North Carolina is providing health care coverage to more people through Medicaid.
Last updated: December 1, 2023
Quick Facts about North Carolina’s Medicaid Expansion
- North Carolina expanded who can get Medicaid starting December 1, 2023.
- Adults ages 19 through 64 earning up to 138% of the federal poverty line (e.g., singles earning about $20,000/year or families of three earning about $34,000/year) may be eligible.
- The best way to apply is online through ePASS; you can also apply in-person, by phone or mailed applications. The processing time for applications can be up to 45 days. Applications submitted online may be processed faster.
- The coverage is comprehensive, including services like primary care, hospital stays, maternity care, vision and hearing, dental/oral health care and more.
- Medicaid pays for doctor visits, yearly check-ups, emergency care, mental health and more – at little or no cost to you.
- Current beneficiaries with full Medicaid coverage will not see any changes.
Yes. More North Carolinians can now get health care coverage through Medicaid. Starting Dec. 1, 2023, NC Medicaid covers people ages 19 through 64 years with higher incomes. Many North Carolinians who did not qualify for health coverage through NC Medicaid prior to Dec. 1, 2023 may now qualify.
Health coverage through Medicaid is comprehensive. Because these services are covered by NC Medicaid, they are provided at no cost or low cost to you. Services include, but are not limited to:
- Primary care so you can go to a doctor for a check-up or when you are not feeling well
- Hospital services when you need to stay overnight (inpatient) or when you can go home the same day (outpatient)
- Maternity and postpartum care if you are pregnant and after giving birth
- Vision and hearing services
- Prescription drug benefits
- Behavioral health
- Preventive and wellness services
- Dental and oral health services
- Medical-related devices and other therapies
Most people can get health care coverage through NC Medicaid if they meet the criteria below. If you were eligible before, you still are. Eligibility criteria:
- You live in North Carolina
- Age 19 through 64
- You are a citizen (some non-U.S. citizens can get health coverage through NC Medicaid)
- If your household income fits within the chart below:
|Household Size||Annual Income before Taxes|
|Single Adults||$20,120 or less|
|Family of 2||$27,214 or less|
|Family of 3||$34,307 or less|
|Family of 4||$41,400 or less|
|Family of 5||$48,493 or less|
|Family of 6||$55,586 or less|
You can apply online through ePASS – a secure, self-service website at ePASS.nc.gov. When you apply online, you can avoid having to go in person to your local Department of Social Services (DSS) office. If your application is complete, it may be processed faster.
If you cannot apply online, you can apply in person at your local DSS office, by calling your local DSS office or by mailing in a paper application available at medicaid.nc.gov/print-application. To find your local DSS office, go to ncdhhs.gov/localDSS.
You cannot “pre-qualify” for Medicaid. You will be assessed for eligibility and evaluated for all Medicaid programs, using the eligibility rules. Be on alert for scams. It is not possible to “pre-qualify” for Medicaid.
Parents who do not meet eligibility requirements for coverage as a Parent/Caretaker can still qualify under the expanded rules if they are aged 19 through 64 and meet other eligibility requirements. All children in the home under 21 years of age must have health insurance that meets the Affordable Care Act requirements. That health insurance could be Medicaid or private health coverage.
It may take up to 45 days after you apply. Incomplete applications may take longer. If your application is incomplete or we need more information, you will hear from your local DSS office requesting additional information. You may be contacted by mail, phone, email and/or text message, so it is important to make sure your contact information is up to date and complete so your caseworker can reach you.
You will receive a letter in the mail that will tell you if you are approved or denied. Authorized Representatives will receive the same communication.
The date coverage begins depends on when you apply for Medicaid. Here are examples of situations people may have:
- You apply for Medicaid in December. Your application is not processed until January (or later). But you need care in December. If you are eligible, your Medicaid coverage will be retroactive to December 1. That means if you get care in December, your provider can bill for services that Medicaid covers. You should not have to pay out of pocket. You may have to pay a copay.
- You apply for Medicaid in January 2024 (or later) but have medical bills you need to pay from services you received in December 2023. When you apply for Medicaid, make sure you answer the questions that ask about medical bills from prior months. You can request that your Medicaid coverage be retroactive for up to three months before the month you applied. So, if you apply in March and you are eligible, Medicaid can pay bills for covered services from December, January and February. Remember, coverage under expansion can only go back to December 2023.
Some non-U.S. citizens can get health coverage through Medicaid. To be eligible you must be:
- A person living in North Carolina
- A qualified non-citizen for at least five years
- This means a person must wait five years after receiving "qualified" immigration status before they can get Medicaid.
- There are exceptions. For example, refugees, asylees or lawful permanent residents who used to be refugees or asylees do not have to wait five years.
Individuals without documents are not eligible for Medicaid unless they have an emergency condition as defined under federal law – such as someone in a car accident who is taken to the emergency room.
It takes time to complete the application. Here is some of the information you will be asked to provide for each person applying:
- Full legal name
- Date of birth
- Social Security number (or immigration documents)
- North Carolina residency
- Income information (from paystubs, W-2 forms, tax returns or business records)
North Carolina uses external resources to verify the information you provide. If more information is needed, you will receive a letter in the mail from your local DSS.
|North Carolina Residency||
· A photo ID with your NC address listed, or
· A utility bill, or
· A lease or mortgage agreement, or
· Vehicle registration, or
· Documentation of employment, or
· If you do not have any documentation, you can check a box in ePASS labeled “NC Residency Declaration.”
· If you’re Employed - pay stubs, employer verification or your most recent tax return to show proof of your income.
· If you’re Self-Employed - your most recent tax return or copies of your business records. If you don’t have that, you can fill out a Verification Form for Self-Employment Income and Expenses form.
|Date of Birth||
· A photo ID with your date of birth listed, or
· Birth certificate.
|Social Security Number||
· A copy of your Social Security card, or
· Another official document containing your name and Social Security number, or
· A military ID card.
· Birth Certificate, or
|Immigration Status||· A copy of your VISA/immigration card.|