North Carolina Expanded Medicaid
North Carolina expanded Medicaid under the ACA in December 2023 making it one of the last states to do so. As of 2026, NC Medicaid (also called NC Medicaid Direct and NC Medicaid Managed Care) covers adults ages 19-64 who earn up to 138% of the Federal Poverty Level, approximately $21,597/year for a single adult.
Who Qualifies for NC Medicaid in 2026?
- Adults ages 19“64 with income at or below 138% FPL (~$21,597/year, single; ~$44,367/year, family of 4)
- Must be a U.S. citizen or qualifying immigrant
- Must be a North Carolina resident
- Cannot have access to affordable employer-sponsored coverage
How to Apply for NC Medicaid
Apply at epass.nc.gov or by calling the NC FAST line at 1-800-662-7030. You can also apply in person at your county Department of Social Services office. Coverage can begin as early as the first day of the month in which you apply if you are found eligible.
NC Medicaid Managed Care Plans
Most NC Medicaid enrollees receive care through managed care plans rather than fee-for-service Medicaid. The managed care plans operating in North Carolina include:
- Aetna Better Health of NC
- Carolina Complete Health (Centene)
- Healthy Blue NC (BCBS of NC)
- UnitedHealthcare Community Plan of NC
- WellCare of NC
Enrollees choose a plan at enrollment; if no choice is made, one is assigned. You can switch plans once per year.
NC Medicaid vs. Marketplace in North Carolina
If your income is below 138% FPL, NC Medicaid is almost always the better option: $0 premium, $0 deductible, minimal copays. If your income is above 138% FPL, marketplace plans with subsidies are available. An independent broker can help you understand exactly where your income puts you and which program provides the best value.
What Is Covered Under NC Medicaid?
NC Medicaid covers a comprehensive range of services, including:
- Doctor visits and specialist care
- Hospital inpatient and outpatient services
- Emergency room care
- Mental health and substance use disorder treatment
- Prescription drugs (formulary varies by managed care plan)
- Preventive care, including screenings and immunizations
- Dental care (limited for adults under some managed care plans)
- Vision care and eyeglasses
Benefits are similar across all five managed care plans, but formularies and networks differ. Review the drug list for your specific plan before enrolling if you take regular medications.
Special Enrollment for NC Medicaid Expansion Enrollees
When NC expanded Medicaid in December 2023, many residents who had been purchasing marketplace plans with subsidies became newly eligible for Medicaid. If you were enrolled in a marketplace plan during expansion and your income was below 138% FPL, you may have been eligible to switch to Medicaid mid-year. Going forward, you can apply for Medicaid at any time, there is no enrollment period or waiting list for expansion Medicaid in North Carolina.
Frequently Asked Questions About NC Medicaid Expansion
Does NC Medicaid cover dental care for adults?
Adult dental coverage under NC Medicaid is limited. Emergency extractions are generally covered, but routine cleanings and restorative care availability depends on your managed care plan. Check your plan's dental benefit details at enrollment.
Can I keep my doctors if I switch to NC Medicaid?
Not necessarily. Each managed care plan has its own provider network. Confirm that your current primary care doctor and any specialists are in-network with the managed care plan you choose before enrolling.
What if I earn slightly above 138% FPL?
If your income exceeds 138% FPL, you move to the ACA marketplace. North Carolina uses healthcare.gov. With enhanced subsidies in effect for 2026, marketplace plans at 139%–250% FPL are often very affordable after premium tax credits and cost-sharing reductions on Silver plans.