How to apply for Medicaid in North Carolina

You apply for Medicaid through the North Carolina Department of Health and Human Services (DHHS), Division of Medical Assistance. The easiest way to start is online through the NC FAST system (North Carolina's Fast Assessment and Service Tracking), which handles Medicaid, food assistance, and cash assistance in one place. You can also apply by mail, phone, or in person at your local DSS (Department of Social Services) office.

The online application at ncfast.dhhs.nc.gov takes about 30 to 45 minutes. You will need your Social Security number, proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of residency (utility bill or lease), and proof of citizenship or legal residency. After you submit, DHHS will send you a notice by mail within 30 days telling you whether you are approved, denied, or need to provide more information.

If you apply by phone, call the NC FAST Customer Service Center at 1-855-408-3278. If you prefer to apply in person, find your county DSS office at www.ncdhhs.gov under "Find a Local Office." Processing takes the same 30 days whether you apply online, by phone, or in person.

Key Takeaways

  • North Carolina has three main Medicaid programs: regular Medicaid for low-income adults and families, Medicaid for seniors and people with disabilities, and Medicaid for pregnant people and children.
  • Income limits vary by program and family size, but generally range from about $1,400 to $2,800 per month for an individual, depending on which program you are entering.
  • You apply through NC FAST online, by phone at 1-855-408-3278, or in person at your county DSS office, and you will hear back within 30 days.
  • You will need proof of income, residency, and citizenship or legal residency status before you submit your application.
  • Once approved, your coverage usually starts on the first day of the month after you are approved, though some programs cover retroactively to the month you applied.

Income limits and family size

North Carolina Medicaid income limits depend on which program you are entering and how many people are in your household. For regular Medicaid (called NC Medicaid), the limit for a single adult is roughly 138% of the federal poverty line, which is about $1,810 per month as of 2024. For a family of three, the limit is around $3,840 per month. These figures change each year.

If you are 65 or older, blind, or disabled, you may be able to receive Medicaid under a different program with different income rules. Some of these programs allow higher income if you have high medical or long-term care costs. Pregnant people and children under 19 have their own income thresholds, which are often higher than the regular adult limit.

The best way to know your exact income limit is to enter your household size and income into the NC FAST pre-screening tool on the website, or to call 1-855-408-3278 and ask. The customer service representative can tell you in minutes whether your income falls within the range for any program.

What documents you need to bring or upload

Before you start your application, gather these documents: proof of income (most recent pay stub, tax return from the last two years, or a letter from your employer on company letterhead stating your job title and monthly pay); proof of residency (utility bill, lease, mortgage statement, or bank statement with your name and address); and proof of citizenship or legal residency (birth certificate, passport, Social Security card, or immigration documents).

If you are applying online through NC FAST, you can upload these documents directly into your application. If you apply by mail, send copies (not originals) to your county DSS office. If you apply in person or by phone, bring the originals or copies with you. DHHS will ask for additional documents only if something on your application does not match their records or if you did not provide enough proof the first time.

If you do not have a Social Security number, you can still apply, but the process takes longer because DHHS has to verify your identity through other means. Call 1-855-408-3278 to ask what documents DHHS will accept in place of a Social Security number.

Timeline from application to coverage

The standard processing time is 30 days from the day DHHS receives your complete application. If you apply online, the system time-stamps your submission immediately. If you mail your application, it is time-stamped when the DSS office receives it. If you apply in person or by phone, the office time-stamps it that day.

DHHS will send you a notice in the mail within 30 days. If you are approved, the notice will tell you your coverage start date, which is usually the first day of the month after approval. Some programs cover retroactively to the month you applied, which means you can use your Medicaid card for medical bills you paid during that month before you were officially approved.

If DHHS needs more information, they will send you a notice asking what they need and giving you 10 days to respond. If you do not respond within 10 days, your application may be denied. If you are denied, the notice will explain why and tell you how to request a hearing to appeal the decision.

