NC Health Choice (North Carolina CHIP) Eligibility 2026: Income Limits and How to Apply

Direct Answer: Who Qualifies for NC Health Choice in 2026

Yes. NC Health Choice covers uninsured children in North Carolina from birth through age 18 when family income is at or below 216% of the federal poverty level. For a family of four in 2026, 216% FPL equals $71,280 per year. Children who meet the income and residency tests are enrolled in NC Medicaid (which administers NC Health Choice since April 2023). No premiums, no copays, and no open enrollment window apply.

• Child must be under age 19 (coverage ends at 19th birthday)
• Family income at or below 216% FPL ($71,280/yr for a family of four in 2026)
• Child must be a North Carolina resident
• Child must be a U.S. citizen or qualifying immigration status (some undocumented children may qualify for emergency Medicaid only)
• No asset test applies for children's coverage in North Carolina
• Child must be uninsured or not have access to cost-effective employer-sponsored coverage

NC Health Choice Income Limits by Household Size (2026)

North Carolina uses Modified Adjusted Gross Income (MAGI) to determine eligibility for NC Health Choice. MAGI is the adjusted gross income from your federal tax return plus certain non-taxable income such as Social Security benefits and untaxed foreign income. A mandatory 5% MAGI income disregard is applied before comparing your income to the threshold; this effectively raises the practical limit by roughly 5 percentage points above the stated 216% FPL. For example, a family of four earning $72,930 per year (221% FPL) still qualifies after the disregard is applied.

North Carolina does not count certain income sources when calculating MAGI for CHIP. Child support received, Supplemental Security Income (SSI), veterans' benefits, and SNAP or other public benefit payments are not counted as income. Self-employment income and rental income are counted. The household size includes everyone in the family's tax household, including children and any dependents who are claimed even if they have separate income.

Is North Carolina a Medicaid Expansion State?

Yes. North Carolina expanded Medicaid under the Affordable Care Act (ACA) effective December 1, 2023, making it the 40th state to expand. Adults ages 19-64 with income up to 138% FPL now qualify for full Medicaid benefits. Before that expansion, adults in the coverage gap (earning 100% to 138% FPL) were not eligible for Medicaid and received only modest ACA marketplace subsidies. The adult expansion does not directly change NC Health Choice income limits for children, which have been at 216% FPL for years.

Because North Carolina is now an expansion state, there is no coverage gap for adults. Adults who earn between 100% and 138% FPL now have Medicaid, not just ACA marketplace plans. For children, the 216% FPL threshold has always been well above both the pre-expansion adult limit and the 138% FPL expansion level, so children's CHIP coverage in North Carolina is generous relative to most states. CHIP eligibility for children is entirely separate from the adult expansion rules.

How to Apply for NC Health Choice in North Carolina (2026)

North Carolina has no open enrollment period for NC Health Choice or Medicaid. Families may apply at any time of year. The fastest application method is online through the NC ePASS portal at epass.nc.gov. ePASS screens for Medicaid, NC Health Choice (CHIP), SNAP, and other benefit programs in a single application session. Applications can also be submitted through HealthCare.gov, in person at any county Department of Social Services (DSS) office, or by phone through the NC Medicaid Contact Center at 1-888-245-0179.

North Carolina processes most CHIP and Medicaid applications for children within 45 days. If the child's situation is urgent (due to a pending medical procedure or emergency), contact the county DSS office directly and request expedited processing. Once approved, North Carolina enrolls children in a Medicaid managed care plan through NC Medicaid Direct or through a managed care organization (MCO). Coverage typically begins on the first day of the month following approval.

Documents Needed to Apply for NC Health Choice

North Carolina requires applicants to verify identity, income, residency, and the child's age. Gathering these documents before starting the ePASS application saves significant time. A single application covers all children in the household simultaneously, and families do not need to apply separately for each child.

• Child's birth certificate or hospital birth record (proves age and citizenship)
• Social Security numbers for the child and each household member (required; exceptions exist for some immigrants)
• Proof of North Carolina residency (utility bill, lease, mortgage statement, or government mail with current address)
• Proof of income for all household earners: pay stubs for the last 30 days, most recent federal tax return, or employer letter showing wages
• Self-employment income documentation: most recent Schedule C (Form 1040), profit and loss statement, or business bank statements
• Immigration documents if applicable (green card, visa, I-94, or Employment Authorization Document)
• Current health insurance information if child has any coverage (to confirm uninsured or underinsured status)

Common Reasons NC Health Choice Applications Are Denied in North Carolina

Most NC Health Choice denials fall into five categories. Understanding these before applying reduces the risk of a preventable denial. When a denial is issued, North Carolina provides a written notice explaining the specific reason and the child's appeal rights. Families have 90 days from the date of the denial notice to request a state fair hearing.

• Income above 216% FPL: the most common reason. If family gross income exceeds $71,280 per year for a household of four in 2026 after the 5% MAGI disregard, the child does not qualify for CHIP. A child who earns their own income (e.g., from a part-time job) may have that income counted depending on household filing status.
• Child already has employer-sponsored coverage: if a parent's employer offers family health coverage at a cost considered affordable under federal rules, North Carolina may deny the CHIP application on cost-effectiveness grounds.
• Missing or incomplete documentation: failure to submit required income, residency, or identity documents within the state-specified deadline is the most common administrative denial.
• Child is 19 or older: NC Health Choice only covers children up to (but not including) age 19. Young adults ages 19-20 may qualify for NC Medicaid under the adult expansion if income is at or below 138% FPL.
• Residency not verified: the child must live in North Carolina. If proof of NC residency cannot be provided, the application will be denied. Homeless children may use a county DSS office address as a mailing address.

