NC Medicaid Rules That Change

At 18, your child can manage their NC Medicaid benefits and make medical decisions privately. You won’t have access to your child’s medical records unless they authorize it. That's why it's important to teach your child how to make health decisions and manage benefits now, so that they will know how to do so later.

Income-Based NC Medicaid

Children 18 or younger can get NC Medicaid for children, whether or not they have a disability, if their household's income is 216% of the Federal Poverty Guidelines (FPG) or less ($5,787 per month or less for a family of four).

When your child turns 19, they are no longer eligible for NC Medicaid for children and must meet regular NC Medicaid requirements. For adults, the income limit for income-based NC Medicaid is 138% of FPG ($1,800 per month if you are single; $3,697 per month for a family of four).

Note: If you don’t claim your child as a dependent on your taxes after they turn 19, NC Medicaid may consider them a single person living alone instead of a member of your household, even if they still live in your house.

If your child doesn’t qualify for income-based NC Medicaid as an adult, look into other health coverage options:

• If you or your child’s other parent can get employer-sponsored coverage, your child can be on that plan until they turn 26.
• If employer-sponsored coverage is not available, your child can buy an individual plan on HealthCare.gov and may get tax subsidies to help pay for it.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,650
	$5,500
	$15,060
	$5,380
	216
Income-based NC Medicaid, adults (138% FPG)
NC Medicaid for children (216% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). Disability-based NC Medicaid eligibility is not included here. For private plans with subsidies, your monthly premium amount depends on your income.

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Rules that Don't Change At 18 or 19

Most other eligibility rules for NC Medicaid and private health insurance don't change when your child turns 18 or 19:

• Disability-Based NC Medicaid covers children and adults who get Supplemental Security Income (SSI) benefits and some low-income people with disabilities who don't get SSI.
  • Note: It may be easier for your child to qualify for SSI and disability-based NC Medicaid as an adult, because parental income is no longer counted and does not affect eligibility.
• Health Coverage for Workers with Disabilities (HCWD) covers people who are 16 to 64 years old, have a disability, work, and have more income or resources than the disability-based NC Medicaid limit.
• Employer-sponsored coverage through your job or your child’s other parent's job must allow your children to be on the plan until their 26th birthday.
• Individual coverage from HealthCare.gov is an option for children and adults who do not have access to other health coverage.
  • Your child may qualify for government subsidies to help pay for a plan if your household income is over 138% of FPG and they can't get affordable employer-sponsored coverage.