North Carolina Medicaid Office
Find North Carolina Medicaid contact information, eligibility requirements, income limits, and how to apply.
North Carolina Medicaid agency
- Agency
- NC Department of Health and Human Services, Division of Health Benefits
- Website
- https://medicaid.ncdhhs.gov
- Phone
- 1-888-245-0179
- Address
- 2501 Mail Service Center Raleigh, NC 27699-2501
- Hours
- NC Medicaid Contact Center: 1-888-245-0179 (TTY 711 or RelayNC.com)
NC Medicaid office (NC DHHS)
NC Medicaid provides health coverage to eligible low-income adults, children, pregnant women, seniors, and people with disabilities across North Carolina. Coverage is now available to more people, including single adults ages 19 through 64 under the state's Medicaid expansion. The agency is administered by NC Department of Health and Human Services (NC DHHS); the consumer-facing site at medicaid.ncdhhs.gov is the front door for applicants, members, and providers.
How to reach NC Medicaid
- NC Medicaid Contact Center — 1-888-245-0179 (TTY 711 or RelayNC.com) for general questions, eligibility questions, and to find your local Department of Social Services. Help is available in other languages.
- ePASS — epass.nc.gov is the secure online application portal (on the application, NC Medicaid appears as "Medical Assistance").
- Local Department of Social Services (DSS) — every county has a DSS office for in-person application help. Use the directory at ncdhhs.gov/localDSS.
- NC Navigator — free help completing an application or exploring health insurance options at 1-855-733-3711.
- Medicaid Ambassadors — trained community members who can guide an applicant through ePASS (they can't complete the application for you).
NC Medicaid posts notice of federally mandated changes — including H.R. 1 — that will affect eligibility rules and how Medicaid operates. Members should keep their contact information current with the local DSS so any change notices reach them.
Who qualifies for NC Medicaid?
NC Medicaid eligibility runs on three basic requirements: U.S. citizenship or an eligible immigration status, North Carolina residency, and a Social Security number (or proof of application for one if eligible). Families that include non-U.S. citizens can still apply — applying does not affect immigration status or chances of becoming a permanent resident or citizen, and a parent can apply for a child even when the parent isn't eligible.
Who may qualify
- Pregnant individuals (highest income ceiling among the standard categories)
- Children ages 0 through 18
- Adults ages 19 through 64 (single adults now qualify since NC expansion)
- Adults age 65 and older (full Medicaid uses one income limit; other older-adult Medicaid programs use a higher one)
- Anyone who needs family planning services only (a higher-income family-planning category)
- People with certain health needs — including physical or cognitive disabilities, traumatic brain injury, or breast or cervical cancer — who may qualify under special coverage categories
Eligibility is a general guide
NC Medicaid frames its published income limits as "a general guide" and tells uncertain applicants to apply anyway: a caseworker will review the application to see what is available and whether deductions could push the household under a limit it would otherwise miss. There's no penalty for applying.
Need help comparing your household to the limits?
Call the NC Medicaid Contact Center at 1-888-245-0179 (TTY 711) to find your local Department of Social Services. Local DSS staff can walk through the eligibility tables, answer language-specific questions, or schedule a phone or in-person interview.
NC Medicaid income limits (current until April 1, 2026)
NC Medicaid publishes monthly income limits by household size and category. The figures below come directly from the agency's current eligibility chart; NC notes the numbers are current until April 1, 2026, after which they refresh with the annual federal poverty update. All dollar amounts are before taxes.
How to count your household
Include yourself, your spouse, your children under age 21 (including stepchildren), and anyone else who appears on the same federal income tax return (including children over 21 who are claimed as a parent's dependent). You do not need to file taxes to get coverage. Don't include parents you live with who file their own return (if you're over 21) or other adult relatives filing separately. For a pregnant person, don't add the unborn child on this page.
Family size of 1
| Category | Monthly income limit |
|---|---|
| Pregnant person (includes one unborn child) | $3,535 or less |
| Child ages 0 through 18 | $2,807 or less |
| Adult ages 19 through 64 | $1,835 or less |
| Adult 65+ — full Medicaid | $1,330 or less |
| Adult 65+ — other Medicaid programs (additional requirements apply) | $1,796 or less |
| Anyone — family planning services only | $2,594 or less |
Family size of 2
| Category | Monthly income limit |
|---|---|
| Pregnant person (includes one unborn child) | $4,463 or less |
| Child ages 0 through 18 | $3,806 or less |
| Adult ages 19 through 64 | $2,399 or less |
| Adult 65+ — full Medicaid | $1,804 or less |
| Adult 65+ — other Medicaid programs | $2,435 or less |
| Anyone — family planning services only | $3,517 or less |
Family size of 3
| Category | Monthly income limit |
|---|---|
| Pregnant person | $5,390 or less |
| Child ages 0 through 18 | $4,804 or less |
| Adult ages 19 through 64 | $3,141 or less |
| Anyone — family planning services only | $4,440 or less |
Family size of 4
| Category | Monthly income limit |
|---|---|
| Pregnant person | $6,318 or less |
| Child ages 0 through 18 | $5,803 or less |
| Adult ages 19 through 64 | $3,795 or less |
| Anyone — family planning services only | $5,363 or less |
Family size of 5
| Category | Monthly income limit |
|---|---|
| Pregnant person | $7,246 or less |
| Child ages 0 through 18 | $6,802 or less |
| Adult ages 19 through 64 | about $4,449 or less |
| Anyone — family planning services only | $6,285 or less |
These tables update annually. Verify the current numbers at medicaid.ncdhhs.gov/eligibility or by calling the NC Medicaid Contact Center at 1-888-245-0179 before relying on a specific figure.
