New federal laws are changing who can qualify for NC Medicaid and how some eligibility, renewal and coverage rules work. Coverage changes for some noncitizens begin Oct. 1, 2026. Beginning Jan. 1, 2027, new rules will affect work and approved activities, how often some adults renew Medicaid and how far back Medicaid may cover eligible medical bills. Work and activity requirements will begin affecting renewals in March 2027.
This page explains what is changing, who may be affected and where to get help.
Your local Department of Social Services determines Medicaid eligibility. Read all mail from NC Medicaid and your local DSS. Respond by the deadline if a letter asks for information.
What’s Changing
Different Medicaid changes begin at different times and affect different groups. Review each topic below to learn what may apply to you.
Oct. 1, 2026
Non-Citizen Coverage
Federal law is changing which immigration statuses qualify for full Medicaid coverage. Some non-citizens may no longer qualify for full coverage.
Jan. 1, 2027
Work and Activities
Most adults ages 19 through 64 will need to meet new work and community engagement requirements to get or keep Medicaid.
Jan. 1, 2027
Renewal Every Six Months
Most adults ages 19 through 64 enrolled through Medicaid expansion will renew Medicaid every six months instead of once a year.
Jan. 1, 2027
Retroactive Coverage
When someone applies for Medicaid, fewer months of eligible medical bills from before the application date may be covered.
What You Should Do Now
Make sure your local DSS has your correct address and phone number. Important information will be sent by mail.
Open letters from NC Medicaid or your local DSS right away. Respond by the deadline if a letter asks for information.
You may need documents that show your income, activities or eligibility for an exception. Keep records such as:
- Pay stubs
- School records
- Job training records
- Internship records
- Volunteer or community service logs
- Documents that show a disability, medical need or other exception
Tell your local DSS if your address, phone number, household information or immigration status changes.
Your local DSS determines Medicaid eligibility and can explain what information or documents you need. Partners does not make Medicaid eligibility decisions.
Manage your Medicaid benefits with an enhanced ePASS account.
Apply for benefits
View case details
Renew Medicaid
Upload documents
Update your information
Use ePASS to apply for benefits, report changes and view case details online; visit ePASS.nc.gov for more information.
Coverage Changes for Some Non-Citizens
A new federal law is changing which immigration statuses can qualify for full Medicaid coverage. Some noncitizens will lose full Medicaid coverage beginning Oct. 1, 2026. This change does not affect U.S. citizens.
What You Should Do Now
- Make sure your local DSS has your correct address.
- Read all letters from NC Medicaid and DSS.
- Respond right away if DSS asks for information about your immigration status.
- Tell DSS if your immigration status changes.
- If you receive a green card, give the updated information to DSS as soon as possible.
Eligibility depends on a person’s exact immigration status and other Medicaid rules. Contact your local DSS for help understanding how the change may affect you.
View the Medicaid Expansion Rules Booklet
(English)
Work and Approved Activity Rules
Starting Jan. 1, 2027, some adults ages 19 through 64 will need to meet new work and community engagement requirements to get or keep Medicaid.
A person may meet the requirement by:
- Earning at least $580 in a month
- Completing 80 hours of approved activities in a month
Approved activities may include work, self-employment, job training, unpaid work, school, volunteering or community service. Activities may be combined. Exceptions and exclusions apply.
Some people may not have to meet the work and approved activity requirements. Your local DSS will determine whether an exception, exclusion or short-term hardship applies to you.
You may qualify if you:
- Receive Medicare
- Receive Supplemental Security Income or Social Security Disability Insurance
- Have been found disabled by Medicaid
- Have a disability or are considered medically frail
- Have a serious or complex medical condition
- Are pregnant or eligible for Medicaid coverage for 12 months after a pregnancy ends
- Participate in a drug or alcohol treatment and rehabilitation program
- Care for a child under age 14 or a person with a disability
- Are a veteran with a 100% disability rating
- Are currently in foster care or are a former foster care youth under age 26
- Already meet certain work requirements through SNAP or Work First
- Are American Indian, Alaska Native or otherwise eligible for Indian Health Services
- Are incarcerated or were incarcerated during the previous three months
This is not a complete list. DSS will review your situation and tell you what documents are required.
Medicaid Renewal Every Six Months
Starting Jan. 1, 2027, most adults ages 19 through 64 enrolled through Medicaid expansion will renew Medicaid every six months instead of once a year.
Unless an exception or exclusion applies, you must meet the work and approved activity requirement during three of the six months before your renewal.
The new work and activity requirements will begin affecting Medicaid renewals in March 2027.
Who Will Continue to Renew Once a Year?
American Indians, Alaska Natives and other members eligible for Indian Health Services will continue to renew Medicaid once a year.
