The Medicaid Income Limit is the most important criteria for deciding whether you qualify for Medicaid in your state. In this post, we are going to explain in detail the North Carolina Medicaid Income Limits for 2021.
Based on this information, you will be able to determine whether your income qualifies you for North Carolina Medicaid or not.
However, before we get into details about the income limit, we will first explain the Medicaid program in North Carolina and how it works.
Next, we will discuss who is eligible for Medicaid, including how eligibility works for various categories, including Children, Pregnant Women, and Adults.
What is Medicaid?
Medicaid is a federal and state health insurance program for people with a low income.
It provides free or low-cost health coverage to millions of Americans, including families and children, pregnant women, the elderly, and people with disabilities.
The Children’s Health Insurance Program (CHIP) offers health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage.
How Many People are on Medicaid?
According to the Centers for Medicare & Medicaid Services, as of November 2020, here are the number of people enrolled in Medicaid and Chip in the entire United States:
- 78,521,263 individuals were enrolled in Medicaid and CHIP
- 72,204,587 individuals were enrolled in Medicaid
- 6,695,834 individuals were enrolled in CHIP
North Carolina Medicaid
The North Carolina Medicaid program provides medical coverage to low-income individuals and families.
As of 2020, the program, along with the Children’s Health Insurance Program (CHIP) covered 1.9 million people.
This includes about 1.3 million children as shown by the image below.
The North Carolina Department of Health and Human Services’ Division of Medical Assistance (DMA) administers North Carolina’s Medicaid Programs.
Who Can Get Medicaid in North Carolina?
You should apply for Medicaid if your income is low and you match one of the descriptions below:
- You think you are pregnant
- The parent or caretaker of a child and/or teenager under the age of 19.
- You are a child or teenager age 18 or under.
- An adult age 65 or older.
- You are legally blind.
- Living with a disability or disabled.
- You are in need of nursing home care.
North Carolina Medicaid Income Limit
The North Carolina Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.
To qualify, you must meet the North Carolina Medicaid Income limits listed below.
Here is the Federal Poverty Level (FPL) for 2021.
| 2021 Federal Poverty Levels for the 48 Contiguous States & D.C. | |||
| Household Size | Poverty Guideline for 48 states & DC | Alaska | Hawaii |
| 1 | $12,880 | $16,090 | $14,820 |
| 2 | $17,420 | $21,770 | $20,040 |
| 3 | $21,960 | $27,450 | $25,260 |
| 4 | $26,500 | $33,130 | $30,480 |
| 5 | $31,040 | $38,810 | $35,700 |
| 6 | $35,580 | $44,490 | $40,920 |
| 7 | $40,120 | $50,170 | $46,140 |
| 8 | $44,660 | $55,850 | $51,360 |
| Over 8 people | add $4,540 for each additional person | $5,680 | $5,220 |
Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:
- Children up to age 1 with family income up to 210 percent of FPL
- Any child age 1-5 with a family income up to 210 percent of FPL
- Children ages 6- 18 with family income up to 133 percent of FPL
- CHIP for children with family income up to 211 percent of FPL
- Pregnant women with family income up to 196 percent of FPL
- Parents of minor children with family income up to 41 percent of FPL
- Individuals who are elderly, blind, and disabled with family income up to 100% of the FPL
North Carolina Medicaid Income Limit Charts
The North Carolina Medicaid eligibility income limit charts are divided by groups.
For example, the first chart is focused on income limits for children who qualify for Medicaid.
Similarly, the second chart below focuses on the Medicaid income limits for adults in North Carolina who qualify for Medicaid.
