CHARLOTTE, N.C. (WBTV) – Sweeping federal changes to Medicaid are set to start rolling out this year, affecting roughly one in every four North Carolinians.
Over the coming months, enrollees will face tighter eligibility rules for noncitizens, followed by new work mandates and twice-yearly renewals.
The changes stem from H.R. 1, a major federal budget law also known as the “One Big Beautiful Bill,” which President Donald Trump signed into law in July 2025.
Starting in October 2026, the bill will set stricter requirements for Medicaid beneficiaries across North Carolina and 39 other states that expanded Medicaid under the Affordable Care Act.
What is Medicaid? Medicaid is the government-funded program that provides health insurance for low-income residents, covering essential care including doctor visits, prescription drugs, hospital stays, laboratory tests and emergency services.
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Which noncitizens can get Medicaid?
Starting Oct. 1, officials say many people who are not U.S. citizens could lose their Medicaid coverage.
Noncitizens can get or keep Medicaid if they belong to the following groups:
Lawful permanent residents with green cards (most green card holders must wait five years before they qualify)Children lawfully residing in the U.S. who are younger than 19Women lawfully residing in the U.S. who are pregnant or who gave birth within the past 12 monthsCubans or Haitians with entrant statusCitizens of the Federated States of Micronesia, the Republic of the Marshall Islands or the Republic of Palau
People lawfully present in the U.S. without permanent residency status may no longer qualify for Medicaid, including refugees and people granted asylum.
People with temporary lawful status — such as those on student visas and work visas — were already ineligible for public health benefits like Medicaid and SNAP food assistance.
Emergency Medicaid: Some noncitizens may still receive coverage through Emergency Medicaid, a limited program that covers the cost of emergency care regardless of immigration status for “true medical emergencies,” provided patients meet income and other eligibility criteria. Click here for more information.
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Work requirements: 80 hours or $580 a month
Starting Jan. 1, 2027, most adults ages 19 to 64 will be subject to a new “work and community engagement requirement” to keep their coverage.
The new rule requires enrollees to complete at least 80 hours a month of work, school, job training or community service. Individuals can also satisfy the requirement if they earn at least $580 a month before taxes.
Faster renewal: The work mandate will take effect alongside a faster renewal schedule. Medicaid beneficiaries will have to renew coverage every six months instead of once a year. People seeking renewal will also be required to meet the work requirement for at least three of the six months leading up to each recertification.
For example, an enrollee renewing in July 2027 would need to have met the work requirement for any three months between January and June of that year.
If someone loses their Medicaid coverage and is unable to appeal the decision, they will need to meet the work and community engagement requirement for three consecutive months before reapplying.
State officials said enrollees can contact the North Carolina Medicaid Ombudsman, an independent office that helps recipients understand Medicaid coverage, notices and bills.
The following organizations may also be able to help:
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Enrollees who do not meet the work requirement or qualify for an exemption may lose their Medicaid benefits, officials said.
The following groups are exempt from the requirement:
People with disabilitiesParents or caretakers of children younger than 14Women who are pregnant or who were pregnant within the last 12 months
Individuals with complex medical conditions may also qualify for an exemption even if their condition is not explicitly listed, according to the North Carolina Department of Health and Human Services.
Retroactive coverage: Also starting Jan. 1, 2027, the window of time Medicaid will retroactively pay for health care costs before an application is submitted will shrink from the current three months.
Those who qualify for retroactive coverage include:
Most adults ages 19 through 64 who do not have a disability: Medicaid will cover up to one month of health care costs incurred before an application is submitted.Children, adults 65 and older, and people with disabilities: Medicaid will cover up to two months of health care costs incurred before an application is submitted.
For anyone who applies by Dec. 31, 2026, Medicaid will still cover approved costs for up to three months prior to the application date.
North Carolina expanded Medicaid in 2023 to low-income adults who previously earned too much to qualify for traditional coverage.
Nearly 735,000 North Carolinians have enrolled in Medicaid since that expansion.
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