Medicaid Work Requirements in North Carolina

Starting January 1, 2027, most NC Medicaid adults ages 19 through 64 in the expansion group must work, go to school, volunteer, or have enough income each month. North Carolina asks for 3 of the 6 months before renewal.

Updated October 30, 2026 · Based on official sources listed below · How we research · Leer en español

Jan 1, 2027

Start date · 3 of 6 months

80 hrs or $580

per month, or half-time school

NC Medicaid

Medicaid expansion adults

1-888-245-0179

NC Medicaid Contact Center (Mon–Fri, 8 a.m.–5 p.m.)

Check your situation in North Carolina

When it starts in North Carolina

July 30, 2026: in comments to CMS, NCDHHS said it was unlikely to fully meet the new federal rule's requirements by January 1, 2027 despite good-faith efforts, and urged CMS to allow extensions.
September 1, 2026: NCDHHS launched its "Know What's Next" toolkit.
January 1, 2027: the requirement and 6-month renewals begin. Most current members are affected at their 2027 renewal.

Who has to meet it

The rule applies to people ages 19 to 64 in the Medicaid adult expansion group, unless they are pregnant, have Medicare, or are exempt. You meet it in a month with 80 hours of work, community service, a work program, or school (in any mix), by going to school at least half-time, or with at least $580 in monthly income.

You are exempt if, for example, you care for a child 13 or younger or a person with a disability, are pregnant or postpartum, are American Indian or Alaska Native, are medically frail, are a veteran with a total (100%) VA disability rating or TDIU, were in foster care at 18 and are under 26, are in drug or alcohol treatment, meet SNAP or TANF work rules, or left jail or prison in the last 3 months. See the full exemption list.

Court ruling, October 29, 2026. In Massachusetts v. Oz, a federal court struck down the CMS rule's extra "significantly impairs" test for the medically frail exemption. If you are in any of the five medically frail groups in the law, you qualify. North Carolina was one of the parties that sued, so the court also gave North Carolina six months of relief from federal enforcement of its medically frail decisions while it updates its systems. The January 1, 2027 start date did not change, and CMS may appeal. What the ruling means.

How North Carolina checks and how to report

Months checked: At renewal: 3 of the 6 months before recertification. If you reapply after losing coverage: 3 months in a row.

Keep proof (pay stubs, timesheets, school records, volunteer logs). Upload documents through an enhanced ePASS account or give them to your local Department of Social Services (DSS). Exempt people send exemption proof to their local DSS if asked.

Other things to know in North Carolina

About 740,000 people have NC Medicaid expansion coverage (NCDHHS, September 2026).
State law (G.S. 108A-55.7) sets community engagement rules effective January 1, 2027.

Official tools and contacts

Check if it applies: "See if work requirements apply to you" checklist
Report and upload: ePASS
NC Medicaid Contact Center (Mon–Fri, 8 a.m.–5 p.m.): 1-888-245-0179
NC Medicaid Ombudsman: 1-877-201-3750
NC Medicaid: work and community engagement requirement
NC Medicaid is changing (medicaid.nc.gov/changes)
Know What's Next toolkit
Agency: NC Department of Health and Human Services (NC Medicaid)

Federal protections that apply in North Carolina

The state must check its own records before asking you for proof.
If it can't confirm you meet the rule, you get a notice and at least 30 days to respond, and your coverage continues meanwhile.
You get written notice and the right to a fair hearing before coverage ends, and you can reapply at any time.
If you lose Medicaid for not meeting the rule, you cannot get marketplace premium tax credits for those months. Learn more.

Frequently asked questions

When do Medicaid work requirements start in North Carolina?

January 1, 2027 (3 of 6 months). Current members are usually checked at their first renewal on or after that date.

How many months does North Carolina check?

At renewal: 3 of the 6 months before recertification. If you reapply after losing coverage: 3 months in a row.

How do I report my hours or an exemption in North Carolina?

Who do I call about NC Medicaid work requirements?

NC Medicaid Contact Center (Mon–Fri, 8 a.m.–5 p.m.): 1-888-245-0179
NC Medicaid Ombudsman: 1-877-201-3750

Can I lose NC Medicaid right away if I don't meet the requirement?

No. Federal law requires a notice, at least 30 days to show you comply or are exempt, continued coverage during that time, and fair hearing rights before coverage ends.