NC Medicaid Work and Community Engagement Requirements

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Starts January 1, 2027

New federal laws are changing the rules for NC Medicaid. Some adults will need to work, volunteer or go to school to keep their Medicaid. These are called work and community engagement requirements. This page tells you what is changing and what you should do.

Who this affects

This probably affects you if all of these are true:

  • you are age 19 through 64, and
  • you do not have a disability, and
  • you are not the parent or caregiver of a child under age 14 and
  • you are not pregnant

However, not everyone in this group is affected. Some exceptions apply, and they are listed later in this page.

How to meet the requirement

There are two ways to meet the new requirement. You or your household can earn at least $580 a month, or you can do 80 hours of approved activities a month. You only need to do one.

  1. You or your household earn at least $580 a month.

    If you earn at least $580 in a month, you meet the rule. NC Medicaid may also include income from people in your household, like your spouse. It may also include some income that is not from a job, like unemployment benefits.

    If you are a seasonal worker, meaning your job is only available during certain months of the year, you can meet the rule if your income during the last six months is an average of $580 a month or more.
     
  2. Or, you do 80 hours of activities a month. Activities can be a combination of:
     
    • Work at a job or for yourself
    • Be in a work training program
    • Do unpaid work, like an internship
    • Go to school at least half-time (this is usually six credit hours)
    • Volunteer or perform community service

You can mix these activities. You must keep proof that you have done them.

When this requirement is checked

NC Medicaid will check every 6 months. You must meet the requirement for 3 out of 6 months leading up to each check. If you do not, you will lose your Medicaid coverage.

If you do not have Medicaid and are applying for it, you must meet this rule for 3 months in a row before you apply. If you do not, you may not be able to get Medicaid. But you can apply again at any time.

Who does not have to meet this requirement

You do not have to do these activities or earn a minimum amount if you are "exempt." You may be exempt if you are any of these:

  • a child up to age 19
  • an adult age 65 or older
  • pregnant, or within 12 months postpartum (after birth)
  • a parent or caregiver of a child under age 14
  • a parent or caregiver of a person with a disability
  • you have medical needs that prevent you from working* (see below)
  • a former foster care youth up to age 26, or someone currently in foster care
  • a person with a disability who gets Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), or whom NC Medicaid has determined to be disabled
  • a veteran with a total disability rating (100%)
  • an American Indian or Alaska Native
  • enrolled in a substance use disorder treatment program
  • in jail or prison, or released from jail or prison in the last 90 days
  • someone who qualifies for Medicare

* If you have a serious medical, physical or behavioral condition that keeps you from being able to do 80 hours of activities in a month, you might also be exempt. This situation is defined in the new rules as "medically frail." NC Medicaid is working out what these new rules mean and what kinds of situations can qualify. If you think your situation might qualify, tell your local Department of Social Services.

What you need to do

  1. Check if you are exempt. If your situation is listed as "exempt" above, you may not have to meet these requirements. You will need to decide this for yourself until NC Medicaid can check at your next renewal or application. If you are not sure, you should call your local Department of Social Services to ask. Gather and keep any papers that might prove that you are exempt. Your local Department of Social Services may ask to see them. 
  2. Keep proof of your activities. If you are not exempt, your local Department of Social Services may ask for proof that you have filled your 80 hours or made at least $580 each month. Keep proof, such as pay stubs, school records and volunteer logs.
  3. Keep your contact information up to date. Make sure your local Department of Social Services has your correct address and phone number. If they need something from you, they will mail you a letter. You need to get that letter so you do not lose coverage.
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