Medicaid programs available in North Carolina

NC Medicaid is the main program for low-income adults, families, and children. You must have income below 138% of the federal poverty line and be a North Carolina resident. This program covers doctor visits, hospital stays, prescription drugs, and preventive care.

Medicaid for Seniors and People with Disabilities (called SSI-related Medicaid) covers people 65 and older or people under 65 who are blind or disabled and receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Income limits are higher for this group, and some people can have assets and still be covered.

Medicaid for Pregnant People and Children covers pregnant people and children under 19 with income up to 211% of the federal poverty line. This program starts before birth and continues through the end of the month after the baby is born (for the pregnant person) and through age 18 for the child.

Emergency Medicaid covers emergency medical conditions for people who would otherwise be uninsured, including undocumented immigrants. It covers only the emergency visit itself, not ongoing care. You do not have to apply in advance; the hospital or emergency room will determine whether you are covered at the time of treatment.

What to do if you are denied

If DHHS denies your application, the denial notice will explain the reason. Common reasons include income above the limit, not providing proof of residency or citizenship, or not being a North Carolina resident. Read the notice carefully to see which reason applies to you.

You have the right to request a hearing to appeal the denial. The notice will tell you how to request a hearing and the deadline (usually 30 days from the date of the notice). You can request a hearing by mail, phone, or online through the NC FAST system. At the hearing, you can present new documents or explain why you think the decision was wrong.

If your income is slightly above the limit, ask whether you are close enough to be reconsidered or whether you might be covered under a different program. If you did not provide enough proof the first time, you can reapply with better documentation. If your circumstances have changed since you applied (you lost a job, your household size changed, or you moved), you can apply again and your new application will be processed as a new case.

How to renew your Medicaid coverage

North Carolina Medicaid requires renewal every 12 months. DHHS will send you a renewal notice in the mail about 30 days before your coverage expires. The notice will tell you how to renew: online through NC FAST, by mail, by phone, or in person at your DSS office.

To renew, you will need to provide updated proof of income and residency. If nothing in your household has changed (same income, same address, same family members), you can often renew by simply confirming that information online or by phone. If your circumstances have changed, you will need to provide new documents.

If you do not renew by the deadline on your notice, your coverage will end. If you miss the deadline but renew within 30 days after your coverage ends, there may be a gap in coverage. If you renew more than 30 days late, you will have to reapply as a new case and wait another 30 days for processing.

Frequently Asked Questions

Can I apply for Medicaid if I am working?

Yes. North Carolina Medicaid covers working people as long as your total household income is below the limit for your program. Some working people with disabilities can earn more and still keep Medicaid through a program called Medicaid Buy-In for Workers with Disabilities. Call 1-855-408-3278 to ask whether this program might work for you.

What if I do not have a permanent address?

You can still apply. Use a shelter address, a friend's or family member's address, or a mailing address where you can receive mail. You will need to provide proof that you are using that address (a letter from the shelter, a statement from the person whose address you are using, or mail addressed to you at that location). DHHS will send all notices to the address you provide on your application.

How do I know if I have been approved?

DHHS will send you a notice in the mail. If you applied online, you can also log into your NC FAST account to check your application status. If you applied by phone or in person, you can call 1-855-408-3278 to ask whether a decision has been made. Do not wait for a notice before using your coverage; if you are approved, your coverage usually starts on the first day of the month after approval.

What if my income changes after I am approved?

Report the change to DHHS as soon as possible. You can report it online through NC FAST, by phone at 1-855-408-3278, or in person at your DSS office. If your income goes up, you may lose coverage or have to pay a small amount toward your care. If your income goes down, you may be covered under a different program with better benefits. DHHS will send you a new notice explaining any changes to your coverage.

Can I use my Medicaid card right away after I am approved?

Your coverage usually starts on the first day of the month after DHHS approves your application. You will receive a Medicaid card in the mail within one to two weeks of your coverage start date. If you need care before your card arrives, you can give your doctor or hospital your Medicaid number (which will be in your approval notice) and they can verify your coverage by phone or online.