How to apply for NC Medicaid
NC Medicaid lists four ways to apply: online through ePASS, in person at a local Department of Social Services, by phone to your local DSS, or by mail, email, fax, or drop-off using the printable application. You can apply at any time of year, and free help is available in other languages. If you have a disability and need communication assistance, the NC Medicaid Contact Center reaches you through 1-888-245-0179 (TTY 711 or RelayNC.com).
Online: ePASS
Apply at epass.nc.gov. ePASS is North Carolina's secure benefits portal; you'll need an NCID (the state's standard government-services login) to begin. On the ePASS application, NC Medicaid appears as "Medical Assistance." A step-by-step video and fact sheet are linked from the apply page. NC also accepts Medicaid applications through HealthCare.gov.
In person at a local DSS
Every county runs a Department of Social Services. Walk-ins are accepted at all local offices, and you can call ahead to schedule an in-person or phone interview (the agency recommends scheduling). Bring the documents listed below if you have them. Interpreters are available — ask the operator when you call.
By phone
Call your local Department of Social Services to apply by phone. Use the directory at ncdhhs.gov/localDSS or call the NC Medicaid Contact Center at 1-888-245-0179 to find the right office.
By mail, email, fax, or drop-off
Download, print, and fill out the application; sign it; then mail, email, fax, or hand-deliver it to your local DSS. The standard form is DHB-5200-ia. If you're a single adult with no dependents and no employer-sponsored health coverage, use the short form (DHB-5201-ia).
Other forms that may apply
- Health Coverage from Jobs — Appendix A (DMA-5202-A) when someone in your household has coverage available through a job.
- American Indian or Alaska Native Family Member — Appendix B (DMA-5202-B) when applicable.
- Designation of Authorized Representative — Appendix C (DHB-5202C-ia) to let someone act on your behalf.
- Income/Resources — Appendix D (DMA-5202D-ia) when applying for NC Medicaid for the Aged, Blind, or Disabled, long-term care, or in-home services.
- Medical Bills — Appendix E (DHB-5202E-ia) when asking for coverage of past medical bills.
What to gather
At minimum you need a full legal name and date of birth for at least one applicant, a mailing address, and a signature. Documents that speed up processing include proof of NC residency (photo ID with address, utility bill, lease or mortgage, vehicle registration, employment documentation), proof of income (pay stubs, employer verification, or most recent tax return), proof of date of birth, an SSN card or proof of application, proof of citizenship (birth certificate or passport), and a copy of any VISA or immigration card for non-citizens.
After you apply
DSS may contact you for more information — keep your address and phone number current. NC Medicaid can take up to 45 days to decide an application; disability applications can take up to 90 days. You'll receive an approval or denial letter by mail.
What NC Medicaid covers
NC Medicaid runs on a managed care model. Most members enroll in a Standard Plan that covers physical health, integrated behavioral health, and pharmacy. Members with more complex needs — serious mental illness, severe substance use disorder, intellectual or developmental disabilities, or traumatic brain injury — may enroll in a Tailored Plan instead, which adds specialized behavioral health and home and community-based supports.
Tailored Plans for more complex health needs
Tailored Plans are a kind of NC Medicaid Managed Care health plan that cover doctor visits, prescription drugs, and services for serious mental health, severe substance use, I/DD, and TBI all in one plan. They are "tailored" for people who have more complex health needs and who need long-term rehabilitation and care, either in a treatment facility or at home. Tailored Plans started July 1, 2024.
Services available through Tailored Plans can include:
- Home and community-based services (NC Medicaid 1915(i))
- Long-term rehabilitation and treatment services, including in-home services
- Support for recovering from substance use disorders
- Support for members with traumatic brain injury and people with intellectual and developmental disabilities
- Institutional and community-based mental health treatment
- A Tailored Care Manager who can schedule appointments, arrange transportation, and more
- Help moving out of a treatment facility and into your own home
- Caregiver breaks (respite)
- Coaching to help find and keep a job
If you are on the NC Innovations Waiver, the TBI Waiver, ICF-IID (Intermediate Care Facility for Individuals with Intellectual Disabilities), Transitions to Community Living (TCL), or state-funded (non-Medicaid) services, you must be on a Tailored Plan. Tailored Plans are the only Medicaid health plan that offer the NC Innovations Waiver or the TBI Waiver.
The four Tailored Plans (LME/MCOs)
Each county is served by a Tailored Plan that is also known as the Local Management Entity / Managed Care Organization (LME/MCO). Assignment follows the county that administers your NC Medicaid. You can call any of them with questions, even if you are not a member:
- Alliance Health — 1-800-510-9132 (TTY 711 or 1-800-735-2962)
- Partners Health Management — 1-888-235-4673 (TTY 711)
- Trillium Health Resources — 1-877-685-2415 (TTY 711)
- Vaya Total Care — 1-800-962-9003 (TTY 711)
Transportation to medical appointments
Like other Medicaid health plans, Tailored Plans offer free, accessible transportation to and from Medicaid appointments (Non-Emergency Medical Transportation, or NEMT). To schedule rides, call your plan.
How to get a Tailored Plan
- Apply for NC Medicaid (skip this step if you already have it).
- Eligibility for the Tailored Plan is automatically reviewed; letters are sent in the mail from your Tailored Plan letting you know if you're eligible.
- You can ask to move to a Tailored Plan by submitting the form "Request to Move to NC Medicaid Direct or LME/MCO."
For eligibility or assignment questions, contact the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY 711 or RelayNC.com). The Enrollment Broker is open 7 a.m. to 7 p.m. Monday through Friday.