How to apply for health insurance under North Carolina’s Medicaid expansion

Gov. Roy Cooper of North Carolina signed the Medicaid expansion law in March. (AP Photo/Hannah Schoenbaum)

By Michael McElroy

December 1, 2023

After a decade of delay, Medicaid expansion is official in North Carolina. Here’s a guide on who can apply and how to do it most easily.

Today is the day.

After nearly a decade of Republican delay and resistance, North Carolina has officially expanded Medicaid. As of today, Friday, Dec. 1, some 600,000 North Carolinians who made too much to previously apply for federal health insurance, but too little to afford it on their own, can enroll.

If you already have Medicaid, you don’t need to do anything at all and should feel free to stop reading now. But if you have questions about whether you’re eligible, how to apply, and why you should apply, this post is for you.

Who Can Apply?

You can enroll in Medicaid if you are:

  • A North Carolina resident.
  • 19 to 64 years old.
  • A citizen (some non-U.S. citizens can get health coverage through NC Medicaid).
  • Meet the following annual income metrics before taxes:

Single adult – earn $20,120 or less

Family of 2 – earn $27,214 or less

Family of 3 – earn $34,307 or less

Family of 4 – earn $41,400 or less

Family of 5 – earn $48,493 or less

Family of 6 – earn $55,586 or less

About 300,000 people already enrolled in the state’s Family Planning Medicaid program for reproductive health services will be automatically enrolled in the full program. Those automatically enrolled will get a confirmation letter from their local Department of Social Services.

Why Apply?

Medicaid pays for a significant range of healthcare services.

It covers doctor visits, preventative care, hospital stays, maternity care, vision and hearing, dental services, yearly check-ups, emergency care, mental health care, substance abuse treatment, and lots of other things. These services come free or at low cost.

Medicaid expansion has saved lives in the other states and prevented many rural hospitals from closing.

How to Apply

The fastest and most convenient way is online. There are a couple of steps, but you won’t have to go anywhere in person and claims are usually processed faster this way. You can apply through the state’s secure ePASS website here. (Here’s a step-by-step ePASS guide and you’ll also need a North Carolina ID account, which you can set up here.)

You can also apply in person at your local Department of Social Services (find yours here). You can also mail them your paper application, but this will take longer, of course.


However you apply, here’s what you’ll need to provide as part of your application::

  • Certified birth certificates or other proof of citizenship/immigration status
  • Social Security cards or valid numbers. (If you applied for a number but don’t yet have it, you can provide proof of the application.)
  • Two separate proofs of residency
  • Pay stubs from the last month
  • All existing medical or life insurance policies
  • A list of all vehicles owned by members of the household, including make, model, year, and VIN
  • Your most recent bank statements
  • Complete list of any property owned
  • Documents from all sources of income, including Social Security and other federal benefits

If you don’t have all the information, officials with the North Carolina Department of Health and Human Services say to sign and submit the application anyway. They will follow up in a couple of weeks.

The total process can take about 45 days, officials said.

If you don’t hear back within that time frame, you can call 1-888-245-0179.

What took so long?

President Barack Obama’s Affordable Care Act opened the door for Medicaid in 2010. Ninety percent of the costs of expansion are paid for by the federal government, but North Carolina was one of only 10 states to refuse to opt into the expansion.

State Republicans blocked any expansion efforts, despite widespread support from medical groups, Democrats, and Gov. Roy Cooper.

The popularity of expansion became too big to ignore however, especially in many conservative rural areas, and many state Republicans buckled this year, titling the momentum

An incentive in President Biden’s 2021 American Rescue Plan tipped things the rest of the way.

The law offered additional financial support for the states that had still not expanded Medicaid, including a “signing bonus” the states could use however they wanted.

Republicans signed on and the legislature passed expansion in March, even if they tied its implementation to the final adoption of the unrelated state budget, which didn’t become law until October.

As of today, that resistance and delay are over.

“Many eligible folks work 2 jobs, take care of kids and parents, and live busy lives,” North Carolina Health and Human Services Secretary Kody Kinsley wrote on Twitter on Thursday.

The effort to expand Medicaid was a “marathon,” he wrote, but the work is not done. Just because someone is eligible, doesn’t mean they know they are, and hundreds of thousands of residents who are now eligible for coverage—but who won’t be automatically enrolled—will have to apply.

State health officials will increase their communication efforts to reach these individuals, Kinsley said.

“This week. Next week. Next year. We’re working with civic orgs and faith leaders to spread the word and get folks covered,” Kinsley added.


  • Michael McElroy

    Michael McElroy is Cardinal & Pine's political correspondent. He is an adjunct instructor at UNC-Chapel Hill's Hussman School of Journalism and Media, and a former editor at The New York Times.


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