North Carolina Medicaid Income Limit for Children
Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.
| North Carolina Medicaid Income Limit – Children | ||||||
| Children Medicaid Ages 0-1 | Children Medicaid Ages 1-5 | Children Medicaid Ages 6-18 | Children Separate CHIP | |||
| % FPL | 100% | 210% | 210% | 133% | 211% | |
|
Household Size
|
1 | $12,880 | $27,048 | $27,048 | $17,130 | $27,177 |
| 2 | $17,420 | $36,582 | $36,582 | $23,169 | $36,756 | |
| 3 | $21,960 | $46,116 | $46,116 | $29,207 | $46,336 | |
| 4 | $26,500 | $55,650 | $55,650 | $35,245 | $55,915 | |
| 5 | $31,040 | $65,184 | $65,184 | $41,283 | $65,494 | |
| 6 | $35,580 | $74,718 | $74,718 | $47,321 | $75,074 | |
| 7 | $40,120 | $84,252 | $84,252 | $53,360 | $84,653 | |
| 8 | $44,660 | $93,786 | $93,786 | $59,398 | $94,233 | |
Next is the income limit for adults by category. Find the category you fall into and you will see the income limit by household size.
North Carolina has not expanded Medicaid to include adults without dependents.
Therefore, adults without dependents do not qualify for Medicaid in North Carolina.
For an update on the Medicaid expansion debate and timeline in North Carolina, see our North Carolina Medicaid Expansion update below.
North Carolina Medicaid Income Limit for Adults
| North Carolina Medicaid Income Limit – Adults | ||||||
| Pregnant Women Medicaid | Adults (Medicaid) Parent/ Caretaker | Seniors & People w/ Disabilities (Medicaid) | Adults (Medicaid) Expansion to Adults | |||
| % FPL | 100% | 196% | 41% | 100% | NO | |
|
Household Size
|
1 | $12,880 | $25,245 | $5,281 | $12,880 | N/A |
| 2 | $17,420 | $34,143 | $7,142 | $17,420 | N/A | |
| 3 | $21,960 | $43,042 | $9,004 | $21,960 | N/A | |
| 4 | $26,500 | $51,940 | $10,865 | $26,500 | N/A | |
| 5 | $31,040 | $60,838 | $12,726 | $31,040 | N/A | |
| 6 | $35,580 | $69,737 | $14,588 | $35,580 | N/A | |
| 7 | $40,120 | $78,635 | $16,449 | $40,120 | N/A | |
| 8 | $44,660 | $87,534 | $18,311 | $44,660 | N/A | |
How to Read the North Carolina Medicaid Income Limits Charts Above
You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.
Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.
For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 196% of the Federal Poverty Level – which for a family of two is $34,143 as shown in the chart above.
How to Apply for North Carolina Medicaid
There are 3 ways you can apply for Medicaid in North Carolina.
Option 1 – Apply online
You can apply online through the North Carolina ePASS Portal – as shown in the image below.
If you have an account, you can log in or create your North Carolina ePASS Account. Click here to be taken to the website.
The video below, from the North Carolina Department of Health and Human Services (NCDHHS) does a great job of walking you through how to apply for Medicaid online.
We highly encourage you to watch it if you are planning to apply for NC Medicaid online.
Option 2 – Apply at DSS Office Near You
You can apply in person at your local Department of Social Services (DSS) office near you. Click here to locate a DSS office.
Option 3 – Download Application
You can download an application, complete it, and mail it to your county DSS office or submit it in person.
North Carolina Medicaid Phone Number
Here’s how to contact the North Carolina Medicaid Agency:
NC Medicaid Contact Center
Phone: 1-888-245-0179
Monday-Friday 8 a.m. to 5 p.m.
Closed on State holidays.
NC Medicaid Ombudsman
ncmedicaidombudsman.org
Phone: 877-201-3750
Monday-Friday 8 a.m. to 5 p.m.
Closed on State holidays.
North Carolina Medicaid Expansion Update
North Carolina is one of 12 states that has not yet expanded Medicaid under the Affordable Care Act (ACA).
If Medicaid is expanded in North Carolina, it is estimated that 624,000 residents would become newly eligible for coverage.
Governor Cooper has long pushed for Medicaid expansion, but GOP lawmakers oppose expansion.
North Carolina’s Medicaid program is transitioning to a managed care model in 2021 after several delays.
North Carolina Medicaid Income Limits Summary
We hope this post on North Carolina Medicaid Income Limits was helpful to you.
If you have any questions about Medicaid in the state of North Carolina, you can ask us in the comments section below.
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Be sure to check out our other articles about Medicaid.
Income limits for Florida Medicaid
North Dakota Medicaid Income Limits Charts