Medicaid's new work requirements will begin to be enforced in January 2027 and could affect thousands of adults in North Carolina enrolled in the program. program expansion, including hundreds of Hispanics.
According to data from the North Carolina Department of Health and Human Services (NCDHHS), Updated on August 1, 2026There are a total of 704,903 people enrolled in the Medicaid expansion as of December 1, 2023.
Of these, 74,090 are Hispanic (10%), a figure that has increased compared to April 2025, when there were 61,708 enrolled in the expansion.
Currently, there are a total of 3,051,942 people enrolled in Medicaid in North Carolina, of which 314,466 are Hispanic.
They urge people to prepare.
North Carolina experts recommend that users prepare now, keep their information updated with the Department of Social Services (DSS), and respond promptly to any document requests.
During an online seminar organized by the National Health Law Program (NHelp), Medicaid specialists explained that new rules Not only will they require proof of income, work, studies, or community activities in some cases, but they will also increase the number of procedures and renewals that beneficiaries will have to complete.
It affects adults enrolled in the expansion
Medicaid's new work requirements represent one of the most significant changes the public health program in North Carolina will face since the expansion of coverage in 2023.
The new rules will primarily affect adults aged 19 to 64. inscribed during the expansion of the program.
Experts emphasized that not everyone with Medicaid will have to comply. Those covered under other categories, such as many parents of minors, people with Medicare or some beneficiaries with disabilities, will not be subject to these requirements.
Therefore, one of the first pieces of advice from experts is to confirm under which category each person is enrolled, since that information does not appear on the Medicaid card.
Ways to meet the requirement
Beneficiaries will be able to demonstrate compliance with the new work requirement rules in various ways.
The lawyers present at the seminar emphasized that one of the simplest requirements will be that the household has at least $580 per month of accountable income.
“If the Medicaid family unit reaches that amount, all its members will automatically be considered compliant, without needing to demonstrate work hours,” they said.
Other ways to meet the requirements
- Attending school at least half time;
- By performing 80 hours of work per month, self-employment, volunteering, or other authorized activities; or
- combining income and eligible activity hours until the requirement is met.
Many people will be exempt
Although the term “employment requirements” is frequently used, experts insisted that a large number of people will be excluded or exempt.
Among them are:
- Pregnant women
- People who care for children under 14 years of age or family members with disabilities
- Veterans with total disability
- People considered medically frail
- Participants in certain public programs
Doug Sea, a Medicaid policy attorney with the organization Charlotte Center for Legal Advocacy (CCLA), explained that there is an important difference between an exclusion and an exception.
“An exclusion is much better than an exception. You only need to meet the requirements when you apply or renew. There is no retroactive review period,” Sea said.
The paperwork will be the biggest challenge
Beyond the work requirement, experts believe the main risk will be the increased administrative burden.
From 2027 onwards, many people will need renew Medicaid every six months, instead of once a year.
In addition, the DSS will first verify the information available in other government databases and, if it cannot confirm eligibility, will request additional documents from beneficiaries.
“All of this means there will be a lot more paperwork and people will have to respond quickly to requests for information,” warned Elizabeth Edwards, an attorney with NHeLP.
What to do to avoid losing Medicaid
Lawyers expressed concern that many people could lose their coverage simply for failing to submit documents on time or due to administrative errors in implementing the new rules.
Experts recommended taking preventative measures now:
- Verify that the DSS has the correct address and phone number.
- Open and read all correspondence sent by Medicaid.
- Respond before the deadlines.
- Keep proof of income, work, studies or community activities.
- Ask for help if you need to obtain medical documentation or other records.
They also reminded everyone that those who lose their coverage have the right to appeal the decision and, in some cases, maintain their benefits while the process is being resolved.
Related: Can you lose your Medicaid? Questions and answers about the changes in North Carolina
A resource for those who need help
If a person receives a letter from DSS that they don't understand, or if their Medicaid is canceled or reduced, experts recommend contacting NCMedHelp, a service specializing in Medicaid.
“This is the best place to call when your Medicaid is denied or canceled, or when you receive documents from DSS that you don’t understand,” Sea said.
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Where to find more information
The North Carolina Department of Health and Human Services (NCDHHS) has already published informational materials in English and Spanish to explain the changes and guide beneficiaries before the new rules take effect.
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You can find all information about Medicaid on the NCDHHS website at the Medicaid section.
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