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 ages 19 through 64, and
• you do not have a disability, and
• you are not pregnant or eligible for postpartum coverage (12 months after a pregnancy ends), and
• you are not a parent, guardian, caretaker relative or family caregiver of a dependent child under age 14 or a person with a disability and

you do not qualify for an exception or exclusion** Some exceptions and exclusions 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 6 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, when your Medicaid is renewed (“recertification”). You must meet the requirement for 3 out of 6 months leading up to each recertification. 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.

Exceptions and exclusions

You do not have to do these activities, or earn a minimum amount, if any of the below describe you:

Your age, role or situation

• You are under age 19 or over age 64.
• You qualify for Medicare.
• You are a former foster care child up to age 26 or you are currently in foster care.
• You are a parent, guardian, caretaker relative or family caregiver of a dependent child under age 14, or of a person with a disability.
• You are American Indian, Alaska Native or eligible for Indian Health Services (IHS).
• You are incarcerated (in jail or prison) or were released from incarceration in the last 90 days.
• You already meet the work rules for the Supplemental Nutrition Assistance Program (SNAP).
• You already meet the work rules for Work First (TANF).

Your health or disability

• You get Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI).
• You are a veteran with a total disability rating (100%).
• You are pregnant or are eligible for postpartum coverage (12 months after a pregnancy ends).
• You are in a drug addiction or alcohol treatment and rehabilitation program.
• You have a serious or complex medical condition. (This situation is defined in the new rules as "medically frail." ) This might include if you:
  • are blind and disabled
  • have a substance use disorder
  • have a disabling mental disorder
  • have a physical, intellectual or developmental disability that impairs your ability to perform 1 or more activities of daily living

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 qualify for an exception or exclusion.If your situation is listed above, you may not have to meet these requirements.If you are not sure, you should call your local Department of Social Servicesto ask. Gather and keep any papers that might prove that you qualify for an exception or exclusion. Your local Department of Social Services may ask to see them. 
2. Keep proof of your activities.If you do not qualify for an exception or exclusion, 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.