Changes to Retroactive Coverage
Retroactive coverage may help pay eligible medical bills for care you received before you applied for Medicaid.
Beginning Jan. 1, 2027, Medicaid will cover fewer months before the application date:
- Most adults ages 19 through 64 without disabilities may receive coverage for one month before they apply.
- Children, adults age 65 or older and people with disabilities may receive coverage for two months before they apply.
What You Should Do
- Apply for Medicaid as soon as you have a medical need.
- Read your renewal notice carefully.
- Respond by the deadline if DSS asks for information or documents.
Waiting to apply could mean that fewer of your earlier medical bills are covered.
Need help understanding NC Medicaid changes?
Call us at 1-888-235-4673
(TTY: NC Relay 711; [English] 1-800-735-2962; [Spanish] 1-888-825-6570)
Frequently Asked Questions
Medicaid changes may affect people differently based on their age, eligibility category, health, household and immigration status. Open the sections below to find answers about the changes that may apply to you.
Why are Medicaid rules changing?
New federal laws are changing who can qualify for Medicaid and how some Medicaid eligibility, renewal and coverage rules work. Different changes begin Oct. 1, 2026, and Jan. 1, 2027.
Will everyone with Medicaid be affected?
No. The changes affect different groups in different ways. Some rules apply to certain adults ages 19 through 64. Other rules affect some non-citizens or people applying for Medicaid.
Who determines whether I qualify for Medicaid?
Your local Department of Social Services, also called DSS, determines Medicaid eligibility. Partners cannot approve, deny or change your eligibility.
DSS can also tell you which rules apply, whether an exception or exclusion applies and what documents you need.
How will I know whether a change applies to me?
Read all letters from NC Medicaid and your local DSS. Contact DSS if you do not understand a letter or are unsure whether a rule applies to you.
Make sure DSS has your correct address and phone number so you receive important notices.
Can I update my information online?
An enhanced ePASS account allows you to report changes, view case details, complete renewals and upload documents online. You may still need to contact DSS with questions about your eligibility or case.
Does the immigration-status change affect U.S. citizens?
No. The change beginning Oct. 1, 2026, affects certain people who are not U.S. citizens. It does not affect U.S. citizens.
Who may continue to qualify for Medicaid?
Beginning Oct. 1, 2026, the following groups may continue to qualify based on citizenship or immigration status:
- Lawful permanent residents, also called green card holders
- Cuban or Haitian entrants
- Compact of Free Association migrants
- Lawfully residing children up to age 19
- Lawfully residing people who are pregnant or within 12 months after a pregnancy ends
Income and other Medicaid eligibility rules still apply.
Who may lose full Medicaid coverage?
Some refugees, people granted asylum, trafficking survivors, humanitarian parolees and people with certain other humanitarian or lawfully residing immigration statuses will lose full Medicaid coverage beginning Oct. 1, 2026.
The state provides a complete list of affected immigration categories. Because these categories are complex, contact DSS for a review of your exact status.
I have a green card. Will I lose coverage?
Lawful permanent residents, also called green card holders, remain among the immigration statuses that may qualify for Medicaid.
Other rules, including income requirements and a possible five-year waiting period, may still apply. Make sure DSS has your current immigration documents.
What happens if my full Medicaid coverage ends?
Coverage for services such as doctor visits, prescriptions, mental health care and dental care will end.
You may still qualify for Emergency Medicaid or receive care through another health coverage program or a safety-net clinic.
What is Emergency Medicaid?
Emergency Medicaid may help pay for care received in a hospital emergency department for a severe, sudden medical emergency.
It does not cover routine care, preventive care or urgent care. You must also meet Medicaid income and other eligibility requirements.
What should I do if my immigration status changes?
Tell your local DSS immediately and provide any documents it requests.
If you receive a green card or your status changes in another way, make sure DSS has the updated information so it can review your eligibility.
Who must meet the work and activity requirements?
The requirements may apply if all of the following are true:
- You are ages 19 through 64
- You do not have a disability
- You are not pregnant or eligible for postpartum coverage
- You are not caring for a child under age 14 or a person with a disability
- You do not qualify for another exception or exclusion
Your local DSS will determine whether the requirements apply to you.
How can I meet the requirement?
You only need to meet one of these options during a month:
- You or your household earn at least $580
- You complete at least 80 hours of approved activities
Approved activities may be combined.
What income may count toward the $580 requirement?
Income from your job or self-employment may count. NC Medicaid may also count income from another person in your household, such as your spouse, and some income that is not from a job, such as unemployment benefits.
Seasonal workers may meet the requirement when their income during the previous six months averages at least $580 a month. Ask DSS what income can be counted in your situation.
What activities may count toward the 80-hour requirement?
