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What is the name of North Carolina’s Medicaid expansion program?
The program is called NC Health Works and will be administered by the North Carolina Department of Health and Human Services.
Am I eligible for Medicaid expansion?
Adults aged 19–64 who make up to 138 percent of the Federal Poverty Level (FPL) qualify for Medicaid expansion. Whether your income meets the 138 percent threshold depends on your household size. As of 2023, a single adult earning $20,120 a year is eligible for Medicaid expansion, while a family of four earning $41,400 a year is eligible.
To determine whether you are eligible for Medicaid expansion, compare your household size to the 138% Federal Poverty Level for 2023.
When can I enroll in the Medicaid expansion program?
Because of the way the law is written, Medicaid expansion does not become effective immediately. That means there is currently NO concrete start date for enrollment.
Instead, the law stipulates that North Carolina’s Medicaid expansion program becomes effective on the latter of two dates:
- When the state budget becomes law, OR
- When the federal Centers for Medicare and Medicaid Services (CMS) approves the program
If N.C. lawmakers and Governor Cooper do not agree on a state budget by June 30, 2024, the Medicaid expansion law will expire, and the legislative process must start again.
How do I enroll?
There will be more information coming soon from the N.C. Department of Health and Human Services on how to enroll. If you currently rely on Medicaid for health insurance coverage, be sure to report any important changes to your local DSS or by visiting epass.nc.gov. These changes may be family size, income or address.
What health plans are available for Medicaid?
Medicaid recently transitioned to a managed care model and most enrollees must choose the health plan that best works for them. Click here to view health plan options available for you. Each health plan has their own network of providers. If you have a provider you want to continue seeing, click here to see which network they are in.
Many providers accept Medicaid plans. However, you will need to visit the Medicaid managed care provider directory to find out which health plan works with your provider.
Will healthcare visits be free?
Healthcare visits will either be free or low cost.
Will I have to pay a monthly premium to enroll in NC Health Works?
Do I need to report work hours to enroll in Medicaid coverage?
Not at this time. As of now, CMS and the Biden administration have not allowed work reporting requirements as a condition of Medicaid coverage.