Medicaid is Changing

Versión en español

New laws are changing the rules for NC Medicaid. Some people will need to follow new rules to keep their coverage. Some non-citizens will lose their coverage. This page tells you what is changing and what you need to do.

There are four important things to know:

1. Many adults ages 19 through 64 will have to show they work or participated in an approved activity.
2. Many adults ages 19 through 64 will have to renew Medicaid every six months.
3. Medicaid may pay medical bills for care provided before you apply.
4. Many non-citizens will no longer be able to have Medicaid coverage.

1. Many adults ages 19 through 64 will have to show they work or participated in an approved activity. 

Starts January 1, 2027

Some adults will need to work, volunteer or go to school to keep their Medicaid. These are called work and community engagement requirements.

This probably affects you if you have Medicaid or want to apply for it, and if all of the following are true:

• you are ages 19 through 64, and
• you do not have a disability, and
• you are not pregnant, and
• you do not care for a child under age 14 and
• you do not qualify for an exemption*

If you are required to follow the work and community engagement rules and you do not, you may lose your Medicaid coverage.

* See more details, including who qualifies for an exemption and how to meet the requirements: NC Medicaid Work and Community Engagement Requirements

2. Many adults ages 19 through 64 will have to renew Medicaid every six months.

Starts January 1, 2027

If you are an adult age 19 through 64, you may need to renew your Medicaid more often.

What is changing

Right now, most people with Medicaid must renew (or "recertify") once a year. NC Medicaid sends a recertification letter that might ask questions or ask for more information about your situation.

Starting January 1, 2027, some of you will renew every six months. You will get a recertification notice in the mail. This does not apply to American Indians or Alaska Natives.

3. Medicaid may pay medical bills for care provided before you apply.

Starts January 1, 2027

When you apply for Medicaid, it can sometimes pay medical bills from before your application date. This is called retroactive coverage. The number of past months it can cover is changing.

What is changing

If you apply for Medicaid on or after January 1, 2027:

• most adults ages 19 through 64 can get coverage for bills from one month before they apply
• children, adults age 65 or older and people with disabilities can get coverage for bills from two months before they apply

Do not wait to apply. Apply as soon as you have a medical need, so more of your bills can be covered.

4. Many non-citizens will no longer be able to have Medicaid coverage.

Starts October 1, 2026

This change affects people who are not U.S. citizens. It does not affect U.S. citizens.

Non-Citizens who will keep Medicaid

On October 1, 2026, you will keep your Medicaid if you are:

• a U.S. citizen or U.S. national
• a lawful permanent resident (green card holder)
• a Cuban or Haitian entrant
• a Compact of Free Association (COFA) migrant — a citizen of the Federated States of Micronesia, the Marshall Islands or the Republic of Palau
• a child up to age 19 who does not have permanent immigration status but is lawfully residing in the United States
• a woman who is pregnant or within 12 months postpartum (after birth), who does not have permanent immigration status but is lawfully residing in the United States

You may still lose Medicaid for other reasons, such as your income. This change is only about your immigration status.

Who will lose Medicaid

Beginning October 1, 2026, federal law no longer allows the following non-citizens to have health coverage through Medicaid. These people will lose their Medicaid coverage.

• someone the U.S. government has given asylum to (an "asylee")
• someone admitted to the U.S. as a refugee
• someone with immigration protection because they are a victim of trafficking (this can include certain family members)
• someone allowed into the U.S. temporarily on "humanitarian parole," including Ukrainian and Afghan parolees
• a non-citizen whose deportation has been withheld
• a non-citizen granted conditional entry
• a person with Amerasian immigrant status
• an American Indian born in Canada or outside the U.S. who is not a U.S. citizen (this includes federally recognized tribal members who are not U.S. citizens)
• a "battered non-citizen" — someone with immigration protection because they were abused by a family member (this can include a spouse, parents and children)
• a veteran or active-duty service member who is not a citizen (this can include certain family members)
• a non-citizen with an Iraqi or Afghan Special Immigrant Visa (this can include a spouse and children)
• a Hmong, Mien, or Highland Laotian non-citizen (this can include a spouse and children)
• an applicant for a green card, asylum, or Temporary Protected Status who has not been approved yet
• another non-citizen lawfully living in the U.S.

What this means for you

If you are on the “Who will lose Medicaid” list above, you will lose your Medicaid coverage October 1, 2026. This includes doctor visits, prescriptions, mental health, dental and other services.

You may still be able to get Emergency Medicaid, which can help pay for emergency care you get in a hospital emergency department. It covers the costs of severe medical emergencies. It is limited to acute, sudden conditions that require immediate medical attention to prevent death or serious impairment. It does not cover urgent care. You must meet income rules and other rules to get it.

What you need to do

Make sure your local Department of Social Services has your correct address. Check your mail carefully. Respond right away if they send you a letter asking about your immigration status.

You can still apply for Medicaid until October 1, 2026.

If you have met the rules for a green card but have not applied yet, apply as soon as you can. Living here for 5 years is not enough on its own. You need a green card, or you will lose coverage. If you get a green card, tell your local Department of Social Services right away.

It’s important to keep in mind that:

• If your status has changed and you are now a lawful permanent resident (green card) holder, make sure your local Department of Social Services has the correct information.
• You may be able to get health coverage through the Affordable Care Act Marketplace at HealthCare.gov. Information you provide there may be shared with the Department of Homeland Security.
• You can also get basic health care services at federally qualified health centers, rural health clinics and free and charitable clinics. Costs vary based on income.

Where to get help

Contact your local Department of Social Services (DSS) if:

• you get a letter asking for information you do not understand
• your immigration status changes and you are now a lawful permanent resident (green card) holder
• you have questions about the 6-month renewal
• you have questions about the work and activity rules
• you have questions about an exemption

To find your local Department of Social Services, use this DSS directory or call the NC Medicaid Contact Center at 1-888-245-0179 (TTY Relay Services: Call 711) to find the DSS closest to you. For help in other languages, ask the operator for an interpreter.