New federal rules start on January 1, 2027.
Changes affect most adults ages 19 – 64 without a disability. You may need to act now to keep your Medicaid.
New Medicaid Requirements
Coverage changes for non-U.S. citizens begin October 1, 2026. Learn more about coverage changes.
Understanding the new rules
1. Work and community engagement
Starting January 1, 2027, most adults ages 19 – 64 without a disability will need to work, go to school or volunteer for 80 hours each month to keep Medicaid. You can also meet the new requirement if your household earns at least $580 per month. This is called the work and community engagement requirement. You must show proof of the time you worked and the money you made.
2. Medicaid renewal change
Starting January 1, 2027, most adults ages 19 – 64 without a disability will have to renew Medicaid every six months instead of once each year. You will get a notice from your local Department of Social Services (DSS) if you need to do anything to renew.
Are you affected?
Some people will not have to meet the new work and community engagement requirement. You may not have to meet the new rules if you:
- Are a parent, guardian, caretaker relative or family caregiver for a child under age 14 or a person with a disability
- Have been determined by NC Medicaid as having a disability yourself
- Are pregnant or were pregnant in the last 12 months
If you are not sure if the new rule applies to you, or if you want to learn more about the changes, please visit the North Carolina Department of Health and Human Services dedicated website for more information.
What should you do now?
Everyone who has NC Medicaid should:
- Check that 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 through ePASS or by calling 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.