What Is the Maximum Income to Qualify for Medicaid in NC?

Medicaid in North Carolina serves as a health coverage program for residents with limited incomes and resources. It aims to ensure access to necessary medical care for eligible individuals and families throughout the state. Understanding the specific eligibility criteria, including income thresholds, is a fundamental step for those seeking to secure this healthcare support.

North Carolina Medicaid Eligibility Groups and Income Limits

North Carolina Medicaid provides health coverage to various groups, each with specific income eligibility criteria expressed as a percentage of the Federal Poverty Level (FPL). These income limits are based on Modified Adjusted Gross Income (MAGI) rules for most categories and include a built-in 5% income disregard. For adults aged 19 to 64, North Carolina expanded Medicaid eligibility effective December 1, 2023, now covering individuals with household incomes up to 138% of the FPL. For a single adult, this translates to a monthly income limit of approximately $1,732. A two-person household in this group would have a monthly income limit of about $2,351, while a family of four could qualify with a monthly income up to around $3,588.

Pregnant individuals in North Carolina are eligible for Medicaid with household incomes up to 201% of the FPL. The unborn child is included in the family size calculation for eligibility. This means a single pregnant person (counted as a two-person household) may have a monthly income of up to approximately $3,339. A pregnant individual in a family of three (counted as a four-person household including the unborn child) could qualify with a monthly income limit of around $5,096. Postpartum coverage for the mother continues for 12 months after the birth.

Children also have specific income thresholds for Medicaid or the Children’s Health Insurance Program (CHIP). Children aged 0-18 are eligible with household incomes up to 216% of the FPL. For a one-person household (a child living alone or with non-tax-filing adults), the monthly income limit is about $2,649. A two-person household (a child and one parent) may qualify with a monthly income up to around $3,595. For a four-person household (two children and two parents), the monthly income limit for children’s eligibility is approximately $5,486.

Parents and caretaker relatives may also qualify for Medicaid, with income limits set at 45% of the FPL. For a two-person household consisting of a parent and one child, this income threshold is approximately $737 per month. For a three-person household with a parent and two children, the monthly income limit is about $999. These income figures are based on the 2025 Federal Poverty Level guidelines, with the exact FPL values varying annually and by household size.

How Income is Counted for Medicaid

North Carolina Medicaid uses the Modified Adjusted Gross Income (MAGI) methodology to determine financial eligibility for most applicant groups. MAGI is a standardized approach based on federal tax rules. It is not a figure directly found on a tax return but is calculated using specific components of income.

Income sources included in MAGI calculations are wages, self-employment income, Social Security benefits, and unemployment benefits. These are considered taxable income. Certain types of income are excluded from MAGI, such as child support payments received.

The determination of household size under MAGI rules is tied to tax filing status and dependency. A MAGI household includes the tax filer, their spouse if living together, and any individuals they claim as tax dependents. This household composition directly influences which Federal Poverty Level chart applies to an individual or family, affecting the maximum income they can have to qualify for coverage. Understanding how income and household size are assessed helps applicants estimate their potential eligibility.

Additional Medicaid Eligibility Requirements

Beyond income, applicants for North Carolina Medicaid must satisfy other requirements. All applicants must be residents of North Carolina, demonstrating intent to reside permanently within the state. Proof of residency can include documents such as a photo ID with a North Carolina address, a utility bill, or a lease agreement.

Applicants must also meet citizenship or eligible immigration status criteria. Applicants must be U.S. citizens or have a qualified non-citizen status. Acceptable documentation may include a birth certificate, passport, or a copy of a VISA or immigration card. Personal information provided for eligibility checks is not used for immigration enforcement purposes.

While most MAGI-based Medicaid categories do not have asset limits, certain non-MAGI programs do. These programs serve Aged, Blind, and Disabled (ABD) individuals or those seeking long-term care services. For these groups, an individual applicant’s countable assets must not exceed $2,000. For married couples where both spouses are applying, the combined asset limit is $3,000. Exempt assets, not counted towards these limits, include a primary residence, one vehicle, and personal belongings.

Applying for North Carolina Medicaid

Applying for North Carolina Medicaid involves several steps, with various methods available to submit an application. Individuals can apply online through the ePASS system or HealthCare.gov. For in-person assistance, applications can be submitted at a local Department of Social Services (DSS) office. Additionally, applications can be mailed, emailed, or faxed to the local DSS.

When applying, documentation is required to verify eligibility. This includes proof of identity and date of birth, such as a photo ID or birth certificate. Applicants need to provide their Social Security Number or proof of having applied for one, along with documents verifying their North Carolina residency. Proof of income, such as recent pay stubs, employer verification, tax returns for employed individuals, or business records for the self-employed, is also necessary. For non-U.S. citizens, documentation of immigration status is required.

After an application is submitted, it undergoes review. The Department of Social Services (DSS) has up to 45 days to determine eligibility for most applications; disability applications can take up to 90 days. During this period, the DSS may contact the applicant to request additional information or schedule an interview. Once a decision is made, applicants receive a notification letter in the mail, informing them whether their application has been approved or denied. Applicants can contact their local DSS office or the NC Medicaid Contact Center to inquire about their application status.