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Impact of H.R. 1 and Federal Changes to Medicaid

NC Medicaid is Changing. Know What’s Next.

New federal rules start on January 1, 2027. Most adults ages 19-64 without a disability will need to work, go to school or volunteer for 80 hours each month to keep Medicaid, or earn at least $580 per household each month. This is called the work and community engagement rule.

If you do not meet the new requirements, you may lose full Medicaid benefits.

This includes coverage to go to doctors or dentists, get prescriptions or receive mental health care. 

Some people will not have to meet the new work and community engagement rule. For example, you may not have to meet the new rules if you:

  •  Are a parent, guardian, caretaker relative or family caregiver for a child under age 14 or a person with a disability
  • Have been determined by NC Medicaid as having a disability yourself
  • Are pregnant or were pregnant in the last 12 months

There are many exceptions. If you are not sure, contact your local Department of Social Services (DSS). Find out whether the new rules apply to you at medicaid.nc.gov/changes.

If this rule applies to you, and you do not qualify for an exception or exclusion, starting January 1, 2027, you will need to do one of the following each month:

  • Earn at least $580 per household each month OR
  • Complete 80 hours of approved activities per household 

Approved activities can include:

  • Working at a job or for yourself
  • Doing an internship
  • Being in a work training program
  • Some kinds of unpaid work
  • Going to school at least half-time
  • Volunteering or doing community service 

You can combine any of the approved activities. This means your 80 hours can be made up of work, school and volunteering.

  1. See if the work or activity rules apply to you. Visit medicaid.nc.gov/changes or contact your local Department of Social Services (DSS).
  2. Make sure your local DSS has your correct address and phone number. Your local DSS will send you a letter if they need information from you. If your address is wrong, you could lose your Medicaid without knowing why.
  3. Respond to any letter as soon as you get it. Letters from your local DSS will have deadlines. Make sure to read and reply to every notice you get.
  4. Start saving important papers. Keep things like pay stubs, school records and volunteer logs, benefit letters or medical records.
  5. Create an enhanced ePASS account if you do not already have one. You can use it to upload documents if Medicaid asks you to show proof of your work, school or volunteer activities. 

Medicaid renewals are changing. Starting January 1, 2027, most adults ages 19 through 64 will renew their Medicaid every 6 months instead of once a year. When it is time for you to renew, your local DSS will mail you a letter if they need information from you.

Changes are happening to these benefits now. Learn more at ncdhhs.gov/FNS.

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