Medicaid is Changing in 2026-27
New Medicaid Requirements May Affect Your Coverage
New laws are changing some NC Medicaid rules. This page tells you who is affected and what you need to do. You may need to act to keep your Medicaid.
Everyone who has NC Medicaid should:
- Check that your local Department of Social Services (local DSS) has your current address and phone number. They will write to you about these changes. If your address is wrong, you could lose your Medicaid without knowing why. Update your address online at ePASS or call your local DSS.
- Answer any letter right away. Letters from your local DSS usually have a deadline. Missing a deadline is a common reason people lose their Medicaid.
- Get an enhanced ePASS account if you do not have one. You need an enhanced account to upload any documents you may need to share to keep your Medicaid coverage.
Ages 19 through 64: New rule starts January 1, 2027
Medicaid will require you to work, go to school or volunteer 80 hours a month.
You can also meet the requirement if your household earns at least $580 a month.
You must show proof of the time you worked and the money you made.
Some people do not need to meet this rule. These include people with a disability, parents of children under age 14, people who are pregnant and others.
See if Work Requirements Apply To You
Also, you must renew your Medicaid every 6 months instead of once a year. You will get a notice if you need to do anything to renew.
Non U.S. citizens: New rule starts October 1, 2026
Many people who are not U.S. citizens will lose their Medicaid.
You may be able to get or keep Medicaid if:
- You are a lawful permanent resident (you have a green card). Most green card holders must also wait 5 years.
- You are a child up to age 19 who is lawfully residing in the United States.
- You are pregnant or gave birth in the last 12 months and are lawfully residing in the United States.
- You have Cuban or Haitian entrant status.
- You are a citizen of Micronesia, the Marshall Islands or Palau living in the United States.
If your situation is not listed here, you might lose your Medicaid starting October 1, 2026.
If you are applying for Medicaid: New rule starts January 1, 2027
Beginning in 2027, Medicaid will cover eligible care you received up to 1 month before you applied.
If you do not have Medicaid and you are applying for it, or if you are reapplying for it, Medicaid can pay for some of the care you get before you submit your application. This is called “retroactive coverage.” The period Medicaid will cover is getting shorter.
- Most adults ages 19 through 64 who do not have a disability: Starting January 1, 2027, Medicaid will cover up to 1 month of health care costs incurred before you submit your application.
- Children, adults 65 and older, and people with a disability: Starting January 1, 2027, Medicaid will cover up to 2 months of health care costs incurred before you submit your application.
If you apply by December 31, 2026, Medicaid will cover approved costs for up to 3 months before you applied.
If none of these situations apply to you
Your Medicaid does not change. As long as you still meet Medicaid eligibility requirements, the new rules do not apply.
These changes only affect you if you are an adult between ages 19 and 64, if you are not a U.S. citizen or if you are applying for Medicaid.
If you lose your Medicaid
You will get a letter. It will explain why, and it will tell you how to appeal if you disagree. You usually have 60 days from the date on the letter. How to appeal a Medicaid decision
For free help with a notice or a bill, call the NC Medicaid Ombudsman at 1-877-201-3750. The Ombudsman is independent of your local Department of Social Services (DSS).
These organizations may also be able to help:
- NCDHHS Low-income Services
- Community resources available on your health plan’s website
- NCCare360
- NC Navigator Consortium
- Hispanic Federation
- Legal Aid of NC
- NC 211