Approved activities may include:
- Working for an employer
- Being self-employed
- Participating in job training
- Completing unpaid work, such as an internship
- Attending school at least half-time
- Volunteering
- Completing community service
Certain supervised job-search activities, in-kind work and trial work periods may also count. Ask DSS whether a specific activity qualifies.
Can I combine different activities?
Yes. For example, you may combine hours from work, school, job training and volunteering to reach 80 hours in a month.
What if I already have Medicaid?
The requirement will be checked when you renew Medicaid every six months. You must meet the requirement during three of the six months before your renewal unless an exception or exclusion applies.
Work and activity requirements will begin affecting renewals in March 2027.
What if I am applying for Medicaid?
You must generally meet the requirement for three consecutive months before applying unless an exception or exclusion applies.
For example, if you apply April 1, you may need to show that you met the requirement in January, February and March. If you do not qualify when you first apply, you may apply again later.
What records should I keep?
Keep documents that show your income or approved activities, such as:
- Pay stubs or employer records
- School or job-training records
- Internship or job-search records
- Volunteer or community-service logs
- Records of unpaid or in-kind work
Your DSS caseworker will tell you what proof is required.
Who may not have to meet the requirement?
Exceptions and exclusions may apply to people who:
- Qualify for Medicare
- Receive SSI or SSDI
- Have a disability or serious medical condition
- Are pregnant or eligible for postpartum coverage
- Care for a child under age 14 or a person with a disability
- Participate in a drug or alcohol treatment program
- Are veterans with a 100% disability rating
- Are currently in foster care or are former foster care youth under age 26
- Meet applicable SNAP or Work First requirements
- Are American Indian, Alaska Native or eligible for Indian Health Services
- Are incarcerated or were recently released from incarceration
This is not a complete list. DSS will determine whether an exception or exclusion applies.
What does “medically frail” mean?
A person may be considered medically frail if they have a serious or complex health condition that affects their ability to meet the requirements.
This may include someone who:
- Is blind and has a disability
- Has a substance use disorder
- Has a disabling mental health condition
- Has a physical, intellectual or developmental disability that affects an activity of daily living
- Has another serious or complex medical condition
Tell DSS if you believe your health condition may qualify.
Do caregivers have to meet the requirement?
A parent, guardian, caretaker relative or family caregiver may qualify for an exclusion when they regularly provide direct care for a child under age 14 or a person with a disability.
Whether the exclusion applies may depend on the caregiver’s relationship to the person, whether they live together and how much direct care is provided. DSS will review your circumstances.
What is a short-term hardship exception?
A short-term hardship may apply when someone:
- Received certain inpatient hospital or facility care
- Had to travel outside the community for an extended period to receive medical care for themselves or someone they care for
- Lives in an area affected by a qualifying presidential emergency or disaster declaration
- Lives in a county with a qualifying high unemployment rate
Contact DSS to ask whether a hardship applies and what information is required.
What documents should I keep?
Keep any records that may show you qualify for an exception, exclusion or hardship. These may include medical, disability, pregnancy, treatment-program, caregiving, foster care, military or other supporting documents.
Your DSS caseworker will tell you which documents are needed.
Who will renew Medicaid every six months?
Starting Jan. 1, 2027, some adults ages 19 through 64 enrolled through Medicaid expansion will renew Medicaid every six months instead of once a year.
NC Medicaid or DSS will send a renewal notice in the mail. Read the notice carefully and respond by the deadline.
How are the work requirements connected to my renewal?
When your Medicaid is renewed, NC Medicaid will check whether you met the income or activity requirement during three of the previous six months.
If you do not meet the requirement and do not qualify for an exception or exclusion, you may lose Medicaid coverage.
Who will continue to renew once a year?
American Indians, Alaska Natives and other members eligible for Indian Health Services will continue to renew Medicaid once a year.
People who receive services through the Indian Health Service, a Tribal health program or an Urban Indian Organization can contact EBCI Tribal Option Member Services at 1-800-260-9992 for guidance.
What is retroactive coverage?
Retroactive coverage may help pay eligible medical bills for care received before the date someone applied for Medicaid.
The amount of time Medicaid can cover before the application date is becoming shorter.
How is retroactive coverage changing?
For applications submitted on or after Jan. 1, 2027:
- Most adults ages 19 through 64 may receive coverage for one month before they apply.
- Children, adults age 65 or older and people with disabilities may receive coverage for two months before they apply.
Before this change, eligible bills could be covered for up to three months before the application date.
Should I wait until I have all my documents before applying?
Do not wait longer than necessary. Apply as soon as you have a medical need so more of your eligible bills may be covered.
You can begin an application even if you do not have every document. DSS may contact you for additional information.
