North Carolina Medicaid Eligibility

This page provides general guidelines for the North Carolina Medicaid eligibility requirements. This is an assistance program that provides medical coverage for low-income people of all ages. The department that handles the Medicaid program is North Carolina Department of Health and Human Services. If you have questions or issues about the Medicaid application or the eligibility requirements, contact the North Carolina Medicaid office.


North Carolina Medicaid Overview

Medicaid is for eligible persons who need help paying their medical bills.


North Carolina Medicaid Eligibility Requirements - Non Income

Enrollees must be U.S. citizens or legal permanent residents and live in North Carolina. Non-citizens that would be Medicaid eligible on all factors other than their citizenship status may be eligible for Medicaid to cover medical emergencies, including the birth of a child. Before Medicaid may be authorized, applicants must provide proof from a medical professional stating the treatment was due to an emergency condition.


Documents Needed For North Carolina Medicaid Application


North Carolina Medicaid Benefits

Regular Medicaid: Doctor visits, Hospital visits, Prescriptions, Dental, Vision, Medicare premiums, Nursing home care, In-home care, Mental health care, Most medically necessary services for children under age 21, Personal care services, Medical equipment, and other home health services.

Medicaid for Pregnant Women: Maternity services only. Prenatal care, delivery and 60 days postpartum care, treating medical conditions which may complicate the pregnancy (approval for some services needed), childbirth and parenting classes, family planning, Maternity Care Coordination services.


North Carolina Medicaid & CHIP Eligibility Levels

Below is the modified adjusted gross income (MAGI) eligibility levels for North Carolina Medicaid and Children's Health Insurance Program (CHIP).

Eligibility Levels - By Percentage Of Federal Poverty Level (FPL)

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
No
Age 0-1: 210%
Age 1-5: 210%
Age 6-18: 133%
211% (6-18) Medicaid: 196%
CHIP: N/A
45% 0%

Eligibility Levels - Individual By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
No
Age 0-1: $2,042
Age 1-5: $2,042
Age 6-18: $1,293
$2,052 (6-18) Medicaid: N/A
CHIP: N/A
$438 $0

Eligibility Levels - Family Of Two By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
No
Age 0-1: $2,753
Age 1-5: $2,753
Age 6-18: $1,743
$2,766 (6-18) Medicaid: $2,569
CHIP: N/A
$590 $0

Eligibility Levels - Family Of Three By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
No
Age 0-1: $3,463
Age 1-5: $3,463
Age 6-18: $2,193
$3,480 (6-18) Medicaid: $3,232
CHIP: N/A
$742 $0

Eligibility Levels - Family Of Four By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
No
Age 0-1: $4,174
Age 1-5: $4,174
Age 6-18: $2,643
$4,194 (6-18) Medicaid: $3,896
CHIP: N/A
$894 $0