Know What’s Next for Medicaid Changes Starting October 1

The North Carolina Department of Health and Human Services released a toolkit to share information about new rules for NC Medicaid. The Know What’s Next toolkit includes flyers, social media posts, a rack card and a wallet card in English and Spanish.

Community organizations can request printed materials at no cost by completing the online ordering form by September 11, 2026. The new rules are due to changes in federal legislation from H.R. 1, signed into law by President Trump in July 2025, and from changes in state law passed by the North Carolina General Assembly. Changes include, but are not limited to, a work requirement for people covered by Medicaid expansion, twice-a-year redetermination for people on Medicaid expansion, and changes for coverage for non-citizens.

“These upcoming federal changes that will impact NC Medicaid put hundreds of thousands of people at risk of losing critical health care coverage,” said North Carolina Health and Human Services Secretary Dev Sangvai. “This toolkit gives community and state partners the ability to communicate these changes to ensure people who are eligible for care stay informed, so they continue to receive the care they need.”

Know What's Next 

For adults ages 19 through 64 without a disability who receive Medicaid through expansion, new rules start on January 1, 2027. They will need to earn $580 each month per household to keep Medicaid or prove they are working, go to school or volunteer for 80 hours each month. People who do not meet the new rule may lose full Medicaid benefits, including coverage to go to doctors or dentists, get prescriptions or receive mental health care.

Some people will not have to meet the new work requirements, including:  

• Parents, guardians, caretaker relatives or family caregivers for a child under age 14 or a person with a disability  
• Anyone who has been determined by NC Medicaid as having a disability 
• Women who are pregnant or were pregnant in the last 12 months 

There are many other exceptions. More information is available at Medicaid.nc.gov/changes, and people can contact their local Department of Social Services (DSS) to find out if the new rules apply to them.

Medicaid renewals are also changing for people with Medicaid expansion. Starting January 1, 2027, most adults ages 19 through 64 will renew their Medicaid every six months instead of once per year. When it is time for people to renew, their local DSS will mail them a letter if they need additional information.

For non-U.S. citizens, new federal rules begin on October 1, 2026. Only the following non-citizens will be eligible for Medicaid:

• Lawful permanent residents (people with a green card)  
• Children up to age 19 and women who are pregnant or within 12 months postpartum (after birth), who are lawfully residing in the United States but do not have permanent immigration status 
• People with Cuban or Haitian entrant status  
• Citizens of the Freely Associated States (Micronesia, Marshall Islands or Palau) living in the U.S. 

There are five steps people can take now.

1. See if the work requirements apply to you. Visit medicaid.nc.gov/changes or contact your local DSS.  
2. Make sure your local DSS has your correct address and phone number.  
3. Respond to any letter as soon as you get it.  
4. Save important papers. Keep things like pay stubs, school records and volunteer logs, benefit letters or medical records which may be needed as proof to keep your Medicaid coverage. 
5. Create an enhanced ePASS account if you do not already have one. You can use it to upload documents to show proof of work, school or volunteer activities.