Access to healthcare should be simple, affordable, and available to those who need it most. If you live in North Carolina and are trying to find out whether you or your family qualify for Medicaid, this is the right place.
NC Medicaid Eligibility Calculator
What Is NC Medicaid?
NC Medicaid is a health coverage program jointly funded by the federal and state governments. It provides health insurance to low-income individuals and families in North Carolina. It includes programs like:
- Medicaid for Families and Children
- Medicaid for Pregnant Women
- Medicaid for the Aged, Blind, and Disabled
- NC Health Choice (CHIP)
- Long-Term Care Medicaid
Who Is Eligible for Medicaid in North Carolina?
Eligibility is based on:
- Household income (as a % of the Federal Poverty Level)
- Family size
- Age
- Pregnancy status
- Disability or health condition
- Residency status (must live in NC)
- Citizenship or qualifying immigration status
Income Limits (2025 Estimates)
| Household Size | Pregnant Women & Children | Adults (Ages 19–64, Expanded Medicaid) | Seniors/Disabled |
|---|---|---|---|
| 1 | $2,217/month | $1,677/month | ~$1,255/month |
| 2 | $2,994/month | $2,268/month | ~$1,703/month |
| 3 | $3,771/month | $2,859/month | ~$2,151/month |
| 4 | $4,548/month | $3,450/month | ~$2,599/month |
Figures vary slightly by program. Use the calculator for the most accurate eligibility check.
How to Use the NC Medicaid Eligibility Calculator
The calculator is designed for speed, accuracy, and ease of use. Follow these steps:
Step-by-Step Instructions:
- Enter Your Household Size:
Include yourself, your spouse, children, and anyone else you financially support. - Input Total Monthly Income:
Include wages, self-employment, Social Security, retirement, etc. - Select Your Age Range or Category:
- Child
- Pregnant woman
- Adult (19–64)
- Senior (65+)
- Person with a disability
- Click “Calculate”
- Get Your Result:
The calculator will instantly display:- Whether you qualify for Medicaid or NC Health Choice
- Which program you qualify for
- Recommendations for next steps (e.g., applying online)
Eligibility Formula Explained (Plain Text)
The calculator uses Federal Poverty Level (FPL) thresholds and Medicaid program rules from North Carolina.
Basic Formula:
Monthly Income Limit = (FPL % × Annual Federal Poverty Line) ÷ 12
Where:
- FPL% = Varies by category (e.g., 138% for adults, 196% for pregnant women)
- Household size = Number of family members
Example: For an adult in a 2-person household:
$20,783 × 138% = $28,679.54 ÷ 12 ≈ $2,389/month income limit
If your income is below the limit, you likely qualify.
Example Scenarios
Example 1: Single Adult, No Kids
- Age: 30
- Household size: 1
- Monthly income: $1,600
- Category: Adult (19–64)
Result: Eligible for Medicaid under NC’s expansion (below 138% FPL)
Example 2: Pregnant Woman with One Child
- Household size: 3
- Monthly income: $3,500
- Category: Pregnant
Result: Income under 196% FPL → Eligible for Pregnant Women’s Medicaid
Benefits of Using the Calculator
✅ Fast eligibility check
✅ Avoids complex government charts
✅ Tailored to North Carolina rules
✅ Mobile and desktop friendly
✅ No personal data saved
✅ Helps you prepare before applying
Where to Apply If Eligible
If the calculator says you're likely eligible, apply here:
- NC ePASS Portal: https://epass.nc.gov
- Call NC Medicaid at 1-800-662-7030
- Visit your local Department of Social Services (DSS)
20 Frequently Asked Questions (FAQs)
1. What is the NC Medicaid Eligibility Calculator?
It’s a tool that checks if you qualify for Medicaid in North Carolina based on your income and household size.
2. Is this calculator official?
No, it's for guidance only—but it uses official NC Medicaid thresholds.
3. Can I use it if I’m pregnant?
Yes. It considers special eligibility limits for pregnant women.
4. Does the calculator apply to children?
Yes. It checks eligibility for children’s Medicaid or NC Health Choice (CHIP).
5. What’s the income limit for adults in 2025?
Approximately 138% of FPL, or ~$1,677/month for one person.
6. Does it include Social Security income?
Yes. You must include all income sources in your total.
7. What’s the difference between Medicaid and NC Health Choice?
Medicaid = for low-income families; NC Health Choice = for children above Medicaid limits but still low-income.
8. Can seniors qualify?
Yes, with income and asset limits. The calculator estimates eligibility based on monthly income.
9. Does North Carolina have Medicaid expansion?
Yes. As of 2024, NC expanded Medicaid to cover adults earning up to 138% FPL.
10. Can I apply for Medicaid online?
Yes, through the ePASS portal.
11. Does the calculator check asset limits?
No. It focuses on income. Some programs, especially for seniors, include asset tests.
12. Is this calculator secure?
Yes. It does not store any personal or financial data.
13. Can undocumented immigrants use Medicaid?
No. Most programs require U.S. citizenship or lawful residency.
14. Can I appeal if I’m denied?
Yes. You can request a hearing through your local DSS office.
15. What if my income is slightly over the limit?
You may qualify for other options like marketplace subsidies or NC Health Choice.
16. Can I use the calculator for long-term care Medicaid?
Only for income estimation. Long-term care also involves asset testing and different eligibility.
17. Can I apply for my children only?
Yes. You can apply for kids under Medicaid or NC Health Choice even if adults don’t qualify.
18. Does Medicaid cover dental in NC?
Limited dental services are available, mainly for children and some adults.
19. Is the calculator mobile-friendly?
Yes. It’s optimized for smartphones and tablets.
20. What happens after I qualify?
You’ll receive a Medicaid card and coverage will begin, often retroactively.
Conclusion
The NC Medicaid Eligibility Calculator offers a fast, convenient way to determine whether you qualify for Medicaid in North Carolina. By analyzing your income, household size, and status, it eliminates confusion and gives you clear answers in seconds.