The short version

North Carolina expanded Medicaid on December 1, 2023, and that change is the single biggest reason so many more people qualify today. If you are an adult between 19 and 64 and your household income is at or below 138% of the federal poverty level, you very likely qualify — and unlike many older Medicaid rules, there is no asset or resource test for this group. That means your savings account, your car, and your home do not count against you.

For 2026, 138% of the federal poverty level works out to approximately $22,025 a year (about $1,835 a month) for a single person and approximately $45,540 a year (about $3,795 a month) for a family of four. These dollar figures are derived from the official 2026 federal poverty guidelines, and the exact cutoff for your household depends on how many people are in it.

If your income is a little too high for Medicaid, that is not the end of the road — it usually means you shop on the Health Insurance Marketplace instead, and we cover that below. But first, let's walk through who actually qualifies, in plain English.

What "138% of the federal poverty level" really means

Medicaid eligibility is tied to a number the federal government updates every year called the federal poverty level, or FPL. North Carolina Medicaid for adults uses 138% of that number as its income ceiling. You do not need to memorize the percentages — you just need to compare your household income to the cutoff for your family size.

Here is roughly how the 2026 adult cutoff looks:

  • One person: about $22,025 a year, or about $1,835 a month
  • Family of four: about $45,540 a year, or about $3,795 a month

Households of other sizes fall between or above those figures. If your income lands near the line, it is worth applying anyway — the exact calculation looks at your specific household and the specific type of income you have, and a small difference can change the answer. The state, not a website estimate, makes the final call.

Whose income counts?

Medicaid generally looks at your tax household — the people you file taxes with — and a measure of income called Modified Adjusted Gross Income (MAGI). In plain terms, that is close to the income you report on your tax return. If your hours change, if you are between jobs, or if your income swings month to month, that can affect eligibility, so it is worth being honest and thorough on the application rather than guessing.

One thing that trips people up: it is your income that matters, not your job title or how you get paid. Hourly workers, tipped workers, gig and self-employed folks, seasonal workers, and people piecing together a couple of part-time jobs can all qualify if the total household income lands at or below the line. And because North Carolina's adult group has no asset test, you are not disqualified by owning a home, having a car, or keeping money in the bank. That is a real change from what a lot of North Carolinians remember about Medicaid from years ago.

Who qualifies in North Carolina

Medicaid is not one single door — it is several pathways, each with its own rules. Here are the main groups.

Adults ages 19 to 64 (the expansion group)

This is the group that grew the most when North Carolina expanded Medicaid. If you are in this age range and your income is at or below 138% of the federal poverty level, you generally qualify, with no asset test. As of state data cited in April 2026, approximately 732,000 North Carolinians were enrolled through Medicaid expansion. If you have been uninsured because you thought you earned too much to qualify or too little to afford a plan, this is exactly the gap expansion was designed to close.

Children

Children have historically qualified at higher income levels than adults, and North Carolina covers them through NC Medicaid. Note that the old NC Health Choice program no longer exists as a separate program — as of April 1, 2023, roughly 55,000 children moved into NC Medicaid, which eliminated enrollment fees and copays and added benefits like behavioral health, EPSDT (a comprehensive children's benefit), and transportation. Children's coverage at what used to be the CHIP income levels (up to 211% of the federal poverty level) is now delivered through NC Medicaid. So if your household earns a bit too much for adult coverage, your children may still qualify.

Pregnant women, seniors, and people with disabilities

These groups have their own eligibility pathways, and the rules can differ from the adult expansion group — sometimes with higher income limits, sometimes with different criteria. If you are pregnant, over 65, or living with a disability and you are unsure, it is worth applying and letting the state evaluate every pathway you might fit. The application is built to check you against every category you could qualify under, so you do not have to figure out in advance which door is yours.

What NC Medicaid actually covers

Qualifying is one question; what you get is another. NC Medicaid is comprehensive coverage, not a bare-bones safety net. When the state moved children out of the old NC Health Choice program and into NC Medicaid in 2023, it did more than change a name — it eliminated enrollment fees and copays for those children and added benefits such as behavioral health, EPSDT (a thorough set of screening and treatment services for kids), and transportation to appointments. For adults in the expansion group, Medicaid covers the kind of everyday care people actually need: doctor visits, hospital care, prescriptions, mental health and substance-use treatment, and more.

That matters when you are comparing your options. A Marketplace plan can be excellent, but it comes with a monthly premium, a deductible, and cost-sharing. NC Medicaid, for those who qualify, generally has little to no monthly cost. So if you are close to the income line, it is genuinely worth finding out which side you fall on before assuming you have to pay for a plan.

A quick, clearly labeled example

Hypothetical, for illustration only — your real result depends on your actual household and income.

Imagine Maria, a 40-year-old in Charlotte who works part-time and earns about $1,600 a month. She rents an apartment, has about $4,000 in savings, and owns her car outright. In the past she assumed her savings would disqualify her from any help. But because North Carolina's adult Medicaid group has no asset test and her monthly income is below the roughly $1,835 single-person cutoff, she would generally qualify for NC Medicaid — her savings and her car simply do not enter the calculation. If Maria later picked up more hours and her income rose above the line, she would likely move over to a Marketplace plan instead, and her children (if she had any) might still qualify for NC Medicaid on their own.

What if your income is too high for Medicaid?

