Upcoming Medicaid Changes

Below is a summary of the upcoming changes to North Carolina Medicaid based on the state's official guidelines.  For more information, visit https://medicaid.ncdhhs.gov/beneficiaries/medicaid-is-changing or contact DSS directly.

Medicaid is Changing in 2026-27

Know What's Next: New Medicaid Requirements May Affect Your Coverage

New laws are changing some NC Medicaid rules. You may need to act to keep your Medicaid.

What EVERYONE Who Has NC Medicaid Should Do

Check your contact information:
Make sure your local Department of Social Services (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.

If you are between ages 19 through 64 - New rule starts January 1, 2027

Work Requirements:
Medicaid will require you to work, go to school, or volunteer 80 hours a month.

Income Alternative:
You can also meet the requirement if your household earns at least $580 a month.

Proof Required:
You must show proof of the time you worked and the money you made.

Exemptions:
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.

Renewals:
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.

If you are not a U.S. citizen - New rule starts October 1, 2026

Many people who are not U.S. citizens will lose their Medicaid. However, you may be able to get or keep Medicaid if:

• You are a lawful permanent resident (you have a green card). Note: 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 do not have Medicaid but want to apply (or reapply) - New rule starts January 1, 2027

Medicaid can pay for some of the care you receive before you submit your application (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 one 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 two months of health care costs incurred before you submit your application.

Current Rule:
If you apply by December 31, 2026, Medicaid will cover approved costs for up to three months before you applied.

If None of These 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.

What to Do If You Lose Your Medicaid

You will get a letter explaining why, and it will tell you how to appeal if you disagree. You usually have 60 days from the date on the letter to appeal a Medicaid decision.

Need Help?

For free help with a notice or a bill, call the independent NC Medicaid Ombudsman at 1-877-201-3750.

General NC Medicaid Contact Center: 888-245-0179 (Monday-Friday 8 a.m. to 5 p.m.)

Page last updated:  September 1, 2026