who should apply under the aged/blind/disabled category), or a child applying as an adult. Review eligibility categories carefully before submitting to match the right program.

If your child's family income is above the North Carolina Medicaid limit for children

NC Health Choice is North Carolina's Children's Health Insurance Program (CHIP), covering children under age 19 in households with income too high for children's Medicaid but at or below approximately 211% FPL (about $46,742 per year for a family of two or $71,280 for a family of four in 2026). NC Health Choice covers the same comprehensive benefits as NC Medicaid, including doctor visits, dental, vision, prescriptions, mental health care, and hospital care, with small copayments (no more than $5 per service for most children). Children ages 0 to 5 qualify for full Medicaid at up to 216% FPL, so most young children are covered under Medicaid before reaching NC Health Choice eligibility. For children ages 6 to 18, Medicaid covers up to 138% FPL and NC Health Choice bridges from 139% to approximately 211% FPL. Applications for NC Health Choice go through the same ePASS portal at epass.nc.gov.

Compare Medicaid and CHIP income limits across all 50 states

If you are 65 or older with limited income: North Carolina Medicare Savings Programs

North Carolina operates three Medicare Savings Programs (MSPs) for low-income Medicare beneficiaries, administered through the NC Division of Medical Assistance and applied for via epass.nc.gov or a county DSS office. The Qualified Medicare Beneficiary (QMB) program covers Medicare Part A and Part B premiums, deductibles, copays, and coinsurance for individuals with income at or below 100% FPL (approximately $1,330 per month for a single person in 2026 after a $20 monthly income disregard). The Specified Low-Income Medicare Beneficiary (SLMB) program covers the Part B premium ($185.00 per month in 2026) for individuals with income between 100% and 120% FPL. The Qualifying Individual (QI) program covers the Part B premium for individuals with income between 120% and 135% FPL, available on a first-come, first-served basis. All three programs automatically qualify enrollees for full Extra Help with Medicare Part D drug costs, saving hundreds of dollars per year in prescription expenses. QMB, SLMB, and QI all have a separate asset test of $9,660 for an individual or $14,470 for a couple in 2026. If you are dually eligible for Medicare and Medicaid, you may qualify for a Dual-Eligible Special Needs Plan (D-SNP) that coordinates both programs. North Carolina has approximately 200,000 dual-eligible enrollees.

Read the Medicare eligibility guide

Frequently Asked Questions