If you earn more than the Medicaid cutoff, you are not stuck. Most people just above the line buy a plan through the Health Insurance Marketplace at HealthCare.gov, and many qualify for premium tax credits that lower the monthly cost. In fact, the Marketplace subsidy range runs from 100% up to 400% of the federal poverty level, and in an expansion state like North Carolina, Medicaid covers people up to 138% while the Marketplace picks up from there. So there is a designed hand-off: below the line, Medicaid; above it, a subsidized Marketplace plan.

If you want to understand how those two systems compare side by side — costs, doctor networks, and how coverage actually feels — see our guide on Medicaid vs. Marketplace insurance and how they differ. And if money is tight and you are weighing every option, our page on what to do if you can't afford health insurance walks through the practical choices. When you are ready to actually enroll, how to get health insurance in North Carolina lays out the steps.

There is also a special group of savings on the Marketplace worth knowing about if your income lands in the lower part of the subsidy range. Households between 100% and 250% of the federal poverty level can qualify for cost-sharing reductions, which lower your deductibles and out-of-pocket costs — but only on a Silver-level plan, with the richest benefits for those under 200%. In other words, being just above the Medicaid line does not mean you are on your own; the Marketplace has its own set of protections designed for people with modest incomes.

What if you're losing coverage right now?

Timing questions come up a lot. If you are losing job-based coverage — even if you quit or were let go — you do not have to wait for the yearly Open Enrollment to get on a Marketplace plan. Losing job-based coverage triggers a Special Enrollment Period: you generally have 60 days from the date you lose coverage to pick a plan, and coverage typically starts the first day of the month after the loss. And if it turns out your income has dropped enough that you now qualify for NC Medicaid, you can apply for Medicaid at any time of year — there is no enrollment window for Medicaid. It is always open.

A note if you also have Medicare

Some people qualify for both Medicare and Medicaid at the same time — often called being "dual eligible." If you are 65 or older or on Medicare because of a disability, the rules interact in ways that can actually work in your favor. Our companion explainer on Medicare vs. Medicaid breaks down the difference and points you in the right direction.

Important changes coming to NC Medicaid

A couple of rule changes are on the calendar, and it is worth knowing about them now so nothing catches you off guard. As of July 2026, these are the confirmed dates:

  • Work and community engagement requirements begin January 1, 2027. Under federal changes, expansion adults ages 19 to 64 will need to earn at least $580 a month or complete 80 hours a month of approved activities — work, self-employment, job training, school at least half-time, or volunteering — verified every six months, with the requirement met in three of six months. Many people are exempt, including those who are pregnant or 12 months postpartum, parents or caregivers of children under 14, people with disabilities (SSI or SSDI), veterans with a 100% disability rating, former foster youth under 26, American Indian and Alaska Native individuals, and Medicare beneficiaries. This is not in effect yet.
  • Six-month eligibility reviews begin December 31, 2026. Expansion adults will have their eligibility redetermined every six months instead of once a year, so keeping your contact information and income details current will matter more.

Because these are tied to a future start date, always confirm the current status when you apply rather than assuming an older article is still accurate.

How to apply for NC Medicaid

Applying is free, and there are several ways to do it. Pick whichever is easiest for you:

  • Online (recommended): through ePASS at epass.nc.gov, or through HealthCare.gov
  • By phone: through your local Department of Social Services, or the NC Medicaid Contact Center at 1-888-245-0179 (TTY 711)
  • In person, by mail, by fax, or drop-off: at any local Department of Social Services office

Applying does not cost anything, and if you are turned down for Medicaid, the same application information can help you move quickly to a Marketplace plan instead. There is no penalty for finding out where you stand.

A few practical tips to make the application go smoothly. Have your income details ready — recent pay stubs, or a reasonable estimate if you are self-employed or work variable hours — along with the names, birth dates, and Social Security numbers for everyone in your household who needs coverage. Apply for the whole household at once rather than one person at a time; that way the state can sort each family member into whichever pathway fits, which is how children sometimes qualify even when the parents' income is too high. And keep your contact information current after you are approved. That last point is about to matter more: starting December 31, 2026, expansion adults will have their eligibility reviewed every six months instead of once a year, so an out-of-date phone number or address is the kind of small thing that can cause a big headache.

Finally, do not talk yourself out of applying because you think you earn too much or too little. The whole point of Medicaid expansion in North Carolina was to close the old gap where people fell in between — too much income for traditional Medicaid, too little to comfortably afford a plan. If you are not sure, the honest answer is to apply and let the state run the numbers, or to talk it through with someone who can look at your specific situation.

How The Jordan Insurance Agency helps

The Jordan Insurance Agency is an independent, licensed insurance agency based in Charlotte, North Carolina, serving clients across the state. We are not a government agency and we do not run Medicaid — the state handles Medicaid applications and decisions directly. What we do is help you understand the whole picture: whether your household is likely to fall on the Medicaid side of the line or the Marketplace side, and what happens if your income changes during the year and you need to move from one to the other.

Because we are independent, we represent multiple Health Insurance carriers rather than just one, so when your income is above the Medicaid cutoff we can compare Marketplace plans honestly and help you claim any premium tax credit you qualify for. Here is the part people are often surprised by: our help costs you nothing. Agents are paid by the insurance carriers, and your premium is exactly the same whether you enroll on your own or with our guidance. There is no upsell and no pressure — if the right answer for your family is to apply for NC Medicaid at ePASS, we will tell you that plainly and point you there.

For the official Medicaid income rules and the exact current-month figures, you can always go straight to the source at medicaid.ncdhhs.gov or apply at epass.nc.gov. When you want a real person to help you make sense of your options in plain English, reach out to The Jordan Insurance Agency and we will walk you through it calmly, one step at a time.