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Map showing which U.S. states have not yet expanded Medicaid


In 2023, North Carolina became the 40th state to expand Medicaid when the N.C. General Assembly passed House Bill 76 and Governor Roy Cooper signed it into law (Note: Implementation of expansion is contingent upon the passage of a state budget in 2023). Popular with voters on both sides of the aisle, this historic bipartisan effort to improve access to healthcare required hard work, strategic thinking, and being grounded in principles and community.

Visit our FAQs webpage for more information about Medicaid expansion or email your questions to

How did North Carolina expand Medicaid?

The steadfast commitment of advocates, community organizers, coalition partners, and everyday North Carolinians finally led our state to expand Medicaid after 13 years. Over the years, the N.C. Justice Center organized community events, met with numerous providers and patients, anchored coalitions, and lobbied legislators on the importance of expanding Medicaid. Although each and every event was unique and important, these are some of the most significant turning points in our Medicaid expansion journey.

Who will benefit from Medicaid expansion?

An estimated 600,000 North Carolinians will benefit from Medicaid expansion. Anyone who is aged 19–64, earns 138% of the federal poverty level or less, and  is a U.S. citizen or has certain types of immigration statuses is eligible for Medicaid coverage.

Many North Carolinians who have been struggling to manage chronic conditions while uninsured or are unemployed because they are too ill, taking care of a loved one, or in school will also be eligible for Medicaid coverage. North Carolinians who live with a substance use disorder or are returning from prison or jail are also likely to be eligible.

Current status of Medicaid expansion

Because the federal and state government jointly run Medicaid, North Carolina must get approval from the Centers for Medicare & Medicaid Services (CMS) to launch its Medicaid expansion program, known as N.C. Health Works. We must also wait for the N.C. General Assembly to pass a state budget before N.C. Health Works can go live. We are hopeful that Medicaid expansion will go live by the end of this year and that North Carolinians will finally be able to sign up for affordable health insurance.

Read our fact sheet to learn more about House Bill 76 and what it means for our state.

Next steps

Once a state budget has been passed and CMS has approved our program, North Carolinians can begin to sign up for Medicaid coverage. We will provide information on how to enroll as more information becomes available. In the meantime, view frequently asked questions about Medicaid expansion and sign up to receive updates as we monitor these developments.

Get involved

Without the steadfast dedication of healthcare advocates all across the state, we wouldn’t have been able to continue pushing for Medicaid expansion! Find out about how you can get involved in our work to strengthen and protect access to affordable healthcare.