Thousands of Medicaid beneficiaries in North Carolina will face significant changes to their health coverage in the coming months as a result of new laws passed by the federal Congress and the state General Assembly.
The changes will especially affect groups of immigrants with legal status who currently receive Medicaid, but they will also bring new obligations for many adults enrolled through the program’s expansion.
With the goal of preparing community organizations, health navigators and families, the National Health Law Program (NHeLP) organized the first of two webinar sessions: “Upcoming Changes to Medicaid Eligibility Rules: What You Need to Know.”
The event was moderated by Elizabeth Edwards, an attorney with NHeLP, and included Kate Woomer-Deters, an attorney with the North Carolina Justice Center, and Julieanne Taylor and Doug Sea, attorneys with the Charlotte Center for Legal Advocacy (CCLA).
More than 300,000 Hispanics enrolled in Medicaid
According to data from the North Carolina Department of Health and Human Services (NCDHHS), in 2025 there were a total of 3,104,834 people enrolled in Medicaid, of whom 44,177 were pregnant women, 569,600 were children and 324,942 were Hispanic.
Of this total, more than 690,000 people obtained coverage through the expansion beginning Dec. 1, 2023, including nearly 62,000 Hispanics.
Unprecedented changes for immigrants
Woomer-Deters explained that the changes represent one of the most significant shifts in Medicaid eligibility since the federal welfare reform of 1996.
The attorney recalled that, until now, different categories of immigrants with legal status, including refugees, asylees, survivors of human trafficking and some victims of domestic violence, could access Medicaid under certain conditions. However, that will change beginning Oct. 1.
“The only three groups that will qualify will be permanent residents, Cuban and Haitian entrants, and migrants from the COFA island nations,” Woomer-Deters explained while describing the new eligibility rules.
As a result, she added, refugees, asylees, trafficking survivors and many victims of domestic violence will no longer meet the requirements to receive Medicaid under the new federal provisions.
The attorney said some of these people may regain eligibility when they obtain permanent residency. However, she warned that victims of domestic violence will face an additional five-year waiting period after obtaining residency before qualifying for the program again.
There will be no automatic terminations
The attorney said that people who currently receive Medicaid and are in those groups should not automatically lose their coverage on Oct. 1.
Woomer-Deters explained that social services departments must first review each beneficiary’s updated immigration status and provide an opportunity to submit documentation before closing their case. She said there is a 90-day period to provide verification of immigration status.
“We should not see terminations beginning Oct. 1. What we should see are letters that will give people the opportunity to show that they are still eligible,” she said.
The attorney asked community organizations to report any errors in the renewal processes, especially in cases involving pregnant women and minors, where administrative problems had previously been identified.
Pregnant women and children will keep their coverage
Amid the uncertainty generated by the changes, Woomer-Deters clarified that pregnant women and people under age 19 will be among the groups least affected.
She explained that North Carolina maintains Medicaid coverage for pregnant women during pregnancy and for 12 months after childbirth, and for children with virtually any legal immigration status, except DACA.
Uncertainty over the public charge rule
During the webinar, another issue generating uncertainty and questions from the community was the future of the public charge rule.
Woomer-Deters explained that, following the federal administration’s elimination of the existing regulation, there is currently no new final rule establishing how the use of benefits will be evaluated in future permanent residency applications.
“We don’t know exactly what is going to happen,” the attorney acknowledged, noting that the federal government announced it will publish new guidance in September.
She also recalled that refugees, asylees, trafficking survivors and victims of domestic violence remain exempt from the public charge analysis when they apply for permanent residency.
Less retroactive coverage
Taylor, an attorney with CCLA, explained that one of the first changes for the general Medicaid population will be a reduction in retroactive coverage.
Currently, people can receive up to three months of coverage for medical expenses incurred before submitting an application. However, beginning in January 2027, those in Medicaid expansion will only be able to receive one month of retroactive coverage, while other categories will be entitled to two months.
“Don’t wait too long to apply,” she warned, because the retroactive coverage period will be considerably shorter.
Renewals every six months
Taylor said Medicaid beneficiaries under the expansion will have to get used to a new renewal schedule.
Instead of renewing their eligibility once a year, as they currently do, they will have to complete the process every six months.
The attorney warned that this change increases the risk of losing coverage simply by failing to respond to a renewal notice in a timely manner.
“It is very important for people to know about this change because they can lose their coverage if they do not recertify every six months,” she said.
Work requirements in 2027
Taylor also provided a preview of the topic that will be addressed in the second part of the webinar series: the new work requirements for Medicaid expansion beneficiaries.
The rules, scheduled to take effect Jan. 1, 2027, will apply to many adults ages 19 to 64 enrolled in that category of the program.
She explained that beneficiaries will generally have to demonstrate at least 80 hours per month of work, self-employment, studies or volunteer activities, although there are various exemptions that will be examined in greater detail in the second part of the webinar.
She also said that North Carolina has requested an extension to implement those requirements, although the federal government has not yet made a final decision.
Programs that will not change regardless of immigration status
Despite the new restrictions, the panelists emphasized that several programs will remain available regardless of immigration status.
These include emergency Medicaid, the WIC program for women, infants and children, vaccinations, free school breakfasts, treatment for communicable diseases, Ryan White-funded services for people with HIV, and food banks, among other community resources.
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