What Is Changing in NC Medicaid, and When

Health coverage is a pillar of wellbeing, and for roughly 740,000 North Carolinians covered through Medicaid expansion, the rules are about to change. On Tuesday evening, the state health department held a livestream fireside chat and tele-town hall, "New Rules for NC Medicaid: Know What's Next," to explain how.

The hour-long event, held from 6 to 7 p.m., featured Melanie Bush, deputy secretary for NC Medicaid, LaQuana Palmer of NC Medicaid communications, and Jenny Hobbs, who chairs the NC Medicaid Beneficiary Advisory Council. Viewers could submit questions on Facebook, X and YouTube, or by phone.

October 1: Narrower Eligibility for Some Non-Citizens

Under changes to federal law, starting October 1 only certain non-citizens remain eligible for Medicaid. NCDHHS lists them as lawful permanent residents, children up to age 19 and pregnant women (through 12 months postpartum) who live lawfully in the country without permanent status, people with Cuban or Haitian entrant status, and citizens of Micronesia, the Marshall Islands or Palau.

January 1, 2027: Work Requirements and Six-Month Renewals

For adults ages 19 to 64 without a disability who are covered through expansion, a work and community-engagement requirement begins January 1. They will need to show household earnings of $580 a month, or 80 hours a month of work, school or volunteering. Exemptions include parents and caregivers of a child under 14 or of a person with a disability, anyone Medicaid has determined has a disability, and women who are pregnant or were pregnant within the past 12 months.

Most expansion adults will also renew every six months rather than once a year.

Preparing Now

The department released a bilingual "Know What's Next" toolkit on September 1 with flyers, social media posts, a rack card and a wallet card. It suggests five steps: check whether the requirement applies, confirm your address and phone number with your county social services office, answer any letter promptly, keep proof such as pay stubs and school or volunteer records, and set up an ePASS account.

Governor Josh Stein has said the federal cuts will harm residents, rural hospitals and the health care system. Information is at medicaid.nc.gov/changes.

Sources: NCDHHS.