North Carolina Medicaid: eligibility, plans, and how to apply

Last verified: June 2026

What is NC Medicaid?

NC Medicaid is the state's joint federal-state health coverage program, administered by the NC Department of Health and Human Services (NCDHHS) through its Division of Health Benefits (DHB). The program covers low-income children, pregnant women, adults, seniors, and people with disabilities. As of December 1, 2023, North Carolina expanded Medicaid eligibility under the Affordable Care Act, bringing coverage to approximately 600,000 newly eligible adults who previously fell into a gap.

The expansion set the income threshold at 138% of the Federal Poverty Level for adults ages 19 through 64. That works out to roughly $1,800 per month for a single adult or about $3,065 per month for a family of three, based on 2025 FPL figures from NCDHHS. No monthly premium. Copays are capped at $4 per service for most enrollees.

Standard plans vs. tailored plans — what's the difference?

Most NC Medicaid enrollees receive care through managed care health plans, and NC uses two distinct plan types. Understanding which type applies to you matters because it determines which health plan you'll enroll in and what services are managed where.

Standard Plans cover physical health services for most enrollees. Four Standard Plans operate statewide: UnitedHealthcare Community Plan (1-800-349-1855), HealthyBlue through Blue Cross NC (1-844-594-5070), AmeriHealth Caritas NC (1-855-375-8811), and Carolina Complete Health through Centene (1-833-552-3876). These plans handle primary care, specialty visits, hospital stays, pharmacy, and dental.

Tailored Plans serve enrollees with behavioral health needs, intellectual or developmental disabilities (I/DD), or traumatic brain injuries (TBI). Four Tailored Plans serve different regions of the state: Alliance Health (1-800-510-9132), Partners Health Management (1-888-235-4673), Trillium Health Resources (1-877-685-2415), and Vaya Health (1-800-962-9003). Tailored Plan enrollees receive both physical and behavioral health services through a single plan.

A small group of enrollees — including those with Medicare and certain medically complex cases — remain in NC Medicaid Direct, which is fee-for-service rather than managed care. Contact the NC Medicaid Contact Center at 1-888-245-0179 if you're unsure which option applies to you.

Who administers NC Medicaid?

NCDHHS's Division of Health Benefits (DHB) runs the program at the state level. Day-to-day enrollment and eligibility decisions happen through the 100 county Departments of Social Services (DSS). Each county has its own DSS office, and applications submitted in person go through that local office. You can also apply or manage your coverage online through ePASS at epass.nc.gov.

Key facts at a glance

What NC Medicaid covers

NC Medicaid covers a broad range of services. Standard Plan enrollees receive physical health care through their health plan, including hospital care, primary care visits, specialist visits, prescription drugs, mental health services, substance use treatment, and dental. Children under 21 receive Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, which means all medically necessary care must be covered regardless of whether it appears on the standard benefit list.

Seniors and people with disabilities who need long-term services and supports may qualify for home- and community-based waiver programs, primarily CAP/DA (Community Alternatives Program for Disabled Adults). Nursing facility care is also covered for those who meet medical and financial criteria.

See the sections below for detail on dental coverage, income limits, and long-term care.

NC Medicaid eligibility at a glance

No monthly premium for any group. $4/service copay cap for most services. FPL = Federal Poverty Level (2025 HHS guidelines). No asset test for MAGI-based groups.

NC Medicaid's two plan types: Standard Plans and Tailored Plans

Compare plans at ncmedicaidplans.gov or call the NC enrollment broker at 1-833-870-5500. Contact the NC Medicaid Contact Center at 1-888-245-0179 if you are unsure which plan type applies to you.

North Carolina Medicaid guides