What's changing with North Carolina Medicaid?
We'll help you understand the new rules and how to stay covered
Starting January 1, 2027, some NC Medicaid members will need to complete at least 80 hours of approved work and community engagement activities each month. These are activities like employment, volunteering, attending school, or participating in a job training program. Meeting these requirements can help you keep your NC Medicaid coverage.
Everything you need to know
Use the links for helpful information for understanding Medicaid coverage.
Do these work requirements apply to me?
How do I keep my NC Medicaid coverage?
How do I renew my NC Medicaid?
What if I lose my NC Medicaid coverage?
Resources to help you meet the work requirements
When will the rules take effect?
Current NC Medicaid members
If you're already enrolled, you won't need to meet the work and community engagement activities until your regular renewal in 2027.
Future NC Medicaid members
If you're applying for coverage, you may need to meet the work and community engagement activities for three consecutive months before your coverage begins.
Do these work requirements apply to me?
You may need to meet the work and community engagement requirements if you:
- Are between the ages of 19 and 64
- Qualify for NC Medicaid based on your income
- Are not eligible for Medicare
- Are not pregnant
- Are a U.S. citizen or meet immigration rules
- Do not meet an exception
You may need to meet the work and community engagement activities if you:
- Are turning 19
- Gave birth to a baby in the past 12 months (12 months postpartum)
- Have aged out of foster care and are turning 26
- Are a parent or caregiver with your youngest dependent turning 14
Who doesn’t have to meet the work requirements?
- Former foster care youth under age 26 or currently in foster care
- An American Indian or Alaska Native who is eligible for Indian Health Service (IHS)
- A parent or caregiver of:
- A child age 13 or younger
- Someone with a disability
- A veteran with a total disability rating
- Medically frail or have serious health needs, such as:
- Blindness or disability
- Serious mental health conditions
- Substance use disorder
- Major physical or developmental disabilities
- Already meeting Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF) work requirements
- In drug or alcohol treatment
- Incarcerated or have been recently released (within 90 days)
- Pregnant or gave birth to a baby less than 12 months ago (12 months postpartum)
- Under the age of 19
NC Medicaid will review your information and determine whether you qualify for an exemption. An exemption is an approved reason why the work and community engagement activities do not apply to you. NC Medicaid may contact you if additional information is needed.
What do I need to do now?
Visit North Carolina ePASS to make sure your contact information is up to date and accurate.
How do I keep my NC Medicaid coverage?
You may need to complete at least 80 hours of approved work and community engagement activities each month to keep your NC Medicaid coverage. This can include:
- Work (or earn at least $580 per month)
- School (attending at least half-time)
- Job training
- Volunteering
If your work is seasonal, your average earnings over six months must be at least $580 per month (or $6,960 per year).
You can mix and match work and community engagement activities to reach 80 hours per month. For example, you can:
- Work 50 hours as a barista and volunteer 30 hours at a local food bank
- Be enrolled in an electrician program at least half-time
- Volunteer 72 hours with an animal shelter and work 8 hours as a grocery clerk
How do I report my work and community engagement requirements?
When it's time to renew your NC Medicaid coverage, you may need to report your work and community engagement activities.
NC Medicaid will first review information it already has. If NC Medicaid needs more information, you'll receive a notice by mail or through your North Carolina ePASS account explaining what to submit. If you're asked to provide information, be sure to respond within 30 days to avoid delays or potential loss of coverage.
NC Medicaid may ask for:
- Pay stubs
- School records
- Proof of volunteer hours or work program hours
You can send this information online, in person, or by mail. If NC Medicaid doesn’t contact you, there is nothing you need to submit.
How do I renew my NC Medicaid?
As Medicaid changes, you may need to renew more often and provide updated information — including work or activity details. You will receive a notice when it’s time to renew your coverage.
Renewing your NC Medicaid benefits is as easy as Ready. Set. Renew.
Step 1: Ready
Get your information ready before you start. This can help you finish faster and avoid delays.
Step 2: Set
Make sure your form is complete and up to date. You can renew using the option that works best for you:
- Online: Visit North Carolina ePASS to complete your renewal.
- By mail: Send the completed forms to the address on your notice.
- In person: Visit your local Department of Social Services (DSS).
- By phone: Call 888-245-0179 (TTY 711) for help completing your renewal.
Step 3: Renew
Submit your renewal and wait for updates. You’ll get a notice from NC Medicaid letting you know if your coverage has been renewed.
What if I lose my NC Medicaid coverage?
If your NC Medicaid coverage recently ended, you may still be able to reapply and get your benefits back.
What can I do next?
Follow each step to get your renewal on track.
Step 1: Find out why your coverage ended.
Step 2: Complete your renewal or submit a new application.
Step 3: Submit missing documents:
- Income
- Household
- Work hours
- Proof of exemption
Step 4: Wait for confirmation
What if my situation changes?
Report any changes in your life as soon as possible to NC Medicaid. Certain life changes could affect whether you qualify for NC Medicaid or need to meet work and community engagement activities, including:
- A change in your income or job
- A new address
- Someone moving in or out of your home
- Family changes including marriage, divorce, pregnancy, or adoption
If NC Medicaid asks you for information, or if you need to report a change, you can contact your local DSS office.
Keep proof of your activities. If you do not qualify for an exception or exclusion, your local DSS may ask for proof that you have filled your 80 hours or made at least $580 each month. Keep proof, such as pay stubs, school records, and volunteer logs.
You can also report changes, apply for benefits, and complete reviews via ePASS.
Resources to help you meet the work requirements
If you need help finding work, job training, or other support services, these North Carolina resources may be able to help.
Frequently Asked Questions
Review our frequently asked questions (FAQs) for additional help with understanding Medicaid requirements.