Expansion Expansion Notice H.R. 1 English

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Case Identifier: caseReference
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Correspondent Name
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Work and Community Engagement Activities for Adults ages 19 through 64 (also called Medicaid Expansion)

June 15, 2026

Dear «Correspondent Name»:

Starting January 1, 2027, NC Medicaid will have new rules for most adults ages 19 through 64 (also called Medicaid expansion). Some adults in this group will need to report that they work, go to school or take part in volunteer activities to keep their full Medicaid benefits. Medicaid will also check eligibility more often for these adults.

The person(s) below are enrolled under Medicaid expansion:
Name ID number
MemberName1 MemberIDNumber1
MemberName2 MemberIDNumber2

What does this mean?

For recertification (renewal)

  • Starting January 1, 2027, adults ages 19 through 64 enrolled under Medicaid expansion must renew their Medicaid every 6 months instead of once a year. NOTE: This does not apply to American Indians or Alaska Natives.
  • Adults ages 19 through 64 Medicaid expansion must complete 80 hours of work, school or volunteer for 3 of the 6 months during their certification period, unless they have an exemption.

For example, if Mary’s certification period is from January to June, and she is not exempt, she must report her work, school, or volunteer activities for 3 of those months to keep her Medicaid benefits for her next 6-month certification period.

To apply for Medicaid

  • Starting January 1, 2027, adults ages 19 through 64 that apply for Medicaid may have to show proof in their application that they worked, went to school or volunteered for 80 hours each month of the 3 months before they apply for Medicaid.
  • For example, Mary applies for Medicaid on April 1, 2027, and she does not have an exemption from work, school or volunteer activities. Mary must show she did her activities in January, February and March to meet this requirement. If Mary did not show activities for all 3 months, she may not get Medicaid.

What do I need to do?

To keep full Medicaid benefits, most adults ages 19 through 64 must have an exemption or complete work, school or volunteer activities.

  1. Check to see if you are exempt.

    Exempt means you do not have to work, go to school or volunteer. You may be exempt if you:

    • Have certain health needs
    • Have a disability
    • Are pregnant or have recently had a baby
    • Take care of a child or disabled family member
    • Meet other exemption rules (listed on the next page).

    Save any papers that show you are exempt. Your local Department of Social Services (also called DSS) may need to see them.

  2. If you are not exempt, you may already be doing some of the work, school or volunteer activities listed on the next page.

    Save your pay stubs, school records and volunteer logs. Your local Department of Social Services may need to see the information to check your 80 hours each month.

Adults ages 19 through 64 who are getting Medicaid benefits and are not exempt or have not done the 80 hours required for work, school or volunteer activities each month, may lose full Medicaid benefits.

Resources and help

Contact the «DSS County Name» Department of Social Services at «DSS Phone Number» if:

  • You get a letter from your local Department of Social Services asking for information you do not understand
  • You have questions about the 6-month renewal period
  • You have questions about work and community engagement (volunteer) requirements
  • You have questions about an exemption

Call the NC Medicaid Contact Center at 1-888-245-0179 if you need help finding your local Department of Social Services.

Visit NC Medicaid's webpage about these changes at medicaid.ncdhhs.gov/HR1.

EXEMPTIONS (Who does not need to do the activities?)

  • Children up to age 19
  • Adults age 65 or older
  • Former foster care children up to age 26 and those currently in foster care
  • Parent or caregiver of a child up to age 14
  • Parent or caregiver of an adult or older child with a disability
  • American Indians and Alaska Natives
  • People with disabilities, getting Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) or found disabled by Medicaid
  • Veterans with a total disability rating (100%)
  • People who are pregnant or eligible for postpartum coverage (12 months after a pregnancy ends)
  • People who are medically frail or have special medical needs
  • People enrolled in a substance use disorder treatment program
  • People who are incarcerated (in jail or prison) or have been released from incarceration in last 90 days
  • People who qualify for Medicare

WORK AND COMMUNITY ENGAGEMENT ACTIVITIES

Adults ages 19 through 64 who are getting Medicaid benefits and are not exempt or have not done the 80 hours required for work, school or volunteer activities each month, may lose full Medicaid benefits.

Qualifying activities include if you:

  • Work at a job or are self-employed
  • Are in a work training program
  • Volunteer in the community
  • Go to school at least half-time
  • You can combine these activities, but they must add up to 80 hours a month

You can also meet the requirement if:

  • You earn at least $580 each month. (This is the same as working 80 hours at the federal minimum wage.)
  • You are a seasonal worker, and your average monthly income was at least $580 per month for the last 6 months.

NOTE: If possible, NC Medicaid will use the work and community engagement activities reported to Food and Nutrition Services (SNAP) or North Carolina’s Work First program (TANF).

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