Nc Medicaid Eligibility Calculator

North Carolina Medicaid eligibility turns on one comparison: your monthly Modified Adjusted Gross Income against a limit set as a percentage of the federal poverty level for your household size and category. This calculator runs that comparison with the current 2026 poverty guidelines and the effective limits North Carolina actually applies, including the 5 percentage point MAGI income disregard, so the number you see matches the method the state uses when it decides a real application.

Quick Answer

How to use the NC Medicaid eligibility calculator

Enter three things and compare. Set your household size, type your monthly income, pick the category that fits the applicant, and click Calculate. The tool looks up the 2026 poverty guideline for your household size, applies the percentage for your category, and tells you whether your income sits at or under the limit, and by how much.

1. Household size. Use your tax household as the starting point. Pregnant applicants add each unborn baby, which raises the limit. Adult children who file their own taxes and non-relatives who live with you usually sit in a different household, so the county decision can differ from a headcount of everyone under the roof.
2. Monthly income. Enter one month of MAGI, not take-home pay and not a single paycheck if your hours swing. If your income varies, average the last few months or use your expected monthly amount, because the state looks at current monthly income for most MAGI decisions.
3. Category. The category changes the percentage, and the differences are large: a child’s limit in the same household is roughly 57% higher than an adult’s. If more than one person in the home needs coverage, run the tool once per person with their own category.

2026 NC Medicaid income limits by household size

The monthly limits below come straight from the tool, rounded to whole dollars. They are built from the 2026 HHS poverty guidelines published by the Assistant Secretary for Planning and Evaluation: $15,960 a year for one person, $33,000 for four, plus $5,680 for each extra person.

North Carolina’s own published chart, reproduced by county social services offices from the NC Medicaid eligibility guide effective April 1, 2026, lists the same limits in a different form: nominal percentages (133%, 211%, 196%) with the 5 point disregard taken off your income during the determination instead of added to the limit. The two methods land on the same answer to within rounding. NC Disability Benefits 101, the state-supported benefits guide, presents the limits the effective way this tool does: 138% for adults, 216% for children, 201% in pregnancy.

How the income limit is calculated

One multiplication and one division. Take the annual poverty guideline for the household size, multiply by the category percentage, and divide by 12 to get the monthly limit. Your monthly MAGI is then compared with that limit.

The reason the percentages look odd is the disregard. Congress set the adult expansion standard at 133% of the poverty level, and federal rules then disregard income equal to 5% of the poverty level, so the working cutoff is 138%. The same disregard lifts the published state standards for children (211%) and pregnancy (196%) to effective cutoffs of 216% and 201%. Any calculator that compares your full income with 211% or 196% will wrongly turn away children and pregnant applicants in that 5 point band, a gap worth about $66 a month for a single-person household and $138 a month for a household of 4. How far a household sits from the line also matters beyond a yes or no, which is the same distance the average poverty gap calculator measures across a population.

Worked examples checked against the tool

Three households, three different categories, each typed into the calculator exactly as written here.

• Adult, household of 3, $3,000 a month. Limit: $27,320 x 1.38 / 12 = $3,141.80. Income is $141.80 under the limit, so the result reads Likely Eligible. This is the pre-filled example in the calculator.
• Child, household of 4, $5,500 a month. Limit: $33,000 x 2.16 / 12 = $5,940.00. The child is likely eligible even though the same income would put an adult in that household $1,705 over the adult limit. Children’s coverage reaches much higher because North Carolina stacks Medicaid for children and NC Health Choice up to the same effective ceiling.
• Pregnant, household of 2, $3,500 a month. A single pregnant applicant counts herself plus the unborn baby, so household size is 2. Limit: $21,640 x 2.01 / 12 = $3,624.70. She is $124.70 under the limit, and pregnancy coverage in North Carolina continues through 12 months after the birth.

MAGI groups and non-MAGI groups play by different rules

Adults, children and pregnant applicants are judged under MAGI rules, which means income only and no asset test. The HealthCare.gov definition of Modified Adjusted Gross Income is adjusted gross income plus untaxed foreign income, non-taxable Social Security benefits and tax-exempt interest. Savings, a car and home equity do not count. Two things catch people out: Social Security counts in full even when part of it is not taxable, and Supplemental Security Income (SSI) does not count at all.

The elderly and disabled categories are older, non-MAGI programs. The same 100% income limit applies, but the state also counts assets, generally capped at $2,000 for an individual and $3,000 for a couple, with the home you live in and one vehicle usually excluded. Someone over the income line in these categories may still qualify through the medically needy spend-down, where medical bills offset excess income over a six month period against a much lower protected income level. If a disability is part of the picture, the size of the benefit itself is a separate question, and the disability amount calculator estimates that side of it. An income-only pass here is therefore weaker for these two categories than for the MAGI groups, and the calculator says so in its result note rather than pretending the screen is the whole test.

What competing calculators miss

Most NC Medicaid calculators get the shape right and the numbers wrong. These are the failures worth checking any tool against, including earlier versions of this one.

• Stale poverty tables. The poverty guideline rises every year. A calculator still holding a 2023 or 2024 table understates every limit by roughly 9 to 17 percent and tells people near the line they cannot get coverage they would actually be granted. Check that the single adult limit reads about $1,835 a month; anything near $1,677 is a 2023 table wearing a new coat of paint.
• The missing disregard. Tools that use 211% for children and 196% for pregnancy against your full income skip the 5 point MAGI disregard and understate those two limits. The effective figures are 216% and 201%.
• Gross pay instead of MAGI. A tool that asks for gross wages without explaining MAGI sends self-employed applicants in with revenue instead of net profit, and misses the add-backs for untaxed Social Security and tax-exempt interest.
• Silence about assets. Screens that give elderly and disabled applicants a clean yes on income alone hide the $2,000 asset test and the medically needy spend-down path entirely.
• No next step. A bare yes or no with no route to ePASS, the county DSS office, or the Marketplace for people just over the line wastes the one moment the reader is ready to act.

If the result says likely eligible, or likely not

Apply either way if you are close. The state, not this page, makes the decision, and caseworkers apply household rules, income exclusions and deductions that a three-field screen cannot. North Carolina expanded Medicaid on December 1, 2023, so adults who were turned away before that date on category grounds alone are often eligible now. Apply online through NC ePASS, in person or by phone at your county Department of Social Services, or through HealthCare.gov, which forwards Medicaid applications to the state. Coverage can reach back to cover medical bills from up to three months before the application month when you were eligible in those months, and once approved, your benefits effective date is what decides which bills it can pay.

If your income is over the Medicaid line, check the Marketplace next: in North Carolina, incomes from 100% to 400% of the poverty level generally qualify for premium tax credits, and the band just above 138% carries the largest subsidies. For elderly or disabled applicants over the income limit, ask the county office about the medically needy spend-down before assuming there is no path.

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