How to Appeal a Denial of NC Health Choice Coverage

North Carolina gives families 90 days from the date of the denial notice to appeal. The appeal process begins with an internal review by NCDHHS Division of Health Benefits. If the internal review upholds the denial, the family may request a state fair hearing before an administrative law judge. To appeal, submit a written request to the county DSS office or contact the NC Medicaid Contact Center at 1-888-245-0179. Families may also contact a Navigators or Certified Application Counselors (CACs) for free help with the appeal.

During the appeal, North Carolina may continue coverage for a child who was already enrolled if the family requests continuation of benefits at the time of appeal. For a child who applied and was denied (never enrolled), continuation of benefits does not apply. New eligibility evidence, such as corrected income documentation, can be submitted at any stage of the appeal process and often resolves the denial without a formal hearing.

What NC Health Choice Covers in 2026

NC Health Choice beneficiaries are now enrolled in full NC Medicaid, which provides one of the more comprehensive children's benefit packages in the Southeast. Federal law requires CHIP programs to cover the following services, and North Carolina meets or exceeds those minimums. Since the April 2023 merger, children receive the same benefit package as all other Medicaid enrollees, with no enrollment fees and no copays for most services.

• Well-child visits and immunizations (including all ACIP-recommended vaccines at no cost)
• Primary care, specialist, and urgent care visits
• Inpatient and outpatient hospital services
• Dental care including preventive cleanings, X-rays, fillings, and orthodontia for medically necessary cases
• Vision care including annual eye exams and eyeglasses
• Mental health and substance use disorder services under the federal mental health parity law
• Prescription drugs on the NC Medicaid formulary
• Non-Emergency Medical Transportation (NEMT) to covered medical appointments (added when NC Health Choice merged into Medicaid in April 2023)
• Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for enrollees under 21

What is the income limit for NC Health Choice for a family of 4 in 2026?

For a family of four in North Carolina, the 2026 NC Health Choice income limit is $71,280 per year (216% of the federal poverty level). Monthly that equals $5,940. Before comparing your income to this threshold, North Carolina applies a mandatory 5% MAGI income disregard, which raises the practical ceiling slightly. Income is calculated using Modified Adjusted Gross Income (MAGI), which includes wages, salaries, self-employment income, and taxable Social Security benefits, but excludes SSI, child support received, and most public benefits.

What documents do I need to apply for NC Health Choice in North Carolina?

To apply for NC Health Choice in North Carolina, gather: the child's birth certificate or proof of age, Social Security numbers for household members, proof of North Carolina residency (utility bill, lease, or government mail), and proof of income for all earners (pay stubs for the last 30 days or most recent federal tax return). Self-employed applicants also need a Schedule C or profit-and-loss statement. Immigration documents are needed for non-citizen applicants. Apply online at epass.nc.gov or call 1-888-245-0179.

What counts as income for NC Health Choice (MAGI definition)?

NC Health Choice uses Modified Adjusted Gross Income (MAGI). Income that counts: wages, salaries, tips, self-employment net income, rental income, alimony received (for divorces finalized before Jan 1, 2019), taxable Social Security benefits, and most investment income. Income that does not count: SSI payments, child support received, veterans' benefits, workers' compensation, SNAP or other public benefit payments, and non-taxable Social Security benefits. The household size includes all tax dependents even if they have separate income sources.

What happens if my child's NC Health Choice application is denied?

If North Carolina denies your NC Health Choice application, you have 90 days from the date on the denial notice to appeal. Submit a written appeal to your county Department of Social Services (DSS) office or call the NC Medicaid Contact Center at 1-888-245-0179. If the internal review upholds the denial, you may request a state fair hearing. Free help with appeals is available from Navigators and Certified Application Counselors. New income documentation or corrected information can be submitted at any point and often resolves the denial without a formal hearing.

Can my child get NC Health Choice if I have a job?

Yes. NC Health Choice is specifically designed for working families. Having a job does not disqualify your child, only your family's income level matters. The income limit is 216% FPL, which equals $71,280 per year for a family of four in 2026. Many NC Health Choice families have two working parents. However, if your employer offers affordable family health coverage (as defined by federal rules), your child may be ineligible. Affordable is defined as coverage that costs no more than a set percentage of your household income.

Is North Carolina a Medicaid expansion state for CHIP?

Yes, and North Carolina expanded adult Medicaid in December 2023. For children, North Carolina has operated at 216% FPL eligibility for CHIP for many years. The state uses an M-CHIP structure, meaning CHIP-funded coverage for children is delivered through Medicaid expansion rather than a standalone CHIP program. Effective April 1, 2023, NC Health Choice beneficiaries were moved into full NC Medicaid, giving them access to a broader benefit package with no premiums or copays.

How long does the NC Health Choice application take?

North Carolina processes most NC Health Choice and children's Medicaid applications within 45 days. In urgent medical situations, contact your county DSS office to request expedited processing, which can reduce the timeline significantly. Most families receive a decision within 30 days for standard applications. Once approved, coverage typically begins on the first day of the month following approval, and the child receives a Medicaid ID card in the mail.

Can my child lose NC Health Choice coverage mid-year if our income goes up?

No, not since January 1, 2024. Federal law requires all states, including North Carolina, to provide 12 months of continuous eligibility for children enrolled in Medicaid and CHIP. Once your child is enrolled in NC Health Choice, coverage cannot be terminated mid-year due to an income increase. Coverage continues through the 12-month benefit period. At renewal, North Carolina will re-check eligibility. If income still qualifies at renewal, coverage continues for another 12 months.